Is obesity the responsibility of the NHS?

[snookspooks]

I've read a few posts lately where posters say the NHS isn't doing enough to combat obesity. As far as I am aware people are taught from pre-school age upwards about healthy eating and the importance of exercise and a healthy lifestyle. This continues through secondary school. I don't know about in further education but I don't remember any from my own FE days. We have access to NHS information online about healthy lifestyles, and the information is repeated in pregnancy and post-natal days by midwives and health visitors (that was my experience but I appreciate it might not be the same for others). We are given the information and it's up to us as individuals what we do with that information. The idea is we use it to prevent getting obese in the first place.

If people do get obese, through whatever factors, and there are many that contribute to this, is it up to the NHS to fix this or should the onus be on individuals? What happened in countries without an NHS style system?

Cancers are mainly preventable but the NHS provides treatment for those but then we can't fix cancers by ourselves, or heart disease, or strokes, but obesity is something we can treat ourselves. I'm not saying it's easy but it is possible. Of course obesity is linked to those diseases/conditions so it's not straightforward.

Is too little responsibility put on those who are obese?

I don't think it's straightforward and I think it's impossible to give treatment for some partially or completely self-inflicted conditions but not others. It's an ethical nightmare. What do other countries do?

This thread should be sent to the NHS blue tickers who were all for the lockdowns when gyms were shut but takeaways were open. And before anyone starts once you are into the routine of going to the gym and its stopped and you get out of the habit its hard to get back into the habit again. You also find that people are quite happy about an overweight person going on a diet until it impinges on THEM, they tend to get quite arsey when you want to bring your own food to their wedding reception so you can stick to the plan despite being the one making digs about your weight in the first place.

People are getting fat because they live in an environment which encourages it. Fifty years ago, we weren’t fat. We haven’t suddenly become dummies with no willpower. To talk about individuals not taking responsibility absolves food manufacturers and governments from their roles. Unhealthy foods are promoted as healthy. The majority of our diet is ultra processed foods and this is a consequence of supermarkets and food companies-and government-actively encouraging thee consumption of over processed food. It’s far too simplistic to blame individuals when the local supermarket has a small proportion of its food as natural, unprocessed-what your grandmother would recognise-and then the majority of shelves groaning with the weight of manufactured food. And we’re all paying the price.

Most posters pointing the finger at obese people probably smoke, or drink alcohol, or have done drugs, or been promiscuous, or don't exercise, or a million other things - all things associated with health issues. I doubt there's anyone here who is being judgy but lives a 100% healthy lifestyle.

I think banning margarine and low quality vegetable oils would go a long way to tackling obesity, or at least raising tax sky high on them, and on processed food.

For years animal fats were demonised and vegetable fats were promoted as a "healthy" alternative. Turns out that they are no such thing. The sugar industry has a lot to answer for too.

Fifty years ago I'd be dead.

@Atethehalloweenchocs it's not stupid at all, it's factual for me. My BMI was over 27 at the end of last summer. I made the decision to stop eating so much unhealthy food, get more exercise, not much more though to be fair, and my BMI is now 22.

I capitalised it at the top. COST PER CALORIE that’s what I was pointing out. And clearly stated it’s not nutritionally complete.

a tin of sardines in oil is 200cals for 44p
a can of plain beans is around 200-250 cals for 63p
most frozen veg will be cheap but still the cost per calorie is important.

the only ones that is cheap per calorie is potatoes.

to be fed aka get enough calories to sustain your daily activities it’s cheaper to do so on highly processed foods.

for a nutritionally complete meal with the right amount of calories it would cost significantly more. Even if you substituted meats for beans

I know this because I have lived this. I have lived both ways and it’s more expensive to eat properly and get all your macros and nutrients and the right amount of veg a day.

My experience is I was a healthy weight (underweight sometimes) for my whole life. Then I had a mental breakdown and was in hospital for 3 years. Over that period of time I've been put on multiple medications, most of which have weight gain as a side effect. I asked for help as soon as I started putting on weight, but none was forthcoming as I was just encouraged to continue taking the medication. I think there should be help as I'm really struggling.

@3littlebeans why don't you start a thread like that? I think it would be a good idea. I can't remember which ozempic thread it was now but talk of trauma and abuse was not appreciated. The consensus was that there was no underlying reason for their obesity, they just needed the wonder drug to resolve their obesity. It's all about insulin resistance not trauma or poverty or abuse or anything else for some. They are quite interesting threads to read.

I can't remember if I said this upthread or not but it's going to be impossible to single out the cause for most people because there will be many. My ex told me grabbing his belly that he was like this because he'd be told to clear his plate as a child. As was I. He was in his 40s by this time so at least 25 years had passed since his childhood plate clearing days. what he didn't take into account was the copious number of take aways he was eating each week. At least 3 deliveries per week and he would order 2 meals with each. So say a Chinese chicken dish with chips and noodles AND chips and Chinese curry. That was for 2 days but even so, its a lot of food, not yo mention no vegetables. He had an active job and cycled to work but his evenings and weekends were spent sat on the sofa gaming or watching tv. He would claim poverty all the time but was spending around £150 a week on take aways. He's an intelligent man but was addicted to nicotine, gaming, energy drinks, take aways and couldn't or wouldn't see the impact it was having on his health and his relationship with me and his sons. Very sad. There was other stuff going on with his childhood but he wouldn't accept his own contribution to his health. Then he had the cheek to call me greedy once when i ate a full meal. i was recently bereaved and had no appetite for ages but really enjoyed that meal. i was about 9 stone at the time.

@UndertheCedartree I've seen that happen in patients. It was alarming how quickly they put on weight. I'm sorry that happened to you too. When I was in hospital bank in the early 90s it was a private hospital and there was a daily exercise class we had to go to which I avoided like the plague, relaxation every day, snooker room, exercise bikes, pool tables, extensive grounds for walks, art therapy, group therapy, psychotherapy, ECT <shudders> and a really holistic approach. What I saw in NHS units was awful. No exercise facilities, fed snacks of doughnuts and cakes every evening, no grounds, no therapies, no relaxation, just drugs.

my friends dad was told his cancer was caused by years of smoking

whilst quiet rightly you pointed out
There are many many causes of obesity, and it is often the result of past trauma, abuse, or indeed drugs prescribed for other illnesses.
but there is also a % where it’s down to poor choices

how many and how big the % are no idea but there are some preventable cancers and some obese people by poor choice

People who’ve blown up due to medications/metabolic conditions/physical disability aside, where it’s down to personal poor choice maybe we shouldn’t be too annoyed as it’s natural selection (or deselection) in action.

The NHS and the government have been trying to ‘fix’ obesity for decades. And all it’s done (according to them) is make it ‘worse’. I wonder why that is?? That would probably be because intentional weight loss is known to make people bigger on the whole.

And if the NHS is going to start picking and choosing who it treats and not helping ‘obese’ people, then we really should be doing the same for the person who breaks their leg after falling over drunk, or the footballer who pulls their hamstring, the alcoholic who has caused their organs to work inefficiently, the driver involved in a crash, the mountain climber who falls etc etc etc.

Honestly, particularly on MN, it’s like being fat is the worst thing a person can be.

It doesn’t work because the NHS is dealing with the symptoms and not the causes.

I am so happy for you that you have never had long term weight issues and gaining a few pounds on lockdown makes you an expert.

Tbh I eat as much as I want and stayed a consistent weight regardless of whether I excercised or not. I did put on a huge amount of weight once - ironically when I was forced into eating slimming world meals whilst staying with the mil for a year.

Whos responsible is a difficult thing when it comes to this topic. I’m a smoker and that’s cut and dry good and bad yet I still can’t quit. I am wholly responsible for that. But losing weight is so difficult as it’s not cut and dry.

I only figured out through the slimming world debacle that I have high amylase. Carbs are like water vapour to my body and the more I eat the better my metabolism works and faster I burn food. I actively lose weight the more white goods I eat. Cut them out and even if the quantities of other food groups are the same ie. protein/ fat and I balloon at a rate of noughts.

So I do think nhs could have a part to play in this. Early intervention for those struggling is key to most illnesses. It wouldn’t be difficult to have off shelf dietician plans and a spit test to analyse someone’s salival structure.

In all honesty my obesity is as a result of a huge reduction in the level of exercise I do each day and a big increase in my calorie intake, I inhale carbs in either liquid or solid form. My portion sizes would put most of MN into a food coma !
I know how to cook nutritious food, I have cupboards full of healthy ingredients, love all vegtables except kale and have recipe books a plenty. I actually love a massive salad
I am knowledge rich and time poor, I get back from work and flick on the deep fat fryer and go big on the beige.
What makes it worse is I spend my working days with a lot of people whose health has been hugely impacted by their lifestyle choices, not all by a long shot, as this thread shows, some people do just get the shitty end of the stick, health wise.
One patient with cancer who was really angry about his recent prognosis, given his incredibly healthy and lifelong lifestyle, asked me 'why me and not you, I have done everything right ?' , whilst I stood there, slightly puce, getting my breath back after climbing a flight of stairs and weighing at least twice what he did. The honest answer is, I have no idea, there is possibly a weird plague surviving gene that allows a certain level of self inflicted harm, that I have been fortunate enough to inherit.
If I carry on as I am, I will end up living with very poor health, less going out with a bang more going out with a whimper. I can't use ignorance as an excuse, nor pre-existing and unrelated health conditions, nor childhood trauma or MH reasons.
Am I the person that @snookspooks has written this thread about ?

My work is 30 miles away (give or take) and I have to be there for 0630 tomorrow. The earliest that the train can get me there from the station in town is 0700, the earliest from the station a 5 minute walk away is 0836. I can get there on time from a different station, but I’d have to drive to that station (15 minutes).

It’s the same coming home. In fact, I don’t think I could get home from a late shift without a car. On Sundays, I couldn’t get there/back in any sort of reasonable time.

It takes me 30-40 minutes door-to-door by car.

I’d love a local job but I live in an area of high unemployment and most jobs are zero hour minimum wage care/retail/warehouse, all of which I’d struggle to do as I have an injury meaning I can’t lift or do constant repetitive tasks. There’s also no progression/career development, which I do have now.

I’d also love to live closer to work, but houses similar to what I have now are £500k more. Some are millions more (lots of footballers). My wage is less than national average but I can manage, mainly as DH has a good pension.

I’d love to be back in the SE, I didn’t drive for years as I didn’t need to, I walked/bus/trained everywhere, but when we were both made redundant, we moved back to my hometown as we could afford a property outright.

Doesn't help that I don’t really like where I live and so struggle to want to go out and walk as there’s nowhere interesting/nice to go. When I lived in the Home Counties, I’d go out all over the place; around London, down to the coast, mooching round nice market towns…

it's not stupid at all, it's factual for me. My BMI was over 27 at the end of last summer. I made the decision to stop eating so much unhealthy food, get more exercise, not much more though to be fair, and my BMI is now 22.

@snookspooks Sweetheart you are coming at people like me with a BMI of 47+ with all the knowledge and experience of someone who put a few additional pounds on and managed to lose them easily, which is of course great for you and well done and all that
Think about how you would manage the situation if you weighed 10 stone more than you should ? I don't know how much you weigh but imagine adding your bodyweight into a rucksack and then carrying it around with you all the time, regardless of what you were doing and not being able to take it off. Now do starjumps

Exercise helps people stay a healthy weight

But over eating gets them overweight
Often started in childhood- see all the threads about the dangers of giving children eating disorders if you try to fix their bad eating habits - we are scared of saying no yo children, we want them to smile at us

Over eating the wrong thing

Caused by easy availability of bad food
Especially when that is cheap
Especially when they work too hard to have any energy left for good choices

@kitsuneghost I don't know where you have got that from but it's nothing to do with lockdown.

@Dymaxion your honesty is refreshing. Do you know why you eat such big portions of food that is not great nutritionally? Apart from being time poor the same as a lot of people. I'm not asking you to share that reason here, just asking if you know yourself.

I am not overweight because I eat big portions of food. You don't know why the pp is overweight. They haven't said. And yet you jump to massive potions.

Losing weight was the hardest thing I ever did. But it was down to me, me alone, and my choices. I had to take responsibility and not rely on anyone else.
It's still a daily battle not to dive into a family size crisp packet, but I don't expect anyone else to do it for me.

@pncr they said so themself.

My bad @snookspooks I missed that it was the same poster.