Do people really not know what to eat?

Didn't say you had. You did play fast and loose with the evidence though, as you said the recent BMJ review indicated there was a lot to be said for a two pronged approach. When actually the little it said about other forms of support was that they made no difference. It must be clear, if you read it, that most of the things you want weren't covered at all by the review. I don't think people should take any evidence for the possible limitations of WLIs and argue this to be a point in favour of something else either untried or shown to fail.

Also dispute that they'd be analogous to anti smoking measures because so much of the public campaigning there centred on the impact to others. There isn't a good equivalent of passive smoking.

On the percentage, hard to say as I don't see it happening for a while yet. WLIs will need to get cheaper, the NHS be more set up to administer and also probably tablet form availability will make a difference too. The ethnic composition of the adult population will make a difference too. Then I expect there'll always be people who don't want to take them, they don't work for and who experience side effects that make the juice not worth the squeeze. But I'm open to the possibility that it might end up with the majority of adults on them at some point in their lives, or a substantial minority.

This sort of thinking is silly. Sausages or gammon now and again are not going to have a huge effect. There is too much of this all or nothing attitude with some people, and it leads others to develop anxiety and stress about eating, which should be a simple process.

I really haven’t said anything about the effectiveness of WLI’s. The state of play appears to be: they are effective for the vast majority who use them, and some (most) of those will need to stay on them long term to avoid regain. I have no problem with that, if people/society are willing to pay the price.

I also freely admit there is no direct evidence for the potential effectiveness for the public health measures I’ve suggested - for the simple reason they have never been tried. However, they are analogous to the whole raft of measures which, over the course of nearly 50 years, have reduced the rate of smoking from almost half to one in eight. So it’s reasonable to think they may also be effective in reducing obesity rates.

Out of interest, what proportion of the population do you think would be on WLI’s long term?

Sausage and gammon are both treated with nitrates… proven carcinogens. So that simple food can cause cancer

I don't object to these things, and even if your guess that they'd make fewer people need WLIs is incorrect, some of them could offer other potential benefits. My problem is when people try and misrepresent the state of the existing evidence. If you accept that this is additional to not a replacement for the proven success of WLIs, we've no quarrel.

If you’ve got time, https://openknowledge.fao.org/items/48b09e6f-bfee-4b80-a2d5-c24440c6d4a8 the information here is really interesting.

@Binus I have suggested much, much more than telling adults to stop snacking. I’ve suggested a whole raft of measures, including:

• a change in the “healthy eating” guidelines, to discourage UPF’s in favour of real food, and to discourage snacking
• a move from low fat as the default recommendation
• measures to make UPF less available, less visible and more expensive, e.g. plain packaging, advertising bans, limits on the number of outlets, bans on vending machines in certain locations (or what can be sold in them), sugar taxes etc.
• a change to the standards for the food provided in schools, hospitals and prisons
• subsidies for real food
• recognition of the addictive nature of sugar and other UPF’s and pointing people to help for that

None of these are “diets” as usually understood. Diets didn’t work for me, despite decades of effort. What did work for me was recognising my addiction and the resultant need to take sugar and most UPF’s out of my life, AND the support to enable me to do it.

I’ve managed to do that while living in our current food environment - but it would have been a hell of a lot easier to do if some of the measures I’ve listed had been in place.

And I’m not saying these things should happen instead of people using WLI’s. I’m saying they should be alongside - and that they would result in fewer people needing to use WLI’s.

Maybe funding should also be poured into mental health for children as well then? Taking away UPFs or making them unaffordable for the majority when some children would be in hospital without them is cruel without also offering support and that would be my concern as the support is currently poor and underfunded.

It's true, I've not seen many people who've quoted the headline results of the BMJ review also state that most of the studies looked at were older generation WLIs. Or that they had to model a lot of the data. And it's not like the reviewers weren't open about that. It doesn't surprise me that medication works best when you take it, but it's been notable that people are talking up the headline whilst clearly not having read it. They also said provision of dietary and exercise support didn't make any difference but that doesn't seem to have been noticed!

The other side of that coin is that the emerging science is pointing towards some SEN, particularly ADHD/behavioural along with poor mental health, being caused or at least exacerbated by UPFs and poor nutrition.

The timelines for the explosion of both are pretty close.

I think there will be nutritional benefits in the longer term from wli. Having taken them for 18 months and been on several of the different wli threads you can see the long term impact. People are focussing on fitness and exercise, building muscle to help them maintain. People are thinking about protein and fibre and how to eat for health and long term benefits. I don’t think that’s isolated to people on mumsnet, I see it across social media.

There is a lot of hand clapping when people regain weight if they come off and joy about studies that show poor long term outcomes. Those studies are often on older glp medications, don’t have any non- study data and don’t consider maintenance. They are extrapolating small numbers.

Well no, WLIs probably not working if you don't take them doesn't make traditional methods any less of a known failure. Nor does it mean that telling adults to stop snacking will result in behavioural change. The evidence we have is that continued WLI usage is much better at reversing obesity than either temporary usage or diets.

But as I said, there are reasons to try and improve our food culture anyway. Diet and nutrition aren't just about obesity prevention and management. We can do both.

@soupyspoon I really don't haha.

@Binus given the recent reports about weight regain when people stop using WLI’s, there is a lot to be said for a both-and approach.

I love spam by the way

Yes. Long term WLI usage is the only thing currently proven to work at making obese people lose weight and keep it off. We know that everything else that's been tried has failed on a population level, and that simply saying people should stop snacking does bugger all to make it happen, because that's not how humans work.

And as there has never been a time when we combined everyone having enough to eat, a low UPF environment and low smoking rates, people who think curbing UPF would reduce obesity are at best, guessing. I don't think it's logical the way some people assume there must be a way for humans to live in abundance and not get obese because of making good choices.

I'm for taking some action anyway, as there are good health reasons why it would be better for people to have better access to higher quality food. But that needs to happen alongside increased WLI availability. It's also not only relevant to obese people, one can be slim and not getting proper nutrition.

@soupyspoon my point was simply that something like spam was the 70s equivalent of the oft quoted chicken nuggets and similar when it comes to food that's 'safe' because you know it'll taste the same every time. It isn't a comment on whether the foods themselves are comparable.

@Binus do you believe that the mass rollout of WLI’s is the right solution to the obesity epidemic?

I’ve no doubt they are a life saver for many. I also believe that moving away from UPF’s towards real food, combined with an end to snacking (for adults) would be equally effective for many, without the side effects or the cost.

I believe this based on my own experience and that of others I know. The challenge is how to stick with the new eating regime. Some people can do it just by deciding to make the change. Most of us need more than that.

Tinned food is not comparable to UPFs

And we ate more simply, so the safe goods could well be egg on toast, sausage and mash, boiled spuds, bland cabbage and a gammon steak.

People turn their noses up at tht sort of food these days.

Totally agree

Also in terms of packaging, the equivalent of that smokers lung on the packet of fags is a massive enlgarged fatty liver or heart on the packet of multi pack crisps. Or big swollen overhanging belly.

I think the point is that smoking has an immediate effect on the people around you, in a way that simply isn't the case for foodstuffs. Even the smelliest thing a person might eat is nowhere near as significant for the people around them as passive smoking. So it's not possible to replicate those campaigns for something that doesn't impact on others in the same way. Also my guess is that as the numbers on WLI continue to increase, obesity rates will start to fall as they have in the US, and in a few years we'll feel we've broken the back of the problem. Unfortunately full population access is likely to take even longer.

Also agree with @Kirbert2 there's more awareness now of how many ND people are very reliant on UPFs. There were no doubt people like that in the 70s, but their safe foods would've probably been much more tinned food. Stuff that's often processed, like spam, but doesn't tend to be thought about in the same way.

I was thinking more of the advertising bans, plain packaging, cigs out of sight, taxation increasing the price etc. So make UPF’s less visible and more expensive.

Plus, NHS stop-smoking services. I would like to see weight management services focus on the real food message, with practical suggestions on how to make that a reality for people who are potentially time poor and on a budget.

Yes Ive said this many times, smoking shaming is ok. Food shaming is not ok

Drug shaming is ok.

And to raise a point above about artificial sweetners, I can get on a soap box about this all day long. I think they are toxic and have done a lot of damage to our palate and our chemical functioning

and many children with SEND and other health reasons also didn't rely on smoking in the same way that they rely on UPFs.

I think that to change this at a population level is going to take government action. Basically replicating the measures which have been used to reduce smoking, and applying them to UPF’s, especially sugar. Until that happens (I’m not holding my breath), there is individual learning and action

Anti-smoking campaigns often centered on how disgusting the habit was, how selfish the people smoking were and how horrible it was for long-term health (not untrue tbf)

I can’t imagine this being tolerated wrt food.

Life stages, then. And not morbidly obese - which kind of supports what I’m saying.

People have always come in a range of sizes. Menopause has always been associated with weight gain, to varying degrees. It makes us more insulin resistant, and that usually means weight gain. If you really want to shift it, you might need longer fasts than 16/8. And to tighten up on some of the things which contribute to insulin resistance, such as carb level, artificial sweeteners, milk, seed oils.

But I can understand that, since it’s a significant change from what you’ve been used to, it is unpleasant and you wish you could change it. Whereas I am very happy being a size 16 at 5’7”, because for most of my adult life I was somewhere between a 24 and 30.

I’m not morbidly obese. I’m 12 stone, and a good size 14. I was always a size 10 but since menopause I’ve ballooned and I just can’t shift it.