Cork doctor: The key to tackling obesity is to take on food giants

Driving back to Cork from Dublin last week, I stopped in a retail outlet for diesel and coffee. Tripping over a tower of Quality Street, I queued with a dozen other commuters for the check-out - surrounded by shelves bulging with chocolates, crisps, protein bars, jellies – every variety of junk food you could imagine.

This is what our food options look like on the road.

As I climbed back in my car and turned on the radio, consultant endocrinologist Prof Donal O’Shea was informing the nation how a decision by a HSE expert group to approve the drug Mounjaro and make it free or at reduced cost could be “transformative”. He said more than a million people were likely to be eligible and this could cost the State up to €3 billion.

Make Mounjaro free while food shelves are overflowing with junk food – where’s the sense in that?

Negotiations with the drug company, Ely Lilly have resulted in “significant” price reductions, according to Professor Michael Barry of the National Centre for Pharmacoeconomics, who said the drug could be considered cost effective or very close to it.

However, it seems people in Ireland hoping to access Mounjaro via the HSE scheme will have to wait a bit longer, as the health service continues to assess whether it can be made available free on the medical card or at reduced cost for certain patients.

A spokeswoman for the HSE Drugs Group said several meetings may be needed before a recommendation is made to HSE management, who have the final say.

Prof O’Shea suggested the drug could be made available to people with a BMI over 30; or alternatively to people with a BMI of 27 combined with comorbidities such as hypertension, cardiovascular disease, pre-diabetes, or type 2 diabetes.

“It’s about benefits to blood pressure, the benefits to insulin resistance, you’re less likely to develop diabetes, you’re less likely to develop cancer,” he said. Despite the high cost, the money would be “massively well spent.” The billions spent would save money that is never seen in the health service, “the hip that doesn’t get replaced, the diabetes that is not developed”.

One cannot argue with the evidence that these drugs are transforming the treatment of obesity and chronic disease. The problem, as I see it, is the spending of shed loads of money on treating obesity while doing almost nothing to regulate the food market that has caused an epidemic of obesity, cardiovascular disease, type 2 diabetes, and dementia.

The real winners here are the food and pharmaceutical industries raking in the profits.

Meanwhile, The Lancet Commission on 21st Century Global Threats to Health, published this month, found obesity offers the largest preventable health loss of any of the 17 threats it examined. The researchers estimated that obesity amounts to over 23 billion years of healthy life at stake between now and 2100. It is the leading threat in 154 of 204 countries and in every world region bar sub Saharan Africa.

Professor of Health Policy at Monash University, Malaysia, and co-chair of the World Obesity Federation’s Policy and Obesity Prevention Committee, Kent Buse summed up the Commission’s findings: “Firstly, the predictions of obesity rates and lost health potential are actually measures of the huge opportunity that exists with a change in policy. No other threat on the list offers that much leverage.”

“Secondly, where the leverage lies. The Commission modelled its best case with and without obesity medicines reaching half of those eligible and found the difference to be small. The gap comes from food, transport and physical activity environments that differ widely between comparable countries.”

Thirdly, said Prof Nuse, commercial influence is the key factor standing in the way of progress. Policies to reduce body mass have “failed to date,” the report says. “The gap between evidence and policy is a consequence of commercial opposition.” The report argues health policy must be insulated from undue commercial influence.

The Commission questions if such policies are politically feasible. However, there is mounting emerging evidence of such policies operating effectively. Chilean laws on front- of -pack warnings and marketing restrictions to children and a ban on sales in schools, in force since 2016, have cut the purchases of sugar drinks by almost a quarter (23.7%) against the expected trend. Colombia has introduced a tax on ultra- processed foods that early evidence found is reducing sales and forcing the food industry to reformulate. A 2025 paper in BMC Medicine outlined how, a year after the policy was introduced, national consumption of ultra- processed foods dropped by 4.3%.

An evaluation of the tax on sugary drinks in Ireland introduced in 2018 found a sharp fall in sugar consumption from soft drinks (30.2%) from retail outlets and a 19.8% reduction from food service venues. Sugar consumption per capita dropped from 5kg at the time of the tax’s introduction down to 3.8kg by 2022 and total consumption of sugar-sweetened drinks fell by at least a quarter. A driver of these impressive results was industry reformulation. Four out of five leading soft drinks brands reformulated their brans to lower sugar content below the tax thresholds.

After the publication of the evaluation in 2024, The Irish Heart Foundation called for a Government commitment to extend the sugar sweetened drinks tax to all high-sugar foods.

Two years later, as the HSE considers rolling out obesity drugs to up to a million people at a cost of billions of euros every year, we are still waiting. “Nagging people to eat healthily does not work,” suggests Prof Buse. “Regulating food systems does.

“Every government that has regulated did so against industry lobbying, litigation, front groups and offers of self-regulation. What decided the outcome was not the quality of evidence but the political cover available to ministers who wanted to act, and whether industry sat inside the process or outside it.”

Obesity treatments should be available to those who need them most but are not where the leverage lies in transforming the obesity epidemic. Have Irish policy makers the gumption to take on the food industry?