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/

Better mental health services to tackle the roots of overeating for many (myself included!) would help a lot I think plus better health education in schools (these are the two areas I feel would have prevented me from becoming obese). I have had to teach myself a lot about diet and exercise and it’s hard to sort the wheat from the chaff. My dp is woefully uneducated about how diet and exercise all really work and his mum is a doctor! But I agree something needs to change, I worry very much about the impact on my DD if both her parents are overweight and the nhs is crippling under the pressure of obesity related issues.

Aagh, quoting @dumple's post there.

Agree with this. People already know walking is better than driving and carrots are better than McDonald’s. It will take more people dying young of obesity to make a difference to society’s perception. There’ll be more weight-loss drugs and surgeries coming.

I am looking forward to the shift in understanding about portion sizes and ‘treating’ oneself.

I also think screens, screen addiction and the move away from manual work (and subsequent impact on mental health) will be examined more closely in coming years.

Make it hard, labour intensive and expensive to be fat, as we’ve done with smoking, and we will see the rates fall

Unfortunately that is what is going to have to happen. Yet currently, we celebrate obesity and have a culture where literal observations are described as fat shaming.

'Fat shaming' should probably be encouraged more tbh - the health system will combust pretty soon (or our taxes will become even more extortionate) if people do not start to take serious action on this, for themselves - someone else cannot do it for them and every person has to eventually become part of the change

That's the difficult answer. People don't want that, never mind that it's the right one.

Hmm

Yes Michael moseley has a lot to say about gut biome but I notice that his diet is 800 calories a day!

The NHS will be forced to make significant changes to the way it functions & there will be charges for more & more patients. Hopefully this will help people change their habits when they realise there isn’t a free NHS waiting to deal with their obesity induced diabetes, back problems etc.

Obesity has very little to do with food and is all about the stressed and fatigued state people find themselves in. Given time to exercise, shop and cook properly, eat at the table with your family, have some de-stressing time at evenings and weekends in which to exercise, huge simple strides could be made.

I hope that as a society we are mature enough to have a nuanced conversation that reflects the fact that the causes of obesity are complex and that there won't be a one size fits all solution. This doesn't mean we shouldn't be talking about obesity though and doing all we can to tackle it.

Obesity is a key risk factor for lots of terrible conditions and diseases that cause untold suffering for millions of people. It costs the NHS an inordinate amount of money dealing with obesity and this money could be spent elsewhere to treat and cure other people.

The problem is that there is already a lot of shame associated with being obese and any discussion about it provokes emotional responses from obese people that feel attacked and judged. This isn't necessarily what needs to happen though and we need to be better at discussing what is ultimately a health condition without importing all kinds of other unhelpful judgements and connatations alongside it.

Change the UK's food culture. Easier said than done.

They are not worried about it becoming a nanny state they just don’t want to upset the corporations making profits from what is essentially an unhealthy drug.
Because society is geared around rich companies making big profits, the things needed to prevent obesity will never happen. A lot of food we eat is not fit for consumption, fast food such as McDonald’s is normalised, as is constant ‘treats’. So much processed food full of salt sugar and additives, there are studies that prove some of it causes cancer yet we are still given it. I don’t actually see the point of the FSA. Also even the medications that cause weight gain, there may be other methods to prevent or treat the condition being medicated which doesn’t cause weight gain but then the rich pharmaceutical companies wouldn’t be happy would they.

What do you expect me to do?

I limit my calories to 1200 a day every day. Bar once in a blue moon (maybe at most every 10 weeks) when I have a meal out.

I don't snack on unhealthy foods, I don't even have biscuits or crisps in the house. My snacks are fruit - melon, grapes, oranges or apples.

I've moved almost completely to a vegetarian diet and I only eat meat once a week - IE one meal a week contains meat.

Breakfast is whole meal granary toast with low fat spread.

I can't exercise. That's cannot. Am not allowed to at the moment, except walking in water which I do 5x a week at a local pool. I'm there at 6.30 3 of those mornings, I go one evening and on a Sunday afternoon.

I go to physio every Tuesday night which I pay for myself at £50 a week.

Please do tell me what in my attitude is ridiculous. And what more I should be doing. Thanks.

Of course fat shaming shouldn’t be encouraged, anymore than shaming victims of the opioid epidemic was helpful. This is a societal problem baked in to how we are having to live our lives. A few obese people - yes maybe people who could do with individual motivation. Almost everyone obese, then we need top down legislation to make it hard for us to be fat.
I am not sure how much more evidence we need that this is a not the fault of an obese individual any more.

Yes it’s easy, addictive and takes a conscious decision in many cases to eat differently

Op this has come up a few times, but that article shows the extent of the issue

Like you I’d settle for more directness on what to do about it

I’m sorry but I can’t agree that the state should be providing cheap gyms, employers should provide free fruit etc. Many of us really like food that isn’t good for us; sweet things, pizza etc taste good and don’t need much effort. Cooking healthy meals, especially if you aren’t rich and/or work full time, is a pain. It can be done though and needs to be done, especially if you have children and want to set them up for a future with good habits. I could eat my own body weight in sweet things, but I know I’ll get bigger if I do, so I really limit my intake.

I’m sure I’ll get piled on, but medical/MH issues aside, it’s mostly a bit of self discipline. Children get taught about healthy lifestyles from Reception and have done for years so most people surely know what they need to do.

You shouldn't be obese on 1200 cals a day even with no exercise tbh. That's crap for you I'm sorry.

I'm sure there are many societal changes that could and should be done, from sugar tax to ban on advertising ultra-processed foods and better advice on nutrition etc etc, but I personally have found semaglutide a game changer. I was obese six months ago, now I'm 5kg from a normal BMI. It's helped me make better food choices, cut down drinking and exercise six days a week.

I think semaglutide should be made more widely available at a much lower (or no) cost to those who need it.

@angstridden2

Do you want to me morally right?

Or do you want a solution that works?

I’ve yet to meet someone morbidly obese who doesn’t have psychological issues.

I didn’t know I didn’t ever feel full until I was put on metformin. There may well be others similar.

With the increasing knowledge of gut microbiome, the surprise findings of fecal transplants changing previously healthy weighted people obese, there is obviously far more to learn here, which sadly, the NHS is shit at - they’re not great at keeping up to date with stuff like this.

I know many obese women who would love help, who want to lose weight, but when you diet strictly for months and only lose a couple of pounds you massively lose heart, and everyone assumes you’re cheating.
Perhaps prescribing ozempic (or other) to people who need help would reduce the burden on the NHS.
Perhaps accepting that the diet industry benefits the diet industry and very little else would stop obese people being told “go to weight watchers” as of it was the cure all.

Of course diet plays a huge part, combined with cost of living, stress, time constraints in people’s lives, but if it was as simple as just crack on and diet there wouldn’t be an obesity problem.
As for children, yes they need exercise, but they also need to be carefree in a way that many simply can’t be now - because they are also affected by stress, pressure, time constraints etc.

There’s no answer to this right now, no cure for this, unless there is a change to how we all live, to how society is structured.

Disagree. I would love to know how a sugar tax really helps. I find just like everything else in a nanny state it punishes all for the sins of a few. Where does personal responsibilty come into this? (I am obviously not including people with disabilities or on medications that make you gain weight in this - those situations are difficult. Although I suspect they are not a large percentage of these obesity stats).

I agree with most of this, but I don’t think most people know how much protein they need to be having (and meat is very expensive compared to anything else - not to mention increasingly unfashionable).

I was obese after lockdown having previously been slim and I thought my
diet was largely fine. I mostly home-cook, eat plenty of veg, get exercise and drink lots of water. By seeing a personal trainer, logging food and getting a diet plan I realised I was massively lacking in protein. Now I’ve upped that, my calorie intake has gone down a lot and I’ve lost weight whilst not feeling hungry.

I agree that this is societal, but to get culture change, it takes every individual to participate (or at least a majority)

'fat shaming' I am using in inverted commas because it would be described as fat shaming if you were to say to the population, for example, that to get the cheapest tax rate your BMI must be in the healthy range. 'Fat shaming' is a term described for any comment that says it is not healthy to be in the overweight or obese category making it essentially a useless term.

And people actually do change behaviour from feeling some sense of shame.

"I feel ashamed my house is a mess"
" I will clean it"

There is nothing to be frightened about in inciting acceptable levels of shame to encourage better behaviour

I think the biggest from of all is the food and drinks that we eat and the amount of it we eat.

If you go into any supermarket, the majority of the food and drink for sale is sugary, fattening, processed food. The aisles are filled with jars, sweets, cake, crisps, ice cream, pop, alcohol, ready meals. There is less of the fruit, vegetable and fresh ingredients. The junk food is fairly cheap too.

There are more and more takeaways popping up everywhere, with deliveroo etc it's so easily available. We've had 3 new KFCs pop up and a new McDonald's all within a 2 mile radius. The local high street is full of pizza and kebab shops.

We've all had the wrong type of foods pushed onto us more and more.

Exercise is of course a factor but the biggest cause of obesity is eating too much.

Give people the tools to be more active and eat more healthy:

• Give people a better work - life balance by tightly regulating working hours and pay.
• Making fresh, healthy foods more affordable.
• subidise kids activities like sports, so you don't have to re- mortgage if kids want to play football & the violin.
• give people on benefits due to disability and term illness acess to sports, physio therapy, better equipment ect (whatever would help to keep a person active within their abilities)

For starters!

It’s because the demand is there though. If everyone swerved those options - or to a much lower degree the aisles and stores would reflect that