herald

Thursday 8 December 2016

"I've had medical professionals pull me aside and say: 'Well, of course no one was fat in Belsen!'"

Professor Donal O'Shea tells Joanna Kiernan about his life, his work and tackling our obesity crisis

Prof Donal O'Shea at St Vincent's Hospital. Joanna Kiernan interview.
Prof Donal O'Shea at St Vincent's Hospital. Joanna Kiernan interview.
Donal O'Shea

Professor Donal O'Shea has been an outspoken voice for those suffering with obesity for over 16 years. He is at the coal face of the issue in Ireland - a nation which is now the fattest country in Europe.

Yet in the very modern surrounds of St Vincent's Public Hospital in Dublin, as we walk towards Professor O'Shea's office, he points out a stark irony; a lonely, but very well stocked, vending machine, filled with crisps, chocolate and fizzy drinks, standing straight across from the entrance to the hospital's Diabetes Centre.

The absurdity of the situation is just one simple example of the everyday battle Professor O'Shea, his colleagues, his patients and society at large faces.

"The work we are doing with Crumlin is showing that children as young as five are turning on their genes for diabetes and heart disease already," Professor O'Shea explains. "They are turning off their defence against cancer and they have insulin levels that are four times higher than they should be.

"A lot of the time people will say 'well, it's the parent's fault if the child is fat!' and we now know that that simply is not true," he adds. "It's probably 20pc the parent and 80pc the environment, because what we have allowed to happen is an environment that makes being healthy really difficult."

Professor O'Shea lives in Dublin with his wife Fionnuala, an anaesthetist, and their three daughters Kate (16), Molly (14) and Anna (12).

He attended school at Terenure College alongside his two brothers, older brother Diarmuid, also in medicine and youngest brother, RTE Rugby panellist and Harlequins Coach, Conor.

No other area ever took precedence over the area diabetes and endocrinology for Professor O'Shea, who then went on to train in the UK following graduation. It was in London where obesity really became a burning issue for him.

"I was interested in how the brain controlled appetite," he says. "I had seen a guy in London, who was enormous; he couldn't fit onto the hospital bed and there wasn't pyjamas to fit him, so he had the curtain around him instead and he was treated on the hospital floor on a mattress. I thought to myself 'this is 1999, this is ridiculous. We have to be able to do better than that'."

On his return to Ireland that year O'Shea set up a treatment unit for obesity in Ireland between St Vincent's and St Columcilles Hospitals, where he works to this day.

But while initial response to the unit was positive, Prof O'Keefe has been disappointed by the lack of enthusiasm shown by many within the medical profession and political sphere for the work they do ever since.

"What I couldn't get over and it still persists even within the medical profession is the complete lack of interest in treating obesity," he explains.

"It's really embarrassing. It is the last politically and socially acceptable form of discrimination and we are doing it politically at the moment in failing to provide bariatric surgery for obese people. The number of times people have pulled me aside and said: 'Well of course there was no one fat in Belsen.' That is frequent and most frequent from within the medical profession."

devastating

Last year the Department of Health took the decision to cut funding for gastric bypass surgeries. The service has yet to be resumed and the move has had a devastating impact on the 250 patients awaiting the procedure.

"You have a cost saving, life-saving, quality of life improving procedure that is relatively cheap as we use mostly existing resources and the Department of Health and the HSE are unable to identify a funding stream for it," Professor O'Shea says.

"The very first surgery we did was with a guy who had spent eight months of the previous 12 in hospital with obesity related breathing problems and he hasn't been back in hospital in the 10 years.

"At what level is the engrained discrimination against obese individuals?" he asks. "When the smoker who gets lung cancer for exactly the same reasons - consumptive behaviour and genes - is whisked into a rapid-access lung cancer clinic, given expensive chemotherapy, expensive surgery and treated with the dignity and the respect that they deserve."

Prof O'Shea takes the point that there are many misconceptions about obesity, which have contributed to the wider public's general perception of obese people. However, he argues that dealing with the issue cannot be simplified into the popular 'eat less, move more' motto; there are complex sociological, psychological, physiological and even socio-economic reasons behind what we eat and how we eat it.

"We are separating out into the super fit and the super fat," he explains. "We have proliferation of triathlons, a gym culture and then at the same time Ireland is the fattest country in Europe, with the fattest children in Europe according to the World Health Organisation. We are not at the scale of the US yet - 33pc of their 12 year olds are overweight or obese and 25pc of our 12 year olds are overweight or obese.

"So Coca-cola are on the one hand putting children's names on their bottles, in their most successful campaign ever, and then on the other hand they are buying up bottled water companies because they know that in 15 years' time these sugar sweetened drinks will be considered effectively poison, if not banned, to those under 18," Prof O'Shea predicts. "It will be like a kid smoking, that is how it will look and it just won't be acceptable."

trained

Professor O'Shea admits that it is difficult for him to switch off.

"I probably let what I do eat into my time outside of work," he smiles. "I go home, but I spend a lot of time thinking about the problem. So when you go into a petrol station and they are offering a can of coke and a packet of crisps at the counter for a euro and they ask do you want it and you say no and then they are trained to repeat the offer because if they do 20pc of people will say 'OK'; it is hard not to think this is why we are where we are. And yes part of me wants to give a 15 minute lecture to that guy behind the counter, rather than just paying for the petrol and going home. So I don't switch off from it really at all."

And as a father, Prof O'Shea has benefited from first-hand experience at how tough policing your children's diet and exercise routines can be.

"I have three girls, 16, 14 and 12. It's really good because I get to see how difficult it is," he admits. "I see how they can just come how and pick up their computer or tablet or phone and can be in contact with anyone they want just sitting there. And getting told things like 'Don't be silly daddy - girls don't cycle to school!' But thankfully they all enjoy swimming and are in a swimming club."

However, O'Shea believes that Ireland has become almost too PC to address our issues with weight, particularly when it comes to our children. We are afraid to cause offence.

"If you hear what an obese kid thinks about themselves; their level of self-esteem is so low and combine that with the level of harm caused by child obesity on their mental health - it would dwarf the desire to be PC. We have to have that discussion," he says. "We have to get parents aware of their kids' weight and GPs happy to mention this to parents.

"I don't think the current generation of 14, 15, 16 year olds will do to their kids what has been done to them - in terms of a lack of physical activity and poor nutrition- because they will have seen the consequences," he adds. "They will protect their kids, much more than we have been able, from the food and drinks industry."

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