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.

Exactly, it's the "mental" side of eating disorders that is massively lacking.

No sane person needs telling that they should eat less cake, fewer McDonalds, less high sugar/salt processed foods, etc. And it's a travesty that the NHS is paying dieticians to tell people the bloody obvious like that.

Like other addictions, people need proper mental health advice, strategies, etc., to help them reduce the intake of "bad" foods. That should be part of the dieticians job, i.e. how to deal with eating disorders, as that's the real problem!

If you haven’t already tried it, you might want to give myo-inisotol a try. It’s a supplement that has actually been proven to help PCOS - I was recommended to take it by a fertility specialist.

Also, metformin/glucophage is also proven to help with PCOS and insulin resistance. It has some nasty side effects but may be worth it in your case. It can also help weight loss. If you aren’t already taking it perhaps bring it up with your doctor?

Good luck with the tests - I hope you manage to get things sorted out.

I asked my GP about myo-inositol because I am on several medications and they scoffed and told me that vitamins just give you expensive wee

I am on it but I had to research the possible conflicts with other medications myself because the GP wasn't interested

this is part of the issue when they treat PCOS as a "fat woman - eat less move more" problem

I think you’ve unintentionally highlighted one of the key issues there. There are many ‘real’ issues when it comes to obesity and although some obese people are obese for the same reasons, not all of us are. I refer back to going to the doctors for abdominal pain and being prescribed gaviscon even though the GP has no clue what the actual origin on the abdo pain is.

For example, I have never in my life binge eaten, I don’t eat takeaways or junk food more regularly than other people, I don’t eat emotionally and I walk 4 miles per day during the week.

Personally my problem is metabolic syndrome, so a mental health approach to weight loss won’t and hasn’t worked for me. My issue is a physical one, treatable with research and education which is what I’ve accessed for myself given it wasn’t available for me from the NHS.

Dieticians do tend to 'baby' people, in my experience. They treat everyone with a weight problem as a bit of an idiot and yes, start from the point of 'food groups' and healthy plates.

I'm sure they occasionally get a client who is genuinely ignorant to basic nutrition but in the main they are faced with people who have been on diets all their life and have a better knowledge of the caloric value of individual items than they do!

The truth they're desperate to avoid is that, for the obese, their problems are often more about addiction and emotion - much harder, and more expensive, to deal with than 'what is a healthy portion of pasta'.

That’s frustrating but it’s good that you are standing up for yourself on this.

I took it as part of fertility treatment and on the advice of two different doctors and it seemed to be effective at regulating my period and almost completely cleared up my hormonal acne. I don’t know to what extent it helps with the insulin resistance aspect.

The absolute stupidest thing is that there are actually plenty of thin women with PCOS. It’s linked with being overweight but that’s not at all the whole story. They go largely undiagnosed unless they have fertility problems.

I’m actually not in the UK and private health care where I live is much more accessible and doctors are much more willing to think outside the box and try alternatives. It’s very sad to see how bad things are with the NHS.

This is exactly what I have experienced. I remember chatting socially to a community dietician who worked on weight loss programmes in the community. She said how hard it was to get people to lose weight. So I started chatting about the complex barriers there can be around emotion/ psychology/ behaviour/ environment etc. and she just looked stunned. She had clearly never considered any of this.

I once mentioned at a doctor's appointment that my endo specialist had diagnosed me with PCOS (on top of an ongoing auto-immune disease) and the GP asked me what it was . I asked him if he was joking and he then looked it up, in front of me.

It's madness to suggest that someone with a metabolic disorder should sit in a room with others who don't have one and expect advice given to be the same.

It's also bonkers that so many women with fertility issues due to PCOS are told to 'lose weight' as if that's as simple for them as other women.

No sane person needs telling that they should eat less cake, fewer McDonalds, less high sugar/salt processed foods, etc. And it's a travesty that the NHS is paying dieticians to tell people the bloody obvious like that.

Tbh I fear that there may be some who do!

The problem as others have said is the "once size fits all" approach.

Some people cannot be helped. My Fil has t2 diabetes due to his weight and lifestyle. He thinks he's being good by drinking less coffee but having 2 surgery shop bought hot chocolates per day. He thinks as he is given a tablet he's fine. Its shocking. Lovely guy but not the brightest.

DH is diabetic and the advice he’s had has been dreadful. He also has a bowel condition which means he can’t eat brown bread. He’s worked out how to manage it very well himself.
He did see someone last year who pushed him into carb counting again which was frankly a disaster.

the skinniest I got to is because I was lifting weights and eating high protein calories. When I stopped exercising because of lockdown i piled on the weight. I’m actually so confused what works now I don’t know where to start again.

Your experience doesn't surprise me, OP. I don't actually know why dieticians bother going to university or studying at all, as (if I give them the benefit of the doubt), they are stymied by a system that tells them exactly what generalised, grossly inadequate, tick-box statements to say and that's it.

A dietician I saw during my son's cancer treatment refused to answer any of my questions (e.g. in children of x age, with x diagnosis, what are the best ways to ensure the child gets the most nutrients they can, particularly given the damage done by treatment, which prevents them swallowing and digesting certain types of foods, changes tastes etc). She told me, and I quote, "No NHS dietician is allowed to give you advice like that. I can only tell you about x (the fake food they want you to pump into your kid through a tube)." I had zero interest in fake food, given it's poor side effects, and asked for guidance on a blended diet. I got the blank wall again with "As an NHS dietician I am not allowed to give you information on a blended diet, all I can tell you is about x (fake food)." As far as I can see, she was just a drug pusher for the fake food company.

This isn't AIBU but you were being unreasonable to approach the NHS for tailored dietary advice.

And also when it was apparent that the girl leading the session wasn't that clued up, why did you ask her "difficult" questions that you already knew the answer to because by your own admission you are clued up and have done your research, just to make her look small?

I have yo-yo dieted all my life and have a history of eating disorders and the LAST place I would look for help is the NHS. This isn't their problem to sort, it's mine.

Why exactly is OP unreasonable in approaching the National Health Service for advice about a medical condition?

I did a 12 week or so course via a local football club and their advice actually was a bit more clued up, but still a bit "one size fits all".
However, with the dietary sessions there were also exercise sessions in a local park. I didn't lose weight, despite eating well and doing their exercise.

What did help me (and only speaking for myself) was to 16:8 intermittent fast and take up running again.

The NHS is very much "leaflet says X so if it doesn't work for you, it's you who's the problem, not our advice".

"Difficult" follow up question is subjective - I'd suggest if I as a layman can ask for clarification of the difference between glycemic index and glycemic load, then an NHS sanctioned dietician leading a course, whos entire job it is to know this stuff probably shouldn't find that question in any way 'difficult' to counter if I was wrong, which at the time, I had no idea if I was or not. The problem with research as a layman is that with the best will in the world, you can't be 100% sure of the validity of your sources hence asking for clarification from an expert.

It would be great if the NHS could fix everything but it just doesn't have the resources. It sounds like you are the ideal person to start a Facebook support group for people with your condition - you probably know more about it than most primary care practitioners.

I have an uncle who's the same, still 2 sugars in his tea 6 times a day, still has cakes and chocolate when he wants to as a 'treat' but because his BM's are stable he's told each time he goes to the diabetic clinic that he's doing the right things.. idnoring the fact he's on max dose metformin to keep him stable...

I have issues with the ethics of that - I'm not a dietician, I'm not in any way medically trained so wouldn't want to be offering advice to strangers online.

I had a very similar experience, but it was during COVID so we did it online the two ladies that did it had no idea how to deal with anything out of the norm 😕 for our group we were all over 50 and needed specifically to talk about diet to help with peri menopause or post menopause as some were in there 70s. It was the eat well plate which is far to high in carbs. I saw the course through but ended up heavier. Now I do fast 800 and take Rybselsus and lat 5 stone in 6 months. Not healthy but I look and feel better and my bloods show good results

I completely agree that it’s a disgrace. And just so hard to find a solution. I have the same condition and dislike the medication available, metformin made me nauseous and I felt so unhealthy on orlistat. I went to slimming world for 6 months and the consultant accused me of lying on my food diary as according to her I couldn’t be eating so little and not losing weight.

Out of interest for T2 - How many carbs a day is low carb?

Totally agree.

My parents have been pretty unimpressed with every NHS dietitian they've met.

My parents did say the national diabetic societies were much better for dietary information - so if there something like that for PCOS they are likely better for up to date information.

I agree OP and while they should be sure that someone has made sensible efforts to lose weight before going on to medical interventions, the process is currently too long and littered with bad advice. If you speak to some of the same doctors who deal with larger patients and work on the NHS they will encourage you to go private because after a certain weight, getting it off irrespective of how you do so is going to be the best thing both for your health and public spending.