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NHS weight loss ‘help’ is a scandal

273 replies

Metabolicallycomplicated · 03/01/2024 07:27

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.

OP posts:
ThreeBeanChilli · 05/01/2024 18:58

Wow weekly nurse appointment! That isn't on offer here!

MedSchoolRat · 05/01/2024 20:08

Why on earth are the NHS [providing] a treatment with no proven track record

There is a track record that there is no difference in potential weight loss, high carb & low cal vs. high protein & low cal, although the 1st RCT I found was small.

Metabolicallycomplicated · 06/01/2024 18:03

MedSchoolRat · 05/01/2024 20:08

Why on earth are the NHS [providing] a treatment with no proven track record

There is a track record that there is no difference in potential weight loss, high carb & low cal vs. high protein & low cal, although the 1st RCT I found was small.

The ‘high protein’ diet they studied was still 40% carbohydrate….

OP posts:

Interested in this thread?

Then you might like threads about this subject:

JustanotherMNSlapperTwat · 06/01/2024 18:24

Metabolicallycomplicated · 06/01/2024 18:03

The ‘high protein’ diet they studied was still 40% carbohydrate….

That's actually mad

"Here we are going to compare a high protein diet vs a high carbohydrate diet but they will both have higher carbs than protein 🤦‍♀️"

MedSchoolRat · 06/01/2024 18:26

I'd quite like to find a syst review that directly compares lowCal+high carb with lowCal+very low carb. All on baseline = women with PCOS and BMI 30-35, and outcomes = weight loss + other things. Can anyone find that?

FaiIureToLunch · 06/01/2024 18:31

Look OP, you need to go keto or low carb. I had PCOS and was a classic apple shape, it was all gone in ten months along with six stone and then I got pregnant accidentally which proved that it had really worked on a deeper hormonal level.

Metabolicallycomplicated · 06/01/2024 18:34

FaiIureToLunch · 06/01/2024 18:31

Look OP, you need to go keto or low carb. I had PCOS and was a classic apple shape, it was all gone in ten months along with six stone and then I got pregnant accidentally which proved that it had really worked on a deeper hormonal level.

Way ahead of you, I eat LCHF, keep carbs around 25g Smile

OP posts:
Metabolicallycomplicated · 06/01/2024 18:39

MedSchoolRat · 06/01/2024 18:26

I'd quite like to find a syst review that directly compares lowCal+high carb with lowCal+very low carb. All on baseline = women with PCOS and BMI 30-35, and outcomes = weight loss + other things. Can anyone find that?

I haven’t found one specifically for PCOS or metabolic syndrome as yet, there’s over 100 low carb diet studies now though, mostly short term and small as most diet studies are due to issues with long term participant compliance.

OP posts:
Metabolicallycomplicated · 06/01/2024 18:43

JustanotherMNSlapperTwat · 06/01/2024 18:24

That's actually mad

"Here we are going to compare a high protein diet vs a high carbohydrate diet but they will both have higher carbs than protein 🤦‍♀️"

Shockingly it’s also one that gets quoted ALL THE TIME. It was only 35 participants too and there was no control for what the primary cause of the PCOS was either (eg whether there were comorbidities like diabetes, metabolic syndrome etc).

But yes you’re correct, in both diets it was 30% fat, then the ‘high protein’ was 30% protein and 40% carb and the ‘high carb’ was 55% carb and 15% protein…. So totally pointless either way for someone metabolically buggered.

OP posts:
Jewel1968 · 07/01/2024 07:11

OP seems to be doing a very good job of assessing the research and working out what might work for her. I can't help but feel there is so much out there that, often contradictory, it's a wonder anyone makes sense of it. I heard recently on a podcast that coffee is a source of fibre - who knew! I googled it afterwards and yes it's a source of soluble fibre.

Ideally we should be able to turn to the NHS for scientifically sound, evidence based advice tailored to individual needs. Not everyone can navigate sensibly the plethora of advice out there.

RokaandRoll · 07/01/2024 07:32

I completely agree with you that NHS dietary advice is terrible- and I believe these private companies are only in it for the money. Of course they don't want to provide you with statistics and they get suspicious when you ask too many questions- they know very well that what they're offering doesn't work for the vast majority.

Your diet sounds excellent, OP. I did well on a very low carb ketogenic diet for a while but ended up doing some damage to my kidneys with too much protein and decided to stop. So I would just say get your kidney function checked regularly just to be on the safe side. I then started paying for Wegovy privately and it has solved my weight problem entirely. Hopefully this will be more widely available on the NHS soon.

Metabolicallycomplicated · 07/01/2024 07:34

Jewel1968 · 07/01/2024 07:11

OP seems to be doing a very good job of assessing the research and working out what might work for her. I can't help but feel there is so much out there that, often contradictory, it's a wonder anyone makes sense of it. I heard recently on a podcast that coffee is a source of fibre - who knew! I googled it afterwards and yes it's a source of soluble fibre.

Ideally we should be able to turn to the NHS for scientifically sound, evidence based advice tailored to individual needs. Not everyone can navigate sensibly the plethora of advice out there.

There’s so much complete bollocks around too supported by seemingly sensible people. The ‘alkaline diet’ is a particularly hilarious example.

My personal rule is I can’t find actual good quality studies (and more than one) supporting it, I’m skeptical. Or, if there’s fewer studies than I’d like but compelling physiological arguments then I’ll test the theory for myself. For example with low carb/ ketosis, the first month I ate this way I monitored my blood glucose, urine ketones and weight and charted it all. I also kept a diary of physical PCOS symptoms and my cycle lengths. I did the same when I started 16:8 fasting. 16:8 didn’t really make a huge amount of difference to anything other than hunger, but weirdly it did seem to narrow the range my blood sugar would move within during the day compared to days where I didn’t fast.

I do recognise that not everyone is a data person or a science person though, and it’s very easy to make something sound ‘scientific’ to people who don’t have an interest in it.

OP posts:
soupfiend · 07/01/2024 07:40

Im interested in the alkaline diet as I have GERD, I hope to try it later in the year when Ive got my head around it a bit more

Metabolicallycomplicated · 07/01/2024 07:48

RokaandRoll · 07/01/2024 07:32

I completely agree with you that NHS dietary advice is terrible- and I believe these private companies are only in it for the money. Of course they don't want to provide you with statistics and they get suspicious when you ask too many questions- they know very well that what they're offering doesn't work for the vast majority.

Your diet sounds excellent, OP. I did well on a very low carb ketogenic diet for a while but ended up doing some damage to my kidneys with too much protein and decided to stop. So I would just say get your kidney function checked regularly just to be on the safe side. I then started paying for Wegovy privately and it has solved my weight problem entirely. Hopefully this will be more widely available on the NHS soon.

Yes I looked into ozempic after I’d lost about 3.5 stone and things slowed right down. Again if I was a t2 diabetic I’d be offered it on the NHS but because my insulin resistance gave me PCOS instead I don’t qualify automatically unfortunately. I would have to go up the tiered weight loss support system which takes 2 years of following their advice (this is a simplification but basically what it boils down to) and if I ate high carb for 2 years I’d be in a worse state than I am now, so when I withdrew from the NHS course I closed that door I think. Happily, after my weight loss stalled for a good 3 months on LCHF my weight suddenly started shifting again by 2ish lbs a week completely randomly, so I know now that if I stall I just need to keep eating the way I’m eating and it will start to shift again at some point. I’ve actually been looking for information about why that happens if anyone’s got any?

I’m quite careful about protein for exactly that reason and sorry to hear you fell foul of it. Im lucky that I have regular blood tests for a gynae issue that’s made me anaemic and that includes liver and kidney function tests, plus a lipid profile so it’s comforting to know if anything went south I’d know about it pretty quick. My cholesterol improved a lot with eating LCHF and losing weight which is good news, that’s something else I try to track if I remember to ask when I call for my HB results.

OP posts:
FaiIureToLunch · 07/01/2024 08:18

Metabolicallycomplicated · 06/01/2024 18:34

Way ahead of you, I eat LCHF, keep carbs around 25g Smile

I doubt it since my children are now 25 & 22.
Although I was way lower than 25g, more like 10g.

Infusedwithchamomileandmint · 07/01/2024 10:30

Interesting that people are saying it's their metabolism,not the way food has developed over the past 30 years.
The way people eat is the cause of the metabolic issues.
16:8 has been shown to reverse this.
Of course some people are more susceptible but not the majority.
The vast majority of adults in the UK are overweight.
We have been encouraged to fill our lives with food and alcohol to make others rich.
Watch "The Men who made us fat"

Get everyone hooked on cheap, UPF and they, driven by their blood sugar will keep coming back for more.
The NHS guidelines are intended as a healthy diet for people who are not overweight/ eating UPF and who are fit and active with zero issues.
People ate like this in the 70s when they walked to work/ school and didn't snack.

Jewel1968 · 07/01/2024 11:44

It's very impressive the logical way OP approaches this. But as she said most people won't have her skill.

@Infusedwithchamomileandmint I think you make a valid point. Of all the stuff I have read over the years the arguments about UPF make a lot of sense to me and how it messes with our saiety and cravings.

@Metabolicallycomplicated have you outlined to your GP what you are doing and the knowledge you have and the inadequate provision from NHS. Not sure if it would make a difference but a detailed email to your GP might help you get better support from NHS?

LadyWithLapdog · 07/01/2024 12:20

I think you can only be referred to whatever service is commissioned locally, though you may have the right to a second opinion?

OP - also well done for how you managed this thread.

Infusedwithchamomileandmint · 07/01/2024 12:44

Jewel1968 · 07/01/2024 11:44

It's very impressive the logical way OP approaches this. But as she said most people won't have her skill.

@Infusedwithchamomileandmint I think you make a valid point. Of all the stuff I have read over the years the arguments about UPF make a lot of sense to me and how it messes with our saiety and cravings.

@Metabolicallycomplicated have you outlined to your GP what you are doing and the knowledge you have and the inadequate provision from NHS. Not sure if it would make a difference but a detailed email to your GP might help you get better support from NHS?

Thanks @Jewel1968
My personal experience is that it can take up to 2 years to " revert" metabolism and change from a diet of UPF to whole foods with associated steady weight loss.
Unfortunately it's too tough in terms of cost, time, sourcing etc within a modern, busy lifestyle.
It takes a huge amount of time and effort for people who are stressed by work, children,finances, MH issues .
UPF are easy to store long term, cheap, palatable and readily available.
Time to stop blaming individuals or the NHS it's literally like swimming against a massive incoming tide.

Gribbie · 07/01/2024 12:51

Metabolicallycomplicated · 07/01/2024 07:48

Yes I looked into ozempic after I’d lost about 3.5 stone and things slowed right down. Again if I was a t2 diabetic I’d be offered it on the NHS but because my insulin resistance gave me PCOS instead I don’t qualify automatically unfortunately. I would have to go up the tiered weight loss support system which takes 2 years of following their advice (this is a simplification but basically what it boils down to) and if I ate high carb for 2 years I’d be in a worse state than I am now, so when I withdrew from the NHS course I closed that door I think. Happily, after my weight loss stalled for a good 3 months on LCHF my weight suddenly started shifting again by 2ish lbs a week completely randomly, so I know now that if I stall I just need to keep eating the way I’m eating and it will start to shift again at some point. I’ve actually been looking for information about why that happens if anyone’s got any?

I’m quite careful about protein for exactly that reason and sorry to hear you fell foul of it. Im lucky that I have regular blood tests for a gynae issue that’s made me anaemic and that includes liver and kidney function tests, plus a lipid profile so it’s comforting to know if anything went south I’d know about it pretty quick. My cholesterol improved a lot with eating LCHF and losing weight which is good news, that’s something else I try to track if I remember to ask when I call for my HB results.

I went to my dr to get access to meds to help me lose weight (I've got PCOS and a physical diaability which limits what exercise I can do) - got told I had to go via the diet team first. I had the choice of second nature app or weekly meetings - I chose the app and it's been fantastic, I don't think I'll need or want the meds. I'm 7 weeks in and 5kg down (incluuding a blip at xmas when I was away so someone else was in charge of meals). It is low carb, in a sustainable way - for 2 meals a day your plate should be 1/2 veg/salad, 1/4 protein, 1/4 wholegrain carbs, plus some good fat (olive oil/butter/etc), or 2/3 veg and 1/3 protein plus the fat. Breakfast is high protein.

Every day you get an article - a few weeks ago it was this one, which I thought might be of interest to you with your plateau comment.

https://www.secondnature.io/guides/mind/motivation/weight-loss-plateaus-explained

Weight-loss plateaus explained | Weight loss tips

Have you reached a 'stalemate' on your weight loss journey, despite keeping up healthy habits? Learn why this happens and what it means for weight loss.

https://www.secondnature.io/guides/mind/motivation/weight-loss-plateaus-explained

Metabolicallycomplicated · 11/01/2024 08:11

Gribbie · 07/01/2024 12:51

I went to my dr to get access to meds to help me lose weight (I've got PCOS and a physical diaability which limits what exercise I can do) - got told I had to go via the diet team first. I had the choice of second nature app or weekly meetings - I chose the app and it's been fantastic, I don't think I'll need or want the meds. I'm 7 weeks in and 5kg down (incluuding a blip at xmas when I was away so someone else was in charge of meals). It is low carb, in a sustainable way - for 2 meals a day your plate should be 1/2 veg/salad, 1/4 protein, 1/4 wholegrain carbs, plus some good fat (olive oil/butter/etc), or 2/3 veg and 1/3 protein plus the fat. Breakfast is high protein.

Every day you get an article - a few weeks ago it was this one, which I thought might be of interest to you with your plateau comment.

https://www.secondnature.io/guides/mind/motivation/weight-loss-plateaus-explained

That sounds great! There’s the freshwell app too that I’m hoping more GP’s start recommending in the future. I wasn’t offered an app, just a choice of their NHS program or slimming world so it might be a bit of a postcode lottery. So glad to hear though that some GP’s are starting to recommend lower carb eating.

That diet isn’t a million miles from mine (bar the wholegrain carbs bit). I eat a lot of green leafy veg and salad. I think people have a perception that low carb eating is like the old Atkins diet stage 1 which was basically all meat and fats, when in reality it’s mostly plants!

OP posts:
Gribbie · 17/01/2024 20:58

Yes - I was pleasently surprised. Nice to see low carb becoming normal. I did lose a few stone before kids using atkins but it just wasn't fun! This is easy and fits around what the rest of the family eat with minor tweeks. I'm 1/3 of the way to my first goal 😁

Midwinter91 · 17/01/2024 23:07

Do they still offer free slimming world in some places? I would love to go but don’t have the spare money

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