With obesity figures soaring worldwide, including in Ireland, the cost of this disease to the nation's health, its health service and indeed the economy as a whole, is incalculable. And yet it is preventable.
Some years ago, a UK documentary on the rising levels of obesity opened with the line: 'Look at America and see our future'. The cost to the US economy of obesity related problems such as diabetes, heart disease, cancer and hypertension, just some of the conditions that research has linked to obesity, is now in excess of $100 billion a year, according to the National Institutes of Health.
Obesity in Ireland
Here in Ireland, we are rapidly moving in the same direction. According to a major survey of Irish adults carried out by the Food Safety Promotion Board in 2000, over 20% of men were found to be obese. In 1990 this figure was just 8%. In women, the rate of obesity was found to be 16%, up from 13%.
However, the highest prevalence of obesity in any group was in women over the age of 50, at almost 30%. More recently, a small consumer survey into the diet and lifestyle of Irish people, found that 51% of men and 32% of women are overweight.
'This survey provides a very important insight into how inactive we have become as a nation. Furthermore people are not aware of the level at which obesity begins for themselves and it is clear that a lot of people who think they are slightly overweight, are in fact obese', said Dr Donal O'Shea, consultant endocrinologist at St Vincent's University Hospital, Dublin.
In fact, the study found that 41% of men over the age of 50 do not take any physical exercise whatsoever. Of men over the age of 25, 18% watch, on average, between 16 and 20 hours of television a week, compared to 8% of women.
This could partly explain why being overweight or obese is more common in Irish men than women. Alcohol intake in this country may also contribute to the problem. Of those who watch 20 hours or more of television a week, 33% said they did not engage in physical activity as they do not have the time!
Furthermore, Dr O'Shea's belief that people are unaware when they cross the line from overweight to obesity is also reflected in the 2000 study. Of the 1,000 people questioned, not one person described themselves as obese, despite the fact that 12% were found to be clinically obese.
The entire way in which obesity is approached by the health services needs to be examined, according to Dr Tony O'Sullivan, policy committee chairman of the Diabetes Federation of Ireland.
'In the past, obesity was very much seen as a social condition. It was someone's fault if they developed it and resolving the problem was left in their hands. However, it is important that we see obesity as a medical condition. It is a condition worth 'medicalising' for two reasons: one, because it has so many negative health implications and two, because it is preventable', he said.
While both studies focused on adults, the implications for children are clear. Raised in an environment where a sedentary lifestyle and an unhealthy diet are prevalent, children are likely to adopt these habits and carry them into adulthood. Nowhere can this be seen more than in the diagnosis of type 2 diabetes in children, something that was unheard of in the past.
'There used to be a huge divergence in the diagnosis of diabetes. Type 1 was generally seen in five to 20 year-olds, then there was a big gap and type 2 was found in 50 to 80 year-olds. Now there is no gap and children as young as 12 are being diagnosed with type 2', Dr O'Sullivan said.
Strong forces at play
Other strong forces are at play when it comes to overeating, many of these are of an economic if not political nature. A recent Financial Times article explored some of these underlying issues.
The US food industry produces far more food than it needs and therefore, forceful marketing is needed to sell the excess to the American public. At the root of this marketing drive is everyone from farmers to fertiliser manufacturers to restaurants and food companies.
In addition, social changes have affected how we eat. Western society has become a fast food culture and the breakdown of family units and family meal times has led to an 'on the hoof' approach to food.
The article cites the most basic of marketing ploys -putting soft drinks vending machines into schools. Have you looked around your local Irish secondary school recently?
Effects of lifestyle
Speaking in Dublin recently, international obesity expert, Dr David Ludwig of Harvard University and the Children's Hospital in Boston, warned that an epidemic of obesity in children is on the way, underpinned by environmental factors.
Television viewing is displacing physical activity and encouraging the 'passive consumption of energy dense foods' among children, he said.
This view is echoed by Dr Lean O'Flaherty, senior nutritionist with the National Dairy Council, who believes that parents need to reduce children's television watching and increase the amount of physical activity they take part in. A balanced approach to nutrition is the key to good health.
'There is a place in the diet for all foods including junk foods in moderation', she said.
Obesity is a multi-factorial condition and it would be very difficult to pinpoint something specifically in the diet and ban it, she added.
Another issue of concern with obesity is the fact that generally, people are unaware of the major health implications of the disease. The consumer study found that in general, Irish people are aware that an unhealthy diet and lack of exercise are contributing factors to obesity.
However, there is a stark lack of awareness of serious diseases and health risks associated with being overweight. Just 26% of respondents were aware that diabetes could be caused by excessive weight.
'The fact that the public are unaware of the gravity of this situation underlines the urgent need for a major health promotion campaign', said Dr O'Shea.
This is an issue echoed by Dr O'Sullivan. 'I would like to see a major public health approach, with advertisements promoting a healthy lifestyle, diet and exercise and education in schools aimed directly at children, he said. Legislation to make a healthier lifestyle more accessible is also important, such as the introduction of cycle lanes on our roads to encourage people to cycle and ensuring there are enough playgrounds for our children'.
Actions and initiatives
So with obesity-related problems gobbling an increasing chunk of total health expenditure, the government is probably planning a major campaign to raise awareness and reduce obesity rates, right? Well it's hard to say.
According to the National Health Strategy, 'actions on major lifestyle factors', including diet and lifestyle 'will be enhanced' and such actions are 'ongoing'. However no specifics are given.
Furthermore, 'initiatives to promote healthy lifestyles in children have been extended on an ongoing basis', with full extension to all schools since December 2005.
Let's hope this date does not fall by the wayside in light of recent spending cuts.
However, two issues that need to be addressed are the lack of dietitians in the health service and the lack of support groups for obese people.
According to Dr O'Sullivan, there is a higher rate of depression, unemployment and remaining single among obese people, yet little support for them.
However, there is light at the end of the tunnel as evidence suggests that significant reduction in medical consequences is possible. A study of dietary change in Finland from 1972-1992, for example revealed a decrease of 55% in deaths from heart disease among men and 68% among women.
If we don't act now the implications will be grave.