herald

Tuesday 12 December 2017

Just why are we sugar coating the word fat

It's time we stopped pussyfooting around the word 'fat' before plus sizes become the norM and we cease taking responsibility for our own health

Fat-shaming is disgusting. Nobody should be made to feel bad about the way they look or told that they should look a certain way to be accepted or considered beautiful. But by embracing our 'curves' and 'fuller figures' could we be harming our health?

Obesity is not a disease; it is the result of overeating and not exercising enough. Yet, we are often afraid to call a spade a spade, or more specifically an overweight person exactly that: overweight, obese, fat.

So society provides a whole host of excuses as to why overweight people are overweight, rather than a much needed, generous helping of the cold, hard truth.

When you take the aesthetics out of the equation, by celebrating those of larger shapes and sizes, no matter how 'comfortable in their own skin' they claim to be, we are contributing to Ireland's increasing obesity problem. Carrying excess fat on your body - no matter how well-dressed it is - is not only unhealthy, it just might kill you.

According to a recent report from the World Health Organisation, Ireland is on course to become the fattest country in Europe by 2030, with 39pc of adults now considered overweight and 18pc obese.

More and more, the HSE is having to address the increased demand for bariatric treatments, such as gastric weightloss surgery, while simultaneously forking out for reinforced hoists and hospitals beds, wider operating tables and stretchers, longer needles and larger MRI machines to address their expanding number of bariatric or obese patients.

"With people being bigger now than they have been before certainly cosmetically you can manage very well and look very well as a heavier person, but you are still carrying the health risks," says Safefood director of human health and nutrition Dr Cliodhna Foley-Nolan.

"We have lost the ability to recognise overweight because it is visually acceptable, and if most people are that way you don't see it as being in any way abnormal."

"There would have been talk in the past that people who smoke shouldn't have treatment for lung cancer because they brought it on themselves. We certainly don't as a society look at obesity in those terms. We believe people should have treatment if they need it," adds Dr Foley-Nolan.

"In Ireland weight is still considered a delicate subject. We would be encouraging a move towards weight health. It is not a personal weakness which causes many of us to be overweight, but the environment that we are now living in where cheap, calorie-laden food is everywhere. And it is true that some of us are more prone to putting on weight than others."

But with two-thirds of the Irish population now overweight, perhaps it's time we started taking responsibility for our own bodies rather than blaming outside factors? If we are more prone to putting on weight, for example, then shouldn't we simply eat less?

Responsibility

"Yes, we all have a personal responsibility and we need to tune ourselves into what that is, whether it's breast health or dental health, or mental health or weight health," Dr Foley-
Nolan explains.

"We do have a responsibility, but equally there has been a huge environmental change that has put a lot of pressure on us, which is why we need to tackle this from a number of points of view.

"You cannot go in to buy a newspaper without being bombarded with unhealthy food. We are also leading a very sedentary lifestyle now and that has altered us genetically over the last two or three decades so we are in a much more challenging environment. It's much harder to say no."

Six years ago Hannah Nolan (32) who stands just 5"4 tall and then tipped the scales at 16 stone, said no.

She has since lost almost eight stone, trained in fitness and nutrition and founded Why Weight Ireland, an online fitness resource.

"I was morbidly obese myself," Hannah explains. "It was through emotional eating and overeating and not exercising enough. Eventually, I realised that my health was being affected in quite a severe way and I wanted to be there for my children. I didn't want to die basically, so I started to lose weight.

"It was a struggle, but I did it and I pushed through," Hannah says. "It was probably one of the most difficult things I have ever had to do but it was also probably the most 
rewarding."

Hannah believes that a huge part of her weight problem was not knowing enough about food and trying a number of diets which put the emphasis on portion control rather than nutrition.

"I think our expectations of what is normal have gone out the window," Hannah says. "I was probably about a size 22 and I would look at people who were a size 14 to 16 and I'd think 'Oh god they are so slim!' because my perception of what was normal had changed so much."

When Hannah was at her largest, she says that people would never comment on her weight. However, as she began to shed the pounds, tongues and fingers began to wag.

"I used to get some people who were larger saying things behind my back like 'Oh she's gone too skinny! She's anorexic!' even though I was in a very healthy weight range. You're almost made to feel like you're a freak because you exercise every day and eat healthy food," Hannah says.

Burger

"When I was big, nobody said 'You're fat!' Even my husband was like 'Oh no, you're not fat! You've just had a baby and I still love you!' But looking back now I wish he'd have just said 'You're a fat cow! Get on with it!' because the reality was I was dangerously obese and that was acceptable to everybody.

"If you were anorexic people might say: 'Oh you are dangerously thin, you need to go and eat a burger!' But if you're eating the burger and you are five stone overweight no one is going to say 'stop eating that burger!' But you actually do need that tough love."

"I'm a size 8 now and when I was bigger I never thought I would be this size," Hannah adds.

"When I was losing weight I thought if I could just get to a size 16, I'd be happy, and that was my goal: to still be overweight and borderline obese, but in my head that was acceptable. When I looked in the mirror I never thought I would ever be able to be as slim as I am now. For me, getting slimmer and seeing this person emerge made me realise that there were a lot of things that I never dreamed possible when I was bigger."

Following the American Medical Association's declaration last summer that obesity should in fact be considered a disease, health researchers at the University of Minnesota carried out a study of the implications of this statement on overweight and obese people.

The research proved that medicalising obesity had resulted in the widespread belief that people diagnosed as such have no control over their weight and, therefore, take little responsibility for it.

But while we Irish have become almost too accepting of a certain level of obesity in both ourselves and others, there appears to be a point on the scales after which we become entirely apathetic.

However uncomfortable discussing a little weight gain here and there might be for us, we are even less inclined to acknowledge the extreme side to the obesity issue, particularly when it effects our mortality.

As a result, when St. Vincent's Hospital in Dublin was last month forced to suspend gastric bypass surgeries after exceeding a cap on the procedures for the year, leaving 180 patients in a state of limbo, there was little public outcry.

Professor Donal O'Shea, a consultant endocrinologist and physician based at St Vincent's University Hospital, however, is incensed by the move, likening it to a death sentence for those scheduled for the operation, which he explains, is not done lightly.

"At this end of the spectrum obesity is effectively 90pc irreversible," Prof O'Shea explains. "If you make a big effort to lose weight, you can get 10pc of the weight off, but that is all for 90pc of people. So if you have allowed a situation to develop where you have become 24 stone, you can only lose two and a half stone. At that kind of weight, surgery is the only thing which will give you significant weight loss."

Easy

According to Prof O'Shea the average patient presenting for the surgery has a body mass index of 51 or 52; the equivalent of 20 stone for a woman and 25 stone for a man. At this weight, the obesity expert says, surgery is not what many might consider as "the easy way out," - it is the only way out.

"If somebody went for the operation because they thought it is the easy way out, the operation would not work for them," he explains, "and our job on the medical side is to make sure that patients who think it is a quick fix, don't have the operation. For those who are suitable, their risk of dying in the years after the surgery is greatly reduced."

Professor O'Shea believes that while personal responsibility and awareness of our weight is key in the battle against obesity, the food and drinks industries - which have employed some questionable marketing techniques throughout the last few decades in order to fuel addictive behaviours - must take some part of the blame.

"Personal responsibility is being taken by the better educated and those who can afford it and are aware of the dangers, while lower socio-economic groups are the ones who are becoming significantly obese and the food and drinks industry have very deliberately targeted that group," he adds.

There are many reasons why Ireland is becoming more overweight than ever, some of which are beyond our control. But perhaps our hestitancy to talk about the elephant in the room is primarily to blame for the problem.

Instead of giving in to our environment or clever advertising or peer pressure, and quietly munching ourselves into oblivion, maybe it is time that we spoke about what we can control in this situation - ourselves - if we choose.

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