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?

Obesity could be reduced by:

Banning drive-throughs (would also help with our massive litter problem)
Banning the likes of Uber Eats and Deliveroo - if you want a takeaway you have to at least leave the house to get it
Banning 2 for 1 and other offers on junk food (coming, but not soon enough)
Investing in cycle infrastructure and stopping this country's ridiculous hate for cyclists
Banning pavement parking so people could actually walk to places

It's the price of healthy food for people. I love sushi and sashimi it costs a fortune. Even though we have some of the best waters for fishing 😳. I love fish and seafood but it's so expensive . Beige processed food is so much cheaper

@Bluekerfuffle I don't keep biscuits or sweet snacks in the house, as a rule.

Dd was home from uni and threw out the wrapped biscuits as they were out of date. (Kitkats and caramel wafers)

I am also wary of falling back into an eating disorder - I had what was thought to be anorexia as a child / teen but I now realise was ARFID.

I wish people wouldn't judge others. You have no idea what it's like in their shoes.

Anyone who wants to try mine is welcome. But they're fugly because I can't really walk and I'll end up in a wheelchair so you know. It isn't great.

We're also taught that drugs, tobacco etc etc are bad for us. but the NHS has smoking cessation services and drug rehab services.

It's cars.

We drive everywhere.

We've forgotten what our bodies are capable of. Able-bodied people scared of walking, cycling or getting rained on even for a mile of two.

So they drive.

Cue the personal abuse!

I think there should be stricter rules on the placement of fast food outlets. In my tiny town of 10,000 people we have several cafes, 2 pizza takeaways, a costa, a subway, several Chinese and Indian restaurants, a kebab shop and 3 chippies. The council have just given permission for a McDonald’s ! Totally unnecessary. The fruit and veg shop is now a chippy. The municipal sports centre is run down and inadequate. The fields around the town where people went walking now have warehouses on them. It’s almost as if the planners are trying to make people fat and unfit!
It’s no good educating people about healthy diet and lifestyle, then removing their green spaces and filling the area with junk food outlets.

In answer to your original question no obesity is not the responsibility of the NHS. It is responsible for treating the diseases obesity causes, which is why it tries (a little bit) to engage in prevention. Unfortunately it doesn't get funded very well for that bit and prevention is a complicated issue (involving food supply and regulation etc) so difficult to 'treat'. Strictly speaking it's actually a public health thing. The report by the bloke from Leon, made some really sound recommendations on all of this, but the government (despite commisiong it) don't want to follow the expert recommendations.

I do think there needs to be a more research conducted on why people get overweight and then progress to being obese. I had a friend in my early 20s who said he knew he was fat and when he got to x stone he'd do something about it. Pounds creep up but for many if threads on here are to go by, there comes a point where people say enough and work to lose the excess weight and be healthier. Or is there a sod it, I'm fat, I might as well carry on aspect to things? There are so many factors at play it's impossible to isolate them to know how instrumental each one is never mind treat them. The whole thing is very complex and very emotive as the responses here prove. I do think obesity should be treated on the NHS with a focus

I find it hilarious I'm a former obese person. I had weight loss surgery paid for by me and body lift. I'm now 9 stone I struggle to keep my weight up , now others see me as a slim person I must be a virtuous, not lazy , have good self control and an active person. No I "cheated" but I would have never stopped yo-yo dieting and maintaing my weight without it. People's attitude towards me has changed so much I'm still the same person as when I was obese. It's not a moral failing to struggle with your weight.

It's to be treated at a population level.

There are countries, developed countries, who have done it.

We could try to emulate them.

With a focus on psychological support. I also think individually we need to take more responsibility for our health. Food availability, poverty, lack of education, lack of access to cooking facilities or fuel to cook, Frankenstein foods and mass availability of nutrient poor foods all need to be addressed at government level. I can't see that ever happening though and people will complain about the nanny state. It's impossible to please everyone. We do have choices though. Some more than others, but we do have choices. I'd want to choose the packets of biscuits every time but I don't. That's my choice. Others are free to make their choices according to their circumstances. Society is a mess. From poor government to capitalism where money is more important than health, the car is king, gym membership is expensive and who has time anyway? No safe spaces to cycle, no bike racks at school, no parking at school either to be fair, no time to cook from scratch due to both parents working long hours and kids in childcare eating toast as a put-you-on until they get home for dinner (my experience of after school childcare) and so on.

Individually how should I take more responsibility for my health?

I already pay privately for therapies.

We can't tackle this with psychological support on an individual level.

Nation-wide strategies around restrictions on car use and cuts in working hours

I agree with this. I work in a school, there are no facilities for staff to shower so staff can't cycle to work or use the school gym as not even any staff changing facilities. These would be a relatively easy fix giving 150 staff access to free fitness opportunities (which other schools do).

My children get a school bus because there is half a mile of 60 mph dangerous road lots of blind bends and crazy overtaking between our village and cycle path which then connects to 3 larger towns. My dh drives because of the same thing.

I drive 33 miles to work because it would take 2 hours to catch 2 buses and a train (or 2 buses and 2.5 hrs) in order to get there on public transport. If we had a cycle path (and work could provide showering facilities) I could cut out both the buses and add a bike ride at each end and probably do the whole journey in less than an hour and fit my exercise into my commute.

All small things but if there was a bit more joined up thinking and planning it would make it easier to be less sedentary, and fewer vehicles on the road.

So as obesity yet again is getting a good hammering today on MN ,my question is how about all the people on here who clearly starve themselves to remain very underweight and all the associated problems related to starvation?
All the competitive under eating threads ,people buying piss strips to check they have ketones in their urine confirming they are starving themselves etc ,how many of these posters are nurturing teenagers who will develop ED because of their Mothers obsession with being thin !
Potentially leading to multi organ failure,osteoporosis and serious MH problems .

@Train007 has anyone here said they starve themselves or are underweight? I might have missed those posts.

Botw1 · Today 13:02If obesity was something we could fix by ourselves no one would be obese”

very fair point.

@snookspooks please tell me how I should take more responsibility for my weight. Thanks.

OK, so that measures perception of effectiveness - what certain groups think would work if they were given the power to impose those changes.

Short of locking people up in camps or issuing ration books and shooting black market sausage dealers on sight, none of their proposed compulsions would work - because humans are genetically predisposed to take full advantage of food due to the nagging suspicion that there's no guarantee there will be more next time. It's why wealthier people tend to be thinner - they've never had a situation where food hasn't been in abundance, so they can just not think about it.

my question is how about all the people on here who clearly starve themselves to remain very underweight and all the associated problems related to starvation?

This may not be a popular opinion to express but at a population level we have far, far more problems stemming from over eating than under eating.

Once again my mere existence is up for debate on the Internet and it feels like being bullied all over again which lead to my obesity in the first place. Once again my right to healthcare is up for debate and once again I wonder I'd I'm actually worthy enough.

I think a lot of the blame is with various 'weight loss' companies giving shit advice. I will not dare name them but some of these routines people follow at work are stupid. Points for this and cutting out that means they are designed to fail.

Eat natural and cut out processed.
Eat in moderation.

The problem is getting that message through.

I also think its a different thing being a healthy weight and maintaining it, when walking doesn't hurt and you already look okay to being morbidly obese.

I really don't know the answer for those already very obese as some areas suggest only fat loss surgery works, so much evidence to show dieting doesnt work long term. It really isn't clear how to come back from it once you already have all those extra fat cells. It's almost like an extra organ that is keeping you fat.

No in serious illness actually it costs a fortune to keep malnourished people alive. Total nutrition shakes cost the NHS a fortune and they prescribe loads if someone comes in very thin poorly we worry about them more than someone who's a bit plump as they have the fat stores there to fight. Being too skinny or too fat isn't healthy.