Chapter 1: What is the main topic discussed in this episode?
The Clare Byrne Show on Newstalk. With Aviva Insurance.
A new study has shown that many lifts are now becoming unsafe due to the rise in obesity. The report by University College London says that lift capacities have not changed over the past two decades and they fail to take into account the weight increase in the general population. Dr Mick Crotty is the clinical lead for obesity with the Irish College of GPs. Good morning to you Mick.
Good morning, Clare.
How are you? I'm very well. Thanks for being with us.
Chapter 2: What does the new study reveal about lift safety and obesity?
Does it make sense to you that lifts and perhaps other infrastructure mightn't be safe anymore when they're at maximum capacity because we are heavier?
I think, yeah, the rates of overweight and obesity have increased and the average, I suppose, body weight and size has increased kind of slightly compared to 10 or 20 years ago. But I suppose this study and this survey is kind of observational data. It's kind of taking a small subset and I think it should be more framed as data.
Noting that public infrastructure hasn't maybe adapted to real world population changes, rather than I suppose this could potentially be construed differently as far as stigmatising and blaming and shaming people with obesity. I think, you know, if we look across all kind of systems and infrastructure, you know, it has to adapt, you know, whether it's for obesity.
aging population, people with impaired mobility, you know, safety standards and body size trends are kind of another aspect of that. And obviously, we know that obesity is a complex, progressive, chronic disease. We know genetics and biology and environment all kind of play a role in this. And I think the environment and infrastructure has to change and adapt to real world kind of populations.
And do you think then that manufacturers need to address this, that it is an issue that needs to be looked at?
Yeah, I think, you know, obviously I'm not an engineer, but I would imagine that there's kind of engineering safeguards and load sensors and kind of safety margins built into kind of lifts and infrastructure.
And, you know, I think if we're, you know, there's a danger if we're talking about kind of, you know, the average adult kind of weight, you know, it doesn't take into account, you know, there could be children and adults and, you know, people of different sizes. So there is kind of a case mix when you look at somebody maybe using a lift.
And I think, you know, looking at averages, you know, the average is maybe going up, but I think it's probably a little bit more kind of nuanced and complicated. And I would imagine that, you know, there isn't any immediate safety concerns and these margins are kind of built into, you know, the guidelines and, you know, around lifts and things.
But definitely, I think it's something to be aware of that the environment needs to adapt and change. And We see it in healthcare, in hospital, GP practices. There needs to be seating that is suitable for somebody in a bigger body, whether it has a higher weight capacity or without arms.
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Chapter 3: How has the average body weight changed over the past two decades?
And I think the environment needs to adapt for that.
Yeah, so it is an issue then in healthcare as well that you need different sorts of, as you say, seating, gurneys, because dignity is hugely important here, isn't it? That people are treated with respect, that they don't feel embarrassed and stigmatised.
Absolutely. And people living with obesity, it's not their fault. It's not a lack of personal responsibility, willpower, motivation. It's a chronic medical condition and we need to focus on, continue to focus on prevention. We need to continue to focus on treatment, but we also need to allow people to live well with this chronic disease and live safely.
And not be kind of blamed and shamed and concerned. And, you know, that that can be an issue for many people living with obesity. And there's projects across the world looking at kind of, you know, health care environments and how to make them more accessible and not just for obesity, but for people with all chronic diseases.
Now, I wanted to ask you as well about a development in this area, which people might read about today in the news, this new weight loss medication in tablet form every day, cheaper than the injections. And the reporting, the BBC says that it might help people keep the weight off after using GLP-1s like Ozempic. What do you make of this new drug that's available?
Orforglipron, if I'm saying that correctly?
Okay. Or for glipron, yes. A new once a day, and I don't know where to come up with the names for these things. So it's a new once a day oral medication. It's a non-peptide, which means it's kind of better absorbed through the stomach. And it's an obesity medication. So it's for people living with kind of obesity.
So when excess weight is affecting their health, I think, you know, it is kind of maybe being pushed out there as something that may be kind of lower cost. It may be more acceptable to certain patients to take a daily tablet compared to maybe a weekly injectable. There's potentially kind of an impact as far as, you know, how it needs to be stored, not in the fridge.
Manufacturing potentially an environmental impact because you don't have all these pens anymore that are disposable and have, have an issue, but it's not licensed in Europe and not available here as yet. We don't know when it will be.
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Chapter 4: What are the implications of infrastructure not adapting to population changes?
We don't know what the cost will be. And I suppose cost is a huge issue because there's a huge inequity of access to obesity treatments at the moment. Really, you know, because of the high cost of medications many people living in the BC can't afford these and they're not accessible through, you know, drug payment scheme or kind of general medical card because of the high cost.
So the hope is that it will be another option for people available, an oral option. If we compare it to the injectables, it may not be as
powerful a medication compared to the higher doses of some of the injectable medications we have at the moment it has been studied in this attain maintain clinical trial looking at maybe people who are on the maximum tolerated dose of semidlutide which is ozentic wegovi or tirzepatide which is moonjarin shifting them then to the oral tablet and what they're seeing is maybe if people are on semidlutide they after a year they maintain most of the weight kind of reduction they've seen if people have been on moonjarin there is about a five kilo kind of weight reduction
So it's another treatment option. None of these treatments, I suppose, are a panacea. They need to be, you know, combined with, you know, nutritional movement, sleep stress, behavioral strategies, access to bariatric surgery, preventative strategies. But, you know, the more tools we have at our disposal, kind of the better it is for people living with this chronic disease.
But from your point of view as clinical lead for obesity with the Irish College of GPs, Mick, are you seeing that these new weight loss medications are changing the obesity picture in Ireland?
I think more people are aware of treatments being available. More people are advocating for their health. They're coming in and they're wanting to have a discussion about overweight and obesity, which I see as a hugely positive thing. I think the challenge from the point of view of general practice is at the moment, obesity care is not reimbursed.
It's not resourced in general practice in Ireland. So, you know, we get kind of, you know, access to referral pathways. We get access to supports to treat people for diabetes and hypertension and cardiovascular disease. We don't have that for obesity. So GPs are being asked to manage another chronic disease, but without the support, the resources. So that's a huge challenge.
All right, Mick, thank you very much for your time this morning. That's Dr. Mick Crotty there. We're going to take a break. Plenty more to come. Stay with us.
The Clare Byrne Show. With Aviva Insurance. Weekday mornings at 9. On Newstalk. Conversation that counts.
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