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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:
EBearhug · 03/01/2024 08:01

The other fun bit is I’d have access to much more tailored advice is I was diabetic.

Don't bet on that. I got referred to my GP's dietician, because I had some specific questions about diet for separate conditions (one of which is diabetes) in the same person (me), where dietary advice can be conflicting - the dietician kept telling me she could refer me to WW or SW, neither of which I'm interested in. What really pissed me off was in the follow up, she started with, "so we agreed you should do WW or SW." I never agreed any such thing, and it didn't make me feel like she listened to me at all, but just trotted out the same formula to everyone regardless.

Metabolicallycomplicated · 03/01/2024 08:01

headcheffer · 03/01/2024 07:58

The NHS uses private providers because our expectation that the NHS becomes the expert at delivering every single treatment for every single condition is part of the problem it faces.

The centrally commissioned programme has been evaluated and 94% of those who completed the 12 weeks saw an average reduction of 6.5% of their starting body weight. The statistics on the programme are held and evaluated centrally by NHS England, as you would expect for a nationally commissioned service.

The reason diet advice focuses on the Eat Well plate is because this is what has been rousted clinically evaluated. The remission research around Type 2 diabetes demonstrated that it isn't low carb that works but rather weight loss via any means.

Eating low GI foods as part of an overall balanced diet is the current recommended diet advice for PCOS - see the Association of UK dieticians website for this.

I fail to see what this service has done wrong for you? It's following the current recommended advice for your condition.

It’s the current recommendations that are flawed - I agree the course is following guidelines and they have to, the problem is those guidelines aren’t based on good research (Gary Taubes has written extensively on this). low GI foods are not recommended in most of the rest of the world, the focus is on low glycemic load to prevent insulin spikes. For example brown bread: low glycemic index, very high glycemic load.

OP posts:
BadSkiingMum · 03/01/2024 08:01

Ah, so if it is a nationally commissioned programme which has been evaluated, why on earth didn’t the supervisor share those statistics with the OP?

Interested in this thread?

Then you might like threads about this subject:

ThreeBeanChilli · 03/01/2024 08:02

Yes I've been desperate for help and thought a dietician or tier 3 weight loss service would help....

And given I'm willing to try fix thinfs it's ridiculous I haven't had help before other issues are becoming more of a problem.

It's a tickingntime bomb.

And yes the NHS referring everyone to ww and slimming world just exacerbates the problem. How is this allowed?!?!?

I've read ultra processed people and listening to zoe but have 10 stone to lose and worried weight loss surgery may be the answer. I'm so cross I started asking for help when I was only 2 or 3 stone overweight.

RosesAndHellebores · 03/01/2024 08:03

It's wrong but unsurprising. The NHS spouts codswallop about all manner of things so weight loss advice, whether direct or commissioned is unlikely to be different from the drivel spouted by health visitors and GPs generally.

WishIMite · 03/01/2024 08:03

I had a similar experience with a long covid clinic. All I was offered was a peer group meeting. I asked for outcomes from the meetings from trials - I.e. did it help people? Did people improve at all? And was told there wasn’t any.

They are spending millions on these clinics! I’d rather they were honest and said there’s no treatment.

TheaBrandt · 03/01/2024 08:03

I had a medical and realised I was on the scale as overweight so took myself in hand. Started with nhs info. Couldn’t believe what I saw the dietary advice was the same as my gcse home ec in the 80s. Did further research found Michal Mosley lost 2 stone doing intermittent fasting / lower carb / upped my exercise. If I’d followed nhs advice I’d still be 12 stone not 10.

Metabolicallycomplicated · 03/01/2024 08:03

EBearhug · 03/01/2024 08:01

The other fun bit is I’d have access to much more tailored advice is I was diabetic.

Don't bet on that. I got referred to my GP's dietician, because I had some specific questions about diet for separate conditions (one of which is diabetes) in the same person (me), where dietary advice can be conflicting - the dietician kept telling me she could refer me to WW or SW, neither of which I'm interested in. What really pissed me off was in the follow up, she started with, "so we agreed you should do WW or SW." I never agreed any such thing, and it didn't make me feel like she listened to me at all, but just trotted out the same formula to everyone regardless.

Youve hit a nail on the head there: the formulaic approach to obesity is a massive problem. There is no recognition that the causes of obesity are completely varied. It’s like someone presenting to a GP with tummy pain and the GO giving them gaviscon in every case, with no investigation into the actual cause.

OP posts:
Metabolicallycomplicated · 03/01/2024 08:05

ThreeBeanChilli · 03/01/2024 08:02

Yes I've been desperate for help and thought a dietician or tier 3 weight loss service would help....

And given I'm willing to try fix thinfs it's ridiculous I haven't had help before other issues are becoming more of a problem.

It's a tickingntime bomb.

And yes the NHS referring everyone to ww and slimming world just exacerbates the problem. How is this allowed?!?!?

I've read ultra processed people and listening to zoe but have 10 stone to lose and worried weight loss surgery may be the answer. I'm so cross I started asking for help when I was only 2 or 3 stone overweight.

If I lose 10 stone I’ll still be classed as ‘overweight’ and I’m also not opposed to weight loss surgery, but I’d rather not cut out body parts because of crap advice if that makes sense?

OP posts:
43ontherocksporfavor · 03/01/2024 08:06

What an awful situation. I fear for those that don’t have your insight OP and hope you can find a way through on your own. I’m not overweight and had a very overweight nurse tell me I should do more exercise!

soupfiend · 03/01/2024 08:07

I think the referrals to SW and WW are built on a classist theory

That the majority of fat people are poor and therefore cant afford a subscription to a weight loss club, therefore that will be part of the package offered because then they will be seen to be doing something for the cohort who are overweight

SW and WW dont solve the problem in my opinion.

Simonjt · 03/01/2024 08:09

Yeah I’m a type 1 diabetic, I was referred to the dietician as I don’t use a lot of insulin, I don’t use a lot of insulin as I don’t need to due to my diet, I’m also lucky that my diabetes is generally stable if I’m well. I was advised to increase my carbohydrates, I asked why and they said to increase by blood sugar, so again I asked why I needed to do that and they said I wasn’t using enough insulin every month…

I now live in Sweden, when I registered for health care as I have type 1 diabetes I was offered a same day GP appointment, I was then offered a lot of support, I took up the offer of the dietician as you could get specialised support for various diets, so I was interested what mine would be as a dairy free vegetarian. It was much better, moderate carb which has been proven to give both lower and more constant blood sugar levels, high protein, veg etc, rather than being told “just get a pump and eat as many carbs are you want”.

Metabolicallycomplicated · 03/01/2024 08:09

soupfiend · 03/01/2024 08:07

I think the referrals to SW and WW are built on a classist theory

That the majority of fat people are poor and therefore cant afford a subscription to a weight loss club, therefore that will be part of the package offered because then they will be seen to be doing something for the cohort who are overweight

SW and WW dont solve the problem in my opinion.

I first went on WW when I was 14 years old, slimming world a couple of years later and on and on it went. It kick started my ‘on the wagon off the wagon’ relationship with food and also my ‘good food bad food’ thinking - massively damaging and something I struggle with even now.

OP posts:
JT69 · 03/01/2024 08:11

Sounds similar to the Oviva app I’m currently part of due to being pre diabetic. Some advice is good but hardly rocket science. Initial consult was all doom and gloom. And then The constant pinging and badgering really affected me. And apparently the face to face sessions are worse. I question how effective it is and the money is spent 🙄 I’m doing my own thing from researching the diabetes Uk website now. I need to lose 5% of my body weight to reduce the risks of diabetes by 60%. That’s very do able and already lost 3%.

Metabolicallycomplicated · 03/01/2024 08:13

Simonjt · 03/01/2024 08:09

Yeah I’m a type 1 diabetic, I was referred to the dietician as I don’t use a lot of insulin, I don’t use a lot of insulin as I don’t need to due to my diet, I’m also lucky that my diabetes is generally stable if I’m well. I was advised to increase my carbohydrates, I asked why and they said to increase by blood sugar, so again I asked why I needed to do that and they said I wasn’t using enough insulin every month…

I now live in Sweden, when I registered for health care as I have type 1 diabetes I was offered a same day GP appointment, I was then offered a lot of support, I took up the offer of the dietician as you could get specialised support for various diets, so I was interested what mine would be as a dairy free vegetarian. It was much better, moderate carb which has been proven to give both lower and more constant blood sugar levels, high protein, veg etc, rather than being told “just get a pump and eat as many carbs are you want”.

It’s the Swedish dietary guidelines for PCOS and t2 that I follow!

OP posts:
Starreyskies · 03/01/2024 08:15

Agree op. At least you got referred.

I'm 20st, struggled being obese since I was a toddler. I built myself up to speak to the gp and he said well it's quite simple. Its a case of eating less and moving more.

I'm not stupid but weight loss isn't just mechanical like that.

Soontobe60 · 03/01/2024 08:18

I really don’t understand why, when you seem to be so knowledgeable, you need to attend a weight loss course in the first place? You said certain diets work for you. What is it you expect the GP to provide for you that’s different to what you already found works?
I appreciate that it may have been frustrating to not be told anything you didn’t already know, but I think your questions about stats that you emailed sound like you’re trying to trip up the course provider. Surely you would have been better asking specific questions about your specific situation?

I would have expected them to know how many participants reached a 10% loss during the 12 week course though at least? They weigh participants weekly and record it so that should be data they own
The problem with this is that you would need exact info about the participants. Take yourself as a participant for example. You started the course but dropped out very quickly. So your weight loss would probably be negligible. Is that because what the course taught you wasn’t correct? No, it was because you dropped out. So the stats that include people who don’t continue with the course would be skewed. Similarly, you’d have to have intimate knowledge as to whether or not participants honestly followed to course guidelines - those who don’t and sneak the odd bar of chocolate / glass of wine / bag of crisps may not lose as much weight. So they would also skew the stats. The course presumably isn’t carried out under strict clinical conditions.

Perhaps contact your GP and let them know that the course wasn’t helpful for whatever reason you believe. Perhaps a better solution to achieving a permanent weight loss would be something like bariatric surgery?

Whoopitywhoops · 03/01/2024 08:18

I totally agree that support for weight loss is a joke. I was referred to an NHS coach for weight loss support. I went to 1 session where he asked me what I thought I needed to do. He had no answers or advice himself. While I understand, I'm going to be the one responsible for my own weight I wanted support for the motivation side. I didn't get it. He literally expected me to just have all the answers myself. The majority of people know what they need to do. It's the doing it that's hard.

AvengedQuince · 03/01/2024 08:19

We wouldn't tell a person with anorexia "just eat more"

Yes we would. Correcting the energy deficit first and foremost is only way to heal oneself.

AvengedQuince · 03/01/2024 08:23

I really don’t understand why, when you seem to be so knowledgeable, you need to attend a weight loss course in the first place? You said certain diets work for you. What is it you expect the GP to provide for you that’s different to what you already found works?

I don't understand either. Perhaps a support group for people following the diets that work for you would be better? Ultimately you are the only one who can save yourself though.

Unabletomitigate · 03/01/2024 08:24

Thank you for posting this, I hope more people read it and think about the points you raised.

If you are still searching for help yourself, I can recommend the KetoAdapt course by Eric Westman. He has all the sucess data you wanted from that last course. The course itself is worth it if you want the support of doing it in a group. If you just want the info and guide, all the info necessary is availble for free on his website.

Good luck.

Mummysatthebodyshop · 03/01/2024 08:24

It's actually not all that bad advice if people actually moved enough.

Soontobe60 · 03/01/2024 08:26

AvengedQuince · 03/01/2024 08:19

We wouldn't tell a person with anorexia "just eat more"

Yes we would. Correcting the energy deficit first and foremost is only way to heal oneself.

My niece is currently being treated for AN - the approach taken with her is very much a scientific, pragmatic approach based around nutritional needs for maintaining a healthy body, combined with therapy for her mental health needs. The message she has taken away is not ‘you need to eat more or you could die’ rather ‘here’s how to keep your body healthy’.
She has made wonderful progress both physically and psychologically because she understands and accepts fully the role food and exercise plays in maintaining a healthy body.

ThreeBeanChilli · 03/01/2024 08:26

Oh absolutely. I'd still be overweight then too but I'd be happy with "overweight" relatively speaking.

And yes I'd much rather not do irreversible damage to my body...

PosiePerkinPootleFlump · 03/01/2024 08:26

If you can afford it, using a continuous glucose monitor for a while will help you understood what causes the worst blood sugar spikes for you so you can avoid them.

Definitely worth reading something like The Glucose Revolution first so you understand what you are seeing in the numbers better.

Ex husband is T1 diabetic and the NHS advice on nutrition he had received was hopeless. A cgm shows that there is very little difference between eg white and brown rice - both cause a massive blood sugar spike if eaten in quantity. Ditto white/brown pasta though the spike tends to be longer and flatter