![]() ![]() People tend not to go for treatment for excess weight until complications set in, agrees Susie Birney, executive director of the Irish Coalition of People living with Obesity (ICPO). It’s a very difficult conversation to bring up and healthcare professionals do need support and training around that.”ĭespite greater scientific understanding in recent decades of body weight processes, a societal belief persists that thin is desirable and equals healthy, while big or fat equals unhealthy “Or, it is a very sensitive topic and some healthcare professionals don’t feel equipped to have that conversation maybe they feel they don’t have the time maybe they have their own struggles or issues with weight. “They will think that maybe the individual in front of them isn’t interested or isn’t motivated to lose weight and there is no point in bringing it up,” says Gaynor. Stigma is also a barrier to healthcare professionals raising the issue with patients. You could be absolutely fine and they will say ‘come back in a year’ or it could be ‘there is something off, let’s watch that’.” “The message we want to get across is go to your doctor, have that conversation, run those tests. That just shows how complicated this disease is.” Even after treatment as extreme as bariatric surgery, people are at risk of regaining the weight. “We know diets in the short term lead to weight loss but that weight will go back on. It’s a biological issue.” While they might believe that if they only dieted harder and exercised more, they would get the desired results, their body is primed to fight against that. To people living with obesity, she would say: “It’s not your fault and it’s not your responsibility alone to fix. Stigma and misunderstandings around obesity, among both patients and health professionals, are delaying intervention, says Gaynor. “And BMI isn’t going to tell you that, it’s only a measurement of size.” ![]() If it is being stored under your skin and on your legs and thighs, that does not tend to impact your health as much as if your fat is stored around your middle and around your organs. As weight goes on, people’s bodies store fat in different places and in different ways. “It’s not really about the shape and size, it’s about how is this impacting on your health,” she explains. The focus of any treatment should be health gain rather than weight loss. Perhaps there is a complication brewing, she suggests, that could be caught before you arrive in the GP surgery with fatty liver disease, diabetes or heart disease. On an individual level, the only way to find out is to have that conversation with a doctor who can run relevant tests to see if excess body fat is impairing your health, or likely to be soon. “What we are not so clear about is the exact percentage who have excess body fat impairing their health,” Gaynor explains. We know that 60 per cent of Ireland’s population have a body mass index (BMI) of over 25 by that measure they are classed as overweight (up to 29.9) or in the obesity range (30 or over). Meanwhile, last October, Ireland became the first European country to adopt new clinical practice guidelines for obesity care based on Canada’s pioneering approach. Expansion of specialist services for adults and children has started, along with the setting up of new community-based multidisciplinary obesity management services in Dublin and Waterford and dietitian-led, community-based obesity management programmes within the HSE’s enhanced community care chronic disease hubs. But a HSE spokeswoman says that “to realise the benefits, in health and economic terms at individual patient, health service and societal level”, a 10-year time frame is recommended for its full implementation. ![]() A Model of Care for the Management of Overweight and Obesity was launched on March 4th, 2021. ![]()
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