...to expect obese people to take responsibility for what they eat?

[Tabby1963]

"If I don't do this, no one's going to help me, and if I don't help myself I'm going to end up dying."

"I should have done something about this, I should have tried harder".

These quotes from a lady on BBC News this morning, and she hits the nail on the head.

As someone who has also struggled with weight issues for most of my life I feel that it is my responsibility what I put in my mouth, and expecting the NHS to fund my weight-loss op is very unreasonable. It is a waste of time unless I actually change my behaviour voluntarily, and if I change my eating behaviour voluntarily then I will solve the problem myself.

Interesting thread. I think it's a pretty complex issue.

I think, in most cases, the obese person has to take quite a lot of responsibility, alongside support from counselling/surgery. I would say the same re alcoholism, drug addiction and smoking. There IS a lot of help available free on the NHS for all of these conditions, but I think the biggest factor is the person themselves exercising their willpower. No amount of NHS intervention can help someone who is unwilling to put in any effort of their own.

I have a history of compulsive/addictive behaviours. Substances, booze, food, fags, exercise... I'm not 100% where it all comes from but I'm convinced that they are all part of the same problem. I have been successful in tackling some, but not all of these. And unfortunately I do have a tendency to replace one vice for another. I still smoke. It's rank and expensive and appallingly bad for my health. I have had help from the NHS at times, I have also paid for private types of treatment at other times. I still smoke. The only conclusion I can possibly draw is that I am the only thing standing between me and a non-smoking life. I really hope I'll get there one day. It is entirely my fault that I've failed to stop smoking (even though I believe there is a clear MH element to all of my addictive behaviours) and so I do understand what the OP is saying.

As far as I'm aware, GPs can still prescribe gym memberships for overweight or obese people (certainly this happens at the gym I go to). This seems a far better idea than gastric surgery because it is a positive move towards creating new habits for the future. Lower risk than surgery too, and probably cheaper?

What I have found, Calamity is that you eventually lose your sweet tooth. When I had really established low carbing as a way of eating, if I was hungry, I would crave a small amount of very rich, good quality food. Everything else tasted wrong, cardboardy soapy textures. Cheap chocolate tasted like icing sugar and the fat in it all soapy, meting point all wrong.

As I said I'm doing it all again but I think it was having DC and being concerned to give a varied diet that did it. Pasta and rice was back on the menu, and started waiting cheaper chocolate again. Thankfully, i've had the sense to reign it in now.

^melting point. Typo.

^ wanting. Typo

Lego, have you tried the ecig? I was a heavy smoker and its worked for me.

You only have to read some of the threads on here when people boast, egg each other on or congratulate each other about getting through obscene amounts of food to see what a fucked up relationship with food many people had.

'Aibu to have eaten an entire pack of mince pies in one go?'

'Oh that's nothing op don't worry about it, I have just eaten a packet of kettle chips in 5 mins'

Etc.

*have not had

Food can be a drug, whether it's the actual food or the lack of food that creates the 'high' that is wanted. I think saying that obese people must take responsibility is far too easy, as it's a very complex issue. Do you feel the same about anorexic people? In many cases, the cause and problem is the same but the symptoms appears opposite. I do believe obese people need to be encouraged to seek help long before they need surgery - I'm not very pro surgery as it fixes the symptom but not the cause. However, educating people about the causes of obesity would be much more efficient than just bang on about responsibility for food habits and activity.

Got to say though, that I know there's lots of people who simply are ignorant, and will just want a quick fix because they cba to sort it out. But you can't judge all obese people the same, so it's better to say nothing!

fackinell- thank you, yes I have :(

Strategies tried so far:

Cold turkey
NRT (patches, gum, lozenges...)
Hypnotherapy
Allen Carr/Gillian Riley
Champix
E-cigs

Harrumph. I will certainly give the e-cig another try. In many ways, it appeals to me more than the other options.

OP, I think the key here as that you are speaking from your experience. If you would like to lose weight and you manage it then good for you.

However it's just not possible to generalise about the reasons why anyone else might be less able to do this. As others have said, there could be medical reasons (apparent or not yet diagnosed), or numerous other reasons behind someone's weight.

Most people consider their own personal and medical information to be private, so when you look at someone who's overweight you actually have no idea of the reasons behind it. For example it's easy to say someone is "lazy" but they might actually have PND, a thyroid disorder, PCOS, or be on steroids or seizure medicines, etc.

Anorexics aren't relevant because their numbers are so small, and it's primarily a disorder of affluence - I'd wager a good chunk of anorexia is treated privately. It's not going to break the NHS.

Chipping - in my case it would be proper psychological/therapist help beyond the 6 sessions of cbt.

Similar to other mental health disorders. My mother has quite severe MH issues and has a case worker, self esteem groups, etc etc.

Have skimmed through most of this, sorry, so apologies if I'm saying what's already been covered.
There is a theory called "thrifty phenotype" that has been linked to obesity - basically, during times of famine a foetus develops mechanisms for storing fat and it has been hypothesised that these mechanisms can then be involved in people becoming obese later in life.
Also, many people who are obese live with family members who, shall we say, have bad eating habits and refuse to eat things that are healthy. As a lot of these people cannot then afford to buy food just for themselves they end up eating what their family members eat just for convenience.
Gym membership is expensive and many gyms are, rightly or wrongly, quite intimidating for larger people.
Restaurants/take-aways also have a role - their portion sizes are enormous.
A lot of people don't/can't cook and, even if they can, gas and electricity are expensive so they might not be able to cook.

Orange I'm glad your band has worked for you by stopping the hunger but I know someone who said she still found it a real battle even with a band as, although she knew she wasn't hungry, she still wanted to eat stuff. She felt that if she hadn't been really disciplined she could have "overridden" it. She has lost the weight she wanted to but said it was still hard.

Isn't there a figure from the US showing shockingly high relapse rates of bariatric surgery (although I know they may have less psychology input there)

I think the psychology is key as others are saying.

So isn't food education a massive issue in the uk and part of the problem?

Takeaways, massive portions and people upset by fruit and veg with no idea of seasons/export times etc. Ignorance will never bring good things and maybe obsesity is ignorance about food as fuel and our bodies.

So therefore the responsibility lies with parents and schools?

I'm well educated regarding food. I just end up binging on large portions of what we have/ the "good cheese" and oatcakes etc. It so isn't about the food.

In a way responsibility lies with parents - I had a fairly messed up childhood, one parent very controlling over food and the other an alcoholic that often didn't have food in the house. But the real issues are in my head. It is SO very hard to overcome. I have been going to a charity run eating disorders group for a year now, I know a lot of the theory, but it just isn't as simple as people on here would like it to be.

I don't want surgery to be honest, I don't think that would solve things. I'd love my mind to be sorted.

"Nothing to do with human behaviour is "very simple". And actually, one can be addicted, with symptoms of withdraw at its removal, to anything."

You misunderstood my first point. Overeating and not enough exercise leading to obesity is simply that. It is physiological.
Secondly, I stated that one cannot be physically addicted to food, as claimed earlier in the thread.

It's definitely worth watching the TED talk by the mellifluously-named FunkyBoldRibena Sandra Aamodt: Why dieting doesn't usually work
One of the points she brings up is that the best health outcomes, and they're close to equal is for all people, in the healthy, overweight and obese weight categories who don't smoke, exercise moderately, drink moderately, and eat vegetables.
Weight basically makes no difference at all to the health outcomes, as long as you do those four things.

You cannot be physically addicted to food, as somebody claimed up thread.

Absolutely you can, as well as (perhaps more accurately described as) self-medication.
High-carbohydrate foods give a serotonin rush. If you're a depressive, like me and most of my family, you feel very low, eat cake, feel better (may be somewhat of a simplification).

We'll have to agree to disagree.
Imo food is psychologically addictive, not physically.

I'm not claiming overcoming binge eating/overeating/anorexia is any easier because it isn't a physical addiction.

The NHS gives no help to those who compulsively overeat as someone suggested upthread. Certainly where I live the most you would get is 6 sessions of counselling - after a very long wait in a waiting list, from a general counsellor with no expertise.

And yes, GP's can prescribe a limited number of free gym sessions. You do know though that you can go to the gym regularly and still be very obese?

i think sugar is addictive - physically addictive

Custardo - yes indeed, see this academic article - "Intense Sweetness Surpasses Cocaine Reward "
www.plosone.org/article/info:doi/10.1371/journal.pone.0000698

Madasfish - My GP once replied to me when I started by conversation with my usual "I know I'm overweight but..." with "you know the biggest determinant of how long you're going to live is actually your genes? How long your parents and grandparents lived for".

But of course smoking, morbid obesity and total lack of exercise will overcome your genes in the end as will not smoking, staying slim'ish and exercising moderately.

The problem is that people who are morbidly obese (as I once was) don;t get there from slim, mysteriously morphing into morbidly obese. They put on a pound or two a month for 10 years so pretending to oneself that being obese isn't important is fooling yourself because often thats not how you stay.

The head of metabolic medicine at a major London hospital once said to me that he considered any BMI under 30 to not involve any significant health risks, that at that level it was much more down to genetics and lifestyle (smoking and exercise etc). And the constant focus on being slim is in fact the reason for so much yo-yo dieting and food issues and lack of self esteem which generally perpetuates a weight problem not solves it. In other words I suppose - Perfect is the enemy of Good. (Can't remember who said that)

My mothers two parents both died in their 60's despite being fit and slim - one was a smoker who died of lung cancer and one an alcoholic who died of cyrhossis of the liver. My mother is obese (not morbidly), survived "terminal" cancer 10 years ago and has diabetes but celebrated her 75 birthday last week. She doesn't smoke, drink heavily and takes a moderate amount of exercise.

The big issue (for me) is how easy it is to tip from obesity into morbid obesity - a knee injury, illness, steroids, stress and I'm very quickly back where I started. And trust me when I tell you from experience that trying to lose weight when you are morbidly obese is like trying to shin up a greased pole carrying 25 stone.

Oh lordy that turned into a bit of any essay