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The Operation Transformation team. David Cantwell/RTÉ

Opinion Operation Transformation is not the problem, it's the Government that lags behind

“Most people live in an environment that is profoundly obesogenic,” writes public health doctor Catherine Conlon.

BEFORE OPERATION TRANSFORMATION returned to our screens this January, I thought the show had run way past its sell-by date. But the series has followed the science and undergone a huge transformation.

Now, I’ve changed my mind. It is Government policy that languishes way behind.

Obesity experts criticise the show for telling people to lose weight by watching what they eat and to exercise, suggesting that this advice is not only inadequate but outdated.

“Telling people who meet the clinical criteria for obesity to ‘eat less and move more’ is not just outdated, it’s unethical,” says Aoife Hearne, former dietician with Operation Transformation [OT].

“I don’t understand how there is anyone who can recommend that on its own or without informing people about other supports now, given what we know about obesity as a chronic disease.”

OT doesn’t need to tell people with obesity about the game-changing impact of weight loss pills in obesity treatment – a massive profit-driven global market is doing that extremely well all on its own.

But is OT about treating people with obesity or is it about inspiring young and old across the country to take control of their health by eating as well as they can and ‘moving more in 24?’

Importance of Environment

Most people live in an environment that is profoundly obesogenic. Food markets are saturated in calorie-dense food that is high in fat, sugar and salt and incessantly marketed amid physical environments where it is often impossible to walk to the local shop, school, work or even for leisure.

The food system is in such a sorry state that we hardly seem to notice anymore. Everywhere you look, every workplace, every leisure facility, every supermarket, every retail outlet. Millions of people struggle to make healthy decisions in a food environment that is swamped in relentless advertising, ready access and low cost promotions.

A new report commissioned by the UK government’s own obesity research unit confirms that it is the food system, and not personal weakness, that is trapping people into buying unhealthy food.

City, University of London, which conducted the research, said ultra-processed food [UPF] and fatty, sugary, salty [HFSS] foods were now standard in children’s diets, with low-income families lacking the resources to mitigate this or foster healthier diets.

The report confirmed what we already know, healthy foods including fruit and vegetables are now ‘out of reach’ for many parents on low incomes compared to high-income families who were ‘positioned to continually stock their homes’ with fruit instead of unhealthy snacks.

Promotions on UPF and multi-deal buys “make them appear better value for money.” The report urged the introduction of policy interventions to increase accessibility and appeal of healthy foods.

Lead author, Dr Paul Coleman said that consumption of UPFs is normalised and integrated into our diets from an early age.

“Our research shows that for low-income parents there is little option but to buy these unhealthy options, even when they know they are bad for their child’s health. The low cost and long shelf life of unhealthy snacks make them the most logical options, despite parents wanting to make healthy purchases.”

The system is biased against children from low-income families from the very start, ensuring they are at higher risk of a lifetime of obesity and chronic disease including type two diabetes, heart disease, cancer and dementia.

The OT team have the latest science at their fingertips as they support individuals in a complex pathway towards a predominantly wholefood diet with options to include sustainable alternatives. Government policy is way behind, motivated by economic concerns and lobbyist viewpoints.

‘Junk food law’

Less well-off countries are way ahead in addressing the impact of UPF on health. Colombia became one of the first countries in the world to explicitly tax UPF in November.

Health experts hailed this as a step that could provide a template for other countries. After years of campaigning, the ‘junk food law’ came into force with the gradual introduction of a levy on affected foods that will begin at 10% immediately and rise to 15% in 2024 and reach 20% by 2025.

The introduction of this UPF tax in Colombia follows on from the introduction of front-of-packaging labels warning of their high calorie, sugar, salt or fat levels. Advocates state the combination of labelling with the UPF tax will increase the effectiveness of the measures.

Mounting evidence confirms the devastating impact of western diets that are predominated by UPFs on both weight and health. Despite this, introduction of robust legislation to counteract this effect is painfully slow.

In its absence, it is left to nutritionists, family doctors and shows like Operation Transformation to advise and support consumers on ploys to negotiate the unhealthy food environment.

Street design that favours sedentary living and makes physical activity very challenging is the second key factor driving the genetic and biological factors that predispose to poor health.

If physical activity was a pill, its market potential would give the new wave of drugs that are now being recognised as game changers in the treatment of obesity and other chronic diseases a run for their money.

Professor of Biological Sciences at Harvard University Daniel Lieberman describes in Exercised the Science of Physical Activity, Rest and Health (2020) how too much sugar in your blood can cause a condition called insulin resistance. As blood sugar rises, the brain demands the pancreas to produce more insulin with diminishing effect causing blood sugar to stay dangerously high.

“Exercise can reverse insulin resistance by restoring blocked insulin receptors and causing muscle cells to produce more of the transporter molecules that shuttle sugar out of the blood stream. The effect is akin to unclogging a drain and flushing out the pipes.

“By simultaneously improving the delivery, transport and use of blood sugar, exercise can resuscitate a once resistant muscle cell to suck up as much as fiftyfold molecules of blood sugar. No drug is so potent,” reports Prof Lieberman.

Weight loss drugs are an important part of the solution to obesity but only in the context of an environment that promotes healthy eating and (the super pill) physical activity- as the norm rather than a constant impossible challenge.

Health Minister Stephen Donnelly and HSE CEO Bernard Gloster have demonstrated a welcome commitment to managing obesity as a disease. Equally, transformative government supports must now be put in place to support obesity prevention.

What does that look like? A suite of measures that include a ban on online marketing of junk food, a tax on junk food, a 9pm broadcasting watershed on advertising of junk food and drinks, a banning of price promotions and end- of- aisle and checkout positioning of junk food.

In terms of physical activity, a massive increase in momentum to ensure that citizens of all ages can move about their communities safely on foot or on two wheels.

Until that happens, OT is doing a good job supporting people of all ages to negotiate appalling food and urban environments that are lagging way behind what is needed for health and wellbeing of all our citizens, particularly those in low-income groups.

Dr Catherine Conlon is a public health doctor with the HSE and former director of human health and nutrition, safefood

Dr Catherine Conlon
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