AIBU - With this new data on obesity and the NHS is it time to have some honest and difficult conversations?

[IAmADancer]

New data from a ‘landmark study’ has show that obesity costs the NHS around 14billion a year and that 2 out of 3 adults are obese.

I know this is a difficult subject but the numbers are pretty clear. With the cost of living crisis and a general requirement for both parents to work now to support themselves how do we support people to make the right choices and tackle a growing problem?

Im really interested to hear people’s opinions on what we can do with such stark figures laid bare.

https://www.telegraph.co.uk/news/2023/05/17/cost-of-obesity-twice-those-who-are-healthy-nhs/

Exercise doesn't have to be in any zone to help - bollocks

It's just that most people eat. Back the calories they burn and rarely burn more than 100 or 200 in a session

The idea that it isn't calorie in calories out is usually spouted by the overweight as an excuse for not bothering

In fact having read what has been really said

• it's not quite as simple, because of what happens when people stop counting calories- they haven't changed their behaviour so the weight goes back on
• it's not quite as simple as UPFs duck you up

But basically people will grasp onto any dodgy headline as a get off of jail free. Add

I have MS, epilepsy and arthritis (yay!)

Some of the drugs I take make me retain water which leads to weight gain and scarily quickly too. Thankfully my neurologist encouraged me to keep on walking & rowing gently and with help from my rheumatologist we made a plan that I can run 3km a few times a week and increase certain meds when the pain kicks in.

This has been a life saver. I'm disabled, my meds are against me but I'm a good healthy weight.

I've recently watched a video that stated adults continue to eat like growing children and it really stuck.

My job is NMW and I've noticed that loose fruit and veg is far cheaper than bagged stuff.

I mean yeah, life is still shite sometimes but at least I have some control!

Why not just ban shit food?
Why do we need chocolate, cakes and biscuits full of crap? Why not have baked goods made fresh with real ingredients? They'll cost more naturally anyway. Food like that is more satisfying as well.
Chocolate should be high quality.

This needs some government and industry intervention. Just like plastic straws.

Has it had an impact on your weight?

I think Wegovy has just been approved for use on NHS. Just looking it up it does say it’s not an easy fix, so people will have to work with it.

But posts requesting those types of drugs, it does look like it’s happening. Not for everyone overweight but some

I would say nearly all weight gain is caused by other issues, economic, physical health, mental health etc, environmental factors. How would you prove what’s in the individual’s control? Maybe start charging for healthcare for sports related injuries, car accidents, accidents on bikes etc etc.

It does sound as if a ozempic could be a game changer🥳
will the food industry respond by trying to make food even more addictive?
It's going to hurt their profit in a big way isn't it or will they give up and focus their efforts on producing a competitor for ozempic?

same. it really sucks when you've tried a multitude of drugs, which all cause weight gain. I was never overweight until I became disabled

Because banning drugs has done a really great job of stopping people buying them…

wrt Michael Moseley, you are mixing up two diets there. The gut biome is immensely important and we have brain cells along the digestinal tract. The stomach is the second brain. The 800 calorie blood sugar diet was based on the Newcastle diet which was about improving sugar levels and negating the need for diabetic meds and stopping pre diabetes becoming full blown diabetes.

I did the 800 calorie diet which is also low carb and lost about 2 stone in a few months. I felt well, no hunger at all after the first couple of days, started exercising and my blood sugar numbers were in the normal range. I was evangelizing about it but then slowly went back to bad eating habits. It is not as easy as people with no disordered eating think it is.

Also the 800 cal part of the diet is not intended to be long term. Once you get where you want to be in weight terms, you start to maintain which usually means upping the calories but quite honestly you can eat a lot as you are looking at the quality and not quantity of food ie a tonne of chips.

I dont think the vast majority of people in the UK are overweight due to medication. Some may be. Therefore we can focus on the rest.

Fat shaming is not the answer.

would you shame an alcoholic?

This is definitely an issue. I work nearly full time, look after DS most of the rest of the time - he's supected ASD, not attending school, can't sleep on his own, often isn't asleep now until 12.30-1am. I don't have a lunch break so I finish earlier so DH can work while I take over with DS, but do have to work around various appointments we have to with DS. My diet and activity levels are both shit, I know this, but I am exhausted. I fit in a walk when I can because I like being outside, but cooking anything healthy from scratch is difficult when by 6pm you're so tired you struggle to remember what day it is, and have another 6 or 7 hours to go before you can go to bed, and even then you're likely to be woken in the night.

I think it's a combination of what people eat AND how they eat.

My DP is Spanish so we spend a lot of time in Spain. Their method of sharing lots of small plates, spread over the course of a few hours genuinely means they feel fuller and consume less. I used to live in France and it's the same story, people have three courses at lunch, taking the edge off their hunger with a veg and fish starter before moving onto a main & then small simple dessert.

Obviously this method of eating takes more time than we allow for food in British culture - imagine most employers' reaction if their employees started going for daily 3 course lunches. But it definitely seems to work in those countries. And then of course the content of the meals is healthier (the famous Mediterranean diet...)

Plus there's the cultural norms to consider which pressure people to watch what they eat. I'm considered slim in the UK but in Spain I'm larger than most of the women I see on the street.

Ultra Processed Foods are now being revealed as contributing to mental health problems also. Our family gave up UPF only two weeks ago after I had a minor heart attack (I’m a woman ) and wanted to overhaul our diet. We have already seen the difference in mood and also feel more energised. Yes it is an adjustment and we do spend a lot of time cooking but it is worth it.

I think a 4 day week or flexible working hours could help. After a day in the office (snacking all day) I’m drained, depleted and crave shite food.

Clearly not everyone can WFH but if you have to physically be somewhere chances are it’s a physical or at the very least stood up job, retail etc.

hard, labour intensive and expensive to be fat,

This won't work because people have to eat.

Why should I have my life made even harder? I struggle to chop and prep veg for example. I don't have great grip. Makes typing on this keyboard fun too but that's by the by.

I also am frequently exhausted and can't face prepping a meal. And don't tell me just to do it - because I can't. I just can't. It's not if I tried a bit harder or pushed through - it's literally falling asleep at the table can't function exhaustion.

Yes, I've lost 1st 9lbs in the last two months.

Wegovy has been approved by Nice but there are supply issues so it's on hold for now I believe. Hopefully will be made available to a lot more people in the future.

And how would fat shaming help?

It's already bad enough with the disability shaming, fat shaming would just be another stick to beat me with

Fat shaming is 100% counterproductive but at the same time it is very problematic that obesity has become normalized, I don't know how to reconcile those two things 🤷

I think the truth is that we don't really understand obesity and the causes of obesity.

It's really not as simple as "eat less crap" if it were, then there'd be a higher success rate of weightloss maintenance - currently sitting around 2%

There's increasing evidence that obesity has a viral cause in most people and a microbial cause in others- there's very few where it's actually due to eating too much rubbish. And that due to the underlying cause, losing weight doesn't cure obesity, t only managed a symptom of it. Obesity is complex and obesity itself is much deeper than someone being overweight. It's becoming increasingly evident that weight gain is a symptom of the disease and not the disease itself.

Evidence for this theory is based in migratory birds, who when given extremely limited diets, still gained fat prior to the migratory season, despite no increase in calories or loss of activity levels. They also lost the weight following migratory period, with again no change in calorie intake or energy expenditure (because they were captive). The obesity epidemic has spread to "third world countries" PRIOR to the increased availability of UPF and high sugar foods, which again gives evidence to a non-food, viral or microbial cause.

It also explains why some people can eat essentially whatever they like and not gain weight.

So what needs to be done? A massive increase in the research in to the cause of obesity beyond what we think we already know. Which may hopefully lead to LONG TERM solutions. Because people being constantly hungry, and feeling constantly deprived is not a solution.

It would also help if we removed the morality view of obesity - that it's a moral failure which requires willpower to overcome. And an acceptance that like any other disease, some people will require medication like ozempic and that by using these medications people aren't "cheating".

To be fair I would have no idea where to buy drugs so would equally have no idea where to buy black market chocolate.
It would still reduce intake for the general population if it isn't easily available Most people aren't going to be hanging around on shady street corners to buy their fix of fruit pastilles.

@PtarmisanCheese

but how do you know these complex chronic conditions aren’t caused by or exacerbated by weight ? For example Fibromyalgia the correlation is well known. That’s not to say it’s perpetual and a difficult cycle to break.

Can you give me an example of where someone’s concerns have been dismissed ?

Our office has free gym equipment on site available for use, shower facilities and regularly promotes healthy choices, runs awareness campaigns and offers well being checks. We have subsidised gym memberships too for external gyms.

Still over 90% of the workforce here is overweight, if not more to be honest. The only people using the facilities are the slim people who would work out anyway.

Personally I think diet is a bigger challenge, what people are putting in their mouths. I don't know how we begin to tackle that!

If that is the total answer why does nhs say for example certain illnesses cause weight gain ? That can’t be to do with food can it ? It is the actual illness . I am not saying it is true for everyone of course it’s not , but your dismissive comments are very hurtful to some people who would struggle to lose weight even on 1100 calories and who can’t excercise .

I think tax unhealthy foods , pay farmers to build and maintain safe off road cycle ways . Provide more outside activities for children . Free gym and slimming club membership for those over a certain BMI

It would also help if we removed the morality view of obesity - that it's a moral failure which requires willpower to overcome. And an acceptance that like any other disease, some people will require medication like ozempic and that by using these medications people aren't "cheating"

Agreed 100%. I don't view ozempic as cheating, more as leveling up the playing field.