Governmental Framework

The UN Intergovernmental Panel’s 2019 Report on Climate Change and Land  (IPCC) describes plant-based diets as a major opportunity for mitigating and adapting to climate change ― and includes a policy recommendation to reduce meat consumption.

The Report States:

Balanced diets, featuring plant-based foods, such as those based on coarse grains, legumes, fruits and vegetables, nuts and seeds, and animal-sourced food produced in resilient, sustainable and low-GHG emission systems, present major opportunities for adaptation and mitigation while generating significant co-benefits in terms of human health (high confidence).

By 2050, dietary changes could free several Mkm2 (medium confidence) of land and provide a technical mitigation potential of 0.7 to 8.0 GtCO2e yr-1, relative to business as usual projections (high confidence).

Transitions towards low-GHG emission diets may be influenced by local production practices, technical and financial barriers and associated livelihoods and cultural habits (high confidence). 

“We don’t want to tell people what to eat,” says Hans-Otto Pörtner, an ecologist who co-chairs the IPCC’s working group on impacts, adaptation and vulnerability. “But it would indeed be beneficial, for both climate and human health, if people in many rich countries consumed less meat, and if politics would create appropriate incentives to that effect.”

The USDA (U.S. DEPARTMENT OF AGRICULTURE)  healthy diet guidelines guidelines, which are the basis for the advice for many other countries, shows the recommended proportions of different foods an individual should consume for a ‘healthy diet’:

• 39% fruit and vegetables ;
• 37% cereals ( pasta, potatoes, rice, potatoes);
• 12% from protein (meat, fish, eggs,  pulses, beans);
• 8% from dairy and milk; and
• 4% from fatty and sugary foods. 
• 5 portions of fruit and vegetables per day
• Fish twice per week
• 2,000 calories per day for a female and 2,500 calories per day for a male.

This 2015 “Healthy Eating Plate” image, (and recommended food intake), replaced the original 1992 USDA food pyramid:

The original USDA 1992 Food Pyramid

The Guidelines state:

“Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations.

A healthy dietary pattern can benefit all individuals regardless of age, race, or ethnicity, or current health status. The Dietary Guidelines provides a framework intended to be customized to individual needs and preferences, as well as the foodways of the diverse cultures in the United States.

Focus on meeting food group needs with nutrient-dense foods and beverages, and stay within calorie limits. An underlying premise of the Dietary Guidelines is that nutritional needs should be met primarily from foods and beverages—specifically, nutrient-dense foods and beverages. Nutrient-dense foods provide vitamins, minerals, and other health-promoting components and have no or little added sugars, saturated fat, and sodium. A healthy dietary pattern consists of nutrient-dense forms of foods and beverages across all food groups, in recommended amounts, and within calorie limits.

The core elements that make up a healthy dietary pattern include:

• Vegetables of all types—dark green; red and orange; beans, peas, and lentils; starchy; and other vegetables
• Fruits, especially whole fruit
• Grains, at least half of which are whole grain
• Dairy, including fat-free or low-fat milk, yogurt, and cheese, and/or lactose-free versions and fortified soy beverages and yogurt as alternatives
• Protein foods, including lean meats, poultry, and eggs; seafood; beans, peas, and lentils; and nuts, seeds, and soy products
• Oils, including vegetable oils and oils in food, such as seafood and nuts

Limit foods and beverages higher in added sugars, saturated fat, and sodium, and limit alcoholic beverages.

At every life stage, meeting food group recommendations—even with nutrient-dense choices—requires most of a person’s daily calorie needs and sodium limits. A healthy dietary pattern doesn’t have much room for extra added sugars, saturated fat, or sodium—or for alcoholic beverages. A small amount of added sugars, saturated fat, or sodium can be added to nutrient-dense foods and beverages to help meet food group recommendations, but foods and beverages high in these components should be limited.

Limits are:

• Added sugars—Less than 10 percent of calories per day starting at age 2. Avoid foods and beverages with added sugars for those younger than age 2.
• Saturated fat—Less than 10 percent of calories per day starting at age 2.
• Sodium—Less than 2,300 milligrams per day—and even less for children younger than age 14.
• Alcoholic beverages—Adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking.”

The USA Center For Disease Control (CDC) tracks the growth in obesity levels in the USA.

Adult Obesity Facts

• Obesity is a common, serious, and costly disease.
• The US obesity prevalence was 42.4% in 2017 – 2018.
• From 1999 –2000 through 2017 –2018, US obesity prevalence increased from 30.5% to 42.4%. During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%.
• Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer. These are among the leading causes of preventable, premature death.
• The estimated annual medical cost of obesity in the United States was $147 billion in 2008.
• Medical costs for people who had obesity was $1,429 higher than medical costs for people with healthy weight.

Obesity affects some groups more than others

• Non-Hispanic Black adults (49.6%) had the highest age-adjusted prevalence of obesity, followed by Hispanic adults (44.8%), non-Hispanic White adults (42.2%) and non-Hispanic Asian adults (17.4%).
• The obesity prevalence was 40.0% among adults aged 20 to 39 years, 44.8% among adults aged 40 to 59 years, and 42.8% among adults aged 60 and older.

Obesity and socioeconomic status

• The association between obesity and income or educational level is complex and differs by sex and race/ethnicity.
• Overall, men and women with college degrees had lower obesity prevalence compared with those with less education.
• The same obesity and education pattern occurred among non-Hispanic White, non-Hispanic Black, and Hispanic women, and non-Hispanic White men. However, the differences were not all statistically significant. Although the difference was not statistically significant among non-Hispanic Black men, obesity prevalence increased with educational attainment. No differences in obesity prevalence by education level were noted among non-Hispanic Asian women and men and Hispanic men.
• Among men, obesity prevalence was lower in the lowest and highest income groups compared with the middle-income group. Researchers observed this pattern among non-Hispanic White and Hispanic men. Obesity prevalence was higher in the highest income group than in the lowest income group among non-Hispanic Black men.
• Among women, obesity prevalence was lower in the highest income group than in the middle and lowest income groups. Researchers observed this pattern among non-Hispanic White, non-Hispanic Asian, and Hispanic women. Among non-Hispanic Black women, there was no difference in obesity prevalence by income.
•  

Overweight and Obesity – EU BMI statistics 2019

Weight problems and obesity are increasing at a rapid rate in most of the EU Member States, with estimates of 52.7 % of the adult  EU’s population overweight ( BMI ≥ 25 ) in 2019.

The proportion of adults who were considered to be overweight ( BMI ≥ 25 ) varied between 37.1 % in Italy and 58.5 % in Croatia for women and between 52.9 % in France and 73.2 % in Croatia for men.

Ireland had the fifth  highest rate of obesity in the EU  in 2019:   26% of Adults BMI ≥ 30.

According to the Eurostat report, Malta with 28% has the highest share of its population rated as obese ( BMI ≥ 30 ), while the EU average was 16%.

With 56% of adults in Ireland classified as overweight ( BMI ≥ 25 ), it ranks Ireland towards the middle of the 27 EU countries with the highest share of overweight adults found in Croatia and Malta with 64%.

Sláintecare is the name for the initiative to reform Ireland’s healthcare to move away from a two-tier system and towards a system based on medical need.

The Department of Health and the HSE are working together to deliver the Sláintecare vision to put people at the centre of the health system. Working towards universal healthcare for all, Sláintecare reform is creating a health and social care service where people can access the right services, closer to home, and based on need and not ability to pay.

With a focus on developing primary and community care, Sláintecare reform is making it possible for people to stay healthy in their homes and communities for as long as possible.

The Department of Health is driving the Sláintecare reform programme and working with the HSE to transform health and social care services – ensuring that the right care is delivered in the right place and at the right time.

The Plan focuses on progressing the implementation of our two key reform programmes, Improving Safe, Timely Access to Care and Promoting Health & Well Being, and Addressing Health Inequalities – Towards Universal Healthcare. Key areas of focus this year include addressing waiting lists, further developments in shifting care to the Community, further investment in innovation, enhanced capacity and access to care, implementing digital and eHealth solutions in line with Government’s recently published national digital framework “Harnessing Digital”, introducing the Sláintecare Consultant Contract, progressing the National Elective Ambulatory Strategy through the provision of new elective capacity in Cork, Dublin and Galway, and the realignment of acute and community services via Regional Health Areas.

Sláintecare Key Principles

The Healthy Ireland Survey 2021 is an annual interviewer-administered face-to-face survey commissioned by the Department of Health. It is part of the Healthy Ireland Framework to improve the health and wellbeing of people living in Ireland.

The objectives of this survey are to:

1. Provide and report on current and credible data in order to enhance the monitoring and assessment of the various policy initiatives under the Framework
2. Support and enhance Ireland’s ability to meet many of its international reporting obligations
3. Feed into the Outcomes Framework for Healthy Ireland and contribute to assessing, monitoring and realising the benefits of the overall health reform strategy
4. Allow targeted monitoring where necessary, with an outcomes-focussed approach, leading to enhanced responsiveness and agility from a policy-making perspective
5. Support the Department of Health in ongoing engagement and awareness-raising activities in the various policy areas and support better understanding of policy priorities.

Weight

Body weight is an important consideration not just in terms of the health of the parents, but also of their children. The negative habits that lead to excessive weight gain (such as poor dietary choices and insufficient physical activity) may be shared among multiple members of a household meaning that children of overweight parents are more likely to become overweight themselves.

As 63% of parents are overweight or obese, this means that it is likely that most children in Ireland are growing up in a household where at least one parent is overweight.

Compared to their peers who are not parents, no meaningful difference exists. 66% of non-parents are overweight or obese, with 27% of this group obese (compared to 23% of parents).

As is the case generally between men and women, fathers are more likely to be overweight than mothers. Almost three-quarters (73%) of fathers are overweight or obese, and while the proportion of mothers who are overweight or obese is lower, there is still a majority (55%) in this situation.

It is reported earlier that those living in deprived areas are more likely than those living in affluent areas to be overweight or obese. Among parents, there is a narrower difference, with 66% of parents living in deprived areas overweight or obese, compared with 61% of parents living in affluent areas. Similarly, the gap among parents is slightly narrower than the gap between deprived and affluent areas among non-parents (non-parents living in deprived areas: 69%; non-parents living in affluent areas: 60%).

Encouragingly, overweight or obese parents are more likely to be trying to lose weight than non-parents who are overweight or obese (55% and 49% respectively). Looking at this across mothers and fathers shows that it is mothers that have a greater contribution to this difference with 69% of mothers who are overweight or obese reporting that they are trying to lose weight, compared to 44% of fathers who are overweight or obese.

Weight Management

• Just over a third (35%) report that they are currently trying to lose weight, while a similar number (33%) are trying to maintain their weight. Five percent are trying to gain weight, while the remainder (26%) are doing none of these.

• Across all age groups women (41%) are more likely than men (30%) to be trying to lose weight.

• Attempts to lose weight are most prevalent among those in the middle age groups, with 40% of those aged between 35 and 64 currently trying to lose weight, compared to 28% of those aged under 25 and 27% of those aged 65 and older.

• Respondents whose self-reported health is less than ‘good’ (43%), parents (43%) and those who are currently employed (38%) are also relatively more likely to be trying to lose weight.

• Men aged under 25 (20%) are disproportionately likely to be trying to gain weight, while smokers (10%) are more than twice as likely as non-smokers (4%) to be trying to do so.

Methods of Weight Management

• The most popular weight loss method is increasing exercise (76%). This is followed by eating fewer calories (52%), eating/drinking less sugar (42%) and eating less fat (36%).

• Diet-related methods of weight loss, such as eating fewer calories, are more popular with women (56%) than men (46%), as well as those who have a Leaving Certificate or higher (53%).

• Among those trying to lose weight, those aged under 35 (84%) are more likely than those aged 35 and older (73%) to report trying to do so through exercise. Younger women (86%) are particularly likely to use exercise for weight loss, although there is no significant difference between men and women overall (77% and 76%, respectively).

The HSE Health Eating Guidelines

The Healthy Food for Life resources are for the entire population over the age of five and they define the Irish Government recommendations on healthy eating and a balanced diet. They provide a consistent and evidence-based approach for healthy eating advice.

The Healthy Food for Life guidelines and resources provide practical support for individuals and families to make healthier food choices and to ultimately improve their health and wellbeing. They include a leaflet, infographic of the food pyramid, sample daily meal plans, guidelines on portion sizes and fact sheets.

The key messages from Healthy Food for Life are:

• Eat more vegetables, salad and fruit – Up to seven servings a day.
• Limit intake of high fat, sugar, salt (HFSS) food and drinks
• Size matters: Use the food pyramid as a guide for serving sizes
• Increase your physical activity levels
• Small changes can make a big difference. Start TODAY!

The Irish Food Pyramid (for adults, teenagers and children aged 5 and over) prescribes the recommended makeup of a healthy diet.

The Food Pyramid organises food into six main shelves – a shelf for each food group.

The most important shelf is on the bottom and the least important on the top.

1. Vegetables, salad and fruit – Eat plenty of these, up to seven servings a day.
2. Starchy foods – Have wholemeal cereals and breads, potatoes, pasta or rice with each meal. Wholegrain is best.
3. Dairy – Have some milk, yoghurt and cheese. Choose reduced-fat or low-fat.
4. Meat and alternatives – Have some meat, poultry, fish, eggs, beans and nuts. Choose lean options and have fish at least twice a week – one being oily.
5. Fats, spreads and oils – Have small amounts and choose unsaturated or reduced-fat options.
6. We call these ‘treats’ – foods that have high amounts of salt, fat and sugar. This is the least important shelf. Have a treat once or twice a week.

You don’t have to get the right balance at every meal. It’s fine if you balance it out over the whole day or even a week.

Healthy Ireland – Food Pyramid

The Model of Care for the Management of Overweight and Obesity

The National Clinical Programme for Obesity was set up as a joint initiative by the HSE Health and Wellbeing Division and the Royal College of Physicians of Ireland (RCPI) in 2017.

The working group, established in 2019, is multidisciplinary, including nominees from different groups involved in the care of people with overweight and obesity. The priority of the working group was to develop a model of care to outline national services for the care of people with overweight and obesity. The members of the working group were as follows:

Prof Donal O’Shea (Chair) HSE National Clinical Lead for Obesity

(Prof. O’Shea’s Weight Management Guide is here: weight-management-guide-2018)
Ms Karen Gaynor Programme Manager, National Clinical Programme for Obesity
Dr Brendan O’Shea General Practitioner, Chair RCPI Clinical Advisory Group
Dr Cathy Breen Specialist Weight Management Service, St. Columcille’s Hospital
Dr Eirin Carolan Consultant Endocrinologist CHI Crumlin
Dr Fionnuala Cooney Public Health Representative
Dr Jean O’Connell Consultant Endocrinologist IEHG
Dr Orla Walsh Adolescent Medicine CHI Temple St.
Ms Sarah O’Brien National Lead, Healthy Eating and Active Living Programme
Prof Helen Heneghan Consultant Surgeon, Bariatric Surgery
Ms June Boulger National Lead, Patient and Public Involvement
Ms Margaret O’Neill National Dietetic Lead
Ms Marian McBride Project Dietitian
Ms Michelle Lynch/Ms Caroline Peppard Self-Management Support Co-ordinators Representative (Joint)
Ms Roisin Doogue Irish Practice Nurses Association Representative
Ms Sheila Cahalane Director of the NMPD Dublin, Kildare and Wicklow -ONMSD
Ms Susie Birney ICPO Patient Representative
Ms Mary Francis Blaney ICPO Patient Representative
Prof Francis Finucane Consultant Endocrinologist – Saolta/NUIG
Dr Grace O’Malley W82Go, CHI Temple St./ISCP Representative
Ms Martina Stanley Medical Social Work Representative
Dr Norah Jordan Clinical Psychologist W82Go, CHI Temple St.
Dr Rita Lawlor Professional Development Co-ordinator for Practice Nurses
Dr Sean Manning Consultant Physician
Dr Colin Davenport Consultant Endocrinologist
Ms Gracia Gomez Kelly/
Ms Niamh Van den Berg AOTI Representative (Joint)
Dr Michael Crotty GP specialist in Weight Management & Bariatric Medicine

In November 2020, the working group published its recommendations in a document entitled – “Model of Care for the Management of Overweight and Obesity”.

Aim:
The aim of this model of care is to outline the spectrum of best practice care and services for overweight and obesity management in Ireland, ensuring the right care, in the right place at the right time.

Objectives:
To define specific services for the effective management of obesity and overweight in children, young people and adults across the life course incorporating prevention, early identification and treatment to prevent progression of disease and complications. To ensure effective integration and support across levels of services, across the lifespan and with services for high risk groups.

Scope:
The scope of this model of care is to define the services required to support the general population of children, young people and adults in the management of overweight and obesity. It includes health services operated and funded by the HSE and includes community-based services as well as hospital-based secondary and tertiary care services.

This model of care is guided by national and international best practice. It is not intended to be a stand-alone clinical guideline. It acknowledges that specific health and social care settings, high risk and vulnerable groups will require additional interventions and support. Working with the relevant national clinical programmes and services, this model of care will inform the future development of shared pathways, policies, strategies and services to improve health outcomes in these settings.

This model of care acknowledges and supports the range of services and activities external to the HSE such as schools and voluntary agencies that play a vital role in prevention and treatment but does not include these settings. While the National Clinical Programme for Obesity advocates for policy, legislation and cross-sectoral action to support healthy environments for all, this model of care does not apply to population-based policy or legislation.

ADULT LEVEL 0 – LIVING WELL WITH OVERWEIGHT AND OBESITY

This level involves a range of initiatives that will be available locally to enable a supportive healthy environment for people with overweight and obesity. These initiatives will support healthy decision making in home, work and social environments.

By ‘Making Every Contact Count’ brief advice and brief interventions, HCPs can provide support to individuals to manage health behaviours that contribute to stabilising weight in a self-compassionate and de-stigmatising manner while respecting patient autonomy. People will have the opportunity to develop self-management skills by participating in tailored programmes within their locality. Across all levels of service there will be shared care pathways developed for high-risk groups.

ADULT LEVEL 1 -GENERAL PRACTICE AND PRIMARY CARE TEAM

Most adults with overweight or obesity will present initially to primary care. The General Practitioner (GP), General Practice Nurse (GPN), and the wider multidisciplinary primary care team are the key health care professionals within this setting. They lead on early identification of overweight, obesity and complications, brief advice, initial management, signposting or onward referral to specialist services within community care hubs, with scheduled follow ups for ongoing support. They have a central role in ensuring an integrated, person-centred approach to support individuals to manage their own condition.

ADULT LEVEL 2 – COMMUNITY SPECIALIST AMBULATORY CARE

Level 2 ambulatory care hubs will provide specialist support to GPs in managing patients with obesity, preventing disease progression and the development of obesity related complications. This care provided in community specialist hubs builds on the level 1 services to provide enhanced support.

This level involves provision of structured, multicomponent weight management services in the community for adults with obesity and complications. These services will be aligned with the National Diabetes Prevention Programme (currently in development), the Chronic Disease Management Programme introduced as part of GP Contractual Reforms 2019 and the National Framework for the Integrated Prevention and Management of Chronic Disease.

ADULT LEVEL 3 – ACUTE SPECIALIST AMBULATORY CARE

Physician led multidisciplinary team (MDT) services will be available initially in every RHA, co-located in hospital sites, to provide care for adults with severe and complicated obesity including assessment for consideration of referral to regional Level 4 services as part of a comprehensive treatment pathway. Subsequent implementation phases will focus on building capacity nationally to meet local demand by developing additional Community Specialist Obesity MDTs within the community specialist hubs.

ADULT LEVEL 4 – SPECIALIST HOSPITAL CARE

Level 4 specialist hospital care describes the services required in secondary care for individuals with severe and complex obesity that are referred from level 3. While this will involve access to in-patient rehabilitation and palliative care services, this level mainly refers to access to bariatric surgical services. There is a need for an adult bariatric surgery centre in each of the six RHA’s with a recognition that these will need to be introduced on a phased basis.

25BMI Client Focus – 37% of Irish Adult Population – “Overweight”

25BMI is focused on the first two Levels of the HSE Model of Care – Level 0 & Level 1:  25kg/m2 30kg/m2 with obesity related sub clinical risk factors, mild physical symptoms (not requiring medical treatment) and mild obesity related psychological symptoms and/ or impairment of well being.

This represents about 37% of the adult population of Ireland – or 1.4 million adults – who are overweight: 25kg/m2 30kg/m2.

25BMI Client Focus – Level 0 and Level 1

Clinical Practise Guidelines, 2022

In 2022, the HSE issued new Clinical Practise Guidelines for the treatment of obesity in adults in Ireland. These Guidelines were adapted from the Canadian Clinical Practise Guidelines which were developed by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons. Ireland was the first country to adopt these Canadian Guidelines as best practise. As mentioned, the Guidelines were reviewed and “adapted” (modified) by a committee of leading Irish obesity physicians and experts to the suit the unique characteristics of the Irish adult population.

ASOI CPG Project Adaptation Coordinator and ASOI Chair Dr Cathy Breen said: “The adaptation of the Canadian CPGs has involved over 70 specialists from all over Ireland who have been working collaboratively, including academic and clinical researchers, anaesthetics, dietetics, endocrinology, epidemiology, general practice, midwifery, nursing, obstetrics, occupational therapy, patient representatives, physiotherapy, psychology, psychiatry, public health, pharmacists, respiratory physicians and surgeons. They have worked together to ensure the guidelines align well with the Irish Model of Care for Obesity and the way care is delivered in the Irish healthcare system.

Background:

The Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity.

Summary:

It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients’ lived experiences; move beyond simplistic approaches of “eat less, move more” and address the root drivers of obesity.

Key Messages:

People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including
medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and
Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health need rather than ability to pay.

Commercial Weight Management Programmes in Ireland

As part of these new Clinical Practise Guidelines, ASOI (The Association for the Study of Obesity on the Island of Ireland), published on their website a summary of the recommendations  alongside 18 chapters covering specific topics.

Chapter 16, is called “Commerical Products and Programmes in Obesity Management”. (ASOI Adult Obesity Clinical Practice Guideline adaptation (ASOI version 1, 2022) by: Seery S, Griffin A, Kelly D, O’Donovan C. Chapter adapted from: Langlois MF,Freedhoff Y, Morin MP).

The Three (3) recommendations for clinicians in Ireland (relating to commercial weight loss programmes and products) are as follows:

1. For adults living with overweight or obesity, some commercial programmes exist which should achieve mild to moderate weight loss over the short or medium term, and a mild reduction of glycated haemoglobin values over a short term in adults with type 2 diabetes compared to usual care or education. However, none of those programmes are currently available in Ireland.
2. We do not recommend the use of over-the-countercommercial weight-loss products for obesity management,owing to lack of evidence (Level 4, Grade D)3
3. We do not suggest that  commercial weight-loss programmes be used for improvement in blood pressure and lipid control in adults living with obesity (Level 4, Grade D)4.

In addition, at the end of this Chapter 16, there is an Appendix entitled “Clinician’s Guide — The 10 safety criteria for commercial weight-management programmes”. The safety criteria are intended to aid a cautious discussion between the clinician and the client (patient) regarding the safety and efficacy of such programmes.

These ten (10) adapted Irish safety criteria are stated in the foot notes to be adapted from two (2) sources: NIDDKD Clinician’s Guide to Commercial Weight Loss Programme Selection and Obesity Canada Weight Management Program Checklist.

The 10 (adapted Irish) saftey criteria are as follows

Nine (9) of the ten (10) safety criteria (above) come from one or other of the above quoted  sources –  the NIDDKD or Obesity Canada.

However, the second (2nd) safety criteria came from neither of these two referenced sources.

The (unknown source ?) second (2nd) criteria states:

“Nutrition advice is individualised. It does not involve very restrictive diets, limited foods or food groups, unusual
combinations of foods or prescribe eating certain foods at certain times.”

25BMI’s comments on the new HSE Clinical Practise Guidelines, 2022

1. There is a strong recommendation in these new HSE Clinical Practise Guidelines for the future treatment of obesity (BMI > 30) to be done through the use of the new obesity drugs Wegov (semaglutide) and Mounjaro (tirzepatide).
2. The inclusion of the second (2nd) criteria in the Irish “Clinician’s Guide — the 10 safety criteria for commercial weight-management programmes” (which was drawn from an unknown source) and states: “Nutrition advice is individualised. It does not involve very restrictive diets, limited foods or food groups..” – effectively will preclude any online commercial weight programme program from being recommended by Irish Clinicians to their patients – as every single weight management programme in the world – (online or otherwise) – is based upon the opposite – that is to say – all weight management programs limit (in some way) the in-take of certain foods or certain food groups.

Healthy Ireland (The Department of Health) and Safefood (one of six North/South Implementation Bodies established under the Belfast (Good Friday) Agreement) are two (2) governmental bodies that provide nutritional advice (online and in the media) to people in Ireland.

Healthy Ireland

Healthy Ireland’s Healthy Weight Campaign is one in a series of national measures to help you manage your weight. The aim of the campaign is to support your health by sharing information about behaviours that can affect your weight. This campaign includes advice on:

1. Eating Well
2. Being Active
3. Sleeping Well
4. Managing Stress

Safefood

Safefood’s role is to promote food safety and provide nutritional advice on the island of Ireland including promoting a better understanding of food safety, nutrition and healthy eating. Safefood’s Healthy Eating online portal includes two main sections (A) a Healthy Eating section wich includes guidelines / recommendations for healthy eating and 101 individual meal recipies, and (B) Healthy Weight For You which is a 12-week weight loss programme that helps you reach a healthy weight through personalised meal plans for adults with a BMI between 25 and 30 who would like to improve their general health.

Tony O’Brien, the former Director General of the HSE, gave an interview to The Irish Times in 2017 about how he managed his weight loss.  (He cut back on his carbohydrate intake (bread / potatoes /etc)  and started exercising regularly). This is what it says:

Tony O’Brien’s weight loss: ‘I haven’t eaten bread since 2012’
The HSE director took action after a press photograph showed him he was obese

It was a press photograph, taken from a low, unflattering angle while he was addressing a nursing conference, that convinced Tony O’Brien things had to change. The picture from 2012 shows a jowly middle-aged man, his facial features almost obscured behind rolls of flesh. The man’s bulk is hidden under a conventional business suit but there is no mistaking he is, in his own words, significantly obese. Nothing unusual there  in today’s society, you might say, except this man had just been appointed as director general of the Health Service Executive.

“The photo was a bit of a shock. I’d have felt very self-conscious continuing that way as head of the health service.”

What he calls “my wake-up call” propelled O’Brien on a five-year journey in search of better health and fitness. A visit to the doctor told him what he already knew – he was morbidly obese and had high blood pressure. Dietary changes kick-started his weight loss and, later, a daily fitness regime helped to accelerate it.

Today, without following any particular diet, O’Brien has lost more than one-quarter of his body weight – up to 35kg. He feels healthier and more energetic, even if he believes his personal weight journey is still “a work in progress”.

“I was at a crossroads,” the 54-year-old recalls. “I was either going to end up with high blood pressure, going on statins and having a lifestyle conditioned by that. Or I was going to take a different turn.” He says he wanted to “walk the walk as well as talking the talk” as a leader in health, but there were other, more personal reasons. His father had died at 62. “You want to be there for your loved ones. I’m a husband, a father, a son. I want to be around for a while, to outlive my father.”

He had to hasten slowly, due to an underlying health condition. O’Brien has late onset myasthenia gravis, an auto-immune condition that can make exercising difficult due to muscle weakness. “It meant an already sedentary lifestyle became even more sedentary.”

Slipping into obesity

Like many people, he hadn’t realised he was slipping into obesity. “I was slimmer, fitter and a gym-goer in my 30s. I could run up a hill and beat teenagers. Then, in my 40s, I gained a bit of weight. Gradually, it creeps up on you.”

It was just a “personal notion”, he says, to give up bread and potatoes. “One day I said to my wife ‘I’m not in a good place, health-wise. I’m just going to give them up and see what that does for me.”

“When you’re in this job, you’re bouncing from meeting to meeting. Wherever you go, everyone thinks they have to feed you. Usually there’s a tray of sandwiches, or a basket of scones. I just stopped eating those things.”

He shed over 5kg quickly and that weight loss allowed him start an exercise programme to consolidate his gains. “I started to go to the gym but not to do stupid stuff. I wanted to do a tailored programme that I could complete in 45 minutes, four or five times a week.” “That’s important to me as I can control the start of my day but I can’t predict the end. Also, with an underlying condition, you can’t predict how tired you might be later in the day.”

He hasn’t eaten bread since June 2012 and says he feels “way better” as a result. “I’ve always loved hot toast with jam, but modern bread is rubbish. It’s full of things like preservatives that bread didn’t use to have.”

He found he was eating “more food, but better food”, especially salads, vegetables and cold meats. “I was very conscious not to replace potatoes with copious amounts of rice and pasta.”

Building on this foundation, and now attending early-morning gym sessions almost daily, he started shedding the pounds dramatically.

About a year ago, his weight loss became evident and tongues started wagging. “The initial reaction was ‘are you not well? There must be something wrong, maybe the job is getting to you’?”

In fact, the opposite was true, but the experience prompted O’Brien to be more open about his regime. He is now about fives sizes smaller in a suit than he was five years ago. “As I’ve gone down in size, I’ve consistently given away clothes that no longer fit. I’ve had to adopt a policy of buying relatively cheap clothes because they don’t last me that long.”

O’Brien did not suggest this interview, and he is anxious that it doesn’t look like self-promotion. “I’m not casting judgment on anyone. Everyone has their own reason why they are the weight they are. “Some people are blessed with metabolism that allows them to eat a horse and never be overweight. Others are unfortunate in their circumstances, or have eating disorders for which they need assistance.”

Neither does he want to seem fanatical about dieting or exercise. “I don’t want to appear like a zealot. Everybody is different.”

Willpower

“Lots of people ask me how do you have the willpower to do it and I tell them it’s the reverse. If I had real willpower, I’d have cut down on [some] foods and continued to eat them. For me, it’s easier to just not eat some food groups.” “But everything I’ve done has made me feel better – cutting out different food groups, not feeling bloated. There is simply no incentive to go back.”

Weight loss doesn’t always progress “in a straight line”, he stresses. “At any time you can go up again in weight and you have to accept that. It happens. The year and your life have their own patterns – Christmas, a wedding – you can’t be obsessive.” If he does gain a few pounds, he takes corrective action by, for example, cutting out all desserts for a few weeks.

Still, he believes anyone can tackle their weight issues by identifying the most influential components of lifestyle and diet, and then making changes. “It’s all too easy to be defeated by the mountain, but those two changes could lead to two other things. It would have been all too easy for me to say when I weighed 120kg ‘this is a mountain and I’ll just not bother’.”

“Recognise it takes time, and don’t beat yourself up. Ask, what is it you are eating most of? Are you physically active and, if not, what exercise might be suitable for you?” One of the images that drives him on, he says, is that of six 5kg bags of potatoes. “I tried carrying six of them around and it ain’t easy – but that’s the weight I used to carry around in body fat.”

Tony O’Brien’s top tips for weight loss

1. Start from where you are by doing one or two things with your diet likely to give you the best return.
2. Stick to mealtimes, but if you need to snack try things such as raw carrots or tomatoes.
3. Take advice on how to begin exercising safely in a way that you can build into a routine that suits your life – don’t focus on things you can’t sustain.
4. Don’t deny yourself some treats but make it part of meals such as dessert on Sunday or whatever works for you.
5. Track your progress but be patient and recognise there may be occasional setbacks. Don’t give up.

IT intervew with Tony ‘Brien – HSE about his personal weight loss