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Obesity crisis requires population-level and specialist individual approaches

By Paul Mulholland - 17th Dec 2023

 A ‘two-pronged’ approach is necessary to address the obesity crisis, the Irish Endocrine Society (IES) Annual Meeting 2023 was told in this year’s McKenna Lecture.

The McKenna Lecture, which took place on the second day of the IES meeting, was delivered by Prof Francis Finucane, Consultant Endocrinologist at Saolta University Health Care Group, and Professor in Medicine at University of Galway.

At the beginning of the lecture, Prof Finucane spoke about his clinical research Fellowship at St James’s Hospital, Dublin.

This work investigated cardiovascular and metabolic perturbations in Irish children with obesity, as well as the response to exercise in young patients with type 2 diabetes (T2D).

He told attendees that it highlighted the much higher cardiovascular risk, and resistance to the benefits of exercise, in young people under 40 affected by T2D.

Prof Finucane also completed a post-doctoral Fellowship at the MRC epidemiology unit at the University of Cambridge, UK.

It was during this Fellowship he was exposed to a 1985 paper, ‘Sick individuals and sick populations’ by the epidemiologist Prof Geoffrey Rose, which provided a framework to respond to public health crises.

The first part of the ‘two-pronged’ approach Prof Rose proposed was to address the “causes of incidence” in the population.

With obesity, Prof Finucane said this would involve removing the drivers of unhealthy diet, such as through sugar taxes and advertising bans.

The second part of the approach is the need for the provision of care to individuals as required, such as specialist clinical interventions for people with severe obesity.

Speaking to the Medical Independent (MI), Prof Finucane said his aim in the lecture was to describe the difference “between one type of intervention, which is the high-risk approach for individual patients, and the population-level approach for everybody”.

“We often mix those two up,” he said.

“And my fundamental objective was to make endocrinologists aware that there is a distinction between the types of interventions we can introduce.”

Prof Finucane told MI that neither population-level nor specialist individual approaches were currently being satisfactorily implemented in relation to addressing obesity in Ireland.

“I think if policymakers and medical experts truly understood obesity and how Geoffrey Rose’s ideas pertained to obesity, we’d be doing a lot better on both fronts.”

However, he also said that progress was being achieved in some areas.

Prof Finucane presented newly published research data about the benefits of purposeful weight loss in patients undergoing a commissioned structured lifestyle programme at Croí, the cardiac charity based in the west of Ireland.

Over 1,000 patients have enrolled on the programme since its inception in 2012.

In adults with severe obesity, the study found older age and good mental health were associated with programme completion and attaining ≥5 per cent weight loss.

Improvements in cardiovascular and metabolic outcomes were proportional to the amount of weight lost. “Our finding that improvements in mental health were also proportional to the amount of weight lost is particularly novel,” according to the study’s conclusion.

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