The move is timely as new weight loss treatments herald a revolution in the treatment of obesity, that is likely to have costly implications to the State. But equal focus must be placed on the urgent need to improve the food environment.

In his recent controversial article in the Daily Mail, Boris Johnson discussed his unsuccessful experience with appetite suppressants but concluded that nonetheless, they could be used to tackle the obesity crisis.

“After 40 years of moral failure, 40 years of weakness in the face of temptation — I was going to acquire a new and invincible chemical willpower,” he said, inadvertently describing everyone with obesity as morally weak and personally to blame for their disease. Victim blaming at its finest.

Mr Johnson had the opportunity while prime minister to introduce new laws to transform the obesogenic food market that sets the UK at the top of the leader-board in Europe’s obesity league. 

Restrictions on junk food advertising, originally due to come into force in January 2023, were delayed by Johnson and have now been further delayed by Rishi Sunak until 2025, after the next British general election.

Former Conservative leader William Hague, writing in The Times, criticised the UK government for delaying measures, branding the weakening of the anti-obesity strategy, under pressure from MPs, as “intellectually shallow, politically weak and morally reprehensible”. 

The delays were predictably welcomed by the industry and also by Tory MPs opposed to the state interfering in how people spend their money, but they alarmed health campaigners.

Mr Johnson’s ill-informed comments are damaging because they increase the confusion around recognition of obesity as a disease. 

Continuing ambiguity inflates the food industry’s ability to successfully lobby for ongoing delays in the introduction of laws that will improve peoples’ ability to make healthy food choices.

Post-doctoral researcher in the UCC’s School of Public Health Dr Margaret Steele and her colleague Consultant Endocrinologist in Galway University Hospital, Professor Francis Finucane, writing in Obesity Reviews this month, expand on this view.

“The archaic view that obesity arises from ‘gluttony or sloth’ has been largely superseded by the recognition that it is ‘a heritable neuro behavioural disorder that is highly sensitive to environmental conditions’.”

Competing paradigms to explain obesity 

Dr Steele says there are two competing paradigms to explain how obesity develops:

The ‘energy model’ proposes that the brain is responsible for body weight regulation, operating mainly below our conscious awareness via complex metabolic, endocrine, and nervous system pathways that control food intake.

The ‘carbohydrate insulin model’ proposes that hormonal responses to highly processed carbohydrates disrupt normal insulin metabolism, leaving fewer calories available for the body’s metabolic needs. This leads to overeating as the appetite increases to compensate for the resulting lack of calories.

Despite ongoing controversy around the brain and hormonal models of the origins of the development of obesity, both models recognise obesity as a change in how food is consumed, broken down and stored rather than an issue of excess body weight.

What is key in understanding obesity as a disease is removing the focus on the motivation or willpower of the individual. 

This is what is done by both Boris Johnson and the professionals in Operation Transformation. Instead, the focus should be on the need for appropriate treatment and a transformation of the obesogenic food environment we are all immersed in.

Professor Finucane suggests that a ‘two-pronged’ approach is needed. This would mean an upscaling of obesity treatment being matched by an increase in obesity prevention. 

One way of achieving this would be to ringfence money raised from the sugar tax, more than €30m per year since 2018.

In terms of the obesogenic environment, the publication of the Public Health (Obesity) Bill promised in the programme for government would be a giant step in regulation for a healthier food market. 

This includes an online ban on the marketing of unhealthy food and drink, a ban on unhealthy food advertising on state-owned transport, buildings, and public infrastructure; regulations for no-fry zones for all new fast food outlets near schools; and the banning of ads for unhealthy food and drinks within 200m of school playgrounds. 

Also needed is the mandatory removal of all foods high in fat, salt and sugar (HFSS) from end of aisle and checkout counters, a ban on buy-one-get-one-free-offers on HFSS goods and a ban on nutrition and health claims on these products.

Increase resources for obesity treatment

As Mr Watt pulls away from sponsoring a programme that emphasises personal responsibility for weight, now is the time to both increase resources for obesity treatment and to introduce overdue legislation to mandate for a healthy food environment.

Moves to improve the food environment were announced recently with the news that the Department of Health is to examine the impact of the tax on sugary drinks, and the potential to develop a similar levy on some processed foods. 

This follows a recommendation from the Commission on Taxation and Welfare that the Government draws up fiscal measures to reduce the consumption of highly processed foods and promote healthier eating.

In a response to a parliamentary question in the Dáil, Health Minister Stephen Donnelly said the sugar tax had a positive effect, but this has yet to be fully evaluated.

In the UK, introduction of the sugar tax on soft drinks was followed by a 28.8% fall in the amount of sugar contained in such beverages.

Following the publication of the PHE report in the UK, George Osborne — the former chancellor who introduced the tax — tweeted: “The sugar tax is a stunning success — and an example of progressive Conservative policy in action.”

Government sources here indicated recently that, while there is ongoing analysis of the sugar tax, new proposals in this area are not believed to be imminent.

Robert Watt’s decision to stop sponsoring Operation Transformation is a heartening and significant step in moving the conversation around obesity away from blame and moral failure towards recognition of obesity as a disease.

Taking the emphasis off willpower must be followed by dedicated treatment resources for obesity and introduction of the promised legislation on public health.

Adequate treatment services and legal controls ensuring a healthier food environment will be expensive, sure, but what price the health and wellbeing of all citizens?

• Dr Catherine Conlon is a public health doctor in Cork and former director of human health and nutrition, Safefood