AS I SEE IT
BY MARIANNE HERON
Having been fat at one point in life and also having been skinny at another, I honestly think in between the two is better. I ran to ‘puppy fat’ at puberty and became thin when suffering from gall stones in mid-life. Being called fatty as a pre-teen was horrible, and when the fat mysteriously melted away my classmates congratulated me on my new figure. How had I done it?
I hadn’t done a thing. I hadn’t eaten nor exercised; more or less, the extra blubber was due to a teenage metabolic slow-down. But the nasty experience of being called fatty and then being admired for weight loss coloured my view about being overweight. I confess that I became prejudiced about corpulent folk, to the extent that, if I saw a seriously chubby candidate’s picture on an election poster, I made a mental note not to vote for them.
That kind of judgemental thinking is neither fair nor accurate. People who are seriously overweight are suffering from obesity, which is a disease recognised as such by the HSE in its National Programme for Obesity, which shares the WHO’s definition as “abnormal or excessive fat accumulation that presents a risk to health”. The term obese applies to about 21% of the Irish population with a BMI of 30 and over, while 35% of us are classified as overweight.
People suffering from obesity may still struggle with the idea that the extra weight is their own fault and with stigma, which blames them for over-eating, lack of willpower and laziness. Candid interviews with celebrities who have had problems with their size, from Jelly Roll to Adele, are helping to change those views.
“I came to understand that over-eating doesn’t cause over-eating. Obesity causes over-eating,” Oprah Winfrey, who has had a decades-long struggle with weight, told People magazine recently. “If you have obesity in your gene pool, it’s not your fault.”
Effective interventions with diet jabs like Ozempic and Wegovy, which work by signalling satiety, slowing digestion and acting on the appetite centre in the brain, or bariatric surgery on the stomach or the small intestine, are also changing the picture.
“Telling people to eat less and move more is a bit like telling people with depression to cheer up,” says Dr Michael Crotty, a GP specialising in obesity at My Best Weight (MBW), a Dalkey-based clinic dedicated to sustainable weight management. He explains that the causes of obesity are complex, involving genes, which account for between 40–70% of our make-up, as well as hormonal and environmental factors, where everything from diet to stress or sleep may be involved.
People with a genetic predisposition to obesity may put on weight because of the kind of environment we have today, offering processed and hyper-palatable foods. Also, our bodies are programmed with a homeostatic effect to protect fat and to replace it when lost, which explains the yo-yo effect where dieters regain what they have lost.
“The goal with obesity care is to improve health, not just to manage weight, and it is the same as any other chronic disease — if you stop treating it, it will come back,” says Dr Crotty.
So-called diet jabs may help to level the playing field for sufferers, but given the price at €200–300 for a month’s treatment, they are too dear for many, while the HSE’s reimbursement for these drugs is somewhat disconnected from its recognition of the disease and is limited to those with diabetes or pre-diabetic states combined with other conditions.
The MBW clinic has a holistic approach, aimed at supporting people in attaining their best metabolic, physical and psychological health. Consultations focus on why individuals struggle with their weight, combined with coaching, diet modification and, where appropriate, medical or surgical treatment.
There are other solutions for those who want to shed a few pounds. My favourite beauty columnist, India Knight, developed the Idiot Proof Diet (From Pig To Twig) with her friend Nevis, cutting out carbs and sugars and focusing on a diet with protein, fruit and vegetables combined with more exercise. They both lost five stone due to such lifestyle change. Worth trying.
Anyway, when I take action over a post-Christmas waistline, I will tell myself that I am out to gain health rather than lose pounds.
