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.

Whoopitywhoops · Today 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

Same as counselling right. They can't put words in your mouth. Besides motivation is fleeting. Habit changing is where it's at.

if your serious about weight lose.

Get a personal trainer 2-3 times a week. Eat twice a day, morning and dinner. No snacks/junk food.

Agree OP it’s ridiculous. I’m at the other end of the scale alternating between anorexia and bulimia but I still remember the first time I was admitted to hospital for a potassium drip (when you’re underweight it doesn’t hurt, it warms you up) and seeing a diabetic woman being served carbs, carbs and more carbs. No, that is not how it works. I’ve also had a dietician have a gentle talk with me about how I should eat more cheese, cake and chocolate. Even if I didn’t have pancreatic issues that is shit advice for an anorexic, sorry.
Overall unfortunately medical trials tend to be too few, too short and not thorough enough. Read “Bad Medicine” for some catharsis. In the meantime just keep eating healthily. Humanity hasn’t “solved” the problem of obesity but if your other one are fine, you can probably relax a bit. You’re a good human (unless you’re a serial killer in which case I will cautiously walk back on that).

OP I really recommend the recent Andrew Huberman podcast with Dr Robert Lustig, an American endocrinologist who I see wrote Fat Chance which I'm going to read. I thought I knew a lot about food but he takes it to the next level - very intense and science-y, but you say you like that.

Also maybe the other recent one by a obs/gyn which talked about endocrinology. Again, eye-opening.

I'm sorry but it's true. What people need is a better mental health service around why people eat more I.e emotional eating

You could have stopped at “people need a better MH service” to be honest.

You've come on a thread where a woman has lost 5 stone through intermittent fasting to tell her if she wants to be serious about weight loss to eat breakfast?

She is serious about weight loss, she's lost 5 stone, on what planet is that not being serious about weight loss?

But sure trot out generic advice as if PCOS doesn't make a difference. 🙄

The NHS weigh loss clinics rely on The Leaflet.

Sessions usually include reading out loud from The Leaflet. Any questions are referred to The Leaflet which includes The Sacred Healthy Plate and The Serving Size Gospel with illustrations takes from the Fifties.

It's a colossal waste of time, money and and human resources. It's shocking how bad it is.

You seem knowledgeable regards diet.

What were you hoping/expecting from this service?

I don’t disagree with you in theory but if you’re so well informed about your condition and diet (more than the course leaders it seems) then what kind of external support were you expecting/wanting?

@cryinglaughing can just see we are having the same thought process!

Particularly if you have a problem seen as self-inflicted you tend to take anything on offer. Don’t pile on OP please. Thank you.

I had gestational diabetes and I was shocked at the advice given at the mandatory clinic session I had to attend, it was so carb heavy. Luckily I am a researcher by profession and was able to find my own way, but most people would trust the NHS and that could have really serious consequences for some people and also it must be costing the NHS money in other ways, like prescribing metformin etc when these things can be controlled by diet.

A friend was told she was pre diabetic and was sent to one of these groups. The first thing they told the group was to stop all medication. He was a young man with no medical training. Friend in cancer recovery and has osteoporosis and on lots of meds for this.

I see a heck of a lot of people on this thread valuing weight loss influencers and podcasts over research.
If overall weight loss rather than lowering carbs is what helps T2 IN ACTUAL CLINICAL TRIALS surely you'd go for that?
Zoe appears to be a bit of a hobby horse.

DH has T1 which is not relevant to dietary advice for T2 but is relevant in that we get Balance magazine and the actual research is digested for ordinary people - T2 don't need a low carb diet.

I listened to a really interesting documentary about 20 years ago by a doctor whose father had type 2 diabetes. He was talking about the guilt he felt having encouraged his dad to follow NHS dietary advice (which he said actually hastened his dad's death).
In particular he talked about the "low fat" fad that we still see everywhere today. Many low fat products are bulked out with carbs. Low fat spreads are full of chemicals. These things are really bad for us, but are designed to appeal to desperate people.
I remember learning about preventative medicine/health eating etc back in the 70s. The NHS is still really poor on all aspects of this IMO.

Surely the questions isn't why did the OP seek professional medical advice for her medical condition?

Surely its why did she have to ask in the first place, why isnt medical support immediately offered to all women diagnosed with a metabolic disorder before they get to the point of gaining too much weight

The medical community ignoring PCOS and treating it as if its a huge coincidence that loads of women with a metabolic disorder have weight issues is the scandal. Not that a woman, who has been forced to become knowledgeable about diets due to the lack of useful medical input, dared to ask for medical help for a medical condition.

I completely agree OP. The NHS (and successive governments') guidelines to losing weight are ignorant at best, damaging at worst. It's scandalous.

What our government should be doing is trying to work out how the hell to reduce the nation's dependency on UPFs. That's also a scandal.

OP appears knowledgeable indeed, but what’s wrong with her expecting medically tailored advice? After all isn’t that why the service is there for?

And what about the thousands of other service users who receive useless advice?

I have put on weight due to disability so not so easy to just go for a walk.

Dr referred me to an app where I was supposed to get a coach. But they don't have enough. Just get told to eat healthy snacks. That's tier 2 was also referred to Tier 3 will take a year to get to see a specialist.

I was asking what she was expecting, I must have missed where she said she wanted a one to one/tailored advice.

Who says it is useless to thousands of others 🤷🏻

A work colleague has been under the NHS for weight loss. She is currently 4st down, with a fair bit to go but whatever they are telling her is working. Slowly but surely.

Well exactly

I'm pretty knowledgeable about my asthma, my triggers, my treatment, when to increase or decrease my dosage

But when I want advice or support I got to my asthma nurse. Because she provides medically tailored advice for my condition

Do people on the thread asking the OP why she asked for medical advice also think I'm wrong for going to my asthma nurse?

There are 2 things at play. Firstly the referral to this group, run by a private provider. This is a quick way for the NHS to 'provide a service' and tick a box. I'm sure NHS have the outcome figures but I'm also sure these figures are far from accurate. I wonder who is managing this? Are these providers just being told to do the Eatwell plate etc? Also note the referrals to WW and SW - another tick box and 'quick fix'.

Secondly the weight loss. It seems there are 2 types of people - those that believe everything their GP/the government tell them and those that research. Given the plethora of info out there, ease of access to online resources, what is the excuse for not having some basic knowledge or to question? Weight loss, at a basic level is consume less energy and expend more. So 'eat' less, move more. There are hormonal issues and upf addiction considerations. However are we saying that if someone tracks calories, eats fresh, unprocessed food ie salad,veg, meat and fish that they won't lose weight?I don't believe this. It may be that a menopausal woman needs to drop calories to pretty low but that's because that's all her body needs.

I think it suits a narrative, and pharma, to say 'it's complex', 'everyone is different' but ultimately, on paper, it's simple. In real life however it's challenging for many reasons. Couple that with many people wanting to abdicate responsibility and look for someone else to solve their problems it's a recipe for disaster.

My local GP service refers people to the Slimming World cult regardless of your medical situation. On my records they know I'm diagnosed with bulimia, yet they tried several times to sign me up to a diet that allows unlimited access to 'free' foods and talks about food in a morally loaded way by calling it 'syns'.

When I complained, they refused to stop sending me the invite letters on the basis that it's 'too difficult to screen out people with eating disorders'. They only stopped when I revoked my permission for all unsolicited contact so now I might be missing out on relevant local health information.

GPs have absolutely no idea about how to treat eating disorders, nor do they care.

Has your GP offered you metformin? It’s well tolerated and has a long hx of use in the nhs.

It’s true the public expect the nhs to be an expert in everything, I was in a clinic recently where a patient wanted advice on the proper way to tie shoelaces as they’d never been shown how to professionally tie shoelaces. Luckily I was on the computer so they couldn’t see my epic eye roll.