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 imagine it plays a part but at the end of the day, its our metabolism.

Sugar (also found in carbs) is converted to fat and this type of fat is stored in the most dangerous ways (ie around key organs). This is true even of sugar found in 'healthy foods' like pasta and fruit if you consume a lot of it. Sugar also causes insulin spikes and the insulin floating round your body tells you to eat more sugar so it can be used up.

Fat makes you feel full so you don't eat a lot of it. Protein cannot be stored by the body, so your body very quickly tells you to stop eating protein - hence why you can't eat large amounts of meat. Also why you get hungry a few hours after a chinese - the rice causes an insulin spike which generates hunger. You don't get this with protein.

If you eat a big Mac, it is the roll and the ketchup that is more likely to be causing weight gain, not the burger itself. (and the cheese as it is processed and not real cheese).

But @dumple isn't an extreme case. It's actually a common story for disabled people - or at least similar versions of this story. In my case, decades of healthy and active living (and I mean very, very active - think lots of sport, an active job, outdoors a lot of time, holidays doing things like hiking in the Himalayas / up the Andes...)..... and now I can barely walk 200 meters (although I am still walking and won't give up until I have no other choice), I am in constant pain, I do what exercise I can, and I have literally had dieticians despair at my weight gains. At one point I was on a fixed period diet of 800 calories, monitored and STILL lost nothing at all, and they had to take me off it because 800 calaries isn't sustainable in the longer term without causing damage. And I'm lucky - I have the best possible health care and have private insurance AND I can still work so I have a decent enough income.

There are an estimated 9.8 million people with disabilities in the UK. Not all those disabilities will contribute towards obesity - but many will in some way, and there will be others with health conditions not classed as disability (plus the impacts now of long Covid) who are unable to lose weight for a variety of reasons.

So it isn't an extreme case, and it isn't rare either - obesity is not a simple "one size fits all" problem, because disability is one factor amongst many. Poverty, choice, class, culture, environment...it is multi-faceted. It's all very well a huge number of posters on here saying people need more exercise, more spaces outdoors, less working time, more "this" or "that", but that's a lovely middle class approach. It isn't the reality for many people whose lives will never reflect those things due to lack of available money or time, and frankly, for many of them, rightly or wrongly in some peoples views, when they get to the end of another long day all they want is a couple of pints, a meal and to veg in front of the TV.

Teach children how to cook from scratch maybe?

Not just one or two odd lessons making rock cakes and pizza but how to do basic sauces, pastry, prep meat and veg, what portion sizes and ratios are sensible, how to budget, how to reuse leftovers.

Kids in homes where it's freezer food, takeaways and ready meals will likely do the same as adults if cooking isn't a familiar skill.

Anyone who thinks that the vast majority of obesity ( excluding those who are on meds/disabilities/poor mobility)is not their fault, pleading poverty etc, should spend a couple of weeks working in a fast food establishment, think Greggs, McD's etc. See what they buy on a regular basis. How much they spend, see the obese parents bringing in their obese children in for pies, pasties, cookies, donuts, full sugar fizzy drinks. Not talking a once in a while treat but regularly.
And now nobody even has to get off their arse and go in person to buy it . Just order off Justeat/Deliveroo (which adds on a significant surcharge) and it magically appears at your door!!
Poverty my arse!!

This! I am calorie-deficit but still overweight. Probably due to constant dieting throughout my life. We need move away from calories in/calories out and reassess the harm that (albeit well meaning) diet advice promoted by the NHS has done.

Indeed. I was referring to the 'traditional' mediterranean diet - clearly not always being followed by everyone! Again, I would argue it is the refined carbs that are causing the weight gain.

We work too many hours in sedentary jobs, live in a way that requires car use rather than walking, and tiredness from our lifestyles means time and motivation for exercise and healthy eating cannot be priorities for many. When life is stressful and exhausting we reach for any shortcuts to make things better - be that driving rather than walking, or getting a takeaway rather than cooking. It’s no surprise that obesity is a 20th century disease. We have created a lifestyle in western society that makes us unhealthy, and the easy way to do nothing about changing those unhealthy lifestyle norms - by reducing the working week, raising wages, building homes and communities where walking and exercising are safe and easy - is to blame the individual rather than spending money on bigger societal change.

I also think that there is a huge amount we don’t know enough about when it comes to genetic propensities for gaining and maintaining weight. I remember watching a reality show a few years ago where a doctor came to live with families in which someone had a chronic condition they couldn’t find answers to through their own GP. One of the cases was a boy who did loads of sport and ate healthily, but was obese, and his mum was at her wits’ end. The doctor assumed the boy was secretly eating but he wasn’t - it turned out after some more specific blood tests that the boy’s GP had never bothered to do, that he had some kind of deficiency which made his body hold on to fat. After treatment to remedy this, he began losing weight. So obesity can be down to health and genetic conditions and not just lifestyle choices. It’s not ok to just assume that everyone who is obese is doing it to themselves. We need to be investing more money into researching genetic and other health causes for obesity, alongside education and social changes, because for some people, no matter what they do, they will always be overweight if their body is working against them.

Thank you @Quveas Can't quote you coz I'm on the app.

Does the DT want to have a ' difficult conversation' with government and industry about an obesogenic environment, unhealthy food and poverty or just cosplay a conversation to help their readership look down on the poor and unhealthy?

All great ideas............but, they are not going to make billions of dollars for anyone so no-one is going to support them in a capitalist economy.

Not everyone’s weight gain is due to medication or a pituitary gland problem, which my daughter has and it does cause weight gain until it’s corrected with medication/operation.

my mum has always been overweight, size 24, and just doesn’t understand what healthy eating is. She’s always baking cakes, has sweets stashed everywhere and always a full biscuit tin, she swears she doesn’t eat much 🥴. I’ve heard this all my life and get bloody frustrated with it. I’m 56 and as a child was teased because my mother was the largest, it was unusual back then, it’s more acceptable now. She was the same size as me when she got married in 1966, a size 12/14.

It all comes down to what you put in your mouth and whether or not you then burn those calories. If you look in the shops most bars of chocolate have been supersized, so have crisps, these didn’t exist 40 years ago. We’re being encouraged to buy bigger, just like in America. My mum is on the verge of type two diabetes, she doesn’t know about diet changes and the nurse didn’t offer up any advice 🤦‍♀️, a recipe for disaster. Then my mum says I don’t know how the nurse dare tell me to lose weight, she’s overweight as well, not a good advert.

I saw a news item recently where a G.P realised that his patients that were obese weren’t losing weight after he’d advised them to do so. What they needed was guidance and education. He decided to give his own time to set up healthy eating advice, to his amazement they started to lose the weight and reverse type two diabetes. Perhaps this is what’s needed.

As for exercise walking is free, you don’t need fancy gym memberships, use tins of beans or bottles of water for weights, buy a weighted hoopla hoop. I have M.S and can no longer exercise like I used to so I’ve had to cut down my calorie intake to compensate for it. You are in control of your own body, stop using the covid lockdowns as the excuse for weight gain. I find the 16/8 way of eating really good. Eat between the 8 hour phase, then nothing for the 16 hour phase, it works and is easy once you get into it. You still have to eat healthily, but I’ve found it really helpful. If I’m really tired and struggling to cook I have a healthy bowl of porridge, topped with nuts, seeds and stewed apple. At the end of the day “YOU ARE WHAT YOU EAT”, sorry but it’s as simple as that!

Everybody knows the basics of losing weight - eat less move more.

Not many people are well versed in the influence of sleep and stress on leptinand ghrelin production, and the impact of ultra processed food.

The answer is simple but hard to achieve.

Create a society and infrastructure that facilitates frequent moderate exercise, a good night of sleep, and plenty of time and sufficient money for a healthy diet.

But that's very much not what big corporations give a shit about. And they're allowed to pump synthetic gunk onto the market and call it food.

When the only available food for visitors to hospital is a Costa or Starbucks outlet we know we are in trouble. The food environment is appalling in this country. In the shop that feeds our local community (coop) most of the food is ultra processed and the same goes for most other food retailers.

What an interesting ad for whatever the Zoe project is this turned out to be.

I'm not obese I'm a healthy weight but without my meds I would naturally be in the slightly underweight category. That was my normal and I hate this normal. Anyway health conditions need to be managed and when the treatment impacts upon weight you can eat as healthily as you like but it barely impacts upon weight. I don't know what the answer is.

I was very fit and healthy and exceedingly slim until I had my accident.

Was a participant in sport on a regular basis - competed and trained

Walked the dogs. And loved doing it. Used to adore a day of thousands of steps tramped over mountains or in forests or at the beach.

But that isn't possible for me anymore.

I'm on long term steroids.

I do know I'm fat. I don't need anyone else to tell me. Honest.

Also exercise doesnt have a huge impact on weight loss
I hear this all the time but it's not my experience.
When I was heavily into running I was running 40 plus miles a week I struggled to keep my weight above seven and a half stone and I was eating about 3,000 calories a day.
The amount and type of exercise that I do makes a huge difference to my body composition, I struggle to understand how it is that other people find exercise doesn't make you lose weight, a 10 mile run Burns a thousand calories!
These days I focus on strength training but I do gain fat if I don't do enough cardio.

Yes it's complex and yes society is geared towards cheap fatty foods but ultimately those companies aren't forcing anyone to eat / drink. Going for a walk or a run is free.

We need better education, incentives to be healthier (cheaper health insurance?) and yes a little shame for - disabilities, medication aside - not taking some responsibility. It's not seen as empowering and beautiful to be addicted to alcohol or crack; why is it when the substance being abused is food?

Yeah its this. We need to free up more time in people's lives. People eat processed, quick to prepare food due to lack of time. Now that two generations have done this, cooking skills are lost.

Now I work and have kids I drive everywhere. I used to cycle and walk everywhere, but I just don't have time for that now. I need to minimise my travel time as my time is so pressed.

Home working I am sure is reducing activity further, if people don't even need to walk to work/ the train station.

Three day working week. Said it before, say it again. Bring that in alongside concerted effort to teach cooking skills and introduce active travel routes and all the rest. We could change society if we really wanted.

We just need to think about what sort of society we want and how to achieve. But instead we plug away at little bits - a cooking scheme here - a cycle path there, a pledge to more funding for CAMHS here. But we really need to sit back and do some radical, whole picture thinking of how we want our society to be.

It's the lifestyle. People eat too much, too frequently and it's mostly empty calories. Also, hardly anyone walks anymore.

This is f#*$ing disgusting considering people who’ve suffered at the hands of others, through no fault of their own, e.g. childhood abuse sufferers can’t even get the mental health support that they need on the NHS.

Obviously, obesity can be linked to poor mental health but why do they take priority?

They also need to get all the crap off the supermarket shelves.

I haven’t RTFT but my weight gain when I was on anti depressants for 12 weeks was shocking - been slim my whole life and put on 3/4 stone in 6 weeks. Also got high cholesterol from them - my doctor was unaware they could cause it. Even regular anti histamine use can cause weight gain.

So I do wonder how many overweight people are on meds that cause it

I agree. I eat bread. Not overweight.

Sugar has already been replaced with sweeteners in many things, sweeteners which come with a different set of health issues. It seems to have done nothing to help the obesity issue.

People who are unable to afford food will eat what they can afford, which is usually the high carb stuff. Cost of living crisis is not going to help the issue. A high carb diet is likely to cause lethargy, therefore people won't excercise, many won't walk as it is, and it is normal now to sit indoors with screens instead of getting out.

It all needs addressing because it is common for people to only try to lose weight when they are told to by a GP or because it is essential for surgery. If they can't afford a decent diet there is no chance.

Zoe Harcombe was writing about this 15 years ago.