NHS weight loss ‘help’ is a scandal

[Metabolicallycomplicated]

I have insulin resistant PCOS but I’m not diabetic, I just want to share my experience of asking for weight loss help.

I have (obviously) tried every diet, way of eating etc etc going, so in desperation I went to my GP and asked for some help to lose weight. I was referred to a weight loss service provided by an external supplier and was reassured they cater for people with diabetes and metabolic health issues like PCOS etc.

Anyway, I attended a few meetings and alarm bells started to ring when I was presented with a work book and turned to the ‘what to eat’ page to find the NHS healthy plate which is a diet made up of 30-40% carbohydrate, very little fat and moderate protein.

In the next meeting, I asked the dietician how this advice worked for people who were metabolically buggered and a guy with T2 diabetes also chirped up and asked the same. The response was ‘well we suggest eating low GI foods for carbs’…. So I asked ‘low Glycemic index or low glycemic load? Because those 2 things are different and for people with insulin resistant conditions, it’s a very important distinction?’. She didn’t answer the question and then proceeded to say the advice on the course was for the general population and she’d put me in touch with her supervisor for these specific questions and I could talk to her.

Losing faith at this point, I emailed the supervisor as instructed and along with specific diet questions I also asked for the statistics on how many people reach A 10% weight loss during the 12 week course, and how many people go on to maintain that weight loss for 2 and 5 years. That I would have thought, is a very simple question. The email I got back was ‘we don’t keep those statistics and why are you asking please?’… eh?? This is a course being prescribed by the NHS and you don’t actually have any statistics or proof points that it’s effective??

So I emailed back, thanked her for her response and withdrew myself from the course.

Why on earth are the NHS paying external companies to provide a treatment with no proven track record in successfully delivering adequate care?? It’s WILD. The way I see it, if you approached your GP for help with an infection and they said ‘here! Try this tablet. It’s never been clinically reviewed or tested, it’s not really designed for people with your specific problem and we have absolutely no clinical evidence that it works but we’re paying this company a fortune to supply it to you’ it would be a national scandal.

We have an obesity epidemic costing the NHS billions and yet absolutely no proper treatment available beyond dietary advice that has seen an explosion in weight related health issues over the last 50 years, which incidentally is based on junky science in the first place and fails to achieve and sustain weight loss in 97% of cases. NHS healthy plate is basically the food pyramid, which in turn is based on research that’s been totally and thoroughly debunked for over 2 decades now. Even ‘body reducing’ advice from the early 50’s focused on reducing carbohydrate, why on earth are we still pretending high carb low fat diets are the answer for a population that is rife with insulin resistant conditions?

The other fun bit is I’d have access to much more tailored advice is I was diabetic. I’m not, and instead because I’m female and my insulin resistance has resulted in PCOS and not diabetes, there is no specific dietary advice available for me despite a low carb diet being the single most impactful way to treat PCOS long term (it’s standard practice across much of the rest of the world now).

We’re here because we treat obesity like a moral failing and actually have no interest in helping fat people, just in berating them and treating them like they’re idiots with no self control. It should be a national scandal and at the very least, we should be calling out external suppliers who have somehow managed to secure massive NHS contracts with zero proof their treatment plan is in any way successful for the patient.

This is very true

I've often considered a hysterectomy, as has my sister with endometriosis. But of course the extension of the medical issues around womens health is that we are not allowed one "in case we want children/more children"

Because women don't know their minds of course

In which case I wish you a speedy recovery from whatever treatment you end up needing and hopefully an end to the bleeding!

See I use the opposite argument

If anyone tries to kidnap me I just need to sit down. Unless there is an entire gang they are going to hurt themselves trying to get me in their van

But I will keep his advice in mind if i ever travel to cannibal country 😂

I imagine it would be fairly easy to lose weight in cannibal country, what with the distinct lack of carbs presumably on offer

Ah finally the perfect PCOS diet solution 🤣🤣🤣

Op fingers crossed it isnt cancer

I also have pcos.
I did have lean pcos was bmi about 22.
Had meformin for ivf.
At about 40 due to stress emotional eating etc ive shot up to 27 or more very quickly. Also have hypothyroid un treated.

However op if you were overweight by 3 and more so by 7 then isnt that more likely diet and portion size. I just would have expected the weight to start closer to puberty??

Metformin gave me sevede diarrhoea but the slow release was fine.

During the ivf i had an EC after christmas - failure but lots of eggs. So probably low quality. By summer i was dieting and then the same drugs didnt work at all -- 1-2 eggs were growing so abandoned.

Im finding the worst is since dc2 my stomach is so bloated and weight so far from where it was that unlike before i can go days without eating and still be as fat feel as bloatec etc

Insulin resistance had been found in toddlers and it has been shown that insulin resistance in toddlers increases the risk of PCOS later

So it's quite possible to OP was overweight as a child due to already having a metabolic disorder and the PCOS was secondary/an extension to/of that disorder

Ancel Keys was one of the first major proponents of the Mediterranean Diet - the most rigorously studied diet in the world, and the diet most recommended for its health benefits. He lived to 100. (Which is more than can be said for Robert Atkins.)

Gary Taubes is a journalist. His pet theory is only one of many. It doesn't seem to be working for you, unless I have misunderstood this statement:

If I lose 10 stone I’ll still be classed as ‘overweight’

I lost 5 of those 10 stone in 8 months but thank you for exposing yourself with the inference that because I’m fat I must also be stupid. Gary Taubes work summarises lots of research in an easily digestible format, although personally I’ve also read and prefer to read original studies. I also read lots of ‘anti’ low carb published work too to round out my information, I mentioned Taubes because I find him easy to read not because I think he’s right (I don’t).

Who mentioned Atkins? Not that his own longevity matters in the slightest (very weird proof point you chose there??), but his WOE isn’t anything to do with how I choose to eat. The fact you mentioned Atkins shows just how little you actually know about modern low carb diets. For reference and so you don’t embarrass yourself again too much, this is how I eat and how many low carb/ keto eaters choose to eat:

I maintain carbs per day between 25 and 40g. Over 40g for more than 2 or 3 days in the week and I gain weight, and under 25g per day limits my ability to maintain enough veg variety in my diet.

I eat meat and poultry most days, then oily fish and offal once a week each.

For cooking I use lard or beef tallow or butter rather than hydrogenated vegetable oils and on salads I use extra virgin olive oil. If I want mayonnaise I make it.

I try to eat 30 varieties of plants per week to support microbiome health, and a couple of times a week I make sure I eat fermented foods like kraut or kefir.

I eat dairy and eggs a few times a week, neither I would consider a staple though.

I eat very little processed food, probably the most processed thing I eat is whole earth peanut butter or maybe soy sauce. I do sometimes have a clear whey protein powder in the morning if I had a very light protein day the day before, but it’s pretty rare.

I eat in an 8 hour window (16:8 fasting) because it suits me better to do that than force myself to eat breakfast. That said, I eat whenever I’m hungry. Again though because my blood sugar is stable I don’t really snack.

What that looks like in terms of example meals is this:

Huge chop salad with olive oil, whipped feta and mackerel with lemon

chicken in a mustard cream sauce served with green beans and spinach cooked in butter

Prawn stir fry made with peanut butter and lots of veg variety

broccoli cheese bake with streaky bacon

Lamb kebabs with huge salad and yoghurt and mint, with kraut and slaw

Beef stroganoff with mushrooms and spinach

Chicken and paneer curry

If we have a meal out I’ll have steak, if we are with friends and grab a takeaway or something I’ll have a kebab without the bread etc. It’s easy to stick to and there’s always something I can have.

It’s not bacon and 6 eggs at every meal, or butter and cream in your coffee if you don’t want it to be.

I was also a child in the 90’s when the world became absolutely obsessed with weighing and proclaiming children to be obese, and having an obese child meant you were a terrible parent. My mum as a result was always absolutely mortified by my weight, visibly embarrassed. It wasn’t nice to grow up knowing you were evidence of bad parenting just by existing.

As I said, my siblings were all healthy weights as are both my parents. As a result when we ate together I was often given around half the portion size of the others, or if they had chips as a treat I would be given boiled potato. If we ate out, my meal was chosen for me and this was the case right from when I was 3 or 4. I wasn’t allowed school meals and had a packed lunch, which was a salad sandwich and an apple every day, while my friends had lunch boxes with lunchables, crisps, chocolate etc.

High school was better as my parents had less control but I did pile weight on in my teens. I’m not sure what you’d expect though. I ate my first ever McDonald’s meal aged 15.

I adore my parents, we’re very close and mum does say now that she wishes she’d ignored other people and just let me be. I was a fat kid and that should have been investigated as to why but there just wasn’t a diagnostic pathway back then for obese children, it was all diet. As it stands we’ll never know if I was metabolically unsound as a kid or whether I became that way in my teens, and I’m not sure it really matters at this point unless you want to avoid being ‘blamed’ for your weight problem.. because I don’t subscribe to the idea that blame has any place when discussing anyone’s body, I kind of don’t need to know the cause of that makes any sense?

This is a fascinating subject, if you arent in the middle of it. @Metabolicallycomplicated thank you for starting this thread. My DD has been diagnosed with insulin resistant PCOS.

The importance of nutrition is hugely overlooked in health care provision.

Too much advice is outdated, based on a shaky assumption that if something worked for Person A then it will work for Person B.

@venusandmars described her elderly DMIL being told to eat biscuits to gain weight by her GP. It is probably the diet method used by the GP, they find themselves gaining weight so cut out the biscuits.

The 'one size fits all' approach sees being overweight as a single issue. The advice given to people ignores that there will be underlying causes and comorbidities. Blanket diet advice can be downright dangerous.

I take warfarin for a blood clotting disorder. I'm also T2 diabetic. Safe warfarin use requires consistency daily so if I wanted to eat a wide variety of vegetables I would need to eat them every day in the same quantities (warfarin is a vitamin K antigen). I tried a low carb diet when first diagnosed with T2 diabetes and found it difficult to maintain a consistent warfarin dosage - too much warfarin and I risk brain haemorrhage, too little and I risk clots. Heads I win, tails I lose.

So OP's diet works for her but could kill me!

You cook in lard and eat enormous quantities of food - no surprise you are very overweight. I really don't think this is an NHS problem.

Given the only quantity the OP referred to as large was the salad, and a large salad is a MN staple let's face it, all your sneering is just showing you for who you are

And the fact that the OP has lost 5 stone on the diet she's talking about, and you are blaming that exact diet for weight gain, when it's causing weight loss...

Who mentioned Atkins? Not that his own longevity matters in the slightest (very weird proof point you chose there??), but his WOE isn’t anything to do with how I choose to eat. The fact you mentioned Atkins shows just how little you actually know about modern low carb diets. For reference and so you don’t embarrass yourself again too much...

Wow, you're aggressive. I mentioned Atkins, who introduced low carb as the answer more than 50 years ago, as he died at 72 - vs Ancel Keys at 100. Taubes is too young still to see how his low carb plan works for him, longevity-wise.

I wasn't implying you were stupid. That seems to be your job, with everyone you've encountered who is offering any alternative dietary advice.

As it stands we’ll never know if I was metabolically unsound as a kid or whether I became that way in my teens, and I’m not sure it really matters at this point unless you want to avoid being ‘blamed’ for your weight problem.. because I don’t subscribe to the idea that blame has any place when discussing anyone’s body, I kind of don’t need to know the cause of that makes any sense?

This makes a lot of sense @Metabolicallycomplicated

I think my reply rose from my frustration that PCOS is seen by many as a gynaecology issue, when in reality the gynaecology issues are symptoms of a whole body condition which is why having your uterus and ovaries removed doesn't cure it. I feel like if people treated it as it actually is there would be much less misinformation and judgement around it

That poster never mentioned that she’s eating „enormous quantities“ apart from the huge salad, which sounds like the perfectly standard „massive mumsnet salad“. So how did you arrive at that conclusion? Or did you simply assume?

@Metabolicallycomplicated lost 5 of those 10 stone in 8 months. I therefore rather doubt that she‘s eating enormous quantities of food. And even if she was - whatever she’s doing is clearly working!

I think it is a fair assumption that someone who is over 10 stone overweight is not eating the appropriate portion size.

I cannot imagine how biased against overweight people you have to be to read the words "lost 5 stone" and think the obvious response is "its obvious you must be eating too much"

Have you actually read this thread? Do you know anything about PCOS? I think no on both counts

This my lunch today, I added a bit of kraut on the side and that’s whipped feta on top, about 50g of it. This is pretty standard in terms of portion size and what I eat generally.

Absolutely bonkers I know to have to contemplate a fat person eating salad but here we are. The space time continuum remains in tact regardless.

Not surprised. Shockingly awful.

Worse still I really don't like the nurses attitude, or her supervisor, when asking poignant questions. It's as if they see you as a nuisance for asking questions that expose how awful their service is.

Have you looked into prolonged fasting- intermittent fasting.
you come across as someone who researches and likes statistics.
I can recommend dr Gary fung on YouTube.
I follow his guidance on IF and have lost 10kg since June 2023.
it’s a way of life now

Yes, I 16:8 fast and it works well for me, like you I find it’s not even a conscious decision anymore I’m just naturally not hungry until 11ish at the earliest.

Yes I did. Once every 12 weeks through the app. Her name is Amy. My initial appointment was In person at the doctors - she wasn’t very nice and made me feel really bad about myself. I’ve heard this from other people too . I just objected to the tone of it all. I’m not 12. So following better advice from Diabetes Uk.

I used to run pretty thorough appointments as a nurse and our practice was really good. I saw people weekly and really talked with them to find out what was going on in their lives and see if there were any issues that needed a further referral. I'm sorry that it very much is a postcode lottery as to how good a service you receive. Obesity needs to be treated holistically. There's no point otherwise imo.