Medical Matters: Now that the smoking ban has finally been implemented, it looks as if our rapidly rising levels of obesity will become the next focus of public health action.
The Minister for Health, Mr Micheál Martin, recently appointed a task force to look at obesity.
In contrast to the tobacco industry, representatives of IBEC and An Bórd Glas are happy to participate in what should be a less adversarial exercise than that involving tobacco use.
To find out if you are overweight or obese, you need to weigh yourself and to accurately measure your height.
This enables you to calculate a number called the Body Mass Index (BMI) - by dividing your weight (in kilograms) by the square of your height (in metres and centimetres).
The ideal number is between 20 and 25.
If it exceeds 30, you are considered obese - and if you find your BMI works out at less than 20, you considered undernourished.
BMI calculations are fairly straightforward for adults; a more complex formula is required to calculate an accurate reading for children.
It is best to get your GP or practice nurse to work out an accurate BMI for children under 12 years of age.
For once, it is appropriate to use the term epidemic to describe the rising levels of obesity.
Over 40 per cent of the Irish population are overweight; one-fifth of this number are obese.
What is even more disturbing is the exponential rate at which these figures are increasing.
The evidence linking obesity with disease is strong. Essentially, it increases your risk of developing heart disease, diabetes and cancer by a factor of three.
Dr Donal O'Shea is a consultant endocrinologist at St Columcille's Hospital, Loughlinstown, Co Dublin, and a member of the Obesity Task Force.
"While the health risks associated with obesity are high, there is a way to reduce the risks," he says, while pointing out that even a modest weight loss of even 5 per cent can make an important difference in reducing the risks of disease and premature death.
"That benefit appears to be seen whether you start at 15 stone or 25 stone."
Dr O'Shea runs a dedicated weight-management clinic in Loughlinstown, where he and his team have successfully treated more than 400 patients in three years.
I don't think we can over-emphasise the importance of encouragement in dealing with this issue.
Any attempt to introduce fat taxes or adopt a "medical policeman" approach would be doomed to fail.
Unlike the smoking ban, where the scientific evidence showed that the health of non-smokers was being damaged, the effects of obesity are personal to the individual who is overweight.
In my view, this is what renders societal sanctions totally inappropriate.
Writing in the Lancet last December, the executive director of the American Obesity Association, Mr Morgan Downey, described the typical consultation between an overweight or obese patient and a doctor.
"A common event, yet it is fraught with anxiety, difficulty and avoidance - on both sides.
A mutual conspiracy of silence exists," he said.
"The patient is tense and avoids any reference to his own weight... he knows his weight is a health risk.
"The government has told him that a healthy diet and 30 minutes of exercise a day will solve his problem. He has tried this but it hasn't done much.
"He is a failure."
I suspect that many obese people will identify with this pen-picture. As someone who has tried dieting in the past, I can empathise with the frustration of trying to lose weight and not succeeding. You actually feel worse than if you had not tried in the first place.
All of which underlines the importance of dealing with the problem in an inclusive way.
Whether within the confines of an individual consultation or at the level of national policy-making, obesity must be afforded a gentle and unhurried approach.
Very much a case for sotto voce and festina lente.
Or as the Irish proverb says: "Mol an óige agus tiocfaidh sí."
• Dr Muiris Houston is pleased to hear from readers at
mhouston@irish-times.ie. He regrets he cannot answer individual medical queries.
