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?

Its the HEALTH service. All realms of health need to be included, obesity is a public health issue, along with many things, that all come under the umbrella of "health". We cant start picking and choosing. Promotion and prevention is just as important as treatment when you are looking at the overall health of society. Its not the national medical service, it doesnt just consider medical conditions, it covers all aspects and realms of health and health care.

Health - "a person's mental or physical condition."

Omg what is this “fat is beautiful movement” that everyone here seems so anxious about. Fat people are on diets constantly, feeling ashamed of how they look, feeling shitty about it all. And it doesn’t help with obesity at a national level. Hand-wringing about some “fat is beautiful” movement is so niche and weird, because it’s not something that is actually playing out in real life.

This.

I think I'm a bit further down the road than you, @SuperLoudPoppingAction , as I'm at the arse end of stage 3, but I always say that I'm obese because of the NHS, as if someone had diagnosed me at 13 when I was being treated by the school butse for bulimia or 17 when I first went to the GP about varicose veins, then I wouldn't be in the state I am now. As it was I told everything was my fault because I eat too much, wasn't diagnosed until I was 45 (privately) and what could have been sorted relatively easily has now meant that I've had to sell my house for treatment. I had 3 ops in the UK last year and my final one is in Germany next month. Its ruined my life and had the NHS been more clued up about the difference between lipoedema and obesity I'd have had a completely different life. Its very much their responsibility until it's proven that the cause is just poor lifestyle in my opinion!

That's really interesting @tinybrother - thanks for sharing. I'll add it to my Economics teaching resources.

I did one of those healthy eating apps (Noom, although MyFitnessPal is similar) in 2020 to lose lockdown biscuit overconsumption weight and some of their methods perhaps draw on those ideas.

I certainly found tracking what I ate over a day/week useful and I got some new ideas for filling reasonably healthy foods I actually like.

I feel like evidence based NHS stuff could use an app like that (there's a sleep one they prescribe, isn't there?)

People have mentioned UPFs which I think is a huge factor. Dr Chris Van Tulleken found changes to his brain structure after an experimental period eating mostly UPFs. Worryingly, those changes didn't reverse even months after he stopped.

I genuinely think this needs to be explored further. All this 'eat less move more' just won't work if the brain has been changed and is now basically addicted to processed food. People talk about 'food chatter' and 'constantly' thinking about food, and that's not laziness or greed, it sounds more like physiological changes in the brain brought out by unscrupulous food companies who WANT us to eat more and buy more.

Nailed it.

The Department of Health needs to turn round and kick the rest of government into line. They are picking up the tab for the outcomes of the processed food industry, food legislation, supermarkets, institutional catering, education, planning permission, working hours rules and loads of other bad decisions.

This has been extensively written about and ignored.

Obesity correlates with social class, and some people just can’t be helped.

1 in 3 isn't "most" though is it

Out of interest OP, you say that obesity is something people can fix themselves, but what about those people with mental health issues linked to disordered eating, would it be acceptable for the NHS to help them? Or those with metabolic disorders maybe, are they worthy?

I think medical professionals within the nhs should have more training around healthy eating and diets. I gained weight due to hypothyroidism and asked my gp about specific diets around hypothyroidism and he didn't have a clue. I have a history of ed which is on my medical records and spoke to a different gp about diets and calorie counting before I was diagnosed with hypothyroidism and couldn't figure out why I was gaing so much weight, I told him I was eating 1000 calories a day to try to lose weight and his answer was eat less.

Hmm, interesting subject. The NHS and GPs should be doing more and they should have more money to fund it. So the bottom line is that its the taxpayers fault. 🙄🤔

I don't think it's the nhs role to prevent obesity

But it's probably worth their while spending to reduce it as the cost of obesity to the nhs is huge - diabetes and cancers for start

No but I think its their role to educate. Which they are unable to do due to lack of training in the subject

If every problem is considered necessary to treat long term, i.e obesity, smoking etc, eventually it'll ruin the NHS.

While part of this is true - poverty and poor education is a massive part of this. It's easier to feed a family with 2 cheap loaves than an avocado. Education eg " having to do a foreign language" has not helped youngsters who would have benefitted more from Domestic Science ( as it was called) lessons - but no they all had to have an equal education. Then there is the generational effect of all of this.

NC Purpose of study
Learning a foreign language is a liberation from insularity and provides an opening to other cultures. A high-quality languages education should foster pupils’ curiosity and deepen their understanding of the world. The teaching should enable pupils to express their ideas and thoughts in another language and to understand and respond to its speakers, both in speech and in writing. It should also provide opportunities for them to communicate for practical purposes, learn new ways of thinking and read great literature in the original language. Language teaching should provide the foundation for learning further languages, equipping pupils to study and work in other countries

I mean how much relevance does this have to most people?

Here's my thoughts @snookspooks do with them what you will.

I was obese by the time I was 11yrs old back in 1994, that was when I remember my mum first taking me to weight watchers and starting to count points.

At 16 I was wearing size 18 clothing.

I've gone up and down, lost 7 stone then gained it back, then lost 5 stone and gained it back.

I know from when I was TTC that I have PCOS, I have high testosterone, the US showed multiple cysts on my ovaries and the blood tests showed insulin resistance.

I got Gestational diabetes when I finally after 3 years did conceive.

I think it's reasonable to say that there are medical, biological factors that have probably contributed to my weight.

On the 6 different occasions I have sought advice and help from a GP/Nurse I have been turned down for any medical interventions, even just blood tests to check my current hormone levels and diabetes status. Each time I've been told in various ways that I just need to eat less and move more and show a bit of willpower.

It's not true.

I can lose weight, I can, but it only works if I almost completely exclude carbs from my diet and am very restrictive about my calories, I find it impossible to maintain long term because as soon as I start trying to eat a more rounded diet to include a little pasta or bread the weight piles back on.

Thats a really interesting chart.

When you ultimately have no choice to buy the value sausages over the finest ones, yes, social class is a factor. However, it’s not as easy as dismissing it as personal choice.
I have been completely skint and had to buy the beige food because that was all I could afford.
thankfully now I am in a much better position financially , I cook 95% of family meals from scratch and make sure that they are healthy.

Your comment is very simplistic and the generalisation isn’t really true.

Why not just stick to excluding carbs if it works? Plenty of people do it.

I really don't think it's the NHS's responsibility. The government could do a lot to improve people's diets through taxation etc.

Though I agree someone slimmer isn't automatically more healthy than someone who isn't as slim. The reality is it's well documented that the obesity crisis is having a huge impact on the NHS.

Yes beige food is cheaper and stress is also a correlation. It's worth looking at why it's a class issue and making changes to the environment/society so poorer people aren't set up to fail.

It's easy to look down on those not winning a race and say they aren't trying enough. But in this case those with means are getting a super head start and those at the back don't even know what direction to run in.

I think public health services need to treat illness when it arises, whatever the cause. If being obese means you become diabetic, you need to be treated.

There are a lot of advantages to promoting healthy lifestyles and good health practices generally, and helping people with effective programs if they want to make changes. Smoking cessation, say. So I think there could be a role for the NHS there. I would like to see though that programs like this have a good track record of success, and aren't just trying to fill a gap for the sake of it.

On the other hand, ultimately individuals are responsible for making change, no one can do it for them, and no program can do it for them. The fact is that often people fail - we don't do what we know we need to, or we decide it's not worth the trade off to us. My father is in that boat - he can lose weight, by being very careful, but he is miserable, and he thinks, I am old, something is going to kill me, and I don't want to restrict my diet in that way and be hungry all the time.

I don't think we can really outsource that kind of thing. Whether it's because we make a decision, or we fail to do what we intend, it's not the responsibility of other people or public health.

I don't know how much is the NHS' responsibility but the correlation between poverty and obesity/poor health outcomes is one that I'd like to see the giver and address. The number of people - and children - living in poverty is a disgrace.