According to the World Health Organisation obesity is defined as a disease in which excess body fat has accumulated to an extent that health is adversely affected (1). According to the WHO the causes are:
• Obesity occurs when there is an imbalance between energy intake (food) and energy output (activity).
• The overwhelming influences of obesity in 99% of the population are environmental and include marketing, advertising, increasing portion sizes, accessibility and availability of foods and facilities, increased automation and increased car use among other factors. (2,3)
For me reading this the first line reads we are taking in more energy(calories) than we expending(exercising) yet the next line doesn’t even include a lack of exercise but focuses on food? More on this later.
The level of the Irish epidemic of obesity is quite clear and quite shocking. According to the Irish Longitudinal Study on Ageing led by Trinity College, Dublin, four out of five over 50s in Ireland are overweight or obese (4). According to a leading obesity expert Professor Donal O’Shea there has been a catastrophic increase , with a 1,200pc increase in those with a body mass index of 52 or over in Ireland. The normal target for BMI is 18 – 25, I understand this scales validity isn’t 100% and muscular people can fall foul of it however there is no getting away from the fact Ireland is in the grips of a crisis. The trend towards obesity in Ireland is increasing. Between 1990 and 2000 the prevalence of obesity increased by 67% overall, up 1.25 fold in women (from 13%) and up 2.5 fold in men (from 8%) (6) . • Ireland has the fourth highest prevalence of overweight and obesity in men in the EU and the seventh highest prevalence among women (2) .
Now how is this impacting on the children of Ireland? In the Growing Up in Ireland Study on children that was carried out on 9 year olds 19% were overweight and 7% obese.(5) This means that over one quarter of children aged 9 are overweight or obese. That is just one category of children can you imagine the real size of the epidemic? At the Irish Heart Foundation Conference in June 2014 The Secretary General of the Department of Health has said that the obesity problem among young people is so bad that the present generation of parents may be the “first to bury our children”.
What is clear is that we have a problem throughout a society from young to old. For me this problem has two main causes:
1. A lack of education on healthy diet and the benefits of exercise (as well as the required levels)
2. Stemming from this poor diets and a lack of exercise (34% of the Irish Population never exercise) (7)
What can we do about it?
Well as Physiotherapists I feel that we are one of the best placed healthcare professionals to deal with this epidemic. We have the necessary time with patients to educate them on their exercise regime and diet. I know some Physiotherapists may not feel comfortable with giving nutritional advice however with some upskilling we should be more than capable and confident. In my opinion it should be part of the undergraduate degree to move forward with the issues of today in the healthcare system.
Physiotherapist’s should have more of a community role by this local councils should be organising events/education days etc for the community where healthcare professionals, in their local community, can educate people, demonstrate exercises and set up initiatives. I really believe that education is key to fighting this epidemic. To fight the increasing levels of inactivity people need to be educated on progressive exercise programmes because the biggest fallout from exercise is people starting at too high a level and quitting because it is too tough. Risk factors to adherence must be identified such as time, fear of injury, self efficacy etc and education on avoiding these is a must.
I know anecdotal evidence isn’t exactly gold standard but a quick story to illustrate my point…. I recently sat down with my Mother who has blood pressure, diet and exercise management issues simply because she didn’t understand what was causing her issues. I ran threw a couple of quick exercises, diet tips and explained the causes of high blood pressure. Now she is already feeling the results. She now exercises twice a day, has cut her calories by 800 and her blood pressure has greatly reduced. I am not claiming to be a god or magician I am simply explaining the power of education. She still needs help, she is still on medication so yes more interventions are needed but if you start with education the path is much easier.
Feedback is of course welcome, This is just my view from personal experience. Of course if the evidence contradicts me I will indeed learn from it.
Thank you for reading.
References:
1. World Health Organisation (1998) Obesity – preventing and managing the global epidemic. Report of a WHO Consultation on Obesity. WHO, Geneva.
2. International Obesity Taskforce and European Association for the Study if Obesity (2002) Obesity in Europe – The Case for Action.
3. European Heart Network (2005) The Marketing of Unhealthy Food to Children in Europe. A report of Phase 1 of the ‘Children, obesity and associated avoidable chronic diseases’ Project. Brussels
4. The Irish Longitudinal Study on Ageing (2015) Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin,Dublin 2: Trinity College Dublin.
5. National Longitudinal Study of Children (2011) Growing Up In Ireland, Government Publications, Dublin: Department of Children and Youth Affairs.
6. Irish Universities Nutrition Alliance (2001) North/South Ireland Food Consumption Survey. http://www.iuna.net
7. European Commission (2014) Eurobarometer on sport reveals high levels of inactivity in the EU, Brussels: The European Union.
Aspiring Physio 