Overweight and obesity is defined as ''abnormal or excessive fat accumulation that presents a risk to health'' (World Health Organisation, 2017). It is a progressive, chronic and complex disease affecting all ages and genders. Body mass index (BMI) is the most widely used measure of obesity in clinical practice as direct assessment of body fat is not readily available. BMI defined as weight in kilograms divided by the square of height in meters (kg/m2), is considered to be the best available population marker for monitoring trends in overweight and obesity in adults, children and young people over time.
Ireland has one of the highest levels of obesity in Europe, with 60% of adults and over one in five children and young people living with overweight and obesity. There are multiple drivers that influence obesity including genetics, environmental and socioeconomic factors.
Obesity is associated with other chronic diseases such as type 2 diabetes, cardiovascular disease, respiratory disease, several types of cancer, pain and musculoskeletal disorders. Certain groups in the population have a high risk of excess weight gain leading to obesity, these include older people, women in pregnancy and post-natal, individuals with eating disorders, mental illness, intellectual and physical disabilities as well as socially excluded and disadvantaged groups.
Overweight and obesity is a highly stigmatized condition. Many people, including healthcare practitioners, have negative attitudes and beliefs about people with overweight and obesity. Weight stigma in healthcare can prevent healthcare professionals from having supportive and non-judgemental consultations with patients, which can result in a lack of diagnosis and low efficacy of interventions for weight management. Experiences of judgement and shame in the healthcare setting prevents people with obesity from seeking help. Weight stigma can also lead to the under-recognition and undermanagement of symptoms of eating disorders. Stigmatisation is associated with greater psychological distress and can cause people to engage in behaviours that make obesity worse.
The complex nature of obesity requires that the health services take a holistic, integrated approach to identification, early intervention and treatment. Actively managing overweight and obesity will improve health, quality of life and overall mortality while reducing healthcare costs.
Against this backdrop the HSE and RCPI established a National Clinical Programme for Obesity in 2017. Supported by a multi-specialist clinical advisory group and a multi-disciplinary working group the objectives of the Clinical Programme for Obesity are:
- To improve access to services and quality of care for adults, children and young people living with overweight and obesity in Ireland.
- To develop integrated models of care that can strengthen the prevention, identification, early intervention and treatment for overweight and obesity across primary care and acute services for adults, children and young people and to prevent the progression of disease and complications.
Key principles that underpin the work of the National Clinical Programme for Obesity are:
- Obesity is a complex, chronic, multifactorial disease that requires a comprehensive multi-disciplinary, approach to care across the lifespan.
- Appropriate and equitable treatment for overweight and obesity is required in addition to public health prevention measures.
- Weight-based stigma and obesity discrimination will not be tolerated in the healthcare system.
- Academic institutions, professional bodies, and regulatory agencies will ensure that formal teaching on the causes, mechanisms, and treatments of obesity are incorporated into standard training programmes.
The Model of Care for the Management of Overweight and Obesity was approved by the HSE Clinical Forum in December 2020.
- it sets out how the healthcare for adults, children and young people living with overweight and obesity in Ireland should be organised and resourced now and in the future.
- it describes the service required, who should provide it and where the service should be delivered across the healthcare system.
- it takes a population health approach to managing obesity, recognising the wider drivers of obesity such as genetics, environment and socioeconomic status.
When implemented the Model of Care will ensure that:
- an end-to-end approach is adopted, defining the way health services are developed over time.
- the right care is delivered to individuals with overweight and obesity at the right time and in the right place, in line with Sláintecare health and social care service reforms.
- the focus is on patient outcomes through monitoring and evaluation of service delivery, supported by quality training for healthcare staff.
- Healthy Weight for Ireland: Obesity Policy and Action Plan 2016-2025 https://health.gov.ie/wp-content/uploads/2016/09/A-Healthy-Weight-for-Ireland-Obesity-Policy-and-Action-Plan-2016-2025.pdf The Government’s Healthy Weight for Ireland: Obesity Policy and Action Plan 2016-2025 sets out a 10-step multi-sectoral action plan to address one of the biggest public health challenges in Ireland. The approach taken in developing this policy was based on Healthy Ireland, the Government framework for improved health and wellbeing. This policy is informed by the evidence, extensive consultation with key stakeholders and meetings, and submissions from a wide sector of organisations, individuals and Non-Governmental Organisations. ‘A Healthy Weight for Ireland’ covers a ten-year period until 2025 and sets targets to be achieved and actions that will produce measurable outcomes.