Catherine Conlon: Now is not the time to scrap ‘Operation Transformation’

The popular RTÉ show has come in for criticism, but given Ireland’s worsening obesity problem, we can ill afford to abandon ways to tackle it, writes Dr Catherine Conlon

'Operation Transformation is a cost-effective vehicle to highlight the damage the modern sedentary and snacking takeaway culture is doing to all our lives.'

Operation Transformation has come under a wave of criticism for stigmatising those with overweight and obesity issues by focusing on their personal responsibility to control their weight.

Bodywhys, the Eating Disorders Association of Ireland, has expressed concerns that the programme promotes eating disorders. Dr Donal O’Shea, HSE lead for obesity, disputes this. He suggests that the trigger for rising numbers of eating disorders is social media. 

Compared to other weight-loss programmes, Operation Transformation has a full multi-disciplinary team looking after the leaders. The eight-week timeframe is long enough to embed behaviour change. While the show has had its faults over the years, he suggests that the first episode this year was the least stigmatising and most holistic that the show has produced.

The counterargument is that the programme is an opportunity to shine a light on the epidemic of overweight and obesity that has followed the rise and rise of a global food system heavily reliant on cheap processed food that is making us ill.

Another criticism of the show is that focusing on weight, exercise, and lifestyle does not work. GP Brendan O'Shea recently attempted to clarify this.

"In younger people and with less severe spectrum overweight, simple coaching on the correct use of the weighing scales, on how to achieve a more active lifestyle, eating habits, and on fasting to weight targets all work to a significant extent," he says.

But there is an important subgroup of people for whom this approach does not work and if there is accelerated weight gain, a limited focus on Body Mass Index becomes self-defeating, hurtful, and stigmatising.

There is increasing recognition of obesity as a disease requiring treatment such as medication and bariatric surgery which, on the basis of severe spectrum overweight, should be considered essential life-saving surgery.

At a time when childhood obesity trends since the pandemic are a real concern,  Operation Transformation is a cost-effective vehicle to highlight the damage the modern sedentary and snacking takeaway culture is doing to all our lives.

Recent data from the UK shows that thousands of children are facing serious consequences of accelerated weight gain during the pandemic. In just 12 months, the rates of obesity among those aged four and five rose from 9.9% in 2019 to 14.4% in 2020-21. The NHS data shows that one in four children in England aged 10 and 11 are obese.

There is reason to be concerned that similar trends exist in this country. Grace O’Malley, clinical lead for W82GO, the Child and Adolescent Weight Management Services in Temple Street Children’s Hospital, has talked about the impact of the pandemic on children.

"Children all over the country have been vastly affected by the pandemic," she says. "This includes time of eating, what foods they are eating, sleep time and time spent being sedentary, use of screens, and lack of safe places to play."

Waiting lists and referrals to the services have increased by 38%, and the complexity of children’s conditions has magnified, with children presenting with multiple challenges including anxiety, gastrointestinal and respiratory complaints, and pre-diabetes.

The last four decades have seen a 10-fold increase in childhood obesity. The main drivers are the high volume and availability of energy-dense, nutrient-poor food and drinks. This is combined with intensive marketing of foods high in fat, sugar, and salt and their relative cheapness compared to healthy alternatives. 

Along with this, a sedentary lifestyle due to high levels of screen time and inadequate opportunities for physical activity has resulted in 15% of five-year-olds being overweight and 5% classified as obese. These rates are highest in children in low-income households.

Portion sizes have increased. Danish pastries and muffins are four times bigger than they were 20 years ago, and croissants and doughnuts have increased threefold.

The State has a duty of care to protect the health and wellbeing of children that are not being met. What can be done to tackle this pandemic-accelerated obesity epidemic, fuelled by a food industry that will use its economic power and political clout to resist any measures that threaten profit or market share?

Ways to combat Ireland's increasing obesity

The Irish Heart Foundation recommends a ban on all forms of marketing of unhealthy food and drinks to children. Junk-food advertising has become a monster by manipulating people’s emotions and their choices. Advertising has completely distorted our perception of what constitutes a healthy diet.

Creating a healthier school environment means better nutrition and more physical activity. Physical education provision in schools is among the lowest in Europe. Mandatory nutrition standards for all school foods, expansion of the school meals scheme, cooking classes, and ensuring every child gets 30 minutes of physical activity a day would address some of these issues.

Reformulation and portion size are among the measures that can have the most impact in reducing high levels of fat, sugar, and salt in children’s diets. 

What is needed is the mandatory introduction of targets to reduce the levels of sugar, fat, and salt in products popular with children. New taxes on foods high in fat, sugar, and salt would reduce consumption and incentivise reformulation of these products. 

Subsidies on healthier foods would shift consumption towards a healthier diet, particularly among low-income groups. Mandatory restrictions on portion sizes in all publicly-run facilities serving food and drinks to children would have a real impact.

Legislation preventing the placing of confectionery and other unhealthy products at the end of aisles and checkouts, as well as a ban on promotions such as buy-one-get-one-free, would reduce pester-power for parents when out shopping with young children.

Building a healthier environment has a major role to play in tackling childhood obesity. This includes the creation of green spaces, playgrounds, and age-appropriate facilities such as adventure playgrounds, biking, and skateboarding facilities that would make a real difference.

Active travel needs the support of segregated cycle lanes and safe walking routes so that all children have the option to walk or cycle to school. ‘Safe streets’ pilots where only pedestrians and cyclists can use the roads around schools at start and finish times of classes have been shown to work.

For too long, the Government has bowed to the free market economy of low taxes and light regulation. The political will to confront the food industry with much-needed legislation that addresses the rights of children to a healthy diet is long overdue.

Operation Transformation has a dual mandate to entertain and to improve public health at an individual as well as the more important population level. Consistently high ratings mean that there is a real opportunity to educate, inform, and influence policy change. 

At a time when the food system is making us ill, if it is to continue, it must do both.

CORRECTION:  An earlier version of this article included a reference to Bodywhys having asked for Operation Transformation to be decommissioned. This was inaccurate. Their full statement on this issue can be read here. We are happy to correct the record.