Update on HSE obesity healthcare initiatives

Obesity is a chronic, complicated disease as well as a driver of other diseases, with serious implications for individuals, families, societies and economies. The need to act has been made more urgent by the impact of the Covid-19 pandemic on weight-related behaviours in children, young people and adults. While obesity cannot be diagnosed by Body Mass Index (BMI) alone, it is a good indicator of how this affects the overall population. Healthy Ireland surveys show that over 60 per cent of Irish adults have a BMI over 25kg/m². In the UK, the prevalence of higher BMIs in primary school-aged children has increased since 2020, particularly among children living in areas where health risk factors are more concentrated. This is also a risk in Ireland too. Obesity is one of the biggest public health challenges in Ireland today, affecting many thousands of people, yet those living with obesity lack support and face stigma at work, home and in the health system. 

On 4 March 2021, the HSE’s Model of Care for the Management of Overweight and Obesity in Ireland was launched (available here: www.hse.ie/eng/about/who/ cspd/ncps/obesity/model-of-care/obesity-model-of-care. pdf). This sets out the services needed to provide end-to-end care for prevention and treatment of overweight and obesity in children, young people, and adults. 

Speaking about action on obesity in the Irish setting earlier this year, Prof Donal O’Shea, HSE Clinical Lead for Obesity, said: “Since the launch of the Model of Care for Overweight and Obesity on World Obesity Day last year, there has been progress in implementing community services for adults and children and training supports for healthcare professionals.” 

The Model of Care for Children and Young People recommends the implementation of end-to-end supports for childhood obesity prevention and treatment. Prevention has been addressed in part through Sláintecare Healthy Communities. Sarah O’Brien, the National Lead for the Healthy Eating and Active Living (HEAL) programme in HSE Health and Wellbeing said: “This year will also see the continued development of the Sláintecare Healthy Communities initiative, which is driving the kind of change needed at a local level to help make healthier choices easier having staff at community level working to deliver nutrition advice to those who need it most and delivering the Healthy Food Made Easy group programme. In 2022, there will be weight management programmes for children and young people with overweight and obesity implemented in two Community Health Organisations.” 

The new weight management programmes will see multidisciplinary teams providing specialist assessment and treatment for children, young people and their families. This includes individual and group programmes, links to local community programmes for additional support, and onward referral to hospital-based teams as necessary. 

Enhanced community care forms part of the adult Model of Care implementation. This programme is ensuring maximum impact for citizens in avoiding hospital admission as far as possible through initiatives that see care delivered within the community, at or near a person’s home where appropriate. In 2022, dietitians will commence delivery of community-based adult weight management programmes in community healthcare networks across the country, allowing individuals with obesity to access dedicated healthcare professionals for support in their community. 

Currently, there are limited services available for the treatment of severe and complex obesity, and with adults, children, and young people travelling long distances and waiting many years for treatment. The publication of the 2022 Waiting List Action Plan earlier this year, the first year of a multi-annual reform programme to stabilise and reduce waiting lists and improve access to services, identified implementation of obesity care pathways as a priority. It will provide funding in 2022 to increase access and capacity nationally to specialist services including bariatric surgery, providing specialist care in the right place at the right time, reducing waiting times and expanding services nationally. Prof O’Shea welcomed this commitment, commenting “this is a very positive development for adults living with severe and complex obesity”. 

Karen Gaynor, Dietetic Lead for HSE Health and Wellbeing and Obesity says: “Healthcare professionals do not feel confident in having the conversation about weight and health. There is a lot of misinformation about what causes overweight and obesity and how to treat it. Patients need non-judgemental, informed, and helpful support. Quality training is key to equip healthcare professionals with the knowledge and skills to do this. 

“The ‘Talking about overweight and obesity’ training, will be made available to all healthcare professionals in 2022. This is part of a suite of training modules to provide effective tools and knowledge to carry out a brief intervention with patients.” 

Access to helpful resources on obesiry for healthcare professionals are available at www.hse.ie/eng/about/who/ cspd/ncps/obesity/programme-resources/.