10% of NHS budget is spent on t2 diabetes vast majority is self inflicted, aibu to think they should contribute?

[Lauranda]

Its estimated that the cost will go up 17% by 2020. Something needs to change or the NHS will collapse.

Maybe make people that are overweight pay something towards their treatment would in courage people to eat better and exercise more.

What are the risk factors for being a goady fucker?

Thanks dinosnores for your reply. I watched the video, well most of it, it was late and I snoozed off, but the twin comparison was most interesting.

I do get your point about the body being programned to stock up on food when it is available, as it readily is now. But doesn't determination to resist this urge to eat come into it too? How can people be helped to do this? Obesity does seem to increase as people get poorer and/or are lower down the social scale, and yes cheap food is often full of fat and sugar.

During my occasional encounters with Weight Watchers, I was always amazed at the number if people who could not sit through the session without continuosly munching on WW crisps, sweets and cereal bars. How do you break this habit?

I'm confused - does this obesity gene mean that you want to eat more than you need, or that you eat the same amount as other people but you store fat instead of burning it off? Or both?

Both my PIL and SIL are obese. They eat colossal portions and always have done. Double the size of a normal adult portion I'd say. I have observed this for years and years. MIL has type 2, SIL has abnormal blood glucose levels. My dd (15) is very overweight too. She was normal weight as a child but teenage rebellion has seen her diet deteriorate, now she is able to spend her pocket money on junk food. Does she have an obesity gene? Is it that which is compelling her to go to the chicken shop three times a week and buy full fat coke? If she read some of the views on this thread which suggest that weight is probably beyond anyone's control I think it'd have a seriously bad effect on her. I don't want her to believe that exercise and a moderate diet won't help or aren't achievable for people who have a genetic propensity to obesity, as she may well do. :-(

"But doesn't determination to resist this urge to eat come into it too?"

Certainly and a surprisingly huge amount of that is due to brain chemistry. We all know that willpower is a challenge (don't need to be a scientist!) and that anyone who wants to lose weight will have to permanently keep their eye on the ball to keep it off.

"I'm confused - does this obesity gene mean that you want to eat more than you need, or that you eat the same amount as other people but you store fat instead of burning it off? Or both?"

There are numerous 'obesity' genes. The most famous one (if you are in to that sort of thing) is the FTO gene which actually only makes a couple of pounds difference, so there are lots of different genes, most of which we probably haven't identified yet. They probably have lots of different effects from making you fidget less, eat more, store fat in the 'wrong' places. Get lots of them and they cause more problems.

"If she read some of the views on this thread which suggest that weight is probably beyond anyone's control I think it'd have a seriously bad effect on her. I don't want her to believe that exercise and a moderate diet won't help or aren't achievable for people who have a genetic propensity to obesity, as she may well do. :-("

It isn't "beyond anyone's control" but there is a big genetic part of it that can't be ignored.

We tell everyone that a healthy balanced diet and exercise is the best thing and the most important treatment. The genetics isn't an excuse to avoid a healthy lifestyle sadly!

Exercise reduces fat in the muscles so reduces insulin resistance, reducing the chances or severity of T2DM potentially. Patients with a genetic predisposition to obesity need to be very aware that they must watch their diet constantly because it is going to be so easy to put weight on.

Patients who want to can, but you just need to watch an episode of 'Secret Eaters' to see how much we all delude ourselves about what and how much eat, so we all need to take responsibility for ourselves in that regard.

There isn't a special obesity gene. We're nearly all programmed to enjoy our food to excess. Almost all of us can all easily gain weight if we don't burn it off. This is the normal human condition.

The trend of trying to blame your genetics for being overweight worry's me. You can prove most things with statistics if you have the time, money an inclination. Not everyone with a PhD is right 100%!

I'm from a working class background and I'm the only one not overweight. When I go back over Xmas its because I'm not the one stuffing myself silly until I'm unable to move. I eat non processed foods and do physical activity. I work damn hard to insure I keep a healthy weight.

If she read some of the views on this thread which suggest that weight is probably beyond anyone's control I think it'd have a seriously bad effect on her. I don't want her to believe that exercise and a moderate diet won't help or aren't achievable for people who have a genetic propensity to obesity, as she may well do.

I agree, that view is seriously dangerous.

Of course obesity is due to what we eat in relation to the amount of exercise we have. But unlike the rest of my family, I have always struggled with my weight. If I eat until I feel full, I put weight on. If I am rushing around very busy and only eat when I am hungry, I put weight on. It is not about resisting going to McDonalds - I actually prefer healthy food. It is about having to be careful every single day about what I eat.

And honestly, when life is good I largely do manage that. When there are other things going on that I am rushing around sorting out, then I do struggle to find the energy to watch so closely what I eat.

I think the hormone that tells you when you are full, maybe doesnt work as well for me? It tells me too late. I rarely eat when I am not hungry and when I have had an illness that reduces my hunger levels, I eat very little. The rest of my family who are thin have no understanding of this. They just say things like, only eat when you are hungry, or don't comfort eat, ignoring the fact that I rarely comfort eat, and that if I only eat when I am hungry, I do put weight on.

Some people are overweight due to their genetics
Some people are overweight due to medical conditions
Some people are overweight because their bodies process some foods differently
Some people are overweight because they have an unhealthy relationship with food
Some people are over weight due to mental Heath problems
Some people are overweight due to lack of money and time to cook decent food
Some people are overweight due to ignorance
Some people are overweight because they are greedy

But some idiots lump everyone in together under the last category and then get confused when others say it's not as easy as do A and B will happen.

dinosnores, your expert voice is most useful on this thread, thank you.

Your comment on 'Secret Eaters' reminded me of a study I read, ages ago so can't reference it. Patients were given a low-carb diet to follow; a good proportion lost weight and everyone was required to keep a record of what they ate. Those who did not lose weight, or even put it on, were admitted to a clinic and were fed exactly what they claimed to have eaten as opposed to the actuality. Sure enough, they all lost weight.

We have an infinite capacity for self deception, unfortunately.

I work damn hard to insure I keep a healthy weight.
Well good for you, perhaps you could work a little harder on being slightly less judgemental regarding the circumstances of others.

Dawn the only people I'm judging is my family.

I agree dieting makes people gain.

Weight watchers for example make a lot of money selling crisps and chocolate that is not healthy its just in smaller portions. So people end up paying more for less! Certain foods are like crack and designed to be irresistible, like Pringles and the body struggles to stop eating.

Marie Genetic factors do not mean you are doomed! The word factor is the clue, genetics are only part of the picture. Anyone who interprets them like that is as simplistic as the OP thinking weight is the 100% cause of diabetes or smoking is 100% cause of lung cancer.
I have a GP friend who is tiny (about size 6-8) where I am humungous (not telling you my size but it is in the plus ranges). We went on holiday with our children years back, self-catered so we ate exactly the same. We decided to observe our weights as I was complaining to her about being fat and it stunned her that over the week her weight maintained and mine went up 3lb. It does not mean she will always be slim and I will always be fat, just that the predispositions are there and I will have to eat less and exercise more to get thinner.

Dino I have come across a couple of these "Type 1 and a 1/2 diabetics" and recently went to a talk on diabesity, it's a fascinating field.

"There isn't a special obesity gene."

Indeed. There isn't just one gene, as I said, but we've (worldwide) identified about 40 something genes that appear to contribute with a lot of target areas to be explored.

"You can prove most things with statistics if you have the time, money an inclination. Not everyone with a PhD is right 100%!"

Which is precisely why research is such a long process. You come up with a hypothesis, then test it (repeatedly) with a huge team looking at all the results and picking it all apart, the results are then reviewed internally to pick them apart, then nationally/internationally at meetings, then submitted to journals where it is only published if experts in the field agree, then when it is published, others can try to replicate it. If they get different results, that is published and discredits the first work. If they get the same results, that confirms it.

The work I'm referring to isn't one paper by a dodgy PhD student, but robust peer-reviewed work confirmed by groups in prestigious universities across the world!

"If she read some of the views on this thread which suggest that weight is probably beyond anyone's control I think it'd have a seriously bad effect on her. I don't want her to believe that exercise and a moderate diet won't help or aren't achievable for people who have a genetic propensity to obesity, as she may well do."

Something else I thought of this morning that there are plenty of other conditions that have a huge genetic component that we still treat. For example, there is a massive contribution of genetics in autism. Does that mean that we stop helping these children and adults because it "won't help"?! Of course not!

Is it just then because so many people (as demonstrated here) believe that obese people to be lazy, feckless and morally bankrupt that they don't want to believe in the evidence for the genetic component here?

As for dieting making you gain weight, there are a few reasons for that.

1. Your hypothalamus sees that you are in a time of feast and always tries to get you to your heaviest weight, ready for the time of famine, which, for us, never comes. Losing weight slowly and steadily is best to try to avoid this as much as possible. I tell patients I'd rather they came back in 6 months having lost 7lbs that they can keep off, than 3 stone that they just put back on.

1. People 'diet' hard and then just go back to their old eating habits, having not dealt with the underlying issues of why they put on weight, not exercising, not continuing their healthy balanced diet. Keeping weight off involves never stopping thinking about what food you are eating and what physical exercise you are doing.

I put my hands up to be being 'lazy, feckless and morally bankrupt' , but I am happy to have it acknowledged that diabetes in my family indicates a genetic component too.

Can you stave off type 2 diabetes?

My dad has it, his mother and both his brothers have it. They are all overweight, my grandmother was morbidly obese and died of a heart attack at 76.

Genetically I am my dad's build, weight goes on around tummy - I am 38/31/38 stats at the moment. I am doing 5:2 and have lost 2incjes off waist in just 1week.

I don't want diabetes - the meds my dad is on make him tired and irritable. He is very sedentary. Has joint problems and I feel his retirement is not what it should be( he would disagree!)

So is the answer to get weight right down?

Dinosnores thank you for taking the time to post, they are very informative and helpful.
ubik like you, diabetes T2 is in my family. My Mum had it (and wasn't overweight), my sister has it. That is one out of 5 siblings. Remember, genetic pre disposition doesn't mean you will.automatically get it ,even if you do nothing to prevent it.
The best preventive steps are exercise, keeping your waist under 50% of your height. and keeping on an eye on your carb intake. So far I haven't developed it, and I am 54.
Having said that, I am going to ask my GP for another fasting glucose test to be on the safe side.

Dinosnores, please may I ask something specific? I know it is important to look after your feet, but my feet are horny serviceable little fellows, quite used to my generally going bare foot not just around the house but in the garden in summer. The nurse yesterday advised against this, but I can't help feeling that tough feet will become weedy feet and more prone to injury if they get used to permanent shoe wearing. Would it be OK to keep an eye out for slow healing anywhere, but meanwhile just carry on?

winklewoman, the nurse is giving you correct advice. We really discourage diabetic people from walking around barefoot for a couple of reasons.

Hard skin/callus can hide areas of ulceration that then only present when they are really, really bad. If it had been spotted on nice, soft skin earlier, it is much easier to treat and hopefully leads to fewer foot abnormalities or even amputations.
s
Diabetes can cause nerve damage in the feet (peripheral neuropathy) so feeling can reduce over time. I've seen a patient stand on a drawing pin and not notice until it became ulcerated. Obviously, that is an extreme case but I do tell people to:

keep the skin on their feet nice and soft
don't walk around barefoot
wash their feet and dry them carefully EVERY day (a surprising number of people find this rather unreasonable!)
if there is ANYTHING (open wound, ulceration, deformity, any concern), see your GP or diabetes podiatrist

www.diabetes.org.uk/putting-feet-first

FGS you are being unreasonable. You could say every disease is self contributory! Flipping heck.

But with respect Dino, both dd and myself ARE lazy AND greedy. Which is how we've ended up overweight. DD never denies herself anything she wants. If she feels like eating chocolate she eats it. Ditto crisps and fizzy drinks. My downfall is snacking on cake, and toast dripping with butter. Neither of us exercise - not because we can't, but because we don't feel like it. I've had a sort of epiphany recently about my lifestyle - I've decided I won't allow myself to get any fatter and owe it to my family, who are still quite young, to safeguard my health as much as possible. So I've stopped eating butter every day and have accepted that as a 47 year old woman with a dodgy thyroid I can no longer eat like a teenage athlete and hope to be as slim as I was until I hit 43. It's like adjusting to having a smaller income in perpetuity - it takes a while to adjust your mind set.

I hope one day dd will take charge of her weight and her health, but I'm not banking on it. She spends a lot of time around obese relatives who are very fatalistic about their health.