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/

This current age reminds me of my reading about the agricultural revolution and how our ancestors health suffered with grain becoming the staple food stuff. It was easier and freed humanity up to create cities and civilisation, but our health suffered.

Sorry but it’s not as simple as that. It’s clear you have been affected by the situation with your mum, but obesity is caused by multiple issues, many of which are linked to mental
health and undiagnosed neurodiversity (esp in the older population). We are coming to increasingly understand the impact of gut health and diversity on weight gain as well as genetics.

Over consumption of calories/lack of exercise is not about being weak willed/lazy either. These are often symptoms themselves of underlying issues.

The most effective thing that can happen is to solve he country’s mental health crisis

This is such an important topic and I agree "fat shaming" and advice like "eat less" won't help. We have a mountain to climb as a country, not helped by terrible weather which makes outdoor exercise most months of the year deeply unpleasant (dark, cold rainy mornings - only a hardcore few will brave that for a jog) and also the impact this has on local produce and what we can actually grow here. We have a carb heavy diet supplemented by processed foods. Breakfast = toast, lunch = sandwiches, dinner = something with potatoes/chips. More indoor exercise facilities (which are affordable) and huge shift in food culture are needed. But that means huge investment and re-education. I was flabbergasted by the awful unhealthy meals available on the post maternity ward - there were no healthy options, just microwave ready meals. If NHS hospitals can't even serve genuinely healthy food then we clearly have a long long way to go. I don't know what else to suggest. BMI isn't even an accurate measure of health / body fat percentage and yet this is still the measure used by the NHS. That in of itself needs to change before there could even begin to be any targetted work done with patients around weight loss / healthy living etc. We are great at sustaining a culture that prides itself on binge drinking and going to the pub after work. It will take a lot for it to become more socially acceptable to instead go for a game of squash but that should be the end goal. (Not specifically squash obviously, any sport would do!)

Yes I was going to say this too. 2 out of 3 adults obese really would be astonishing - we are not quite yet there though. Maybe we are heading that way!

I live in an affluent area and I would guess only around 10-20% of adults are overweight or obese. In my hometown it’s more like 80-90%.

People still don't understand or are too stupid to accept the overwhelming evidence that obesity is a chronic, relapsing disease. I wouldn't hold out much hope of them grasping the role of the microbiome.

We need to build activity into daily life. DH and I cycle to work, kids cycle to school. Always pottering around the house and garden. Eat well and out for long walks and active on the weekend. It doesn’t feel like effort and we enjoy it but it stops us all putting weight on.

This obviously does not apply to those overweight and obese with disabilities and health conditions but let’s be honest the vast majority of people don’t have health conditions prior to being overweight.

Thing is, you go to the supermarket and there’s a bit of fruit and veg. Then all the rest is crap. The food is designed to make people want more and overeat. Real food doesn’t stand a chance against all the processed crap

The problem is it is so complex. So no one size all is going to fix it. The reaon I am obese could be conpletely different to the next person.

In my case, it is poor mental health. I was a healthy weight until my early 30s when my weight ballooned. The suicide attempts went hand in hand with weight gain.

My poor eating habits and lack of exercise are so deeply ingrained I am finding it hard to change them. At the moment I am not a drain on the NHS as I don't require any medication/weight loss surgery etc. I am starting, for the billionth time, to try to lose weight. I am calorie counting and exercising 3 times a week.

Had my poor mental health been addressed properly after the first attempt, I might be in a different space now.

So this is a long winded way to say this is how you fix the obesity crisis for me. But this is sadly one of many solutions needed and why it is a public health crisis and not necesarily pure greed and laziness.

This is part of the problem - Everybody knows the basics of losing weight - eat less move more.

This is simply not true!! Calories in calories out is a myth. Exercise does not lead to weight loss unless you can exercise in the fat burning zone for over 45 minutes a day - which only really already fit peole can do. Walking a million steps at even a fairly fast pace will not really impact your weight - only if you are walking to get your heart rate up to about 140 bpm for more than 45 minutes. But 'do 12000 steps a day' gets people thinking they are losing weight, when it will be having very little impact. I'm not saying walking/exercise is not a healthy pastime, it is, but it won't really impact on weight loss on its own.

You can eat way more calories on a low carb/high fat diet/high protein and do no exercise and still lose a significant amount of weight. This is because of the stimulation of thermogenesis and the body using up more energy from fat. Article below - most obese people and pre-diabetic people will have some degree of insulin resistance.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233655/

Conclusions: Consistent with the carbohydrate-insulin model, lowering dietary carbohydrate increased energy expenditure during weight loss maintenance. This metabolic effect may improve the success of obesity treatment, especially among those with high insulin secretion.

High tax on high sugar treats
If I am paying £15 for a bar of chocolate or bag of Haribos I would certainly be less likely to buy as much and therefore eat as much
A family bag of haribo for £1 and a large bar of chocolate for £2 does not put me off.

I used to work for a NHS free weight loss programme for obese patients who were high risk diabetes and had other weight related health issues. Honestly 90% of them just couldn't be bothered to do any form of exercise or to reduce calorie intake. There was a general lack of accountability and total blame shifting for their high BMI levels. Its really simple, in general, if you eat too much and exercise too little then you will be overweight. The NHS spends £1.5 million EVERY HOUR on diabetes.

I know that the issues around weight are very complex and there is no silver bullet solution. But I also don’t think telling people to “eat less” is such a bad idea. Our society is geared around snacks, coffees etc at every opportunity and portion sizes are ridiculous. So many of us consume too much food without even thinking and part of it is just a case of changing our mindset, no it doesn’t solve the problem but it does help.

Yes. Everyone has voted against state inference. But we need state intervention sometimes in a balanced way to protect the public good. Otherwise commerce takes over. We have literally allowed retailers to determine our health. Supermarkets and fast food outlets should be subjected to much more government regulation.

Yup. I think this accounts for the large % of the increase.
I am in a club of 6 women. We take it in turns to host. We all live within walking distance of each other. Most drive, or get a lift with someone who is.
There is one who lives a little further away (less than a mile and over the fields) and honestly, the hoo haa over meeting up to walk over.
The school run. Popping to the local shop.

Google suggest that Italy has one of the lowest obesity rates in Europe around 10%

Some of the posters on this thread would benefit from listening to the Zoe podcast re ozempic, where an expert explains the reasons why we overeat. It's very enlightening. For many people it's not "easy" to maintain a healthy BMI and it's not just a matter of "personal responsibility".

I'm hopeful that ozempic/wegovy/semaglutide will be a game changer for this issue. I've been overweight most of my life, always struggled with overeating. I have various friends and family that have never struggled with it, always been naturally slim without any effort at all. Since I started using ozempic I get it. They have something naturally that I'm missing. I don't know what that thing is. It might be physical, mental or emotional. Or maybe a bit of each. Whatever it is, ozempic seems to be mimicking it. For the first time in my life I've no desire to overeat. I eat a meal and I'm full for hours afterwards. Two meals a day is plenty for me and I've no desire to snack. I no longer think about food all the time.

I don’t eat the most healthy or nutritious food (am frequently cooking pizza and fish fingers for the kids). However I have drastically reduced my portions recently. I also only eat between 10am and 6pm.

I hate cooking and am never going to be a really healthy eater but I think quantity is a huge factor in why people put on weight. Everything in moderation is fine, people just eat way too much nowadays. Since reducing my eating window I have got used to a mild feeling of hunger in the evenings. I think most people can’t cope with being a tiny bit hungry so over eat.

I also think parents are obsessed with letting their children snack all the time. I make mine wait for meal times and not fill up on snacks.

how do we support people to make the right choices

Treating all the complex issues where obesity is one of the outcomes is really not as simple as saying people are making wrong choices.

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
I agree but society isn't shaped by what we the people want, rather we the people are cash cows farmed and milked by the big corporations, they are the ones pulling the strings and they need us to be addicted to the things they want us to buy in order to keep them wealthy and in control.

You are right. Easy fast food, ultra proessed food and the abundance of coffee shops show we have been Americanised, and base our economy around consumption and instant gratification.

I think it has to be a carrot and stick approach, but we need the buy-in of government, as well as the big corporations and employers if we are going to achieve a seismic shift in our attitudes towards food, exercise and health. But our modern lives are so intrinsically enslaved to long work hours, social media, cars etc and thus a sedentary life, that this will be decades in the unpicking.

Definitely need massive increase in price of sweets, chocolate, fizzy pop, and UPF's. Also perhaps part payment towards any weight related NHS treatment that isn't caused by other health issues.

Two of my close friends are obese.

One has always had a tendency to put on weight and was a 10-12 up until her early 20s when she was a 18-20, no medical condition just greed and no exercise. In her early 40s she suffered a stroke and was left with limited movement but got loads better on one side. She lost 4 stone after and then during covid and is now back at size 20.

She could have a gastric band or weight loss injection but don’t think she will.

Other friend much better in terms of gym and exercise but has gone on various diet plans plus PT and diet and lost lots of weight. Now is type 2 diabetic and a couple of other medical conditions where she’d like to lose weight so she doesn’t have to take medication. She’s now on a weight loss infection prescribed by her GP.

I’m slightly overweight mostly as I eat or drink too much of wrong things and exercise when I can.

Both women listed above say wrong eating choices, drinking lots of alcohol and less exercise has helped put on weight. Stroke person over covid was walking 30 mins every lunchtime plus virtual dance class and online pilates. With a good diet she lost weight. Now back at work but mostly wfh but she lives with mother who likes her to have lunch with her rather than walk!

All about choices.

I’m assuming you would include mental health in your asides- because I believe that is the biggest cause. At the moment all there is is condescending advice of eat better run around more.

How can you run around more if you struggle to get out of bed, do exercise if you have panic attacks, eat less when you know it will stimulate your vagus nerve and release dopamine?

The people who really need educating round this are doctors - they need to understand the whole issue not just the numbers on the scales.

We need to stop talking about getting people walking more or to the gym. Sorry but this won't have an impact for 99.9% if people. Why? walking burns hardly any calories, people tend to think they have done something good and deserve a treat so eat more then the calories back, exercising requires motivation and commitment. If people aren't motivated and commited to changing their diet or eating less they won't start exercising in any meaningful way. Lastly exercising when you are fat is hard, to do exercise that will make a difference us very hard if not impossible for most people esp if they have never exercised properly.

I'm not saying people shouldn't be encouraged to walk and move more however I do not agree with the tax payer funding this. The amount of free exercise on YouTube is amazing, point people that way.

Until people understand that to lose weight you have to move away from crap then it's going to be difficult. People need less calories than they think. People overeat fir many reasons however one thing that seems to work are these new drugs that make you feel full. The NHS needs to start a programme with these asap. We will then see if it does work AND if people really want to take responsibility for themselves.