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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:
DragonMama3 · 03/01/2024 09:16

JustanotherMNSlapperTwat · 03/01/2024 07:52

I also have PCOS and I was directed to the NHS weight loss service

I attended for one session where I was told I should eat up to 12 slices of bread a day so long as I avoided too much cheese

I didn't bother going back

I was told to eat potatoes and pasta. I was like erm, this isn't right...

LovelaceBiggWither · 03/01/2024 09:19

drspouse · 03/01/2024 08:57

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.

So you and your spouse do not have T2 but have a magazine you read and based on that you can confidently tell people with actual T2 that we don't need low carbs?

Wow.

I'd love nothing better than to eat all the carbs but as I don't want to go blind or develop gangrene and lose my limbs I follow a low carb diet and my blood glucose control is excellent. Loosen my compliance and my blood glucose control is not excellent.

NonSequentialRhubarb · 03/01/2024 09:22

I've never bothered to pursue weight loss help from the NHS as I don't believe it would be any good.

When I was pregnant, I had gestational diabetes. When I asked for help managing my diet for it, they reluctantly send me to the dietician. Who just showed me an Eat Well plate but also told me not to eat carbs. When I asked questions about specific weird things I'd found from my own diet (eg I could eat a peanut butter sandwich and be fine but a bacon one spiked me a lot), she'd just say "oh well everyone's bodies work differently".

When I went online and looked up gestational diabetes support groups, the wealth of information there was amazing. So many tips that did actually help me control my sugars. And not one of those tips was ever mentioned by anyone from the NHS, including the consultant!

Interested in this thread?

Then you might like threads about this subject:

vickylou78 · 03/01/2024 09:23

Op have you tried just restricting calories? Surely weight loss is just about the amount of calories in versus the amount used? And if insulin issues the calories you take in should be low carb?

I know calorie counting is miserable and you may feel hungry for a few weeks but if someone really needs to lose weight then this is how to do it... Isn't it?

I must admit I can't keep to calorie controlled diet for long as it makes me so sad but you can't deny that it works!

CeciledeVolangesdeNouveau · 03/01/2024 09:23

Yes, and what would be the financial incentive to conduct clinical trials on T2? Unless there’s another drug in development, none.

Nospecialcharactersplease · 03/01/2024 09:27

Lots of people letting the NHS off the hook here as a Jack of all trades and a master of none. Surely if it’s going to invest expertise in anything, it would be obesity - driver of all the metabolic diseases that are the major causes of ill health and death these days (diabetes, heart disease, cancer).

Others also seems affronted by the OPs willingness to challenge NHS gospel and ask for the evidence base. I get people are deferential to health professionals, but the advice for obesity sufferers is horse shit and it’s completely fine to challenge where it comes from, when it was last reviewed and what alternatives might be available. Same with women’s health, come to that. Nothing will change until it’s a priority, and that won’t happen until it’s seen as the national scandal it is.

After decades of doing everything under the sun, I am in a similar place to OP. Slimming World fucked me over massively in the long term, mentally and metabolically. Tried working with a dietician privately - explained I had PCOS and disordered eating and wanted tailored advice, but it turns out she was just an NHS robot doing private work on the side and she got out that damn healthy eating plate and told me to eat a matchbox of cheese everyday. Thanks, love.

Maybe we can have a supportive thread for insulin resistant women? Everyone bringing their own failures and successes so we can learn together? I for one would be interested in those Swedish guidelines a few PPs have mentioned…

itsmeagainagain · 03/01/2024 09:28

I don't wish this to sound rude OP but it sounds like you perhaps already know the best way to eat for PCOS... I have PCOS and I know that low carb works best I just struggle to follow that way of eating - is it a willpower problem? The NHS guidelines on weightless are massively outdated

CeciledeVolangesdeNouveau · 03/01/2024 09:31

The nhs doesn’t have the time or the manpower unfortunately. As I’ve said upthread I struggle with undereating and have just been released just after being promised monitoring for refeeding syndrome which can kill you in a literal heartbeat. They are drowning right now and there’s nothing anyone can do sadly.

AlwaysPettyOnTheInside · 03/01/2024 09:33

Metabolicallycomplicated · 03/01/2024 07:51

This is exactly what works for me, yes. I 16:8 and follow LCHF. Lost 5st in a year. I also have no gallbladder though so high fat can cause issues for me, hence asking the NHS for help with alternatives.

I'm not sure what else you expected them to tell you tbh. There are only 3 food groups.

But yeah, the advice they dish out is bullshit. I didn't attend the 12 week course they sent me to for raised BG because they tell you to eat carbs. Many of the practitioners don't agree with it, but its the NHS line so they have to push it.

There's a lot of history behind this, the low fat, low calorie trope, the 3 meals a day, the wheat & corn is good for you - it all comes from food manufacturers and big pharma. Its not in their interest for people to eat less, or whole foods, or be well.

High fructose corn syrup is the worst, and America lace their bread with it. They fill their 'food' with waste products from other food manufacturing processes just to make more money. Its not in their interest for people to eat whole foods and cook from scratch.

Metabolicallycomplicated · 03/01/2024 09:36

Just clarifying I’m not looking for diet advice or suggestions here for myself, I’m fully aware what I need to do for myself, this is a conversation about the systemic issue with weight loss advice from the NHS.

OP posts:
Noroomontheshelf · 03/01/2024 09:39

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.

No, it’s because the NHS is free at the point of use. No one is assessed for their ability to pay for their treatment privately before being prescribed drugs or treatment.

WW & SW are part of the drive to ‘social prescribing’ which means that instead of just giving people drugs/ medical interventions, GPs prescribe community based interventions such as the gym or SW/ WW.

CeciledeVolangesdeNouveau · 03/01/2024 09:42

There are unfortunately a ton of problems with the NHS which don’t look like they’re being fixed soon. None of them are OP’s fault and she’s allowed to point them out.

balou85 · 03/01/2024 09:44

if you're working in addiction services, you see many people who want support via a 12 step programme or other motivating tools to help with their addiction, but ultimately the ones who succeed have reached rock bottom or a place where they know it's
now up to them. They need to be ready.
Research also shows that when people attend therapy, the best indicator
of therapeutic success is when the client is ready to change. From personal
and professional experience, I'd say the same applies to weight loss.
When you're ready and acknowledge your
own very active role in managing your own problem,
that's when change happens.

AlwaysPettyOnTheInside · 03/01/2024 09:45

Regards SW and WW, and the 12 week course, I'd rather have had free or reduced sports. SW is not healthy either. I'm not so sure about WW but SW does not promote health at all.

Metabolicallycomplicated · 03/01/2024 09:46

cryinglaughing · 03/01/2024 08:40

You seem knowledgeable regards diet.

What were you hoping/expecting from this service?

I am knowledgable and have lost 5st. I was hoping for advice on a more sustainable long term eating approach than LCHF, because as mentioned, I have no gallbladder so higher fat eating won’t be sustainable for me forever. I wanted this advice to account for the fact I have PCOS and am insulin resistant. I also wanted access to a dietician I could ask questions of, and receive science based answers.

OP posts:
CeciledeVolangesdeNouveau · 03/01/2024 09:48

OP, maybe you do need a one off with a private doctor if you can find the funds? They aren’t generally the best to be honest but there’s probably one out there who is an expert on what you need. It’s in the NHS’s interest to get you better but mostly you have a one size fits all service and it doesn’t fit people with additional difficulties.

Heatherjayne1972 · 03/01/2024 09:51

How right you are op

id like to add that food choices in the uk are awful as well. Not so much the supermarkets as there is choice of healthier foods
But my partner is a lorry driver and there’s no healthy food at service stations- at all
plenty of kfc/ Greggs/ Starbucks / mc Donald’s etc etc Lots of beige food but for a diabetic lorry driver there’s no healthy options

thats another scandal

NoCloudsAllowed · 03/01/2024 09:54

You're right, it's shit and underfunded.

The official advice changes at a glacial pace. Obesity is a complex problem that would ideally have a multi-agency approach involving the whole community, the NHS just can't do that and there's zero political will to make change that would put people's backs up.

FormerlyPathologicallyHappy · 03/01/2024 09:54

A lot of nhs dieticians work with patients who are on enteral feeds, it’s a complex area of medicine, or eating disorders. It’s not really for advice on sustainable weight loss their trying to keep people alive who are literally at risk of immediate malnutrition/starvation and have comorbidities such as strokes/cancer such as head and neck cancers where the swallow reflex is lost.

JustanotherMNSlapperTwat · 03/01/2024 09:55

Heatherjayne1972 · 03/01/2024 09:51

How right you are op

id like to add that food choices in the uk are awful as well. Not so much the supermarkets as there is choice of healthier foods
But my partner is a lorry driver and there’s no healthy food at service stations- at all
plenty of kfc/ Greggs/ Starbucks / mc Donald’s etc etc Lots of beige food but for a diabetic lorry driver there’s no healthy options

thats another scandal

You are right that is a nightmare

My DH has encyclopaedic like knowledge of all the service stations with an M&S foods because its the only place to get a decent salad

Otherwise it's a game of "which pack od sandwiches is least unhealthy" when the reality is they all are

Youvebeenmuffled · 03/01/2024 09:56

Exactly my experience, I’ve found following pcos mentor and their recommendations of vitamins/supplements helpful.

always managed before gallbladder removal by low carb/high fat but since it’s gone I can no longer tolerate this and despite sticking religiously to no more than 1200 cals and exercising the weight has piled on

Noroomontheshelf · 03/01/2024 10:00

From personal experience, the people I know who work as dieticians/ health promotion/ fitness and weightloss trainers, have no personal experience of issues with food. They are healthy people who have always loved being active and are interested in food and healthy eating, and that is their interest and motivation for the career path they chose.
To a person, they have no understanding of why people would have issues with weight or food, and are sneering and mocking to those who do ( behind their backs).

In my view that are wholly unsuited to the profession they have chosen and have no empathy with, and little compassion for, the people they work with.

christmaspawpaws · 03/01/2024 10:00

KFC do a rice box or salad box
McDonald's do a grilled chicken salad
Greggs do lean meat sandwiches
Starbucks granted is more tricky!

BubbleBubbleBubbleBubblePop · 03/01/2024 10:02

Metabolicallycomplicated · 03/01/2024 07:51

This is exactly what works for me, yes. I 16:8 and follow LCHF. Lost 5st in a year. I also have no gallbladder though so high fat can cause issues for me, hence asking the NHS for help with alternatives.

If you can't handle high fat, can you not do low carb without high fat? That works very well for me.

vintageshopshopping · 03/01/2024 10:02

The NHS generally is a scandal