Obesity treatment without prevention is like repairing flood damage without turning off the tap – we have to address the food system that is causing it

Leading obesity expert Prof Donal O’ Shea suggested recently that almost a million people in Ireland are not being prescribed weight-loss drugs such as Ozempic because of a ‘degree of ignorance’ among Irish doctors who believe patients should simply ‘eat less and move more.’ He added that health professionals are failing to understand obesity is a chronic disease that can be treated with medication.

‘Simply telling somebody to eat less and move more is like telling somebody with depression to cheer up,’ Prof O’Shea said.

While the evidence that obesity is a chronic disease that responds to treatment is now ground in fact, treating numbers of people who have developed obesity with highly effective treatments makes no sense at all, unless we mandate for transformative changes in the food environment at the same time.

While demand to ensure access to affordable obesity treatment is mounting, the political will to address the obesogenic food environment is non-existent. That would mean challenging a profit-driven food industry that will fight tooth and nail to maintain the status quo.

Obesity treatment without prevention is like repairing flood damage without turning off the tap – we have to address the food system that is causing it.

A new study in The Lancet published this month found that Ireland remains at risk of a surge in overweight and obesity rates in the next 25 years, despite the revolution in obesity treatments.

The researchers predicted that more than half of adults and a third of children and young people worldwide will be overweight or obese by 2050, posing an ‘unparalleled threat’ of early death, disease, and enormous strain on healthcare systems.’

The report stated that global failures in the response to the growing obesity crisis over the past three decades have led to a staggering increase in the numbers affected.

‘The unprecedented global epidemic of overweight and obesity is a profound tragedy and monumental societal failure,’ said lead author Prof Emmanuela Gakidou, from the University of Washington.

The researchers warned that children everywhere are gaining weight faster than previous generations, and obesity is occurring earlier, increasing the risk of type 2 diabetes, high blood pressure, heart disease and cancer at a younger age.

The report highlighted that while less than one-in-ten (seven per cent) of men born in the 1960s in high-income countries were obese by the time they were 25; for men born in the 1990s this had jumped to just less than one-in-five (19 per cent), and is predicted to reach one-in-four (25 per cent) for men born in 2015.

Added to that, almost a quarter of the world’s obese adult population by 2050 are predicted to be 65 or over, further exacerbating the pressure on healthcare services already buckling under the strain of managing chronic disease.

What is our response? To maximise the availability of an admittedly highly effective, though expensive, obesity treatment while ignoring the impact of the ubiquitous availability of cheap, unhealthy food that is wrecking our health.

In 2025, just under a quarter (24.2 per cent) of the Irish population is living with obesity. That amounts to about 1,247,000 people. While treating people with the disease of obesity with effective treatment is warranted it cannot happen in isolation. It must be balanced with effective legislation to mandate for a healthy food environment – that makes healthy food both widely accessible and affordable.

Added to that, the constant flooding of the market with online and physical marketing of junk food that is vastly profitable for the food industry must be controlled.

March 4 was World Obesity Day. The Minister for Health, Jennifer Carroll McNeill marked the day by the release of a video emphasising that healthy living is more than just diet and exercise. She suggested that while great strides have been made in terms of health promotion, prevention measures and new treatments, we need to do more, especially to protect our children’s health.

“I want to shine a light on some of the ways we can help people reach their healthy weight and live longer, healthier lives.

“We need to make healthier food the easier option, and improve access to green spaces and exercise. We need to continue to improve our treatment service,’ the Minister said while stating that weight stigma must become a thing of the past.

The Minister added that she was committed to addressing obesity to address the risk of heart disease, diabetes and cancer, and to improve people’s health and wellbeing.’

A paradigmatic shift in the food market to ensure that healthy food is accessible and affordable is urgently needed in alignment with the increased availability of obesity treatments.

Here are three steps the Minister could take that would make this aspiration a reality.

• An immediate ban on the marketing of unhealthy food on all digital and physical infrastructure.
• A salt and sugar reformulation tax on junk food with revenue directed towards making food accessible and affordable in disadvantaged communities.
• Ensuring that free school meals comply with national food standards – specifically that they are free of ultra-processed foods.

These steps are all under consideration, but robust policy is needed to push the food market away from highly processed takeaway foods towards healthy sustainable foods at an affordable price.

Since the introduction of the sugary drinks tax in 2018, the sugar content of soft drinks has dropped by about a third, and the percentage of drinks falling into the sugar tax band has plummeted. In other words, the tax is incentivising the soft drinks industry to change the formulation to healthier drinks with less sugar.

The same could happen with a tax on junk food that would incentivise the food industry to move away from unhealthy foods that are taxable, to healthier options.

Ideally, these junk food taxes could subsidise the cost of healthier food options and support local producers to both grow and sell these items at affordable prices.

Less well-off countries are way ahead of us in addressing the impact of ultra-processed foods (UPF) on health. Colombia became one of the first countries in the world to explicitly tax UPF in 2023.

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 began at 10 per cent in 2023, rising to 15 per cent in 2024 and reaching 20 per cent by 2025.

This UPF tax followed on from the introduction of front-of-packaging warning labels warning of their high calorie, sugar, salt and fat levels. The combined effect of these two measures shows a level of political commitment that is completely lacking in many wealthier countries including Ireland.

Obesity treatments have the capacity to transform the management of a chronic debilitating disease for up to a quarter of the adult population in Ireland.

But treatment must be aligned with an urgent political commitment to address the appalling food environment that fails to address the health and wellbeing needs of all our citizens. Those in low-income groups who cannot afford healthier options are most at risk.

Author
Dr Catherine Conlon is a public health doctorand former director of human health and nutrition, safefood.