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/

I disagree.
It literally does boil down to calories in versus calories out, but there are many complex, confounding factors that impact on the calories any individual expends or consumes.
Its not helpful, given that 50% of the population is overweight, to imply that this isn’t related to food consumption

I think what this thread highlights is that on some topics it's impossible to talk about population level statistics and trends without individuals turning into "but what about my specific situation?".

Some pregnancy and infant feeding topics are the same. Because they're subjects people might have strong personal feelings about their own situation, it's easy to get caught up in personal anecdote.

The likelihood is that there's a lot of factors affecting obesity and obesity related illnesses, and there's a lot to be said for more transparency on food quality, the rise of UHP foods, and considering the interconnection between some medications and weight gain, but the fact so many people get wound up at the suggestion that individuals might also need to take steps is probably why any change on a public health level is going to be slow.

It definitely boils down to calories in calories out.

I did the low carb boot camp and lost a stone in 10 weeks. When I really looked at what I was eating it was pretty low calories- no snacking no alcohol three meals a day 2.5l water a day. As soon as I started eating LOTS of cheese,.LOTS of fat etc I stopped losing weight. I thought the weight loss was magic keto but really it was calories.

I’m not suggesting it’s not related to food consumption. I am stating it’s not related to calories consumption. And while the overwhelming advice to lose weight is calorie controlled fat reduced carb heavy we’ll be fat.

I totally agree with this.

They need to change the way UPF is marketed to children NOW and ban some of the ingredients totally.

We also need to stop this culture of endless snacking. It starts when they are toddlers. The number of parents I knew when my DC were small who would say, ‘Oh, so-and-so can’t last until lunch,’ ‘He gets really grumpy if he doesn’t have a snack’ and then you realise that the child is eating tiny meals because, guess what, they’ve had loads of snacks between meals. It’s a vicious circle.

I know people will come on now and cite the ever-present (on MN) ARFID or sensory issues, but children do not need endless snacks.

It’s not as simple as calories in calories out, particularly for women. What works for one woman may very well not work for a menopausal hormone imbalanced woman.

The link shows a comparison of overeating on different diets to demonstrate that what you eat is important.

https://www.dietdoctor.com/happens-overeat-low-carb-diet

The BMI is not right at all it really shouldn't be used. I'm overweight because disabled but how do I cost the NHS. 3 Years ago I was 30kgs lighters and I got pains and couldn't walk and was told to loose weight. Then a year later had to go private and it was found I had a twisted pelvis. 5 cm cyst in spine cord and many more things. My surgeon thinks there from teenage years and other conditions I couldn't stop. Even medicine don't know why I got it. The private knee Dr said to lose weight by private don't cover weight loss the waiting list for NHS weight loss care is over 7 months.

So I'm keeping a food diary and trying my hardest.

But with a high BMI I've never needed special lifting equipment, ambulance etc.

There is something such a big frame and very small frame. I found an article based on height and wrist size and it adds or minus 15%. If used I bet the amount of overweight people would drop and people would get more respect of drs.

Also my friend is in the small framed group and was told by NHS IVF treatment she will get treatment but to put on weight. The years it took and twins she was unnaturally big. Cost loads of money to the NHS through being in hospital for 6 weeks with high blood pressure. Who created that problem - the BMI.

We also need to stop this culture of endless snacking. It starts when they are toddlers. The number of parents I knew when my DC were small who would say, ‘Oh, so-and-so can’t last until lunch,’ ‘He gets really grumpy if he doesn’t have a snack’ and then you realise that the child is eating tiny meals because, guess what, they’ve had loads of snacks between meals. It’s a vicious circle
Agree with this. It's ok to be hungry just before a mealtime.

We've had a mid morning and mid afternoon snack as well fell into the rhythm that nursery set when DC were younger, but it made sense that if breakfast was 7am and lunch was 12 then a piece of fruit or some veg sticks mid morning was sensible to us. We never subscribed to the idea that the second DC were bored or felt like grazing we had to provide them with a multitude of child marketed snacks.

“It’s not as simple as calories in calories out, particularly for women. What works for one woman may very well not work for a menopausal hormone imbalanced woman”

Please explain what you mean. The same diet/food intake/calorie intake won’t work for both women because the menopausal woman’s metabolism has changed and her tdee is lower. She simply can’t eat as much as she could before menopause.

People have explained and shared links.

We live in an era where thin people want to believe that fat people are just stupid and lazy, perhaps that feels good to them because they’re disciplined, it will never happen to them.

Perhaps not allowing so many fast food joints would be a start,does a city need 10 Mcdonalds for example. People cooking from scratch ,less ready meals

I cant really comment too much ive always been a healthy eater,havent eaten red meat for years dont eat cakes crispsbiscuits or pastry only sweets i eat dark chocolate. But then im naturally slim weigh same as i did at 20 and im many years off that. Still a size 6 but im only 4 11 I think weight is diferent for all some people are naturally slim some have to work at it, its such a difficult subject.one size doesnt fit all

Supply and demand. There are a lot of fast food places because people are going to them.

Although I agree, the number of McDonald's etc is overkill. Maybe the number should be limited per town/city.

No one said it isn’t related to food consumption. I said it wasn’t as simple as CICO. As this video explains if you watch it.

I'm a little sceptical tbh.

These threads are always choc full of overweight people that claim to exercise 5x a week and eat healthily. Yet you still seem to see a lot more fat people in McDonald's than down the gym? 🤔

Just because she ‘can’t eat as much as she could eat before menopause’ (without gaining weight is what you mean there), doesn’t mean she doesn’t need to eat as much in terms of ensuring a full range of nutrients.

I remember reading somewhere that the most important thing is never to let yourself get fat, as once you're fat your body works differently - being fat changes the metabolic processes that govern appetite and satiety, and this makes successful, sustained weight loss and weight loss maintenance extremely difficult.

And as someone who was effortlessly slim for 4 decades and is now effortlessly fat and trying to lose weight at nearly 60, I can concur.

"It definitely boils down to calories in calories out."

Well yes, but that overlooks the fact that people who are overweight have an impaired leptin/grehlin/insulin response, that's CAUSED by being fat, and that makes maintaining a calorie deficit extremely difficult.

Being fat makes you fat and keeps you fat.

'I'm a little sceptical tbh.

These threads are always choc full of overweight people that claim to exercise 5x a week and eat healthily. Yet you still seem to see a lot more fat people in McDonald's than down the gym?'

The evidence that regular exercise results in really significant, sustained weight loss isn't strong: https://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories

And you only need to eat two biscuits a day worth of calories above your TDEE to be overweight within a year.

I

Yep. Being fat is the last ‘acceptable’ form of discrimination if you ask me.

There is no doubt some people might be ‘fat and lazy’, but it’s certainly not as many as people make out. There are so many things that determine a person’s body size and health and although the two may be correlated, the casual link isn’t clear cut. And even IF a person is lazy and fat, what good is berating them going to do? Why don’t they deserve respect and care still?

You also hardly ever see threads like this about people who binge drink and end up in hospital needing treatment or police intervention.

These headlines are very reductionist and oversimplified. As I and someone else said, it’s more likely that fat person cost the NHS more because they’re usually dismissed with ‘lose weight’ for everything, meaning treatment is often delayed and more costly.

I’m also sceptical of those that flock to threads like this with little understanding and a desire to make sure we all know very stupid we are for allowing ourselves to be fat in the first place.

I’ve seen chronic illness turn enough previously slim people obese to know that it’s not just down to self control in many cases. The complete denial that medication and mental illness have a huge impact on the nation’s weight is astounding.

"but the fact so many people get wound up at the suggestion that individuals might also need to take steps is probably why any change on a public health level is going to be slow."

The evidence from obesity research is that significant, sustained weight loss among even motivated, well supported overweight people, is rare.

Losing weight and sustaining weight loss is extremely hard. Most overweight people try and fail repeatedly to lose weight and sustain that weight loss.

Which is why overweight people find this debate tricky.

I don’t think overweight people are stupid or lazy I just think they eat too much.

In 70 years we have gone from obesity being a rarity to 60% of the population overweight and obese. Far too many for this to be about medical disorders.

Consumption has increased exponentially, portions are supersized, sugar content increased, food availability increased, and activity levels have dropped.

The % of people overweight due to health or medication issues is relatively small. Although being overweight causes health problems of itself.

Also, my slim (all his life) father got Type 2 diabetes at 37. My slim (all her life) mother was diagnosed with high BP at 45. I’m now 47 and fat. With a perfect BP and cholesterol. I’m also ill with ME/CFS. Now, even though there’s a strong genetic link to both of these conditions, if I do get either of them, it won’t be that that’s caused it, it will be my weight won’t it?!🙄

The only thing I have needed treatment for over the years is my usual acne stuff because of PCOS (now buy my own). And then a referral to the ME/CFS clinic. As well as the usual acute infections (tonsillitis in my 20’s a few times). I also need treatment for my bulimia (caused by repeated attempts to be less fat), but I paid privately for that.

This. Not all slim people but a significant amount would prefer that we stay far so they can feel superior. They might not even realise they feel that way but it comes across in the language they use.

A few years ago I lost a significant amount of weight via Slimming World. Some people couldn't help but express their disdain for Slimming World (mostly because they misunderstand it). Now I'm fat again but slowly losing weight with the help of ozempic they don't approve of that method either. It's almost as if they don't want me to have any help with this issue, while at the same time pointing out the health risks of remaining overweight.

Research is starting to show it’s not about calories. This will soon become an outdated piece of evidence.

It’s about what you put in your body. As I said upthread, since changing my diet I am eating up to 3000cals a day and loosing weight.

I eat lots of extra virgin olive oil, nuts, cheese, fish, turkey, chicken, veg, fruit, dark chocolate and things like kefir. I have completely cut out UPF’s and very much follow the Tim Spector diet.

The quality of food we put in our bodies trumps calories.

"I don’t think overweight people are stupid or lazy I just think they eat too much."

So I'm 50lbs overweight. I eat enough to maintain that 50lbs overweight - my body's TDEE is that of someone who weighs 200lbs and who needs enough calories to maintain that weight. In order to lose weight I need to eat less than my body is telling me I need to eat to fuel my TDEE. I need to create a 'calorie deficit'. This generally means I need to not 'eat to appetite'.

What weight loss requires is that you ignore/fight your body's hunger/satiety signals that are driven by complex metabolic processes, and that you continue to do this for months and years.

Which is incredibly hard in an obesogenic food environment, and is why most people who try to lose weight fail to sustain weight loss over the medium to long term.