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?

You say ‘cancers are mainly preventable’ then you say ‘30-50% of cancers are preventable according to WHO’. Do u not realise how different those two sentences are?

OP said one and I said another. I do not agree that they are mainly preventable but I do believe many/almost half are.

Can cancer be genetic?

I have two medical conditions which cause/exarcerbate weight gain. I am not as large as many with the same conditions but I will never have a normal BMI. There are many, many reasons for gaining weight. Why should I be denied treatment for something that is no fault of my own?

The vast majority of people can walk, cycle or use means other than cars.

Can they? What about people who work unsociable hours? It's also pretty common for people to need a car to drive to the station. Do you wfh or have a partner who does? If so you're not going to have any idea what it's like to juggle commuting & commitments. Don't let it stop you judging though!

Some people never get better though. They remain unwell for their entire lives. So losing the weight is much harder, although obviously still possible.

10% women have pcos which makes losing weight hard and putting it on easier than those without pcos (not meaning that all people with pcos are overweight/obese, just that it is on average harder to manage weight)

10% of women have lipodema - an abnormal fat growth condition where the body cannot break down lipodema fat and therefore no amount of dieting or exercise will remove this fat - however impacting only women it has not been researched in any meaningful way And the nhs will not covet the only current means of removal which is liposuction. Hopefully there is treatments in the future as Australian researchers have identified a faulty gene that is responsible but it would not be for decades.

5% of people have underactive thyroid which, like pcos, leads to a more difficult battle with weight.

1% have crushingly disease- again a difficulty in maintaining weight.

This is 26% of women before you even get to depression, medications that cause weight gain and any genetic or other conditions that lead to weight issues.

So yes, I do think that this should be part of the NHSs work. No they aren't responsible for people being overweight, but those people should be supported,.especially where the weight issue is part of health conditions that they suffer and support in health issues.is the job of the NHS.

Yes.

It is really disgusting that people are arguing that cancer is 'mainly preventable'. Crass and insensitive and in the majority of cases it is simply wrong.

Some cancers are preventable, not the majority.

To understand all illness, you have to view it from a biological, psychological and social perspective.

It is fallacy to view it from just one perspective - none exist in a vacuum.

Read about the social determinants of health.

Me too pncr. I gain on anything over 1200 calories.

I'm not sure you can single out obesity, what about smoking, drinking, drug taking. dangerous driving, high risk sports, unprotected sex, anorexia, etc?

@extremeprivacypreferred that's what I thought but wasn't sure.

It is fallacy to view it from just one perspective - none exist in a vacuum.

yep

I think you are forgetting the simple thing , healthy food in general doesn't taste as good to most people as shite food.

I like sardines but I'd rather eat a cheeseburger, I'm a healthy BMI but yes I like the taste of junk food and I eat healthy food because it's good for me. If they had equal nutrition and calories I'd down cheese burgers everyday.

@pncr
You’re never going to get people to understand.

Being on high dose long term of steroids may save your life but in my opinion, it also messes you up - thin hair, delicate skin, infections and the list goes on. It’s much harder to lose weight on them. It’s not impossible but it’s not “calories in, calories out”, it needs careful input and support which I found I had to beg for and eventually, I paid privately for it. i recognise my privilege in being able to afford this. Added to the fact most people on these long term big doses are mainly on them due to serious diseases that limit mobility. It annoys me when people on occasional doses think they know. My adrenals are fucked and I have a moon face and neck lump but my lungs and nervous system aren’t trying to murder me. You win some, you lose some.

It sounds like you put in huge effort and that’s amazing. You should be proud of yourself for your achievements and don’t let ignorant people who’ve not had to battle steroids like we have, get you down.

I’ve been working hard to change my lifestyle in a permanent way and of course its harder for
me due to my meds and illnesses but I make sure to take the time to Pat myself on the back. It keeps me going.

My BMI is around 22 because I choose not to eat too much and keep as active as possible.

This sentence alone shows that you have no understanding at all of the complexities of the problem and causes of obesity.

Obesity is the responsibility of the multi national companies who make ultra processed foods and the marketing companies

Government could have much stronger legislation re ultra processed foods, see the sugar tax on drinks - its caused the companies to reformulate drinks = higher prices - lower sugar consumption. More government intervention is needed against the food corporations. Currently, they make money, and cause problems, that we then pay taxes to cope with.

Exactly. Cancers can be caused by genes and by viruses and bacteria such as Epstein-Barr, HPV, Hepatitis, helicobacter pylori etc. Just because some lifestyle factors influence cancer, don’t deduce that all cancers are lifestyle related.

It's part of the problem, but not the only reason. Obesity is multi faceted and complex.
"30-50% of cancer is preventable" well that means 70-50% of cancers aren't. And given WHOs track record, I take their advice with a pinch of salt. Also 20% is a huge discrepancy.
In many cancer cases, we don't fully understand why a cell mutates. Genes are certainly a factor and then given the right environmental factors, whoosh cell mutations away, but what we don't know is why that faulty gene develops and gets passed on in the first place...if we could fully understand the cause it would be easier to find the cure.

To answer your question OP, what we need is more research into obesity, 'willpower' has pretty much been debunked as a load of religious pious, virtuous bollocks. But if one can blame it on 'lack of virtue' then it's not contagious, and therefore not dangerous, the sociology of health is fascinating, I'm sure it won't be long before covid enters the syllabus, it's also a good get out clause for not spending money on research, blame the person on lack of will power and the jobs a goodun!
So, so much about the human psyche remains a mystery, and until we understand more about our physiological, psychological and sociological function of our brain we'll never fully understand the link between physical and psychological health. In the meantime we continue to treat the illness brought about by obesity, so yes if obesity could be tackled, the NHS would be better off, but that is the same with most preventive illnesses (alcohol, drugs, STIs) it's a bit like saying could education reduce our prison population,and yes it could, but it requires a ton of investment at the beginning of life, instead we spend money and resources on fighting the fires instead of preventing the fires in the first place. The sad thing is labour tried really hard to prevent the fires by introducing sure start and other community services, and then the conservatives pulled the plug on it, it wasn't long enough to see the effects take hold. And therein lies a biggest issue of all, politicians only ever look at the short term goals, they don't take the longer view, that's why we're in the mess we're in (yes okay it's a bit more nuanced and complex than that, but ultimately politicians need to look at the longer goal, and regardless of which party they are in, they need to look at society as a whole. An educated working population should always be the long term goal, and that is tackled at grass roots).

most cancers are NOT preventable - and the OP has apologised for saying so

20 % of cancers are lung cancers, caused by what you breath in, tobacco smoke or pollutants, including asbestos

What about cervical cancer, caused by a sexually transmitted virus?

30-40% of cancers maybe considered preventable but this has little to do with obesity

The WHO condsiders are 3-4% of cancers may have obesity as a contributary factor

Those of us taking massive sontinuous steroid doses as part of cancer treatment are overweight BECAUSE of cancer, not as a CAUSE of the cancer.

I had a BMI of around 22 when I got ill

But on top of everything else I am going through, I still have to deal with arrogant smug bastards judging me because I am fat, I have cancer, therefore it is all my fault.

This is medieval

When I was young there were hardly any overweight people. When we first went to Florida in the 1980s we were astounded by the fatness of so many people, especially the children, these levels of fatness were not common in the UK. Now after the introduction of US food we see obese people daily

Absolutely agree. It’s a road I don’t want to go down, anything judged ‘self-inflicted’ in any way would not be treated. Teenagers experimenting with drugs, for example. No, until we sort out poverty, mental health and many other things, this is too complex an issue to decide something like ‘we won’t treat x or y’.

The problem of obesity can often be directly linked to poverty. Eating healthily has never been more expensive, cooking from scratch is far less common, and people who have to work 40+ hours a week for minimum wage are too tired to meal plan (time-poor).
Add to that the issue that the cheapest foods (ready-prepared, instant, UHP) are the unhealthiest, that Domestic Science and Cookery have been largely dropped from education and that more people than ever are earning on average £11,000 less than the equivalent wage than people doing similar jobs some years ago and you can identify the reason for this poverty.
If, as PP have suggested, the unhealthy foods were taxed more to subsidise the healthy ones, that would be a start, but previous attempts (E.g. the sugar tax in the UK, which just drive people to the far more harmful low sugar, i.e. full of potential carcinogenic alternatives), have shown that often the entirely well-meaning campaigns are turned upside-down by the knock-on effects of badly-executed policies.
So it is left to the NHS to pick up the pieces, but they certainly should not stop treating these. What is needed is an overhaul of education, wages, and laws governing the sale of unhealthy food - but that, even if there was the will to do it, is unlikely to happen for at least a generation…

Of course the NHS has to fix the health problems people get themselves into BUT not to prevent them, that is a public health issue, the two should not be mixed up.

Why are people so fat when our parents were not, is perhaps a better question.

Have we become more prone to genetic issues and therefore can't help it or are we, generally speaking, eating crap and exercising less?

Just look at the queues that form outside Macd's drive throughs or the rise in ready meal consumption or the deliveroo type eating we all do? bloody hell some people (who don't need too) are even too lazy to drive to tesco, they order on line instead.

I live in an affluent area, the numbers of wealthy, "intelligent" obese people is quite shocking, some are just walking heart attacks.

But adults are one thing but its the number of fat kids i feel sorry for, they'll be even fatter parents, if they make it that far.

@Howpo I'd be dead not fat.

If I'd been born when my mother was I wouldn't have survived.

The accident I had in my teens would've left me either dead or in a wheelchair.

The other conditions I have wouldn't have been treated.

The issue with my bad leg would have cost me my leg so I'd have a prosthetic

My arthritis wouldn't be treated and I'd be like my grandmother was - twisted and unable to move out of bed.

I'm not sure any of those are better options. Tbh.