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Fighting Obesity Around the World: Perspectives from Ireland

By Robin Schepper

Friday, November 1, 2013

Obesity is no longer just an American problem. Like the United States, Ireland presents alarming obesity statistics: 23 percent of two-to four-year-olds are overweight or obese; 19 percent of teenagers are overweight or obese; and 61 percent of Irish adults are overweight or obese. Last month, I delivered the keynote address at Ireland’s Obesity and Behaviour Change Seminar in Dublin. Hosted by Ireland’s Nutrition and Health Foundation (NHF), a non-profit tasked with promoting a healthy Ireland, the conference addressed ways to change individual behavior with respect to healthy eating and active living. As someone who prides herself on facilitating cross-pollination among diverse stakeholders, I was anxious to learn from and share with colleagues across the pond.

In my remarks, I focused on the need for both individual behavior change and environmental change, recognizing that making the healthy choice is often hard when healthy options are not widely available or promoted. Given how complex obesity is, no single strategy will make it go away. Ireland, like other nations, needs multiple strategies that address food and physical activity in a variety of settings– where the Irish work, live, learn and play. While Ireland will determine what strategies make most sense for its citizens, I shared some key lessons from my U.S. experience that I thought could be helpful in their efforts:

  1. Reframe the issue as more than a health issue: Obesity is not just a health issue. It is linked to increased health care costs for the government and decreased performance and productivity for businesses.
  2. Recruit prominent spokespeople from all walks of life: In the U.S., First Lady Michelle Obama and professional football player Eli Manning are key messengers from different sectors who promote healthy eating and active living.
  3. Ensure everyone has a role to play: All sectors of society need to be involved to resolve this epidemic and every individual can play a role, whether a parent, grandparent, coach, employer, or sibling.
  4. Measure the impact of policies broadly: While improving health is the end goal of these policies and programs, we ought to think about measuring other results along the way. By studying the influence that obesity has on productivity and performance, we will paint a more complete picture of how obesity prevention benefits society.

While in Ireland, I was pleased to learn more about local innovative strategies to promote healthy eating and active living. For example, the Nutrition and Health Foundation shared information on initiatives they recently launched:

  • Kidz Size Me Campaign – This voluntary effort asks restaurants to offer half-sized adult meals to children. Smaller sizes allow them to introduce different healthy food options to children without exceeding their recommended daily calorie intake. The NHF also provides restaurants with nutritional guidelines for main courses, drinks and desserts. This campaign is being implemented in partnership with the Ireland Restaurant Association.
  • Eat Smart, Move Smart (soon to be Eat Smart, Hurl Smart) – This campaign targets teenage girls and helps them develop the knowledge and lifestyle habits necessary to become healthy, active young adults and stay in the sport of Camogie (a cross of field hockey and lacrosse), by either playing, coaching, or being a referee. NHF partners with the Camogie Association in this effort.
  • Healthy Options at the Cinema – When launched, this initiative will provide healthy food and beverage options at movie theaters in Ireland.

During my time in Dublin, where one-quarter of the nation’s four million residents live, I contemplated Irish habits and the environment in relation to Ireland’s obesity rates. One of the conference speakers mentioned that the obesity rate in Dublin was lower than the rest of the country and he wondered if a good public transportation network (including sidewalks and safe biking paths) made the difference. Research from John Pucher of Rutgers University and his colleagues provides support for this hypothesis, finding significant relationships between active travel and obesity rates at the population level. Many European countries, including Ireland, exhibit higher rates of active transit than the US. During my visit, I witnessed quite a few people commuting by bike each morning.

With respect to food, I noticed that portion sizes in restaurants were considerably smaller than at an average American restaurant. Researchers such as Paul Rozin at the University of Pennsylvania have documented smaller portion sizes in Europe compared to the U.S. For example, a 2002 study found that the “extra large” soda portion in Dublin was the same as the “large” in the U.S. Despite these observed differences, obesity persists in Ireland, suggesting that additional factors are at play.

I also noticed that Ireland boasts significant national pride in domestic food sourcing. I saw television commercial after television commercial proclaiming that the meat or dairy advertised was from Ireland. This struck me as an opportunity to increase the effectiveness of positive messaging around healthy eating. Harnessing that national pride during nutrition education campaigns or while marketing healthy food options could help increase the impact of such campaigns.

None of us knows the best way to reverse these alarming trends. Yet we are seeing some promising results which we must continue to build on. I know Ireland will be watching what the United States does to tackle our obesity crisis even as they address their own obesity challenges. Similarly, we can learn from their actions. While solutions must be tailored to the needs of the community, we cannot afford to ignore emerging evidence and practice from other countries; the scale of the problem demands that we disseminate best practices across sectors and international borders. Just as we share promising practices among communities throughout the U.S., we should share with, and learn from, Ireland and other nations as well.

Robin Schepper is a senior advisor at BPC and former executive director of the Let’s Move initiative at the White House. She can be reached at rschepper@bipartisanpolicy.org

KEYWORDS: DUBLIN, IRELAND, MICHELLE OBAMA, NUTRITION, PHYSICAL ACTIVITY