We do need a proper conversation about obesity and metabolic disorder

[BecomeStronger]

I've been doing some reading about immunity, which affects not only our ability to fight a nasty virus but also things like cancer and heart disease. This is not news, but the stats for the increased impact, of so many different conditions, on those who are obese are truly shocking.

Of course, people who are already suffering should be treated by whatever means are available but isn't it time that the causes were addressed properly?

By which I absolutely don't mean telling fat people it's all their own fault, it's far more complex than that, but we need to move on from a place where you're not even allowed to mention weight, especially in the context of health.

It's simply not true that it's possible to be obese and fit/healthy and even if an obese person appears healthy, it's a ticking timebomb. (certainly it's true that being fat and active is better than fat and sedentary, but that's not the same thing).

IMO we need a massive public health campaign, with the necessary support in place, to address obesity in the same way that we addressed smoking. Of course it won't go away, it won't happen overnight and it won't be easy (like smoking) but something has to be done.

At the moment there seems to be outrage if even doctors suggest to their patients that lifestyle changes are necessary and yet this is by far the most effective "treatment" there is for so many of the illnesses linked to metabolic disorder.

You absolutely can make a dent in obesity by replacing sugar by artificial sweeteners. The sugar tax has resulted in a decrease in sugar consumption and it targets people who aren’t prepared to drink water instead of pop.

Same with salt - “behind the scenes” work to reduce salt intake by targeting salt levels in ready meals has reduced salt consumption.

I would like to see junk food taxed and services such as
Deliveroo and Just Eat - they mean it’s so, so easy to grab a calorie laden takeaway instead of just making do with beans on toast if you’re knackered and haven’t gotten anything in.

But fundamentally it’s down to individuals to choose what they put in their mouth.

We live in a society where people think that there is a pill for every ill
I wish there was! If only there was a pill you could just take to stop you being fat.

I see up thread lots have mentioned online weight loss groups and plans . No, it’s no good at all. This is why we are failing.

People need face to face, low cost groups for weight loss. Weight watchers and slimming world work not because the diets are fabulous but because of the social component. There is support and encouragement and from those groups people connect and walk/exercise together.

When people are struggling with huge weight issues they are isolated. They may be surround by family but the isolation is there in that they can’t do what everyone else can do like when I took my kid to a theme park and couldn’t go in the rides with them.

We need more decent supportive groups with realistic plans to do this. This includes dieting advice, actual nutritionally sound advice and a lot of us haven’t a clue whether to do cardio or weight training (both we have to do both) but many opt for the cardio because it’s easy and free to walk but getting in that strength building requires a PT so you don’t fuck yourself up.

Going to the gym solo is so should destroying and still lonely. Seriously think about those that sign up to gym memberships and never use them. I doubt it’s all down to laziness.

@AwaAnBileYerHeid this is exactly the sanctimonious bollocks that makes people not want to have these discussions.

I heard once that women with big boobs are more likely to get breast cancer, just because there’s more breast tissue to go wrong.

More fat means higher levels of oestrogen which can increase your risk of breast cancer. It isn’t as simple as having bigger boobs.

Obesity is often a symptom and the underlying causes in individuals is rarely addressed. It's also muddied by lifestyle causes with a spectrum between lifestyle and wider medical and emotional triggers.

Advice needs to be targeted to different causes. Purely lifestyle is different to dealing with emotional causes or to medical causes.

Change for Life is often dreadful advice.
This year has seen the repeated shutdown / inhibition of gyms/ fitness industry, and 8 months and counting loss of parkrun which has been one of the most inclusive initiatives at improving fitness across the population. It shows how much public health is really valued. There's been no need to padlock public sports courts, tape up outdoor gyms and ban outdoor non-contact sports, and such measures do far more harm than good.

There is far too much morality attached to obesity and public health. While it is a fact that excess fat, especially around the organs is a risk to health, it's not a moral failing. Conversations on this topic always get very defensive. We know we live in a society that makes it hard to continually resist temptation and keep active, or even have health issues addressed properly.

You can be beautiful beyond BMI 35. You can run marathons (and it's harder, slower work than it is for leaner people). But the biological fact is that excess fat stands a high chance of affecting health.

Obesity is an outcome not an action.

Giving up smoking is hard but it’s really obvious what to do - do not light a cigarette.

Obesity is far more complex with loads of different lifestyle factors combined. You cannot just tell someone to “not be fat”.
Eat less doesn’t even work either - stress, shift work, poor sleep, all these things mean you can retain fat despite not eating “too much” for your basic height/weight/sex.

There’s a lot of simplistic thinking on this thread. Ignoring the difference between internal /visceral fat and external fat, and the dangers of ‘TOFI’; ignoring the impact of artificial sweetener on glucose/insulin responses and blithely saying use them to replace sugar; ignoring the increasing research into the links between autoimmune and inflammatory response, and its links to psychological rather than physiological events...
I’m fat, and have consequent health issues: if /when I lose weight I am healthier, and the same is true of a lot of people but it’s NOT a universal truth and the binary ThinGood/FatBad isn’t the final word.

This conversation is always so difficult and as a fat person I will probably end up hiding the thread at some point and these always end up so absolutely, mercilessly cruel.

The difference between smoking, drinking to excess and taking too many pills and being fat is that you DO the first things and you ARE the latter. Everybody can see it all the time, no matter what your behaviour is. The campaigns against smoking etc say 'don't smoke' not 'don't be a smoker' or 'dont have tarred up lungs'. So the obesity campaigns do feel like shaming because you're drawing attention to me and it doesn't matter what my actual behaviour is at that point.

As a society we've decided that 'move more eat less' is a catch all for everyone but the reality is that everybody does process food differently. If we didn't, men wouldn't be generally thinner, diabetes wouldn't exist, some people wouldn't even be taller than others would they? So saying it's not harder for anybody to lose weight than anyone else is just a lie.

I'm not saying we can't find ways to encourage people to eat healthily it have campaigns against unhealthy food (the sugar tax has been really great for me actually) - just that how you approach it matters.

ThinGood/FatBad isn’t the final word

Of course it's not, DH lost 3 stone as a result of having cancer, that's not good. However, the fact that he had three stone to lose was his only risk factor in getting the cancer. The consultant was shocked "we only ever see smokers or obese people with this kind of cancer at your age". He didn't know DH had already lost a lot of weight by that point. Plus the fact that his weight had reduced significantly reduced the risks associated with the operation and improved his chances of recovery.

Some thin people will be unhealthy, but nowhere near at the same rate as those who are overweight.

Rather than looking at bmi we need to look at activity levels, mental health, other measures of health and not body weight in isolation. You just can’t tell who is healthy by looking at them.

I have to agree with this - and to be clear, I am obese, and have been my entire life. The number of times people just read a weight, and don't think about how it happened. For instance in pregnancy - I was obese throughout, put on 6 kilos by the end of it, which went away almost immediately as it was kid and blood. But I was grouped as obese with women who weren't obese at the start, but put on 4 stone by the end when clearly, there's different reasons for the obesity, and there's going to be different health concerns for each of us as a result. (for example, my blood pressure and glucose tolerance was always great, despite every medic worrying, but other women I knew really struggled and weren't tested - one went on to have an absolute giant of a baby and subsequently they decided it must have been gestational diabetes)

Same for Covid, or Diabetes - is it that being obese puts you at risk, or is there a common factor which puts you both at increased risk of being obese, and of getting covid/diabetes? Because I could be eating maintenance calories in veg and meat, or in cupcakes, remain obese, but have very different health risks.

The difference between smoking, drinking to excess and taking too many pills and being fat is that you DO the first things and you ARE the latter.

Absolutely, and you can go cold Turkey on cigarettes and booze but you can’t avoid eating or shopping for food where you’re surrounded by temptation.

That's really interesting @ThePlantsitter, thank you.

Its clear the food industry has an awful lot to answer for, it's deliberately created many of these problems for four decades or more.

That damage is done so governments need to find a way to reverse it.

Rather than looking at bmi we need to look at activity levels, mental health, other measures of health and not body weight in isolation. You just can’t tell who is healthy by looking at them.

I agree weight, physical and mental health are inextricably linked and I agree that it's possible for a very fit, strong athlete, for example, to show as obese on the BMI scale, but they won't look fat.

@GlittercheeksOakleaf

Don't refer to people being fat. Refer to people as having excess body fat because that's what it is. I have excess body fat. I've still got bones and hair and fingernails and a heart and a brain but I'm not called any of those things so why is it ok to call people fat?

Because skin and bones is pretty much a constant, fat or thin is not. So you say someone is thin, just like you say someone is fat. Although personally in real life I never ever hear anyone saying anything about someone’s weight. It’s something most folks actively try to avoid. To the extent at the over weight category most folks will lie about it and say “no you don’t look fat at all you look great, or gosh you don’t look that size, or you carry it well”

People don’t run around saying folks are fat anymore. They try not to comment, and if the person asks you lie. Becayse anything else is too risky in terms of the ability to cause offence.

I think we really need to focus on the food industry and why so much sugar is added unnecessarily to foodstuffs. Allot of issues stem from a bad diet as children and a sugar addiction can be a very real barrier to why people fail.

@BecomeStronger

Its mentioned in every appointment. Broken toe? Lose weight. Nosebleeds? Lose weight. Itchy mole? Lose weight. If anything they can't stop going on about it in appointments that have nothing to do with it

I understand what you're saying but it could be relevant in all those cases. Nosebleeds associated with high blood pressure, a broken toe is less of an problem for someone carrying less weight and I don't know about skin cancer but I've been really shocked to learn about the huge numbers of cancers where the risk is significantly increased by being over weight.

As I said, I've done a lot of reading about immunity and weight seems to be the one overriding thing that makes a differenc.

Oh come on, you're reaching there. You don't think doctors check blood pressure in someone presenting with nosebleeds before diagnosing them? And a broken toe will get better if I lose weight, bones magically fuse back together for thin people? Is that why we don't put them in casts for a broken leg...oh wait.

This is why overweight people struggle so much to get decent and consistent care from the NHS, everything boils down to 'prove yourself first and then we might consider treating you'. Go away and lose weight to see if this life threatening issue magically goes away with a few pounds lost. Yes I've experienced this. Yes I've been brushed off without a proper diagnosis because all the doctor could see was my weight. No the ailments he missed were not linked to or solved by weight loss and YES I suffered complications as a result of being ignored.

Fat people need doctors to see past their weight to be diagnosed properly. Weight can certainly be a complicating factor and should be raised where relevant but too many prejudice medical staff use it as an excuse to get rid of you, save money on tests, free up a hospital bed and make their lives easier.

We need to do the research on this because despite the fact that nobody wants to be overweight, two thirds of our adult population are overweight and only a tiny percentage manage to lose weight and keep it off.

There are too many vested interests in making money from processed foods and drinks in our morally bankrupt government.

Research tends to get funding when there is a drug to be monetarised at the end of it.

My local hospital serves crappy cook chill meals to the sick and Burger King to the staff and visitors. Go figure. Health is not the priority of the government. Lockdown is a political decision and is not health driven.

I do understand your frustration but in so many chronic conditions it's not "go away and prove yourself" it's "prescribing" the one treatment that is known to work.

And yes the toe will heal quicker if there's less stress on it.

"I've laid the blame entirely at the feet of the system"

I hate threads that make me feeling like a frothing Libertarian.
Are some folk truly saying that we should take Agency away completely from people who have become obese, pretend that they are simply victims and have no power to change against a giant 'system' that made them that way?

How is that a good thing? How does that empower them and treat them with respect? I am Not getting it.

There's a balance to be had @yeOldeTrout. It's not as simple as telling people to lose weight and expecting them to be able to do it though. The system has been working against them for too long for that to be a realistic possibility.

These endless threads are at odds with the claim that you can’t talk about fat.

It's not my problem so I'll bow out.
But if obesity WERE my problem, I'd be very insulted to be told "Ah you poor thing, you're not really responsible."

There was a lovely thread on MN a while ago where a lot of people were being brutally honest that they were fat because they ate too much. It was their situation to live with, their decisions what to do about it, not some kind of nebulous 'system' working against them that they had no decision-making power in.

With responsibility to fix a problem comes opportunities to fix it, or even opportunities to make peace with a difficult situation.

Isn't the real 'problem' with obesity simply getting a lot of people to recognise it is a situation that would help their lives to fix? Most fat people know they are fat, but they've decided it's too difficult or not important enough to try to change or they aren't actually fat enough to have a problem that is worth addressing.

I live my life always hungry.
I think you've hit the nail on the head. For many, many people if we want to be slim we have to accept being hungry most of the time.

Absolutely. And we all have those skinny friends who eat like horses (i could SHOVEL food of any kind down my ex, we had similar workloads and i did more housework yet he was always UNDERweight!?) so people clearly do metabolise food differently, yet as a fattie you're constantly told its one size fits all

Equating obesity with say smoking is why we cannot adequately address obesity.

Smoking is something you do, obese is something you are.

If I wanted to stop smoking, I can stop and it’s done for a day.
I can’t decide right I’ve had enough of being obese, I recognise it’s risky, I won’t be obese tomorrow.

If I want to quit smoking I call the stop smoking service and they offer me nicotine replacement therapy and I avoid smoky environments and people who smoke so I’m not tempted

If I want to quit obesity can I have appetite suppressants and avoid food and people who eat?

We know addiction is complex and we don’t have a full understanding of it but we know treatment failure for motivated adults who want to quit smoking is low. We have a treatment programme that works.

We know obesity is complex and we don’t have a full understanding of it. We know treatment failure for motivated adults who want to quit obesity is high and we don’t have a treatment programme that works long term.

We know dieting does not treat obesity adequately. That significant calorie deficits work short term but are not maintainable in the long term. Simply put if you want to go from obese to normal weight and maintain it nobody will be able to tell you how. Because we know obesity is multifactorial but we don’t yet know how to target treatment to individuals, whether the treatment programme is adequate is a shot in the dark.

Campaigns that link obesity to health issues eg Cancer research are fat shaming because people cant quit fat

People can
Take more exercise
Eat a healthy diet
Avoid sugar
Etc etc
But people don’t like that because ‘I can eat that because I’m not fat’

If obesity even in those who exercise and eat well is still linked to adverse health outcomes you are simply stating a genetic link like Asian heritage people are more likely to develop type 2 diabetes. It’s an awareness campaign not a health promotion campaign.