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.

Dino - if there's a huge genetic component then why do people from cultures where average bmi is low tend to get fat when they move to the uk or the us? Why are rich people massively thinner as a group than poor people? Both rich and poor people live in a society where unhealthy food is readily available, and where most people, especially professionals, work in a sedentary long hours culture? What is it about being an educated professional that stops you from falling victim to your genes?

Lauranda I might have agreed with you.
Except I've just eaten a twix.
So YAbu.

"What is it about being an educated professional that stops you from falling victim to your genes?"

lemis, sadly it doesn't entirely work like that! Prof O'Rahilly, one of the world experts in this, will happily admit that he is certainly not a slim chap!

The different cultures (rich/poor or different countries) have different environments, the availability of food, the types of food available, the culture around eating, the physical activity that people do. In the west, we have an obesogenic environment, a perfect storm that some people manage to avoid because of (off the top of my head) education regarding better diet, more money making it easier to buy better choices, time to exercise etc. It is the society that we live in now here that causes the problems, whereas the same people would 'get away' with it in a different time/culture etc.

Another good article that explains the importance of the obesogenic environment:

www.ncbi.nlm.nih.gov/pmc/articles/PMC2570383/

I other words it comes down to the choices you make as an individual whether you get fat?

Shall I eat this third slice of toast dripping with butter?

Should I buy a Mars bar at the garage when I stop to refuel?

Should I take the car or walk the one mile into town?

1000's and 1000's of choices over the course of a life time.

Yep, pretty much!

Genetics seems to affect how many Mars bars you'll want to eat, how much exercise you'll want to do (or indeed not want to do), how full you'll get when eating, if you'll eat when you are not full, what portion size you'll have, how fatty/sugary you'll choose to have a meal, how much you fidget.

We're not automatons at the blind mercy of our genetics and we still have the responsibility of making all these little choices. They need to go hand in hand, with the knowledge that our genetics do make it harder for some people.

The genetic component falls under the banner of "susceptibility", which broadly means: in the right environment, the effects of these genes will makes themselves known. The genetic factors alone are unlikely to cause obesity without the "right" environment.

You and I may have different genetic susceptibility to obesity, but if we both eat 1500 good calories a day and exercise regularly, neither of us will be fat. If we both switch to 4000 calories a day and sit on the sofa, we may see that one of us puts on more weight than the other, because that person has a particular set of genes that mean the way the excess calories are dealt with is different.

In the first scenario, genetics makes no difference. In the second scenario, genetics can be the differential (but rarely the reason).

why do people from cultures where average bmi is low tend to get fat when they move to the uk or the us?
Assuming their genetic makeup hasn't changed (it doesn't), the differential is diet/exercise.

Why are rich people massively thinner as a group than poor people?
Assuming that the genotypes (the genetic makeups) are randomly and equally spread between rich and poor, the differential is diet/exercise.

"If we both switch to 4000 calories a day and sit on the sofa, we may see that one of us puts on more weight than the other, because that person has a particular set of genes that mean the way the excess calories are dealt with is different."

No, no, no! That's not it! It isn't to do with 'metabolism', which is what I think you are getting at. If you eat the same and do the same, you are both going to put on weight.

Please read my post just above yours, MaidofStars. You've got to see the genes within an environment, where some people make different choices. Some of those choices mean that some people are more susceptible to put on weight.

Anyway, I've spent plenty of time on this and must stop neglecting my children and home! I'd really recommend reading the articles and links I've posted and hope some people have found them helpful.

In terms of lifestyle - went to Denmark recently. No fat people. Really everyone is a normal weight. Differences we noticed:

1. it's a wealthy country, hard to be rich but equally it's hard to be really poor.
2. people cycle evetywhere all ages - grey haired old ladies cycling along next to 10 year olds
3. we were given free fruit every time we went into hotel. No chocolates etc
4. junk food expensive esp crisps /choc

So I suppose small lifestyle differences can add upto alot

No, no, no! That's not it! It isn't to do with 'metabolism', which is what I think you are getting at. If you eat the same and do the same, you are both going to put on weight

At 4000 calories a day while sitting on a sofa, of course we will both put on weight . What will almost certainly not happen is that we both put on weight at exactly the same rate, in exactly the same places, with exactly the same response from our body to the excess weight.

Are you saying that you don't think there are metabolic variations which are underpinned by genetic factors?

You've got to see the genes within an environment, where some people make different choices

You have presented a different context to me, both of which are valid. You are referencing genetics and behaviour, I am referencing genetics and physiology.

"where some people make different choices. Some of those choices mean that some people are more susceptible to put on weight."

So it's not me being weak willed when I buy that Mars bar at the garage when I stop to buy petrol.

It's my genes. THEY'RE MAKING ME DO IT!

It's one step up from blaming it on my glands I suppose....

Thank you very much for the feet advice, DinoSnores. Bring on the crocs and flipflops. .

Your posts have been most helpful.

I did chuckle at the chubbiness of Prof O'Rahilly though.

If you're "working hard" to not get fat then maybe you're doing something wrong.
Calorie control is unpleasant, so a very bad way to prevent excess body size; also increases chances of T2 diabetes if done without exercise (supermodels have terrible pre diabetic measures). Exercise that you don't enjoy is a better way to not get fat, but still poor quality tactics because not sustainable. An active lifestyle or habits that you enjoy and a healthy relationship with (mostly) healthy food is sustainable and shouldn't feel like hard work.

I don't know the answers for everyone how to get there & not judging anyone. Most my age 40+ relatives are plump, btw, and my dad has been labeled pre diabetic, so it seems my genes aren't "great", either. I am still sure that it's lifestyle not genes that will determine my body's future.

*So it's not me being weak willed when I buy that Mars bar at the garage when I stop to buy petrol.

It's my genes. THEY'RE MAKING ME DO IT!

It's one step up from blaming it on my glands I suppose....*

I think the argument is that some people are less able to reist a Mars bar when they see one than others. I'm not convinced.

Just had a few dried figs in order to tide me over until after spin tonight.

Sorry reporting me for questioning if some people are "unable to stop gorging on fat and sugar"?

Ahh, Laurandra you're back. I'm still wondering about your peer reviewed evidence and your qualifications?

Hello

Thanks for your reports about this thread. From our end it's looking as though the OP has got up to something a bit irregular so we've suspended her ability to post for now. However, the thread overall is interesting and informative, we think, so we will leave it to stand for now.

Oh dear. Has she been naughty? I assume you aren't going to tell us what?

hecate; love the pic!

I'm still wondering about your peer reviewed evidence and your qualifications?

I doubt if she even understands what peer reviewed evidence is.

Hecate, I've been smelling a sock rat for a while now.

I just want to know why, I always do. I need closure, dammit.

I suspect that MarieNE and OP are one and the same. Looking at spelling, sentence structure etc.

Oh Dawn, you're not supposed to say it out loud

Damn, been here years and didn't know that.