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.

The current NICE guidelines (that's the ones based on research, not influencers) say weight loss for T2 that doesn't need medication, and low glycaemic index for gestational diabetes. The T2 guidelines are from 2009 so I agree might be a bit out of date but unless you can point to a clinical trial of low carb for T2?

So it's not massively surprising if dietary interventions funded by the NHS go by those guidelines (and that's why Balance, which as I say digests actual research for patients, goes by these guidelines as well).
Wholegrains are lower glycaemic index than white rice/bread so for women with GD who have previously been eating white bread, wholemeal bread is a vast improvement.

I've mentioned this upthread, but the NHS is not responsible for public health. So interventions that prevent disease, promote wellbeing, prolong life, reduce inequality etc are the responsibility of local authorities. So people need to be challenging their local councils about the quality of services.

@InfraredMarbles has it spot on

I don't get why people are so defensive about the NHS.

Most other systems are better?

I've had so many bad experiences I just don't bother unless it's absolutely necessary.

I've had to pay for various services the NHS wouldn't provide.

Exactly the problem! Pasta bake may well be an excellent choice for you if you're metabolically well, i however have insulin resistant PCOS so for me, that would be a big problem.

But glycemic index literally means nothing to a t2 diabetic - it doesn't speak to total insulin response. What does speak to that is glycemic LOAD, which is a much more accurate indication of the impact a food is going to have on total insulin response. It seems like a pedantic distinction until you understand things like brown bread, potato, brown pasta etc have an acceptable GI but a completely unacceptable GL, ergo these foods we're telling t2 diabetics to eat as the main focus of their meals are actually as likely to spike their insulin as white bread, white pasta etc and should be avoided.

There's over 100 studies now on low carb, it's one of the most thoroughly research approaches to nutrition globally. Some more specifics on t2 here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319397/

GL vs GI for t2's here:

Also, the 'NICE guidelines based on research, not influencers' comment is laughable. The NICE guidelines are based on 50+ year old studies (7 nations, womens health study, American Heart Foundation etc etc) that were incredibly flawed in their methodology. Ancel Keys in particular was a charlatan and his 'research' formed the basis of government issued nutrition advice for 2 generations. He was the diet and health 'influencer' of his day and his ideas were as pervasive as they were damaging. The NICE guidelines are also 25 years behind the guidelines in much of the rest of the developed world, who either rejected or revised the advice based on Keys and others dodgy research as far back as the mid-90's.

And the worst part of it all is that patients are then expected to express profuse gratitude if - after diagnosing a condition late (often after valid patient concerns have been dismissed out of hand in a patronising manner) - the NHS deigns to treat them at all, in a substandard manner. Because it is "free", allegedly. Except this is not true: we pay an extortionate amount for this inefficient and substandard system. Private healthcare costs a fraction of the tax I pay for the NHS each year which, frankly, may as well not exist because I have had to go private for pretty much every health need I or my children have had in the last decade to avoid waiting years for treatment/ diagnosis.

Vastly superior healthcare with appointments with consultants available within a matter of days and far superior outcomes across the board exists in other countries that pay only a couple of percentage points more in GDP for their healthcare than we do. Yet it's clear that if we matched that funding with say 2% increase in tax and gave that money to the NHS it still wouldn't come close to providing this acceptable (and expected in developed countries) level of care. The money would just vanish into the pit as it has done when taxes were raised previously to allegedly "fix" it.

The NHS model does not work. No other country in the world has sought to emulate it for a very good reason! We do not need to reinvent the wheel: it's perfectly simple to see what works elsewhere and results in far superior outcomes. We need to disband the NHS and implement a model that actually works in the countries that used to be our international comparators before our economy and currency was totally trashed.

My 90 year old MIL was frail and losing weight. Her Dr's advice was to eat a couple of chocolate biscuits with her mid-morning cuppa and with her cup of tea in the afternoon. The result? She had no appetite for her lunch or dinner and became terribly malnourished. I stayed with her for a couple of weeks and fed her on buttery scrambled egg, home made prawn cocktail or salmon mousse, spinach and broccoli soup made with chicken stock and enriched with butter and cream, tiny shepherd's pies with 20% fat lamb mince topped with buttery potato and parsnip mash. Almost everything had hidden veg included so there wasn't a seperate portion to be eaten. She improved greatly and put on some weight, but she was no longer eating biscuits and worried that she wasn't following her Dr's advice!

Several years ago I had ridiculously high blood pressure. Dr gave me prescriptions to reduce it, and the standard 'diet' sheet. The medication worked pretty effectively and at my follow-up appointment the Dr's closing remarks were "don't worry if your BP goes up again, there's plenty more medication that we can give you."

I didn't like the idea of taking meds for the rest of my life so I researched all the other things I could do to more naturally reduce my blood pressure (including weight loss). I experiemented on what worked for me - LCHF being particularly effective for both reducing BP and losing weight. Sufficient so that I could come off all medication. When I went back to the GP with my 'success story' they were not at all interested and cautioned me against a restrictive diet.

In fact my diet is full of wonderful vegetables, including seeds, nuts, and an occasional small portion of pulses (beans, peas, lentils) or higher carb veg (beetroot, parsnip etc). Plus I enjoy being able to have a fatty duck leg, butter on my veg, cheese sauce on my cauliflower. In general, I find it is sustainable long term because it is delicious and satiating.

They’d put a screenshot up on the diabetes forum. The advice came from Tayside NHS’s Diabetes Managed Clinical Network - the publication is an Information Pack for People Newly Diagnosed with Type 2 Diabetes.

I completely agree with your point about the view from certain quarters that anything termed wholegrain equates to being really wholesome, you need more of it in your diet. Must admit looking at carb content of foods wasn’t something I ever did before my T2 diagnosis. When I started and compared the carb content of wholegrain products to their counterpart “white” products (“white” used as a shorthand description), it was something of an eye opener. Whilst the carb content per 100g was lower in the wholegrain products, it was still high enough to take note and make sure you weren’t overindulging.

PCOS certainly makes it harder to lose weight. However excess weight can also contribute to PCOS

Do we have the same numbers of women (or percentage of female population - real females) with PCOS as Italy I wonder

Obesity is a health condition in and of itself, its not just a state of being.

No I dont make those assumptions at all, I can tell you all the calorific amounts in foods just like most overweight people

And like others I got fat on good wholesome home cooked food, I like big rich dishes, probably too much of everything in it, I dont know why you assume that when I say 'wrong stuff' Im talking about takeaways

But I agree that what is the 'wrong stuff' for one person is not for another and just like you, the wrong stuff for me is a range of 'wholesome carbohydrates' that unfortunately I clearly cant tolerate well

So whats the answer?

Eat less of it, eat smaller portions of it. And whether its this or that condition, or this or that response in the body, it will still require you to eat less food overall, or less of some sorts of food to lose weight

I’m very glad you’ve made these points and thank you so much.
The Type 2 diabetes nutrition course I attended through the NHS covered glycemic index - in fairness to the trainer, I think at an appropriate level given the mix of ages/backgrounds at this 7 week course - but didn’t cover glycemic load at all.

After doing my own research on glycemic load - thanks to it being mentioned a few times in a report a private nutritionist had written for me after I went for one session - I was left with the impression we’d only been told half of the story at the NHS course I went to. It’s so important for the reasons you’ve said about insulin response. I think more focus should be put on glycemic load in NHS nutrition advice for Type 2 diabetics.

Isn't the problem too that there are so many seemingly science based methods of losing weight accessible on the intranet that it's impossible to know what really works. And then if you factor in a condition like insulin resistance surely it gets more confusing.

PCOS and obesity are chicken and egg, and not all PCOS is caused by insulin resistance which is why you get some women with PCOS who don’t struggle with their weight at all. Equally, you can be an obese woman and not suffer with PCOS.

In my case, my issues began at puberty. As a result I never grew proper breast tissue (found that out when we were admitted back to hospital when my son was 2 days old because he lost 12% of his birth weight and no one had thought to mention women with PCOS often don’t have enough breast tissue to functionally breastfeed… they chose instead to tell me it was ‘very rare’ for a woman not to be able to produce milk and not to worry… whole other story). I also produce very minimal progesterone, but over produce androgens and oestrogen. That results in a lot of unopposed oestrogen flying around and my current issue No one tells you about is the resulting endometrial hyperplasia and potential endometrial cancer I’m now facing again as a direct result of PCOS being left unchecked.

Puberty was precocious too, I began periods at 8 years old. I was obese at that time having been first classified as such at 3 years old. So whether being an obese child caused PCOS or whether I had poor hormone control and therefore became obese is for the birds. If you ask my mum, I had a healthy diet as a child but she also put me on slim fast when I was 7, so her own idea of ‘healthy’ isn’t great. That said, I am the only fat person in the family. My siblings grew up on exactly the same diet and portions and were all a normal weight as are both my parents.

Italy has a higher rate of PCOS than the UK

Obesity can be a health condition in and of itself. It can also be a symptom of another health condition. In the same way that anemia can be a health condition in and of itself and a symptom of a stomach ulcer.

PCOS doesn't just make it harder to lose weight, if it comes with insulin resistance it promotes fat storage and increases hunger, both making you fatter and more inclined to eat more. Making the weight gain a symptom of the disorder.

And yes, excessive weight can contribute to PCOS. Higher androgen levels can also contribute to pcos. Both are caused by insulin resistance. Do you also blame the person with PCOS for their high androgen levels? Or just their socially unacceptable, thanks to the pesky victorians, fatness?

This is linked to us de-medicalising obesity though. It’s left the gates open for crack pots and industry to fill a void where proper information and treatment should be. If NHS healthy eating guidelines worked for everyone, there would be no diet industry.

My PCOS has pretty much been untreated throughout my life

Diagnosed in late teens, there has been nothing. The symptoms have only really receded during peri menopause. I was prescribed metformin many many years ago, probably about 20 years ago now, but couldnt get on with it and that was that. Nothing else!

My sister also has it and only us 2 are overweight, no one else in the family. However we both do eat too much so I know in my case that losing weight is possible (and Ive done it) but I had to take decades to learn that fat was not the enemy. I think the low fat mantra from the 70s and 80s did so much damage.

No one tells you about is the resulting endometrial hyperplasia and potential endometrial cancer I’m now facing again as a direct result of PCOS being left unchecked.

This is why I am grateful I moved house and ended up with a new GP

My old GP shrugged at my PCOS diagnosis and wasn't interested in discussing it

When I moved to my new GP one of the first conversations they had with me was whether I was planning on trying IVF again and if not if I was interested in a mirena coil because it reduced the risk of endo and ovarian cancer. Literally no one had even told me I was higher risk never mind offered me an option to reduce the risk.

I hope that potential cancer doesn't turn into actual cancer @Metabolicallycomplicated and you get some decent medical support exactly as you should!

I have a biopsy in the morning, but endometrial measurement is 22mm so it’s not looking hopeful. If it’s not cancer or pre cancer it will be a surprise.

Off topic but I absolutely adore the unhinged Victorian fat shaming ideas, particularly Cesare Lombroso who believes obesity was linked to promiscuity. He took the weights and measurements of prostitutes and concluded that sex made you fat because older women who had been prostitutes for longer were often fatter…. Absolutely nothing to do with the poor diet they had eaten for longer given their economic circumstances or the fact many of the women he studied were post-menopausal… nope. Sex makes women fat

I will keep everything crossed for you that the outcome will be as positive that it can be

I'm going to start using that. Next time someone makes a goady comment around my weight I'm going to point out it must mean I have an excellent sex life and if they are skinny it's such a shame for them 😂

Thank you, even if the news is the Worst Thing, if you’re going to get cancer it’s not a bad one. Usually diagnosed early due to abnormal bleeding making you go to the doctors pretty quick, and in my case they’d do a hysterectomy to rid me of it.

Ive been bleeding since October so it will be a blessed relief to have an answer and hopefully a solution.

You want Daniel Brinton for that conversation too - in the 1870’s being plump was the fashion and he remarked:

“The only lady who we ever heard derived advantage from [being thin] was Madame Ida Pfeiffer. She relates that somewhere in her African travels the natives had a mind to kill and eat her, but she looked so unpalatably lean and tough that the temptation was not strong enough, and thus her life was saved.”

Basically, his argument was that making yourself unappetising to cannibals was the only reason a woman should ever consider losing weight

Like I say, gloriously unhinged.