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.

I am finding it so depressing to read all of these terrible experiences about weightloss advice from the NHS. I am a recovered yoyo dieter. 1 year ago I decided to stop dieting and learn how to nourish myself and to take care of my own body myself. I read The Obesity code, Ultraprocessed People, Why we Get Sick, Fast Feast Repeat, Atomic Habits, Spoon Fed, the Diet Myth and various others. I have listened to hundreds of podcasts, my favorites include dr Chatterjees, intermittant fasting stories, The Doctors kitchen and the Zoe. I have had to teach myself to heal my body through targetting my gut microbiome, focusing on whole foods, intermittant fasting daily and improving sleep and stresd. I have lost 20lb, i no longer binge eat, I can hear my body signals now for the first time in my life. I would have got none of these life skills from my GP or the NHS. I am actually thinking of retraining to become a health coach because I can see so many people struggling like I did who dont have the time or headspace to research themselves.

I’ve read all Gary Taubes’s stuff and I have the obesity code downloaded to listen to on audible. I’m cautious of echo chambers though so I’ve also read a few titles that attempt to debunk low carb eating.

Thanks for the tip, I will check out Gary Taube.

I was given free access to a choice of 3 apps. All had awful reviews and no real I formation. I chose 1. The "help" was to upload a photo if what I was eating. No feedback or advice. I had a phonecall.planned about 3 months in. Wtf is the point?

Theissue is, many of us KNOW what we need to do. But need sone support to actually do and stick to it.

Agree
Much of the nhs advice hasn't changed since the 1970s. Baked potato good, butter bad. Chicken good but don't eat the skin.
Have cereal for breakfast and limit eggs. WRONG

Losing weight is about calories in and calories out, so it is about eating fewer calories....but

In order to do that a person needs the right tool for them

The tools might be a particular way of eating that is easier for them to get less calories in them, whether that be fasting, lower carb, low fat whatever. That will differ from person to person

The tools might be medical intervention like orlistat, it could be wegovy/ozempic, it could be weight loss surgery

The tools might be weight loss clubs

The tools might be managing medication for other disorders which make it difficult for someone to manage their hunger feelings or cravings or manage metabolism

The right tool needs time to assess and work through/combination of tools and thats not what people are being given.

This is a good way to view it I think, i like a similar analogy that is basically ‘thermodynamics is as true and as useful when talking about weight loss as it is to say that in order to cure a patient of cancer, you just need to get rid of the cancer’

@JT69 you actually got contact with that app all I get told is they don't have enough coaches. Messaged me on Christmas day about not falling into old habits on national binge day.

My GP recommended a low carb diet to me. I’m slightly overweight with high cholesterol. It has helped to bring it down. He told me that most of the NHS dietary advice was dangerously out of date and I’m inclined to agree with him.

Dieticians on NHS are like unicorns - extremely rare!

I’m Type 2 diabetic and some of the NHS advice I’ve seen aimed at Type 2 diabetics is frankly bizarre.
One recent example shared on a diabetes forum stated, “fill up on fibre and starchy (carbohydrate) foods.” It then went on to give examples - whole grain cereals, whole grain pasta, whole grain rice, whole grain bread, potatoes - and said, “make these foods the main part of every meal.”

Every meal?!? I also couldn’t believe it said to “fill up” on these foods. 😱

This thread has really helped me. I e been hanging on to "tier 2" support (a.phone call from a coach every few weeks ask me how I'm doing but no nutritional advice or ability to advise really) in order to access tier 3. I thought in 2 years time (the rule in our area) I'd get more tailored support and if it didn't work surgery. I will still have that as a back up plan but it's making me realise the tier e support isn't likely to help me lose weight.

It's quite frightening to feel I've been struggling with this for 10 years and the NHS hasn't been able to help and actually isn't able to even guide in the right direction.

But also quite reasuring that it's not that I've done anything wrong the support just isn't out there. Which is crazy.

I really have just been looking for help as I want to suss it.

The biggest change would be to switch medical thinking around and see being overweight as likely a symptom not a cause.

Unintentional weight loss is seen as an indicator that there is an underlying problem. Medical thinking jumps to look for that problem.

Unintentional weight gain is seen as a moral or educational failing. It is seen as a personal or societal issue. Medical thinking is that it is none of their business. Hence patients being batted away onto ineffective weight loss schemes.

But if you switch the thinking around and start to see unintentional weight gain as a symptom then you will start to see a number of potential causes. Each of these will have its own approach.

Yes that sounds it exactly!

You say a diabetes forum, but was that from the NHS or jus someone posting like we are here?

There does seem to be this view from certain quarters that anything termed 'whole grain' is somehow really wholesome and good for you and we need more of it

Its marketing speak

I dont disagree with this in theory but I also bear in mind that other countries that dont have the same food availability or food culture as us (ie crappy processed foods and huge volumes) have less obesity and less overweight

Which indicates to me that largely and mostly its about eating too much of the wrong stuff pure and simple.

And unfortunately I count myself within this group!!!

Low carb moderate fat lots of protein
Type 1 no gallbladder works for me the best
Avoid dairy

@ThreeBeanChilli i start the tier3 on Tuesday. It is an 6 month programme and involves keeping a food diary and a monthly video appt with a “nutrition advisor” who will help you identify small changes you can make to your diet. It doesn’t involve them recommending a specific diet. You can be referred to tier4 at the end if you lose at least 5% of your weight during the programme and have improved mental wellbeing scores. I’m already calorie counting so not sure what the nutrition advisor will advise that I’m not already doing 🤔

However in Italy, where obesity levels are generally much lower than the UK, 30% of women with PCOS are obese, compared to 38% in the UK which is not a actually big difference

For comparison 11% of people in Italy are obese compared to 26% in the UK, so a wider difference in the general population compared to the people with PCOS

Thereby implying that the issue with obesity and PCOS is far more linked to it being a metabolic syndrome and a health condition than it is to someone's diet

@soupfiend I think availability & culture is an over simplification.

I'm a hugely overweight t2 diabetic. I'm not a sweet or biscuit eater (evidenced by the untouched open tub of Roses in front of me). Takeaways are a few times per year. Most of my food is home cooked from scratch.

Yet I'm still massively overweight.

What I do have is an excitable immune system which attacks my blood, my thyroid and now, my skin. It has also been suggested that the diabetes is an autoimmune response.

So does being overweight cause my autoimmune issues, do my autoimmune issues cause me to be more likely to be overweight or are the two things unconnected? Answers on a postcard.

All my GP sees is that I am overweight. Thankfully my haematologist can see past my vast bulk and sends me for regular blood tests to work out which organ my immune system is now targeting.

The problem is that the blanket advice approach doesn’t recognise that ‘the wrong stuff’ isn’t the same for everyone. For example, a pasta bake with a side salad - advised to eat on NHS program as ‘healthy’ and a good choice but for ke that would spike my insulin response and cause weight gain and worsening PCOS symptoms.

Your comment also assumes fat people all eat takeaways and huge portions which also isn’t true in all cases. For some people it could be, but those are not the people who reach morbid obesity before they change their behaviour. A fat person who doesn’t know the caloric contents of most foods and whether they are healthy or not is a rare bird indeed.

Oh I'd have thought a pasta bake and salad was a "good" choice.

I feel so overwhelmed not knowing what to do.

This, really.

As the OP stated obesity is a huge cost yet preventative help is not there/ inadequate. But they are useless for pretty much everything.

Mental health services virtually non-existent and if provided at all consist mainly of CBT which isn't appropriate for certain people/ conditions. Pretty much no way of accessing any long-term therapy through many Trusts unless you are sectioned.

Terrible treatment in many places for menopause with GPs refusing to prescribe HRT to many who need it.

Horrific maternity care. Inhumane post-natal wards in particular. Appalling lack of treatment for birth-related injuries. Misleading information routinely provided to mothers about the respective risks if C sections versus vaginal birth.

Waits of over a year in my local trust for smoking cessation appointments.

Conditions such as ME/ long Covid still dismissed by many doctors. For decades they tried to convince ME sufferers that it was a psychological problem!

Similarly tens of thousands of neurodiverse people never referred for diagnosis until adulthood and then having to fight for this or even be told the NHS won't provide the service at all in certain Trusts! No support services post-diagnosis in most areas. Diagnosis for children taking years to complete.

Waits of 2-3 years for children in needs of a simple grommet operation in some areas so that they go through half of primary school practically deaf.

No compliance wjth the Equality Act requirements to make public services accessible for disabled people.

No cohesive care for patients who have multiple conditions so that the interaction is considered. Even with specialist consultants it is all in silos and they don't speak to each other to agree a co-ordinated care plan for each patient.

GPs providing outdated information on everything from diet to dermatology that actually causes more harm than receiving no advice at all.

Insistence that all respiratory issues are viral even when there's clearly an infection leading to severe complications due to a blanket unwillingness to prescribe antibiotics even when this is very risky for the patient.

Failure to vaccinate children against chicken pox until recently when this has been part of the standard vaccination programme in other countries for decades, justified by using children as human shields to protect adults against shingles because they don't provide the shingles vaccine, either.

Far too few regular health checks and screenings to pick up health problems at an early stage when they are more treatable and cheaper to treat.

Children don't even get a paediatrician as a GP as they do in the majority of healthcare systems in developed countries. Even in children's hospitals often no bed is provided for a parent, and no food even for breastfeeding mothers whose children are patients.

The UK has one of the lowest cancer survival rates in the developed world.

A&Es... well. A joke. Ambulances taking several hours to arrive.

Pretty much zero dental care now provided.

Horrendous hospitals that are often filthy, wards without private rooms (almost unheard of in most developed countries). Inedible food that I wouldn't feed to a dog.

Usually waiting until a crisis before treating rather than focusing on health and preventative medicine and early diagnosis which is far more expensive. No wonder the number of people chronically unwell is rising year on year. No linking up between community services, social care and healthcare. Buck passing and cover ups of mistakes.

Totally irresponsible policies on medication security leading to essential medicines being unavailable sometimes for months at a time. The NHS/ Government response is to shrug and blame external factors that were completely foreseeable.

There's no really anything positive to be said about the NHS. On pretty much every measure of quality healthcare it is woeful. Far from being a national treasure, it is a national shame.

Excellent post!
No amount of money is going to fix the NHS. It’s broken.

I second this, you’re very intelligent and informed woman. Well done for reading more into it! Absolutely shocking, and you’re right, it would never fly if it was prescribing a Willy-nilly drug that may or may not help. Great post with food for thought (no pun intended).