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?

It might be more accurate to say they work but if people go back to eating too much and doing little exercise then of course it won't work long term. That's why changes need to be be lifelong not just for a few weeks. Healthy lifestyle, not a healthy few weeks or months or whatever. Medical issues aside of course.

I am a carer and can go to WW, whoever and lose 3 stone; but then something stressful happens - which means me caring 24/7, 3 hours sleep a night, etc and I don’t have the time or energy to think about what I am eating. I just eat whatever is to hand. I gain weight again; but then doctors tell me with regard to dieting:

”Don’t put any more stress on yourself!”

Imo, until England treats disabled people better in the NHS, social care and the benefits system; then they and unpaid family carers end up with additional long term health problems and a shorter life expectancy, due to poverty, stress and lack of time for medical appointments (for the carers). I have noticed most of my friends with disabled children have ended up overweight and/or with chronic health problems.

They don’t work. Science proves that. There are strong biological reasons they don’t work. Survival being the main one. And people can and do engage in healthy behaviours and they’re still fat. And often ‘healthy’ too.

You mention ‘medical issues aside’…but it’s not just medical issues that affect people. It’s their socioeconomic status, their mental health, their lifestyles and personal circumstances. But people just assume that fat person are lazy and gluttonous, when that is just not true.

So if diets don't work should overweight and obese people just not bother to do anything about their weight because there's no point?

More needs to happen to stop people getting fat in the first place. Individually everyone needs to take responsibility for that, and nationally the government, food manufacturers, the NHS, schools etc. it's a fine balance I think between a responsible government and a nanny state and we all have choices to a greater or lesser extent. Defensiveness and blaming various things isn't the answer. Action not excuses. And I mean that individually and from the government and food manufacturers and anyone else who has the power the effect change.

Snook that's the million dollar question really. We KNOW diets don't work so just keeping putting the blame on the obese person is completely counter productive. It would be more helpful to see what does work.

So if diets don't work should overweight and obese people just not bother to do anything about their weight because there's no point?

Pretty much, yes. That doesn’t mean they shouldn’t be encouraged to move more, drink less alcohol and eat well but those things can be done without focusing on weight.

I’m obese, I have chronic health issues including chronic fatigue, I struggle to get out of bed let alone exercise. My health conditions mean I can’t eat certain foods including what are pushed as healthy foods, lots of green veg makes me violently sick and inflames my symptoms. I’m also restricted on diet due to some of my medications, meaning I have a very limited diet and although I’d love nothing more than to sit down and eat a giant plate of steamed broccoli, I physically can’t. Because I’m now so big it’s creating other medical issues on top of the ones that triggered my weight gain. Are you telling me it’s my fault I’ve become obese and shouldn’t get any help from the nhs?

Obesity 100% starts from parents. The lack of knowledge and understanding about what and how to feed children is what's causing the issue. The constant snacking, massive portion sizes, sugar and quality of food is detrimental to these children who then have to fight the battle for their entire adulthood because of shitty parenting mistakes. It's no coincidence that obesity is higher in less educated parts of the country. As a country we need way more education around what is acceptable nutrition for our children - and maybe the NHS should help with that.

Loosing weight needs to stop being the foucs and developing a healthy relationship with food should be. Intuitive eating main foucs is not to loose weight. People are not going to become healthier when you guilt and shame them. That doesn't work it makes the problem worse.

It’s not as straightforward as that. Humans are born with an innate ability to know when they need nourishment. That’s why babies cry when they’re hungry and start pushing away when they’re satisfied. It’s the intuitive eating @Rainbowsandbutterflies1990 is referring to.

The problem comes when we start interfering with that and telling people what they ‘should and shouldn’t’ eat. That said, it’s best all round to be given a wide variety of foods, including sugary/fatty stuff. But being able to accommodate a wide variety of food is a privilege not everyone has, for many reasons. Which may be the reason obesity is higher in poorer areas.

I remember the experiment they did on tv once. Well, I think it was on tv, I’ll try and find it. They put a lot of kids in a room - like a party atmosphere - and had lots of sweets as well as ‘healthier’ snacks. Prior to this they had split them into two groups. One of which was allowed pretty much unlimited access to sweets/crisps etc and the other group was told to cut them out and not have any. The group that had previously been allowed sweets mostly ate all of the foods provided, including the carrot sticks etc and ate what they needed. Yet the group that were previously deprived of the sweets pretty much ate nothing but sweets and crisps.

I hear what you're saying but that's not exactly what I meant with my post. Studies have shown that if you are obese as a child you are more likely to be obese as an adult and also the other way around. So if you can get your kids through their childhood without becoming obese then you've gotten them off to a good start and after that it's up to them to make their own food choices.

If a child is obese at age 5, and can eat whatever they want growing up, then when they do become teens they are more likely to have body image issues, eating disorders, etc. and it's much harder to get the weight off. As a society, we blame adults for not having will power or discipline to be able to lost the weight when for most people, the weight has always been there.

Sure, kids who come from a healthier household, may gorge when they leave the nest or are able to make their own food decisions but it's easier to come back from that - gaining 20lbs then losing 20lbs, etc. whereas if you are already obese at 18 years old, losing 50lbs in a healthy way would take years and years.

I see what you mean and yes it makes sense. That said, it’s still not always straightforward, especially if poorer or with other disadvantages but I do get what you’re saying.

I was brought up in a very privileged household food wise. We had a wide variety of food available - lots of fruit and veg, as well as access to crisps and sweets. Some home cooked meals and some M&S days! We had dinners and puddings. I was like a bean pole until I was 18 and my nick name was Olive (Oil). I got pregnant at 19, gained weight as you do, went for my post natal check at 6 weeks and still had about 10 lbs to get back to my normal pre pregnancy weight. The doctor recommended Weight Watchers. So I lost a stone relatively easily. I kept it off for quite a while but it slowly crept back on. The cycle started again and continued for about 20 years, with me getting bigger and bigger at each attempt, and culminating in bulimia. My point being, I am more convinced than anything that if I never attempted the weight loss in the first place, I’d likely still be a similar weight and would not have ever needed to diet. This is sort of proven by the fact my parents and sisters have never dieted and are all slim still!

Beret - there are so many stories like this. The actual dieting and the message that so many on this thread want to get out to people is in fact the thing that makes people bigger in the long run.

We need to stop doing this.

They talk about Abundance versus scarcity mindset. And I 100% belive it. When u don't restrict what food u eat and can eat anything and buy it anytime u want. U are not going to feel need to binge on it or keep thinking about eating it. As u can have it anytime u want. If the food is scarce then there is more chance of binging on it. It happened to me when I got covid last year. I had to stay at home and on first day I binged all the chocolate in the house because I know I just couldn't go buy it. I panicked. The brain is wired like this due to food not always being so widely available.

They I mean intuitive eating. Its deigned by 2 dietitians who talk about the damage the diet culture is doing and what to do to build a healthy relationship with food.

Elyse Resch and Evelyn Tribole. They were the ones who originally wrote a book about it but I think it’s been something that’s been known about for a while, even before they did the book. And of course, it’s great. You’re right in that restriction causes bingeing.

The only thing I would caution against is making the principles of IE into hard and fast rules. Otherwise that’s just another form of restriction. Like it’s absolutely ok to continue eating past fullness, or eat when you’re not hungry, depending on your circumstances. Eventually you settle into a pattern that works for you and heals your relationship with food and eating.

Unfortunately I tried to experiement with intuitive eating nad it opened the floodgates and I put lots more weight on.

I think my hunger cues are off (likely autistic)

This is a much more complex issue than 'you're obese because you eat too much and don't move enough' lots of people have underlying mental health issues that cause the binging behaviours etc. lots of people are time and money poor especially at the moment, which in turn leads people to buy cheap, convenient foods which aren't as good for you as pre packaged fruit and veg or freshly prepared home cooked meals. Schools and home (especially those who come from poorer economic backgrounds) aren't providing the education around preparing easy home cooked meals and education in the earlier years of your life are proven to be the best combat to obesity. The education around healthy eating in schools is often misguided and not researched enough also, for example in DS's school this week they've started giving out stickers to the children that finish all their lunch, it's just not helpful, encouraging finishing all your food stops children from being able to recognise feeling full. It's too complex to just say 'don't treat fat people on the NHS and tax all the beige food to high heaven'
Another point though is people do dangerous things all the time, if they injured doing said dangerous thing, does this mean they don't deserve to be treated by the NHS? These conversations don't occur in places where healthcare is paid for at the point of use, but plenty of obese people work and pay taxes that pay to run the healthcare system, everyone deserves health care regardless of the choices they make in life in my opinion.

That’s very possible. Though it is normal for floodgates to open when you first try it. Most people go a bit mad with ‘forbidden’ foods when they first start but it generally settles down so if you didn’t try it for long it could be worth another go. That said, I understand being ND can cause differences in lots of things so your experience makes sense as well. And obviously you know your body and mind best.

I gained a bit of weight when I first started IE, though I had gained considerably more than that prior because of recovery from bulimia. It pretty much settled and has stayed the same in the 7 years I’ve been practising it.

I think over 3 years of obsessively reading the intuitive literature I gained about 4 stone which hasn't come off. I really don't know the answer! I think intuitive eating is a great concept for those who haven't gained weight though.

U wasn't doing intuitive eating wrong as u put on weight it's very normal to do that while u first begin to find ur feed and after years of diet culture its very difficult to trust your body. I know personally I've found it very difficult. And has put on weight. Its only after year that I'm now beginning to stop and loose. That's difficult in inself as ive got to stop then going into diet thinking about and restricting what im eating to loose more weight. So trying to find balance . I'm also Neurodiverse which has its added struggles. As i eat to stim and dopamine, I'm doing a course for adhder with intuitive eating. And it's been really helpful.

Thank u it seems from reading a few of ur posts u that IE has worked for u its good to hear from someone who has been doing it for a while. I'm only year in so very new and still find it extremely difficult but know this is the best for me and even thou I'm the heaviest I've ever been I'm the most active and have the least disordered eating I've ever had.

It’s the same for me too. The only thing is, I’m not active but that’s because of my illnesses and I would be if I could because I miss my long walks (particularly when we go to the Lake and Peak Districts) and swimming like I used to.

In terms of the IE, yes, it’s been a revelation. At first it was definitely a learning curve and I didn’t always do it ‘right’ but it’s not like something you’re off and on, it’s just relearning what we were born knowing.

It might be more accurate to say they work but if people go back to eating too much and doing little exercise then of course it won't work long term. That's why changes need to be be lifelong not just for a few weeks. Healthy lifestyle, not a healthy few weeks or months or whatever.

This is exactly my point. I totally agree that "diets" don't work at all - it isn't physically possible to just eat a lot less for a few months, lose weight, then go back to the way you were before and expect the weight to stay off. It has to be a wholesale change in the way you eat and view food for the rest of your life. You cannot ever go back to the way you were before, and that's often where people fall down.

if you are already obese at 18 years old, losing 50lbs in a healthy way would take years and years.

This isn't really true. I lost 60lbs recently over a period of about 18 months. It was in no way dangerous or unhealthy. Younger people have higher metabolism and energy levels, so the younger you are, the easier it is to do. They get a lot more return even on small changes to diet or lifetstyle.

You’re missing the point about why they don’t work. The video I posted explains well.

And if your weight loss is only recent, I hope you’re in the small minority who do keep it off. I imagine most of us who are trying to tell you it doesn’t work long term have been exactly where you have with your “I’ve lost weight so anyone can” way of thinking.

I’m one of those people who has health reasons that led me to put on weight (hypothyroidism and pcos). I worked a very stressful job, was a single parent etc etc. I was 4 stone overweight and just couldn’t lose it. Whenever I ran (something I’d done lots in the past, running marathons etc) I had a flu like response. My diet was ok but nowhere near good enough really.

Then when lockdown happened things changed. I no longer had to travel. No commute. Kids were old enough for me to leave for an hour to exercise locally.

Short version I managed to slowly start exercising and slowly ate better food. I lost 2 stone over about 6 months and then another stone more slowly. I’m still very very gradually losing weight through eating a good diet and running and walking lots. I’m now so fit I can run marathons again. If you’d told me that 3 years ago I’d have laughed.

What changed? Well I could say me - I’ve put huge amounts of effort in to be consistent, running in horrible weather, spending time consistently meal planning etc. It’s been really tough especially with health issues still there.

But also changes to my job gave me more time. I’d just moved to a nice area with lots of green space. My kids were older so I could leave them. I had pay rises which meant we could afford decent food - so much easier to eat better. I became more senior in work meaning I had more flexibility. My partner moved in so I could get out more easily.

In other words my environment changed for the better. It still took huge amounts of effort from me but that effort was easier because my environment was easier. Some people will never get that change and some people will never have barriers such as health problems removed.

Short version - my privilege enabled me to work hard at making changes. Until we change the environment, tackle poverty, exhaustion, food industry, long hours etc it’s going to be so much harder for people.