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.

Did you get the rybelsus from your GP or privately?
Well done on your weight loss :)

My GP actually said this about long Covid treatment! I thought I had it ( thankfully I didnt) and he said " Just hope you haven't got it, the treatment is useless. and based on nothing".

I think everyone has put together all the issues.

1. Everything moves slowly in the NHS. There is a group of HCPs /scientists - the Public Health Collaboration (videos on youtube) who are trying to effect change. (I highly recommend taking a look at them)
2. Obesity is a multifactoral problem which needs individualised treatment planning - I'm not sure this is every likely to happen as it would be quite costly (and not as profitable as making us fat then feeding us medicines to make us temporarily thinner)
3. Our food environment does not match what we are asked to eat to stay healthy. I'm not sure it will change because there are large lobby groups and companies that make a huge amount of money on making us fat and then selling us temporary 'thin cures' that harm us long term.
4. We're focusing and putting money into the wrong things - everyone talks about 'education' but in Health promotion education is shown to be ineffective at changing behaviour - what changes behaviour is making the decision you want people to make (ie healthy eating) the easiest decision for them through 'Health in all policy' approach - transport, approving new food outlets, subsidising vegetables, service commissioning, green spaces, housing etc.

I agree.

Weight management advice in the last 50 years is a scandal and now there is a scientific and evidenced solution (though still not easy and would benefit from proper support and joined up thinking) it apparently isn’t being used.

As for your use of the phrase ‘moral issue’ I think it might take generations to get past this sadly.

So along with our culture of fast food and sociable eating and highly processed foods and repeatedly rewarding kids for test scores in primary schools with sweets (I kid you not) it is there is a lot to address.

some choice contributions I have had from the NHS when I have asked for help between ages 30 and 50 several different Drs and Nurses

’here is the number for overeaters anonymous’

’you just need to eat more salad’

<frustrated face> ‘are you depressed???’

here is a prescription (it worked and a few weeks later I was in a and e on the way to gallbladder surgery) and I developed a food phobia for a while after which also worked

at follow up having lost a lot in an unhealthy way, see above ‘would you like to get your varicose veins done now so you can swim without embarrassment’

’your Knee hurts because you badly twisted it while hiking you say? Best solution - loose the weight’ well dr could we try physio since loosing weight is neither easy nor the actual cause of this particular pain ffs

’yes there is potentially a link between your ovarian cancer and your longstanding weight problem / repeat miscarriages’

most recently oh well’ll run some bloods - result hypothyroidism
this won’t have helped my plight over probably the last 10 years and hasn’t ever been tested before

ffs

NHS dietetics proper is no better in our area.

Support for my son, who's autistic, non-verbal, intellectually disabled and eats 3 foods consisted of adult info sessions explaining what a 'healthy' diet is.

Not a word about how the fuck we might get him to eat it.

From reading some of the replies on here I think part of the problem seems to be that people are maybe not being referred to, or are not looking for, the kind of help that they actually need.

In very general terms, for the majority of people, the way to lose weight is to eat less and move more. When your body is burning more calories than you are consuming, you lose weight. So in that sense, weight loss is really simple (generally).

That is why calorie counting and exercise works- slimming world, WW etc are just variations of calorie counting that they make money on, with the added motivation of attending a group, getting weighed publicly, having that support system to keep you “on track”.

BUT as many people have said on this thread, it is the mental side that a lot of people struggle with. If you are at the doctors because you have 10 stone to lose and you know you binge eat, then what you need is not really help with weight loss in the sense that you probably know what you should be eating. You need help with that mental block so that you CAN do what you know would help you.

I don’t know if that’s a GP issue or a personal issue, are people going to the GP and just asking for help with weight loss without saying “btw I know what to eat but I suffer with a binge eating disorder” for example, in which case they are being signposted to the wrong kind of help if they are even seeing a dietician as they should be seeing a counsellor (I would argue anyway).

Ive just completed a course run by my NHS area for people who are pre diabetic. It was very good. Take a look at the Freshwell app. which is excellent!

I don't expect my GP to be an expert in everything. What I expect is for any GP to be able to recognise the limit of their knowledge and properly refer on to someone more specialist if needed. Too many times this isn't actually done, despite NICE guidelines.

Its not clear if you were replying to me but if so, then I am not asking for your advice on my weight loss. You clearly need to be more informed if you think a weight loss drug will magically cure an eating disorder.

100% agree. Same PCOS profile as you, overweight with insulin resistance but not T2. In fact I have a pretty good hba1c score which seems to baffle most dietitians. I also discharged myself from the dietetics service, they couldn’t tell me which grains to eat, kept saying to eat miller light yogurt instead of sweets and crisps (of which I eat very little anyway!). Absolute rubbish.

There's a third problem though

There are the people who are overweight from eating too much for whom a simple move more, eat less, here have a weekly weight in - my DH is one of these and it works for him just to keep him a bit more aware of his diet and exercise

Then there are the people with eating disorders of all kinds for whom move more, eat less and have a semi public weigh in is a terrible fix

And then there are people with metabolic conditions and diabetes etc who need tailored dietary advice which is specific to their medical condition

It's like sending an overweight person in a wheelchair to a session and them just being told that going for a gentle walk will help them lose weight.

If the weight gain is in conjunction with an associated medical condition that needs to be taken into account.

When I started putting on weight from POCS I was a size 8 and I was exercising 4 to 5 times a week and had a reasonably healthy (but ultimately not the best for PCOS) diet. Move more and eat less was completely useless for me as was the general perception that I was just a lazy binge eater with will power issues.

I'm now physically disabled (unrelated reasons) and I'm finding it far easier to lose weight following a good diet for pcos and the right supplements than I ever did with all of my exercise before

It is NOT just 'eat less and move more'

1. There is evidence to show that you can feed people the same diet and they will take different amounts of calories and nutrients from it. It is not just based on their weight either. It's quite a lot about the gut.
2. Exercise is for physical health NOT weight loss - it is not effective in producing long term weight loss although it can be part of maintaining weight loss.
3. Different people have different levels of hunger and hunger management is part biological, part psychological - it is useless to say 'just use willpower' as it has been shown that willpower is finite and limited. For people using their willpower to get through difficult lives, there isn't any left over for coping with constant hunger.
4. The 2000 calories a day for 'adults' is wrong for the vast majority of people and for many shorter older women is significantly too high.

It is not as simple as people like to say.

It is awful, I agree. You sound like an intelligent, informed woman who can probably manage to access the right information to help you. But that's not the case with every patient and I worry about the people who are getting terrible advice that will make their conditions even worse.
I fully agree. It's appalling.

It’s because most people don’t have a basic knowledge of diet, blood sugar, insulin etc. I know a diabetic who takes insulin then checks blood sugar…Oh it’s low! What a surprise..I’d better eat some Jelly Babies. Oh now my sugars are too high! Another surprise…better take more insulin.

It’s disappointing when “professionals” don’t have the necessary knowledge. You’re intelligent and have done your research, which means you are the expert. However, as you know, it would be nice to have some validation from someone qualified because then you feel you have support and validation.

Having said that, I’m not sure low carb works long term….I find that keeping carbs fairly low and calorie counting works better. You can’t eat fat and so you’d have to keep your protein high and this will still raise your blood sugar and put a strain on your kidneys. I think the best strategy would be intermittent fasting (8:16) and two sensible meals. I usually go for mashed potato instead of rice because potato has about half the carbs.

I'm not saying set yourself up as an expert, just exchange knowledge with others who are actually living with the condition. The point is that there are other avenues than expecting the NHS to sort out these issues. It is not appropriate for the NHS to cover every aspect of every citizen's wellness - we need more social solutions and individuals need to take more responsibility. If you don't want to start your own group, consider joining some of the existing ones. This one is US-based but has 15,000 members: https://www.facebook.com/groups/255929514435465

I kind of like low carbon 🤣🤣 breathe out more, get rid of that carbon makes as much sense as the 12 slices of bread a day advice the NHS gave!

I've been T2 diabetic for 25 years and I'm still waiting for a GP diabetic specialist or a diabetic nurse specialist to actually tell me when I should be testing my blood sugars and for what kind of level I need to aim for. Everyone says different things and I'm left completely confused, to the extent I don't even bother checking them anymore as I don't know what I'm checking for nor when to check.

You'd think there'd be a simple instruction for when to take it and what kind of levels you need to aim for, but no, nothing. I've looked on the internet, I've looked in the instruction book that comes with the testing kit, but nothing says when to test and what level you're aiming for.

I ask every time I talk to a so-called specialist at our GP practice and am told different things every time. Some say do it first thing before breakfast, others say 2 hours after every meal, others say 2 hours before a meal. No wonder there are so many people with uncontrolled diabetes!

No I totally agree with you that there are different methods/diets for different medical issues, hence I said “generally” in my post there are absolutely going to be people who fall outside of that.

But in your example, my mum also suffers with PCOS, she was given information from the gynae department about what a “healthy” diet for PCOS looks like and she was also made aware that there is lots of info online on this. She knows what she should be eating and shouldn’t be eating, once you know that information it is up to the individual to apply it, and that’s where things like weight loss clubs can come in handy because once you know what you need to be eating or not eating, it’s about staying on track, and for some people having a weekly meeting, moral support from others in the same boat helps.

Finding the right diet/supplements is important but there are many ways you can find that information, not just via the GP.

When I was diagnosed with PCOS I was told by a gynae that I had PCOS that I probably wouldn't have a baby naturally and then she walked out of the room leaving me. I'm glad your mum got better treatment than I did.

There are also many ways online I can find out how to manage my asthma but I expect to be able to discuss the best ways with my asthma nurse

PCOS is a medical condition. Asking the medical experts for help with a medical condition is not something that should be reproached.

It's baffling to me the dissonance. Either the NHS has dieticians in which case they should be fully trained to deal with a range of conditions like any medical professional should be. Or they shouldn't have them at all and people should look elsewhere.

But it's not okay to just go "Oh well they are a bit shit but it's your own fault for asking them, although they are paid for by the tax payer you should have known to use better, different sources of information"

I am truly sorry that was your experience with gynae, my mum did have a great experience and so did I when I was investigated for PCOS prior to falling pregnant so I’m sorry you had such a bad one.

Your likening it to discussing asthma with your asthma nurse is a makes sense, but makes my point that just a general GP or a “course” on diet isn’t the way to receive this personal dietary advice. OP was sent on a course built for weight loss for the general population- mis sold by the GP as having also knowledge of PCOS, diabetes etc. The course is being presented to a group of people at a time and presumably contains the basic information for weight loss in general AKA better diet, exercise etc.

If you need to receive specific tailored advice from a professional that there is a service for that (or should be, there is in my area which my FIL accessed as a T2 diabetic). Your GP can refer you for a personal appointment with a dietician which is just you and them to receive more personalised info.

IME weight loss is used by some GPs as a way of gatekeeping access to services.

You could go to an appointment with your left leg in a carrier bag and would still be met with the head tilt and a suggestion that what you really need to do is lose weight.

So true.

That and the advice to take paracetamol and come back if symptoms have not improved within three weeks.

I think they struggle with the idea that you can have two separate things wrong with you at the same time.

The orthodoxy is that being overweight is the cause and can never be a symptom or completely separate.

As a patient you do need to be able to advocate for yourself, remind your GP what medication you are already on and why. I take warfarin which reacts with anything and everything and constantly have to remind HCPs whenever something else needs to be added to the mix.

I do wonder what will happen when my memory starts getting shaky.