introduction

Obesity, our favourite health ticking time bomb, is back in the headlines. As usual the situation is grim and about to develop into a full blown catastrophe. But wait, we have a whole list of new drugs to help us out- that’s good right? Yes, in a sense, but we still have a lot of the same problems. Read about new drugs designed to help with Obesity here. A Danish pharmaceutical firm (Novo Nordisk), has shown in clinical trials that their drug (Brand name=Wegovy) lead to weight loss of about 15%. Most public health interventions lead to a 5-10% weightloss. Forecasts indicate a demand for these glp-1 drugs could reach $150bn by 2031. Interestingly, The Econmist notes that;

“The world’s expanding waistlines are not a sign of the moral failure of the billions who are overweight, but the result of biology”

Thie is completely one sided. Yes we have genetics, but since those genetics interact with the environment and that envrionment has systematically removed physical activity from daily living since about the 1970s, I think we can start questioning morals immediately. Especially when sitting down is considered the new smoking and installing a standing desk anywhere in the civilised world is an extensive HR issue.

I often tell clients the 23 hours of the day you spend outside the gym need to have some movement as well. Wearing a fitbit showed them exactly how much movement they were doing. I’ve seen clients report less than 1,000 steps a day (including a gym session). They could eat nothing but salad but if there was more energy coming in than going out they will still gain weight. How much movement is required always varies from person to person. Surprisingly the Economist compeletely missed part of it’s own field (Nudge economics) as a potential solution. Highly processed food is not as tasty from far away and behind a screen which is why online food shopping helped most of my clients retrain their habits. Often times a client will say to me, “I went into a super market again recently, why is all the rubbish food so easy to get at?” They’ve seen this thousands of times but online food shopping takes you out of that habit loop of mindless or impulse buying. Once you’re at a distance for more than a month suddenly a resilience seems to render in a clients mind. Making the easy option the right option is vital and it should be the law. We’re not cave men anymore and we’re not in a famine and recently a winter we thought would up end Europe as we know it was shrugged off even straight after a Global Pandemic. We can tackle problems these days comparing us to famine times or cave men makes no sense. Where we are as a society is closer to the below.

“Governments must raise taxes somehow, they should use taxation to act as a counterweight to industries that profit from, as he put it, “encouraging excess”. John Stuart Mill

Obesity is the surest sign of excess. In Ireland we already have sugar taxes and a physical seperation of alcohol from the rest of the shop. We need to go further. Color coding should be introduced on the packet and/or on the background of the food or drink available for purchase. Green foods with known health benefits these foods would have their VAT cut to the absolute minimum and be placed directly in the most likely places for a consumer to buy them. Violations should bring severe fines I’m talking 50% of your turnover. Yellow foods where known health benefits are poorly understood or considered to be potentially harmful. Red foods where known health benefits are non-existent and or potentially dangerous. Red foods need to go to the top tax bracket and keep going up in price. They should be concealed from view placed at the furtherest point from the check out, mutli-buy options and discounts made illegal, re supply should be limited to one day of slow demand and should be surrounded by healthy green alternatives above, below, left and right. Heavy fines should be imposed for non compliance. I know this is totalitarian but we’re approaching an existential crisis. The time for soft decisive action was long ago and we missed it. I’m open to other options.

We need more serious political involvement if we’re going to tackle Obesity. I went through an entire education system where physical education wasn’t valued. I sat in the grind schools that rolled their eyes when I mentioned that I was heavily involved in the GAA. I once had a teacher tell me my ability to speak Irish will be more important than Sport. Time has completely destroyed that advice. I worked for 12 years full time in Sport and Exercise. It has taken our society until 2020 to accept physical education as a leaving certificate subject. I’ve seen religious education make it into the exam system since 2005. In 2012 then Minister Ruairí Quinn wanted Philosophy as a leaving certificate exam subject. All the while the ticking nuclear time bomb of Obesity was approaching single digits. My argument was clear Religious Education and Philosophy are no good to you if you’ve died so young in life that you haven’t developed the patience and wisdom to appreciate them. Physical Education is the bridge to these parts of life. It comes first.

If you’re really not convinced by this approach then perhaps consider Bill Gates

“When people aren’t healthy, they can’t turn their attention to other priorities. But when health improves, life improves by every measure.” Bill Gates

Anyone who had had a cold will get what I mean above. Obesity is already linked to Diabetes, Heart Disease and certain types or cancer. These will take all your attention are life threatening and in some case life ending. If as the World Obesity Federation predicts we have 4 billion people classified as obese by 2035 then our attention will be drawn away from other things that Governments and Businesses really value such as the economy. The bill for the obesity drug stands between €140 - €300 a month. If you discontinue the medication the risk of weight regain exists similar to other lifetsyle interventions. The cost of Obesity to the world economy could be close $4 trn by 2035. It’s the economy stupid!. Privately a lot of people will struggle to afford the medication. Publicly the cost is still huge to supply the drug and I haven’t met enough voters screaming “Raise our taxes” at politicians. For every second we waste log jammed that bomb I mentioned earlier ticks closer to explosion.

Body Mass Index (BMI)

At this stage I must surely have fightened you enough to ask yourself am I Obese? How do I know?. Here is a short explaination. BMI is a simple measurement that you can use to identify individuals who are overweight or obese. BMI (kg/m2) is calculated by dividing weight (in kilograms) by the square of height in metres. BMI does not distinguish between fat and lean (muscle) mass. Athletes or elite sports people with a muscular build may be classified as obese, but actually have a low body fat. Individuals in this category are relatively easy to recognise. BMI does not necessarily reflect body-fat distribution. Abdominal fat is a risk factor for disease even if an individual has a BMI in the healthy weight range. Measuring waist circumference will determine if fat distribution is a risk factor.  It has better predictive power than BMI for diabetes and cardiovascular disease.

Classification

What BMI means?

BMI is a risk score it does not diagnose anything futher. I accept that Obesity is seen as a disease but for other conditions like Type 2 Diabetes, High Blood Pressure and Coronary Artery Disease you need more medical input and this is where you talk to your GP. The best way to view BMI is as feedback. It can quickly tell you if you’re drifting into a risk category. It is what you choose to do with the information that matters. Most people I coach get obsessed with the BMI number but what influences the number is physical activity and food intake. The focus should be on these actions. BMI is an interpretation a snap shot. A quick summary. The real actions that make up the number get hidden. That being said feel free to check yourself below.

What Physical Activity Should I do if I’m Obese?

Physical Activity | Cardiovascular work

• Frequency : 5-7 days per week

• Intensity : Rate of perceived exertion 11 (light) - 16 (Hard)

• Time: 60 - 90 mins or 11, 000 - 14,000 steps

• Type: Examples Walking, Cycling, Swimming, Elliptical, Stair Climber, Rower, Aerobics Class

(Fontaine & Roitman, 2018)

Conclusion

Get off your backside and start living a healthier lifestyle because if you don’t you’ll either pay for treating obesity privately or publicly via taxation. Once you’ve figured that out for you then maybe comment below so we can figure out the big question How do we make the world move again?

References

1. Wegovy costs between 140 - 300 euro a month. https://www.grangeclinic.ie/weight-loss-injection-scheme

2. The Economist https://www.economist.com/leaders/2023/03/02/new-drugs-could-spell-an-end-to-the-worlds-obesity-epidemic March 4th 2023 Edition

3. Fontaine, ThomasP., Roitman, Jeffrey L.Chapter 4 Metabolic Conditions and Disorders In: NSCA’s Essentials of Training Special Populations (2018)