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HOSPITAL CONSULTANT PROFESSOR Helen Heneghan is seeing more and more people needing urgent treatment after going abroad for weight-loss surgery.
The long waiting list for bariatric operations has driven many patients to overseas clinics, but Heneghan warns that nightmare stories are becoming more common.
The bariatric surgeon and her team at St Vincent’s University Hospital in Dublin now deal with a worrying number of complications from procedures carried out by poorly regulated providers in other countries.
“We get admissions through the emergency department two or three times a week,” she said.
There’s been a significant increase in patients travelling abroad for surgery since the pandemic began, and the result is a lot more people presenting to our hospitals in serious trouble when they get home.
Heneghan appreciates that some feel medical tourism is their only option.
Waiting times for operations in Ireland can be as long as seven years, leaving patients at higher risk of health problems. Many develop new complications while waiting for surgery, and a small number even die.
“We’ve had 13 deaths on our waiting list over the last few years,” she told The Journal.
“We don’t get much traction when we talk about these sorts of figures, whereas there’d be uproar among clinicians if people died on, say, a transplant waiting list. I think there’s still a perception with obesity that it’s that person’s fault, which is absolutely not the case.”
Heneghan isn’t alone in her frustration at the lack of resources for obesity treatment.
The HSE’s new model of care for obesity management includes plans for better-resourced services in general practice, community and hospital settings, but clinicians fear that many of its proposals are far from being realised.
“We know what we need to do but the funding hasn’t been put in place to deliver it,” said Heneghan.
Obesity is costing our health service every single day, and yet we invest very little in treating the underlying condition.
“With obesity treatment, or anything to do with obesity, it’s usually the first thing to be shelved when there’s any other pressure on the health system.”
Francis Finucane, a consultant endocrinologist who runs the MSc in obesity at NUI Galway, points out that there are also barriers to safe and effective weight-loss drugs.
“We have well-established drug therapy regimes that work very well in terms of reducing cardiovascular risk and the risk of diabetes, and reducing excess dietary intake. I could see a patient with obesity in my clinic and advise that they start a particular drug therapy, but that patient would then have to pay for the drug out of pocket,” he said.
That wouldn’t be the case if they had diabetes, for example, or if they have hypertension, or cardiovascular disease. We don’t stigmatise those conditions in the way we stigmatise the problem of excess body weight.
However, he added that medication and surgery only go so far in addressing the problem.
Bariatric procedures might be the only way forward for people with severe obesity, but he said public policy must also tackle the environmental drivers of people being overweight.
“What we need are population-wide initiatives like compulsory labelling of calories, like sugar taxes, like restricting the advertising of junk food.”
He suggested that Irish policymakers look at public health measures being mooted in Britain, including the proposed banning of pre-watershed TV adverts and multi-buy deals for unhealthy foods.
“I think that’s an approach we need to replicate in Ireland and even take on more aggressively. We have completely inadequate policies when it comes to advertising targeted at children.”
The need for action seems clear in light of the recent warning by the World Health Organization that “epidemic” levels of overweight and obesity are linked to more than 1.2 million deaths a year across Europe. In Ireland, around 60% of adults are currently overweight or obese.
But stigma still deters many from accessing support and treatment.
Consultant endocrinologist Jean O’Connell, who chairs the Association for the Study of Obesity (ASOI), points out that obesity is a complex, chronic disease driven by multiple genetic, biological and environmental factors – and not, as many think, a lifestyle choice.
“The big misunderstanding is that it’s caused by eating too much. Healthy eating and exercise are important in managing any chronic disease, but we have to move away from this idea that obesity can be addressed solely through willpower.”
O’Connell said that some doctors wrongly assume any patient can lose weight if they try hard enough.
The notion that individuals are to blame for obesity, she said, ignores the science behind why people have bigger bodies – and the fact that many will never manage to reach and maintain a so-called “normal” weight.
Such assumptions can also affect how health professionals engage with patients.
For example, recent research found that more than half of entry-level physiotherapy students in Ireland feel that treating people with above-average BMIs isn’t worth the time, with most agreeing with the statement that “overweight individuals tend to be lazy about exercise”.
Susie Birney of the Irish Coalition for People Living with Obesity said that even long-serving medical professionals jump to conclusions.
“We hear people in our support groups saying that doctors will point to their weight whatever the problem. It stops people from getting support because you end up going into yourself,” she said.
A patient advocate, Birney had bariatric surgery in 2015 after trying numerous diets and therapies.
She began putting on weight as a teenager, and in later years was diagnosed with type two diabetes and polycystic ovaries.
The surgery reversed her diabetes straight away, but she said it wasn’t a quick-fix solution: she regained some of that weight in subsequent years and again sought support.
Birney always thought her size was a result of food and activity, but she began to think differently after being referred to the weight management service in Dublin.
“The multi-disciplinary team there is what completely changed my understanding of my weight and all its fluctuations,” she said.
“I started to see that it wasn’t just my own fault that I needed help.”
Infographics by Fionn Thompson
This work is co-funded by Journal Media and a grant programme from the European Parliament. Any opinions or conclusions expressed in this work are the author’s own. The European Parliament has no involvement in nor responsibility for the editorial content published by the project. For more information, see here.
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We all have a tendency to look for reasons or excuses outside of ourselves for negative things in life, excessive weight gain is one of them.
People that have a medical reason outside of their control that causes their weight gain, are the minority of those that are obese, for the majority of us, its eating too much and not exercising.
Weight gain is an incremental thing, nobody goes on a weekend of excessive eating and on Monday morning wakes up obese, it’s the longterm lack of exercise that allows it to gain a foothold, then people get depressed about their weight gain and comfort eat or resign themselves to being a lost cause, the more they eat, the less energy and motivation they have and it becomes a vicious circle.
We all have to force ourselves to exercise and not make excuses.
@David Van-Standen: did you even read the article? You appear to have articulated ever assumption and bias that the doctors quoted in the article are trying to overcome in creating awareness and effective treatment plans for their patients.
@D. Memery: What did David say that’s untrue?
@D. Memery: Yes I did read it and yes I disagree with a great deal of it, especially the creating awareness and not blaming the majority of us, that simply eat too much and don’t exercise enough, or do any exercise whatsoever and become obese.
My opinion is my own and its not formulated out of bias or assumptions, it come from personal experience and frankly, the last thing that people struggling with overeating and under exercising need, is another excuse for continuing to do so or to be told they are not responsible for actions that are within their control.
The truth may offend some people, it may cause them distress, guilt or even despair, but nevertheless it still remains the truth.
@David Van-Standen: as a truck driver I completely disagree with what you said. It’s the perfect example of stigma.In my 50s I’m guilty (not the best word) of comfort eating because of mental health issues. Weeks alone eating on ferries and going straight to bed. I do exercise but nowhere near enough because it’s not practical. I’ve tried everything to lose weight.I now take the view that everything I’m being about weight loss is a lie or a marketing ploy. So me taking personal responsibility for my weight loss is an over simplification of the issue. I’m really worried I’m shortening my life and that I won’t be around for my children.I’m suggesting your pulpet thumping stigma inspiring views are part of the issue. I want to lose weight.I need some guidance not just personal responsibility
@Allora: You know what the problem is you have said it yourself, you are comfort eating and that is causing weight gain. It is almost impossible to out run a bad diet with exercise. The guidance is simple stop eating junk food and exercise more. For almost everyone it’s that difficult but also that simple. Simple doesn’t mean easy but the solution is not complex.
@Allora: You may completely disagree with what I said, but you described your own situation and confirmed everything I said, that you say you disagree with, you eat too much often because you comfort eat, you don’t exercise enough, because you say its not practical, you also state that you taking personal responsibility is an oversimplification on my part.
I am sorry, but it really is that simple, if we eat more than we burn, we store it as fat, eating less without exercise will only result in limited weight loss and because its not really a lifestyle change, its easy to slip and accept defeat, so making regular exercise part of our lives means we get psychological benefits in addition to the physical weight loss.
@David Van-Standen: it’s not eating too much – It’s eating too much of the wrong food.
@v39e84kK: yes just like the cure for alcohol and drug addiction is don’t consume any, for anorexia it’s eat more, for anxiety it’s worry less, for depression it’s be happier. We’ve a world trying to move away from mental health stigma. But we still try and over simplify the solutions. You could argue that net zero can be achieved simply. Stop all use of electricity and fossil fuels. Zero road deaths can be achieved easily. Don’t crash. Etc etc
In addition improving fitness, which means we start to view ourselves differently and in a positive, rather than negative way, which means our mental health improves too.
I will offer you some unsolicited advice and I say this with genuine good intentions, reduce the amount you eat, try to eat healthy options and set yourself a regular exercise routine.
Get yourself two barbell weights that you can bring in the truck and start with upper body exercises, look online for a simple set of 5 exercises, ten reps of each everyday, set yourself 45 minutes of walking everyday, not strolling, with you heart rate raised to over 100 bpm rain or shine.
It will be tough for the first week or two, but you will start to see results, feel better about yourself and this will motivate you to continue.
@wormtubes: If you want to pedantic about it, its eating too many calories. But I think we are all aware that issue is eating more than we burn.
Just to clarify by barbells, I mean the hand dumbells that are a bar and you can increase the weight, so as it gets easier you can increase it slightly, which makes them more flexible than fixed weight dumbells.
Also, if you do exercises in which you lift both weights at the same time and mirror image your workout, you will be more balanced in both the workout and the results and less likely to strain yourself, by trying to lift too much weight.
@David Van-Standen: while what you say is technically true that in order to maintain weight you must balance calories in and calories out. Telling someone who is obese that’s all they have to do is like telling an alcoholic they should just stop drinking. Weight gain and weight loss can be a severe mental struggle. Why do we accept anorexia bulimia and alcoholism as mental diseases but not obesity and accuse sufferers as lazy.
@David Van-Standen: Reducing calorie intake is far more important than exercise. A chocolate bar will wipe out the benefit of an hour of exercise.
@David Van-Standen: so a huge amount of presuppositions in this comment again. My choices are comfort eat or depression because I have long term psychological issues and I’m neurodivergent. My comfort eating is actually holding off my depression. I see that I presented some of my own struggles here and you jumped right in with analysis one you couldn’t possibly understand or know. As such my issue is categorised as an eating disorder as is the case in relation to many who are obese. Would you be as direct to put it politely to someone with anorexia? I’m curious to know. That’s also directed to those here who have similar views.
@Rmaybe:
Anorexia is a mental illness that means the person cannot see themselves as they are, they develop a physical aversion to food and starve themselves to the point of death.
Alcoholism is a mental illness, people become both physically and mentally addicted to Alcohol.
However, obesity is just eating too much, not exercising and this effects a growing number of our population and the vast majority of us that are overweight.
The same as drinking too much doesn’t mean you’re an alcoholic and dieting doesn’t mean you’re anorexic, eating too much doesn’t mean you’re chronically obese, it means you’re overweight or obese.
Chronic morbid obesity is a mental illness, but those are the minority of cases, but including everyone in that group, is like calling all drinkers alcoholics…
@David Van-Standen: You might try and study science rather than use your own personal experience. The last thing people with obesity need is frankly your attitude.
@Dave Harris: Nope, it’s a chocolate bar.
@Allora: Coddling won’t help you. You are making excuses for your eating and it won’t stop until you don’t let those excuses control your behaviour.
@Dave Harris: your message is so good,we have been told for years and years,that alcohol can be in our genes from generations before us,I think if u have that gene,it might not be alcohol,but it could be cigarettes drugs food,and I think it’s the same with weight,and might take u 4 times longer than someone else to lose a pound,and can gain it back as quick,it’s sad isn’t it Dave,that everyone is put into the same category and judge without knowing anything about who u are
@Allora: Of course I jumped right in with my unsolicited advice, I said as much and that it was said with good intentions.
Its is well documented that some people, especially those suffering from psychological issues can become obsessive about exercise, you presented a snap shot of your of situation and I within the confines of the character limit offered some constructive advice based on what you said.
The premise being that you replace your current psychological support mechanism of comfort eating, with the more positive one of regular exercise, then exercise could become your comfort activity to go to in times of other internal or external pressure, leading to positive rather than negative physical health consequences.
@v39e84kK: so what do you suggest he does to make his job more endurable?
@David Van-Standen: in all that advice that you spouted from your pedestal there was one thing lacking….empathy,. for the love of God don’t ever consider a career in counselling or personal training. You should probably not dish out any sort of advice to total strangers on the Internet, especially when they have disclosed mental health difficulties and you know nothing about their physical or menatl health. And your view of anorexia is very outdated. Anorexia is an eating disorder which is complex and has many triggers. Over eating can also be an eating disorder or it can come from a poor relationship with food which can come from many other areas. Comfort eating is an example of this. Don’t dismiss Comfort eating as something silly that you can just stop doing. It is a cycle of control reward and punishment just like anorexia bulimia and alcohol problems. To resolve the issue you must first understand why you over eat. It is a complex problem which you are trying to fix with a one size fits all. Excuse the pun.
You have clearly missed the entire message of the article
Try being a woman heading into perimenopause or menopause. I’ve spent the last decades since i was 14 doing sports, from martial arts, basketball and gaa. Since the aches and pains in joints and back started the exercise regime has had to lessen, pain is getting the better of me. Then there’s the diet, i don’t eat takeaways, or chocolate and eat lots of fruit and vegetables but somehow the wasteband is widening. I hate it, but short of getting surgery what can i do? Im not a greedy piglet but i am heading towards obesity and really struggling to get hrt and pain meds right so i can return to exercise more.
@Lisa Jones: There’s no mystery to why you’re gaining weight. You’re taking in more calories than you’re burning. Eat less and you will lose weight. This is a lifestyle issue.
@AuroraStarstreak: unless you actually understand anything about menopause and women’s bodies around hormones and loss of estrogen and how the body holds onto fat deposits then what you say isn’t exactly true. Learn more about it.
@Lisa Jones: Your body can’t break the first law of thermodynamics.
Eat less to compensate for hormonal changes.
You are currently eating more calories than you need.
This your own personal responsibility.
@Lisa Jones: Excess weight comes from somewhere, it doesn’t just appear out of the air. Yes, some people would benefit from medical help but in the great majority of cases obesity is simply consuming more calories than are used.
@Lisa Jones: there is a fab YouTube fitness channel called PahlaB for older women hitting menopause. She talks quite a lot about how the body does not have enough estrogen to clear “stress” in the same way it used to. Some really good ideas about moderate exercise, moderate eating and managing stress. She has real, practical advice for the concerns you mention here
At a simplistic level, is it just not calories in and calories spent?
If someone consistently consumes more calories than they burn, will they not just end up being overweight?
@Daney Howard: Yes. But logic and common sense aren’t good for victimhood culture.
It’s a complex one, and we would do well to not overly blame obese people.
I used to be heavily obese. I lost 6 stone. I’ve been a healthy weight for 3 years, and I intend on keeping that way.
It’s incredibly difficult. I need to seriously limit my calories, and do an inordinate amount exercise. Far more than anyone I know. My body seems to forever push me towards obesity, and staying at a healthy weight is an unending battle.
Yes, at the most fundamental it comes down to choice and responsibility. But there’s so much pushing against that – culture, mental health, individual metabolism, etc etc – that it’s no surprise that so many become obese.
@Colm Hennessy:
I commend that approach and wish you well.
It is indeed a complex issue involving so many factors that are both external and internal. Budget has such a large part to play in diet, or consumption, with heavily processed foods being so prevalent on shelves. Calories alone are certainly something, but there are so many other aspects to a diet, or rather a nutritional balance, that is getting lost along the way, that could be as important.
I thought the sugar tax was supposed to sort this all out, maybe just stick a fat tax on people over a certain bmi instead. That will teach em
@Smithweiser: The sugar tax is a good thing, though I don’t remember anyone saying it would solve all our obesity issues. Even if it makes a few people go from buying Coke to buying Coke zero because its cheaper then its working.
@Smithweiser: haha that made me laugh
@Smithweiser: high taxes on cigarettes and alcohol for similar reasons………
Our bodies like sugar. Food manufacturers know this, so they put more sugar in processed foods. Our bodies cannot keep up with the calories coming in, so we eat more than we need before our brains tell us we have had enough.
When we have an excess of 3500 calories coming in, we gain one pound. Over the course of time this adds up and we are overweight and then obese.
Small habits can mitigate this, but it takes a high lebel of management to track calories. Eating four biscuits – which takes about 5 minutes- might be about 300 calories in. And that takes about an hour to walk 3 miles to burn it off.
Calories in. Calories out. And guess what, women (especially older women) do not need 2,000 calories a day as it says on most food packaging labels. And men do not need 2,500 calories a day. Ask your GP and they will give you a good estimate as to your daily calorie requirements to maintain weight. For me, at my age and stage of life, it is about 1500 calories if I am lucky.
No one wants to hear these things, but if you ask anyone who is fit and not overweight, you will probably get a version of this answer. No magic bullet or pill, unfortunately.
@Seeking Truth: you need the minimum amount just for the functions of the body to function normally. You eat under that, the body goes into starvation mode and shifting weight is difficult, over it to excess, you put on weight. Then if you exercise you need more calories to fuel the metabolic state caused by the exercise and the repair to the muscle groups. That needs to be taught in schools, exercise and fitness are just as important as maths or languages
@Disco Inferno: a very true point. Usually anything under 1200 calories causes the body to go into survival mode and to store any energy it can. Totally contrary to what one would think but starvation diets do not work. Moderation is key. Moderation is boring but consistency and balance certainly helps.
@Seeking Truth: you are spot on,cutting down to low calories,the body ends up eating into your muscle,because it don’t know when it’s going to get food again,there is so many diets out there,and it’s been for years,all protein no carbs,and the 1 where u could only have shakes,a friend of mine gave 7 weeks on just them shakes,OMG she was in a terrible state,she looked like someone had cancer or some very bad illness,it didn’t effect her physically but mentally she was not the funny mad for the craic girl she was,she said when she looked in the mirror,she saw the overweight person,and when shopping for clothes,she would still go to the bigger sizes,it can be hard going
Most fat people are fat because they eat too much and don’t exercise enough. The vast majority. Reading the article you’d come away thinking type 2 diabetes was a cause and not the result of obesity. One lady says the GP will say your obesity is the source of whatever complaint you present with, that’s because it probably is. The GP is right.
You can keep banning ads and blah blah blah or people can just accept personal responsibility.
@v39e84kK: reading your comments left on this article you are portraying yourself as a narrow minded person. One would feel sorry for any of your family or friends that may struggle with their weight – even if it was caused by medical condition or medication, you would be the last person that they would ask for support or help as in your mind its a black and white issue I.e. its the persons fault.
the one thing I always come back to is this: there were no fat people at all when I was growing up in the sixties, seventies and even eighties. Everyone was slim. If you saw a fat person it was 100% due to a metabolic issue. The population was skinny, look back on footage from “the way we were” (recent RTE documentary). Slim people everywhere. Go figure. Its diet, lack of exercise and an abundance of wrong food choices now. If you go to pay for petrol you’re assaulted by chocolate and sweets on the way to the cashier!!
I wonder why Irish people are more prone to this “disease”? Must be the weather. Remember if you eat crap and drink a load of pints it is not your fault if you become obese. It’s a disease!!
Well, this is an interesting topic to start the day with. Have a friend that just underwent lap band surgery recently due to how he metabolises food and gains weight, but also see more instances of that it literally is just overeating the wrong food and no exercise.
I do not believe in shaming, the recent JP twit’r post was abhorrent, but at least got a discussion going.
No-one denies that ‘bigger-bodies’ is a thing, but it also is not a catch all that encompasses the entire spectrum, nor does people think there’s a perfect BMI.
Where the article lacks any counter-argument on, is how many that are obese, not diabetic, that are actually healthy, and can actually through diet and exercise, change that. Lumping those into just ‘ oh you can’t will willpower’ alone, is missing some factors.
Diabetes type 2 is caused by diet. It’s suffers are fat. That’s the cause.
@v39e84kK: not always, you can be slim and have type 2 diabetes. There are many other causes including effects of long-term medications, DNA, pregnancy, polycystic ovary syndrome, metabolism disorders etc. Healthy eating and exerise is good overall but unfortunately not enough sometimes.
@nineteen: Yes, there are some who get type 2 in the ways you list but the simple fact is the vast majority get diabetes from their own inability to discipline themselves.
@Justin Gillespie: VAST majority yes. People absolutely love pointing out small outliers online as if every comment speaking sense needs to be a double blind peer reviewed study citing the 0.0000023% that doesn’t fit the standard explanation. Tiresome.
Obesity is not a choice for most people. The one single cuase is always going to be energy consumption vs energy expenditure. There is no getting away from that and any individual can, in theory, choose to address their energy balance. But the socio-economic and biopsychosocial factors that result in an individual being obese are not a choice. An imperfect solution to this problem in an imperfect world is probably with medical intervention.
@james spice: It is a choice. Eat too much, or don’t. Just because it’s hard doesn’t mean it isn’t a choice.
@v39e84kK: is anorexia a choice or a mental health condition.
@Rmaybe:
By definition, it’s a disorder.
@v39e84kK: that aspect is a choice. I sure hope you don’t work in any capicity with helping obese people with their issues.
@james spice: I hope you don’t because it would be ineffective pity party. Like most woke modern healthcare BS.
There are some physiological reasons for obesity. Some are sociological. We do know that performing the surgery saves health care costs in the long run.
Everyone has an opinion on weight , there’s lots of experts here . It’s impressive . I have 2 stone extra on me and I hate it . It’s really shaming reading this , certainly doesn’t motivate me .
@Mia Morrissey: All I see are people saying that diet and exercise are the solution. What is your issue with that? Do you want lies? Because that won’t work. The great deception about weight is that it’s complicated. It is not complicated. Fat people eat too much and don’t exercise enough. That’s it, that covers 99% of the causes. Almost everything else is perpetuated to make money or simply confuse people.
@Mia Morrissey: diet and excersise are of course the end solution to your weight issue. Energy consumption vs energy expenditure is always going to be the underlying mechanism that will get you to your goal body composition. However, diet and excersise may not be the place you start to address your weight . Some people need to address underlying mental health issues before they can take on the behaviour change necessary to tackle nutrition and excersise. Give yourself a year. Be kind to yourself. Maybe you need to learn to cook and learn more about food before you tackle the weight. Maybe you need to find an form of excersise you love first. Maybe you need to sit down and have a conversation with those close to you about how you can make this work. Seek out professional help if you can afford it.
@Mia Morrissey: i put on a ton of weight over the lockdown and this actually doea motivate me
I have the opposite problem, I can’t put on weight. I can drop 5kg in a week easy but struggle to regain it.
@Hatchjaw: Do you have tapeworms?
Yet nobody would say that not putting on weight is your fault and its simply because you have the wrong attitude
@AuroraStarstreak: defo worms ..
The poor quality food we shovel into ourselves is the cause of a lot more problems than just obesity.
So many comments showing a complete lack of knowledge about what the science actually now says about obesity. So many factors that effect how the body handles energy intake and expenditure are now being studied and new areas of research are opening up. Old tropes are very much in evidence in the comments and sadly the prejudice against people who are obese is also very clear. There are far too many factors effecting why an individual becomes obese to go into here but public health strategies need to be implemented at a national level to address a national issue. We could start with economic measures such as sugar taxes and stopping bogof offers on junk foods but how about some positive actions instead of negative ones? Subsidise fruit, veg, lean meats, fish, pulses and legumes, etc.
I have a breakfast roll most mornings, a garlic chip & cheese Mondays & Thursday, Tuesday I have indian, Wednesday I have Chinese. Friday is my cheat day then as I have fish & chips. I still can’t lose any weight though, I might have an underactive thyroid.
have your say