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If the aging population is adding to the stats and younger people are thinner then we are on course for a sudden reduction in bmi over a few years soon.
All the oversize ones will shuffle off
Young people are changing, though. Many exercise regularly, drink almost exclusively water and eat quite healthy too.
Really? I teach approx 140 in a week and only one or two drink water, the rest think energy drinks are the best form of hydration and a McDonald's is a treat they'd have every day of they could.
I've watched and shared this quote heavily recently. It's provoking, and I do t 100% agree (environmental arguments) but covers a bit about obesity and where calories come from these days.
BMI is a very crude measure – its doesn;t work if you are particularly tall or short either and certainly not if you have big muscle mass
It's a pretty good measure, as most of us aren't abnormally tall or short, or elite rugby players. I do marathons for fun, I'm at about 20-21 BMI, and I've got wobbly bits around my waist. If you've got a BMI of 27, say, and you're not an elite professional athlete, I'm happy to wager you're overweight.
MY pal who is 6'7" would disagree. He is skinny and his bmi comes up as overweight, Something to do with using square of height rather than a cube?
But yes - its fine for 90% of the population in the middle of the bellcurve.
Interestingly waist measurement as a crude measure is apparently actually better at predicting early death from diseases of obesity than BMI or so I have read.
The real challenge is highlighting the obesity issue, vs the current trend of “not body shaming”…
People simply don’t see obesity as ‘being ill’…
If I told my auntie I thought she had a melanoma / suspicious skin lesion etc, it would be taken seriously and thought to be a kind gesture. If I told my auntie she’s obese and it will make her unwell, I’d be told to FO and I’m rude.. (my aunti isn’t fat, but..examples…)
Once we can approach the idea like this, we can take steps forward..
People over 80 seem to manage it. Anyone in the extended family or their new friend/partner looking fat, thin, weak, poor skin glow - they'll be concerned and say something politely and discreetly to someone closer to that individual. I think it's that it was more common for that generation to go through lack of food, poor available nutrition, and consequences for the aforementioned things (e.g. precursor to other health problems, man won't get a job if he's a weakling) - it was a serious thing to be concerned about.
MY pal who is 6’7″ would disagree. He is skinny and his bmi comes up as overweight,
BMI isn’t perfect but 100+kg is not skinny at that height.
Many rugby props look fat and possibly are doing their ticker no good, what happens when they stop training? I bet very few loose the extra 5 stone they carry
A few ex rugby players where I work and their massive bellies suggest to me it has not gone well.
BMI is a great simple measure that will give a very good indiction on who is overweight especially if used by professionals as they can easily spot if the person is in the 1% where it doesn't work well and make a different assessment.
I have a BMI of 22 but in my medical I am always told my body fat is on the high side. Can't argue with that and while I look in very good shape compared to 99% of people my age I can clearly feel fat around my waist and ribs. I could get all defensive about it claiming I am fit, eat really well and a good weight but that would be silly wouldn't it as body fat is body fat.
You can be aerobically fit and fairly fat! In fact, if you walk across the park chatting with your fat mate, they’ve actually done more ‘work’ than you. <br /><br />Like on ‘supersize v super skinny’ when often, the pasty IT nerd had worse biomarkers than the blob they were paired with. <br />It’s actually pretty poorly studied how much subcutaneous fat is ‘healthy’ as obviously it’s the visceral fat that is the issue and one is just being used as a crude assumption about the other. <br /><br />There is no consensus on what a healthy diet is. Traditionally skinny/healthy cultures from around the world have diets that consist of what’s local, not one particular food group.
I looked at my MyFitnessPal entries from when I was at my skinniest (whilst still being fit enough for a 340w ftp) and every ‘bad’ food bar alcohol from this thread was consumed.
It’s not a western diet that makes developing populations fat- it’s a western lifestyle.
In Peter Attia’s book he says how the biggest change in his thinking from when he started to when he finished writing it, was how the role of food and exercise switched around in his mind. He realised there was no obvious consensus on diet but that being metabolically fit is the key to avoiding all the main health problems. <br /><br />One other thing I haven’t heard mentioned- back in the day when ‘everyone was skinny’, don’t forget they were smoking 60 appetite suppressants a day!! <br />My mate Bill (72) struggles with his weight and associated health problems like diabetes and he swears blind that giving up smoking on retirement was the worst thing he did. He ballooned steadily ever since. Of course- he just swapped one likely mortal disease for another
My granddad didn’t smoke and was a fit, strong farmer who could dig an acre of spuds until the day he died. He was always 15 stone. <br />My dad by contrast- has always smoked and he’s an unhealthy looking 12 stone. <br />I have never smoked and I too settle at 15 stone. It takes an almost constant obsession with diet to get under that. <br />Even when I was fit enough to do 250w for 4h30 at the tour of Cambridgeshire this year, I still weighed over 15 stone.
So whether people in the 70’s or whatever looked skinnier- that doesn’t mean they were any healthier. And were probably just as likely to drain our healthcare resources with emphysema or lung cancer. <br /><br />I think this also explains the ‘skinny poor bloke’ caricature above. They’re perhaps the demographic still most likely to be smokers?
It's possible to be fit, healthy, olympic medal winning with a high BMI in the right sport, but 99% of people with high BMIs are just fat, regardless of their protestations that it's all solid muscle cunningly disguised in the shape of a belly.
Who the **** goes to McDonalds and buys a salad?
My wife. She normally has the chicken salad as she has coeliacs. We maybe have McD once or twice a year if it's flying or long drive and there's nowt else.
BMI isn’t perfect but 100+kg is not skinny at that height.
You can see his ribs his body fat is that low but his BMI shows as overweight / obese
Crosshair makes a very good point actually. There's really no "one size" fits all and a person can be really healthy despite being slightly overweight or skinny and unhealthy but we know that and the problem is that most people in the UK aren't getting enough exercise.
There’s really no “one size” fits all and a person can be really healthy despite being slightly overweight or skinny and unhealthy
Yes they can be those things but I would put a very strong bet on most of the overweight people (not slightly overweight as that is not the discussion here) not being that healthy overall as it is a very good indicator of lifestyle and care about their own body.
this epidemic of obesity is going to cost the country hugely in treatment for diabetes and other illness. Its going to be crippling to the nhs
Yep. The government can either try and address the root causes of just put extra funding in to address the extra burden on NHS. Seeing that they will do neither of those things then not looking great is it.
but we know that and the problem is that most people in the UK aren’t getting enough exercise.
On page 2 of this thread there a picture of a milk shake that has more calories in it than a grown adult male needs in a day, and people on here are still thinking that if only folks moved a bit more, things would be fine.
Its going to be crippling to the nhs
In my practice (and I don't think we're outliers particularly) about 10% of our patient population has T2D, about 25% have hypertension, very few of those folks with T2 just have that though, it normally comes along with a festival of other LTC just for fun. We're now (just this week) having to send obesity data to the NAO.
At my annual checkup last week it was noted that I had slipped in to the obese category. As noted on the previous page obese evokes an image on morbidly obese, obese is now almost the norm. It shocked me and I'm going to do something about it.
I'm 6ft 3 and 104kg with 36in waist a bit of a gut and 2nd chin.
Too many drinking and snaking habits picked up during the pandamic. I don't expect to get back to a bmi of 20 ever again but 25 is a goal.
All of this is why do many pharma companies are aiming at anti glp medicines.
I just fear that with the advent of weightloss drugs that actually work it will just result in even less focus on people actually being a healthy weight naturally.
We will just end up with a huge number of normal weight unhealthy people instead
If the government were brave enough they would halve the cost of fresh fruit, vegetables, salad produce and fruit, then tax heavily (and I mean heavily) all 'treats', sugary drinks, snacks, chocolates, biscuits, cakes and anything else containing sugar, especially cane sugar.
It's about education, learning to cook (I batch cook mostly in a slow cooker or wok) and shopping carefully.
I very rarely use a supermarket as there doesn't seem to be much 'actual' food in these places.
Oh and ban the word 'treat'.
A cynic might think the current govt don't GAS about food quality, they're just thinking of a low health and high health insurance / treatment cost future w/o the NHS in it's past or current form. Libertarians try not to tell people what to do esp when the end result is something that can be profited from.
Agree with the idea of taxing some things but also subsidising some things to compensate. As has already been discussed cost is a significant issue as is convenience for those that are working multiple jobs and have no time. Strangely enough supermarkets have a role to play here as their own brand stuff is usually significantly cheaper and often tastier than branded stuff, but marketing means we often like to 'treat' ourselves by throwing money away
Obesity is associated with a higher risk of metabolic illness as above but not in a 1 to 1 ratio. So say around 60-70% of obese people have evidence of metabolic illness, compared to 20% of normal weight people (I don't have the exact numbers but they are about right). Therefore it seems it is possible to be obese and healthy (well, normal life expectancy etc) and it is certainly possible to be slim and unhealthy (any/all of the metabolic issues above). Most of the excess weight from obesity is in the form of subcutaneous fat (under the skin) which is relatively inert metabolically. A small amount is visceral fat (around the organs) - excess here causes metabolic problems - often it is only a few hundred grams extra.
- It is not clear that obesity/xs weight (subcutaneous) per se causes anything in particular, and may actually just be a cosmetic concern. It seems increasingly likely that most of the complications are related to metabolic illness (visceral fat), for which obesity (by BMI) is a risk factor (so not a cause as such).
- Maintaining weight loss is incredibly difficult long term (short term is relatively easy). Most of the evidence suggests the vast majority don't succeed long term without gastric bypass surgery (or perhaps the newer injectables though no long term data yet).
- Reversing metabolic illness and its complications is more straightforward and increasingly seems to be achievable longer term.
So we have this dual edged sword - weight is an easy measurements for the public to understand (the vast majority don't know their BMI so they use weight as a surrogate), and we talk about obesity as the problem and weight loss as the solution. BUT long term weight loss is largely not achievable by most. So we are really steering people to repeated/ongoing failure. On a 1-1 basis we can have this discussion and help people to understand their focus should be on lifestyle measures to reverse/reduce their risk of metabolic issues, rather than what is happening to their weight. But on a population level I've no idea how we make this shift.
Or looking at it in another way - in my experience people obsess about losing weight (which the evidence shows will only lead to failure), whereas even some of that attention given to metabolic factors would help them to live longer and better (and use less health/social/benefits services etc), but may or may not induce significant weight loss. Working with patients I only track their lifestyle, BP and metabolic markers (bloods) - I don't track their weight at all as outside of their cosmetic concerns I don't think it adds anything to the picture. Many still will struggle with the idea that if they are not losing significant weight then they are not getting the benefits.
"Germany and France are a lot closer to the UK than you might imagine. When I last looked the UK was 27% Germany 25% and France 22%."
"Obese" or "Obese and overweight"?
The last figure I saw for French obesity (this year) was less than half the UK figure...
I do think state intervention is required at this point but I have zero faith in this government to do anything that actually works as intended. The sugar tax seemed like an ok idea but imo has totally failed and actually may be causing equal or more harm than if it never existed, partly because on it's own a sugary drink tax doesn't work when it doesn't apply to junk food at the same time and because the rules have been bypassed by food companies by whacking artificial sweeteners in everything to keep the junk drinks cheap so people buy just as much processed rubbish as before and haven't had to adjust their palettes to less sweet products. That's without the potential harm caused by the artificial sweeteners to the bodies blood sugar regulation process, gut microbiome etc.
We need healthy food promotion, ban on junk food advertising, subsidise fresh fruit and vegetables and tax upfs. Won't happen under a Tory government and not sure about Labour but can only hope.
Another thing to consider is heating. Most people live in homes that are heated to more than the temperature would be on a warm summers day. Then they probably step into the comfort of their heated car and then into another heated building.
Calories are units of heat and if our bodies get slightly cold these calories are burned off.
In the olden days there wouldn't have been central heating and humans were used to getting a little bit chilly often.
I don’t think you should ban these foods it’s a choice.
We need to help people make healthy choices and teach them how to cook.
I agree in principle but I think expecting individuals to go against the flow of the society/system they are part of is generally doomed to failure. There'll be exceptions for sure, but most people are products of the environment they live in and the deck is pretty heavily stacked the wrong way. Biggest factor by a long way I reckon is the ready availability of cheap, tasty highly processed foods.
One way to do that would be use the tax raised on sugary/high processed foods to subsidise healthy foods.
Yeah, there definitely need to be some sort of interventions like this at the state level I reckon.
Just watched this and found it fascinating, must admit it got me questioning some things i had always thought.
I agree in principle but I think expecting individuals to go against the flow of the society/system they are part of is generally doomed to failure. There’ll be exceptions for sure, but most people are products of the environment they live in and the deck is pretty heavily stacked the wrong way.
Agree. I have always gone against the flow and it takes some strength. I became vegetarian in 1983 where the options were not that great and the offer in restaurants was to "eat around the meat" or "just take the meat off"
It is just the same avoiding UPF, you basically cannot eat anything other than natural ingredients so can't eat anything when out and about, any prepared food from shops and have got to prepare pretty much all food from scratch. I am very determined and just do that but expecting a country to do it rather than take the easy and largely ignorant options is never going to happen.
Kerley and MrSalmon have got it. The setup we have at the moment is Obesogenic. The default choices are fundamentally poor choices.
If you have the gumption to go against the default then it is vaguely satisfying to do so and see the results, but you just can't expect the majority of people to do that.
This thread just prompted me to check what my BMI is (a great population level indicator, not perfect at individual label IMO).
28.7!! (179cm and 92kg) Used to be 79-81kg when running marathons/ Ironman triathlons but it’s steadily crept up over 5 or so years. I haven’t got a ‘gut’ etc, and have got some muscle mass, but I don’t think kidding myself that I’m a pro rugby player is going to improve my long term health.
Surely for most people this is a combination of diet (UPF, cost, time, cooking skills etc) and exercise (I’m active probably 5 days a week, but evidently the balance isn’t right at the moment!)
The UK's obesity epidemic is massively multifactorial. Everything from our working practices, income, upbringing and family structure plays into it. The sugar tax is like a stone skipping off the surface of a loch, the population will happily pay more for sugar at this point, and sugar substitutes are arguably worse for you. Our focus needs to be on saving the generation currently sub-20 years old by offering them an alternative, and protecting them from exposure to our toxic eating/exercising and working culture. Effectively by wresting control of much of their nutrition from their parents.
The problem is, the solution is stark, and initially will be so 'nanny state' that I can't see how we break the cycle.
Interestingly waist measurement as a crude measure is apparently actually better at predicting early death from diseases of obesity than BMI or so I have read.
That's the approach I'm taking currently to diet and fitness - ignoring actual weight/BMI and focusing on reductions in waist measurement coupled with some other subjective measures - mood, energy levels, levels of inflammatory stuff (eczema/asthma).
Yeah, when I look at those metabolically-perfect pro cyclists with 5% body fat eating 120g of simple sugars an hour, I think “what are these selfish Tory scumbags doing not banning more and more pleasurable things in life!” 🤥
For a ‘progressive’ place- this forum wants to ban an awful lot of things 🤣
Rocket fuel is not the issue. Eating rocket fuel when your job consists of whacking the Y key on a keyboard for 8 hour shifts like obese Homer is the issue…
The boy probably packs away more sweets than the fattest bloater in his class but is thin as a rake as he’s usually done 10,000+ steps looking after his animals before he leaves for school.
Obesity is linked to the majority of the big killers in the UK, as well as tons of nasty, painful and disabling conditions. Second only to mental health in terms of lack of resources as a ratio to harm done in my opinion
A further factor is the unhealthy relationship between the manufacturers of highly highly processed foods and the supermarkets - they often dictate the pricing, shelf space and promotions - my local store has lots of space and offers for pizzas, ready meals, ice creams and alcohol but is constantly short of fresh fruit and veg.
My wife’s Grandparents* saw this coming (they were both GP’s). Her grandfather would happily tell random dangerously large/unfit strangers in restaurants or around town how they were killing themselves.
If he were still alive- he’d have been struck off for “fat shaming” no doubt.
He was as lean as a whippet and yet always had 4 sugars in his tea and a bag of sweets in his car 🤔
In this weird post-truth apocalypse we have to resort to banning ‘dangerous foods’ lest people are forced to take responsibility for an action (or rather their gross in-action) themselves 🤦🏻♂️
*I watched them on a windswept February Northumberland beach (well into their 90’s) going for a jog when a brisk walk wasn’t enough to stay warm 🤣
my local store has lots of space and offers for pizzas, ready meals, ice creams and alcohol but is constantly short of fresh fruit and veg.
Shelf life & therefore economic results for shops are a factor there too.
28.7!! (179cm and 92kg) Used to be 79-81kg when running marathons/ Ironman triathlons but it’s steadily crept up over 5 or so years. I haven’t got a ‘gut’ etc, and have got some muscle mass, but I don’t think kidding myself that I’m a pro rugby player is going to improve my long term health.
Surely for most people this is a combination of diet (UPF, cost, time, cooking skills etc) and exercise (I’m active probably 5 days a week, but evidently the balance isn’t right at the moment!)
My BMI is very marginally lower than yours, exercise as much and I would struggle to identify any UPF in my diet.
The biggest patient I’ve ever worked with was over 300kg (at one point bedridden at 355kg). I went to watch him swim laps for an hour once. Not fast, but surprisingly capable. PTSD
Surely we all know when even cycling magazines are pushing people to ride motorbikes where they can turn the pedals occasionally to cosplay a workout, hoping for fitness to save people is a lost cause.....
It's a wide ranging problem, but I'd start with the usual thing of following the money. Our entire economy is built on consuming things we don't need and excess food is as simple an example as any. If banning junk food ads would have no effect on the consumption of junk food the industry wouldn't have put the effort in to persuading the government not to.
Obviously everything is individual choice, but the odds aren't stacked in peoples favour when you have an industry worth billions who have it in their interest that individuals choose one way.
Slight tangent.....
Our new esteemed health secretary is Victoria Atkins, fresh from the treasury where she was one of the blockers for an extra £1 billion to NHS England to cover the financial black hole caused by the doctor's strikes. Nice bit of karma.
But more pertinent to the discussion here.....her husband is Paul Kenward, managing director of British Sugar. The healthy secretary in charge of long term policies to improve the nation's health is married to the bloke motivated to keep the UK addicted to sugar....can't see any issue there!
I also think the issue is snacking and processed foods.
When we were kids we'd be out playing football, cycling etc. Today I think it's more about xbox's and social media.
However, many more adults cycle today. The Marin car park is always crammed on weekends, when I started cycling 20 or so years ago, it was never like that!
I also think the issue is snacking and processed foods.
Yep and 99% of the snacking is probably processed food. Snacking just wasn't a thing when I was young in the 70's but the heavily processed food wasn't really a thing either.
Snacking on an apple or banana wouldn't be too bad but unfortunately people are more drawn to less healthy options.
Snacking just wasn’t a thing when I was young in the 70’s but the heavily processed food wasn’t really a thing either.
Are you sure? I seem to remember eating biscuits when I got in from school in the 70s, and chocolate and sweets existed in every corner shop which we weren't strangers to. We only drank pop at grandparents or at Xmas time, but almost everyone, adult or child, took sugar in their tea or coffee. Maybe everyone was skinnier because they smoked so much. Or maybe we though everyone was skinnier because we couldn't see each other through the fag-smoke everywhere. 😀
I’m 6ft 3 and 104kg with 36in waist a bit of a gut and 2nd chin.
Same height and weigh 25kg less than you.
When my OH was losing weight a few years ago I filled a trade bucket with the equivalent weight of water that she'd just lost, she was gobsmacked how much it weighed.
Another way is to weigh out what you need to lose, and then pick it up - in your case, you're carrying a large full-fat ebike over-and-above...
It's not the sugar making you fat, it's the FAT!
Takeaway curries, pizza, McD, Fishnchips. We're talking gallons of saturated fat here - massive calorie overload and very hard to metabolise into energy.
Sugar is that instantly available source. Eat it and within a few mins it's available to use. Much harder for your body to break up fat molecules and turn them into energy.
My latest newsletter from High North Performance is on weight loss and they say
"We’d therefore generally recommend that you focus mainly on cutting down fat and alcohol, with just a modest reduction in carbohydrate intake, and a slight increase in protein intake".
It’s not the sugar making you fat, it’s the FAT!
Takeaway curries, pizza, McD, Fishnchips. We’re talking gallons of saturated fat here – massive calorie overload and very hard to metabolise into energy.
Sugar is that instantly available source. Eat it and within a few mins it’s available to use. Much harder for your body to break up fat molecules and turn them into energy.
hmmm, you might get some backlash on that.
What high quantities of sugar do for insulin levels and that's knock on effects to you weight gain makes your narrative a little simplistic.
🤔Sugar is that instantly available source. Eat it and within a few mins it’s available to use. Much harder for your body to break up fat molecules and turn them into energy.
@convert I never said high quantities of sugar, so don't attribute that to me. Long-chain sugar (carbs) are the best fuel for endurance.
Fat is harder to metabolise than sugar. That is scientific fact.
@convert I never said high quantities of sugar, so don’t attribute that to me. Long-chain sugar (carbs) are the best fuel for endurance
This is a thread is about obesity and over consulption.And you also said.....
Takeaway curries, pizza, McD, Fishnchips. We’re talking gallons of saturated fat here – massive calorie overload and very hard to metabolise into energy
That does not scream an endurance slant to your response....
It’s not the sugar making you fat, it’s the FAT!
Takeaway curries, pizza, McD, Fishnchips. We’re talking gallons of saturated fat here – massive calorie overload and very hard to metabolise into energy.
Sugar is that instantly available source. Eat it and within a few mins it’s available to use. Much harder for your body to break up fat molecules and turn them into energy.
Careful with this rhetoric. For most of the population, it's excessive carbohydrates and simple sugars which are the majority of the problem. On a population level, we need to be eating more fats (quality white meats, nuts, seeds, fish, cheese, etc) and far less pasta, baked potatoes, sandwiches, and similar white crap
Perhaps you mean refined / processed food
It’s not the sugar making you fat, it’s the FAT!
While fat contains lots of calories the medical consensus is shifting from fat being number one enemy to sugar particularly fructose
Its easier to overeat with fat as its more energy dense but as above sugars are now seen as more important in weight gain
the key is a balanced diet low in sugar and do not run a calorie surplus
Are you sure?
Am I sure what my life was like in the 70s? yep, I am pretty sure. While chocolate and biscuits were available I was not allowed to eat them at will. Guessing that was just my life then.
Fat fingers this morning. As you were.
Am I sure what my life was like in the 70s? yep, I am pretty sure. While chocolate and biscuits were available I was not allowed to eat them at will. Guessing that was just my life then.
The same for me - and the big "food" companies did not pump all sorts of stuff with sugars in the same way as they do now. Yes they also pump foodstuffs full of fats and salt as well to make them addictive but hidden sugars and not so hidden sugar is a real issue and as above the medical consensus is shifting towards sugar particularly fructose being the main cause of obesity
High fructose corn syrup.
Going back to my childhood in the 80s, sure we had junk back then, but it was 1 packet of biscuits for my family of 5 to last a week.
High fructose corn syrup - a byproduct of industrial food processing used as a food additive. Its not "food" and is probably public enemy number one. Its put into all sorts of things to make it addictive.
NICE guidance
https://www.nice.org.uk/guidance/cg189
NICE ends to be fairly conservative and slow to react to changes in the medical consensus however you can be sure the information is valid and rigourous and free from a lot of the nonsense that is around diets
BMJ is a good place to look for information on the debate around diet. Summaries of papers ar usually free to access
Luckily our new health secretary Victoria Atkins, appointed in the reshuffle yesterday and literally responsible for creating policy on this issue will be making research into the link between high sugar levels in processed food and our obesity epidemic a high priority.
Being married to the Chief Executive of British Sugar will obviously provide no conflict of interest at all.
FFS
It's interesting that the 'slimming diet' industry is worth millions. People will spend a lot of money on products that deliver a quick fix. Sadly there is no quick fix. It means eating sensibly, exercising, drinking less alcohol and moving more.
Something I've noticed in the last few decades is families feeding their children carbs, lots of pasta and rice dishes. Not many children have veg (which is so easy to cook in a microwave), salads or fruit.
Too many sweets and treats made with corn syrup.
Also I believe in sitting down as a family for meal times. Many people are now eating on the go, walking around with finger food. Too many take-a-ways available. It's easier now to sit at a desk or at home just constantly snacking.
However it is important to have pudding, cake, biscuits, crisps, bagged snacks, chocolate or any treat, but only as a treat, just not all the time.
Obesity is a complex mix of challenges across societal beliefs and behaviours, our environment, hormonal influences and obviously food. There are huge numbers of people who try really hard to lose weight, do lots of exercise but really struggle and it is not because they lack intelligence or commitment, it really isn't very easy.
We use a motivational interviewing, collaborative, approach with patients, with the focus usually around pain and long term conditions, but obesity is often part and parcel of this. Although there are often commonalities (like the environment people live in), everyone is different and getting long term positive behaviour change is done in different ways for each patient, it has always been fascinating seeing shifts in thinking with patients as they explore their motivations and understanding of the life they lead now and the life they want to lead. There are also a lot of patients, who for various reasons, have no desire or ability to elicit any change.
We definitely need a lot more joined up systems thinking, including linking local government to the NHS and a shift in focus to long term outcomes instead of crisis management and treating symptoms of whatever ailments we have. This also needs a change in behaviour and education across society, it's a challenge to say the least, especially when there is a lot of money in the food and pharmaceutical industry.
Although I personally follow a high protein low carb diet, I don't think this is the only way forward. I suppose my views on diet are relatively simple, try to eat more real food (including fats), get enough protein (especially for older populations) and for the majority of people, cut down a bit on carbs, especially drinking them. It is more complicated than that and there are a huge number of discussions in the scientific journals about responses to different foods and how the food itself or combinations leads to overeating, and again everyone is individual. Even though they can often only focus on part of the problem, there are GPs across the country performing some fantastic work with patients when it comes to diet and we are getting to the point where we have a decade of data with real people making long term changes. Although a lot of these have headlines that say low carb, I would say it's more a focus on real food (and not being scared of fat!) and also supporting people in food choices on small budgets...I've posted links on here before, but Dr David Unwin, a Northern GP is a good starter to see how patients can get long lasting changes, improve metabolic health and lose weight with a simple approach to diet:
https://nutrition.bmj.com/content/6/1/46
If anyone is interested in more public facing resources, Dr David Oliver and Dr Kim Andrews offer a huge amount of information and support for patients (including an app), again the headline is low carb, but it is an eat real food approach:
Going back to my childhood in the 80s, sure we had junk back then, but it was 1 packet of biscuits for my family of 5 to last a week.
Same here, and you didn't touch them without asking first.
I’ve posted links on here before, but Dr David Unwin, a Northern GP is a good starter to see how patients can get long lasting changes, improve metabolic health and lose weight with a simple approach to diet:
Just to show how complex the whole picture is, as well as that information from Dr Unwin, you should probably read the report that the scientific advisory committee on nutrition released about low-carb diets for folks with T2 diabetes. Their conclusion are on page 14, it's not a clear cut as some "evangelicalists for low carb" would have you believe.
Just ordered this book https://www.amazon.co.uk/Eat-Well-Die-Slowly-Metabolic/dp/1838137807 after listening to a pod cast about evidence/lack of evidence/flawed science in nutrition. Claims (which I think are echoed elsewhere) that nutritional advice still used today about the balance of carbs vs fat/protein is based on biased studies from 50's and 60's, perpetuated and supported by vested interests in food industry. Looking forward to evaluating it.....
Its really not Tom. Yes the medical consensus is slow to change but the NICE guidence is the highest quality we have to go on and based on up to date data
There is a huge amount of quackery around this topic. Be very careful whi you believe and check them via independent sources
Their conclusion are on page 14, it’s not a clear cut as some “evangelicalists for low carb” would have you believe.
Low carbs seams to mean different things to different people, so it can be a confusing term.
I think the evangelists are the "keto" people, however the sensible advice is considerable reduction. So it isn't no or nearly no carbs, it might be 50 gramms of cooked brown rice or 4 baby potatoes as the carb portion of a meal, plus some "colour" vegetables which also contain carbs (and fibre).
This is going to sound sexist but its not intended that way.
Women getting more independence and more women drivers has a huge effect on obesity these days. When i was a kid my dad did the driving whilst my mum made do with buses & walking. Whilst my dad was at work we walked everywhere. To school, to the shops, to our friends house. We got the bus to town to help mum with shopping and we carried multiple bags for her to bring it home. We were as fit as fiddles and i imagine this 10,000 steps per day figure they bang on about was more like 20 or 30k.
Now we have mothers driving 250metres to bus stops to drop their kids off. Oh dont get me started on not using schools within walking distances due to 'performance'. If we got rid of 'performance standards' and forced everyone to go to their allocated schools all schools levels would rise, not just the selected few that the better off can afford to choose. Mothers then drive home or go to work. Kids no longer see fit and healthy attitudes from their mothers (Yes fathers as well but the person who would be there waiting for them from school was traditionally the mum) and in fact are being moulded into new, younger versions of their now, plump, low exercise, drive everywhere parents.
Everything that has been discussed about diets is of course correct.
@MSP really, read the conclusions. They essentially say, there's no real strong evidence for reduction in any carbs (they measured diets with almost no carbs to those that allow up 100g as "low carb") as being either good or bad for health or weight, or good/bad for disease reduction, or cholesterol levels over the long term. (over 12 months)
As @tjagain keeps pointing out, there's quackery and there's independently produced studies with evidence.
Going back to my childhood in the 80s, sure we had junk back then, but it was 1 packet of biscuits for my family of 5 to last a week.
On a similar note, we used to get a single tin of Quality Streets to last us all Christmas (a family of five). Granted they were significantly bigger back then, but these days they are piled high in the supermarkets from October onwards and people get through multiple tins (or plastics as they are now) each October, November and December. Then they put the Creme Eggs out before the new year has even begun...
for example the book TomB refers to above. I checked the author. a pathologist and virologist with a company selling "wellness"
I didn't look at her any further and at least she is a qualified medic of some sort but the fact she has a business selling " wellness" raises a small red flag
Maybe she talks sense, maybe she doesn't. I don't know having not looked beyond her qualifications
Before you believe any of this stuff research the author. Look for peer reviewed papers in reputable journals. look for critiques of their work
From the state of people I see waddling around at work, the future looks like diabetes will the norm.
It can't be nice carrying around so much extra weight, yet I hear people telling each other how great they look when they are obese.
It's going to take some serious cultural changes in order to make people reduce their calorie and alcohol intake. It's maybe too late for some so maybe we should be focusing more on the young.
@nickc have you had time to read that report and look at the included studies recently? It’s not a negative report on low carb even in its current form but the “low carb evangelists” wouldn’t even recognise them as low carb diets, 50 to about 300g a day if memory serves wasn’t it? There is also a lot more information now as the primary cut off for the report was 2018. Other international organisations have also updated similar reports, stuff changes.
I am really interested in what works in the real world with patients and if a healthcare or medical professional can help patients make meaningful and long lasting changes to their health then it’s to be applauded. If there are GPs doing it through high carb dietary approaches and that information has been published, then that needs to be shared too. People do get a bit evangelical when they’ve been doing something for many years and got nowhere then get excellent results with a different approach. A lot of lives changed. It doesn’t mean it’s the only or even best approach, but it’s the approach that works for them. 🙂
They essentially say, there’s no real strong evidence for reduction in any carbs (they measured diets with almost no carbs to those that allow up 100g as “low carb”) as being either good or bad for health or weight, or good/bad for disease reduction, or cholesterol levels over the long term. (over 12 months)
That is a specific report looking at impacts on people who have type 2 diabetes. Did you read the conclusions? because if you did you are misrepresenting them.
Conclusions From the evidence considered, it was not possible to assess the impact of a ‘low’ compared to a ‘high’ carbohydrate diet on markers and clinical outcomes of T2D in adults with T2D. This was because:
• the definition of a low carbohydrate diet varied widely across the primary RCTs, with prescribed carbohydrate intakes in lower carbohydrate groups ranging from 14 to 50% TE (median, 40% TE)
• there was overlap in reported mean carbohydrate intakes between the lower and higher carbohydrate diets in the shorter term (≥3 to 6 months) (13 to 47% TE in the lower and 41 to 55% in the higher carbohydrate diets) and in the longer term (≥12 months) (17 to 46% TE in the lower and 43 to 54% in the higher carbohydrate diets)
• according to categories of carbohydrate intake, reported mean carbohydrate intakes in the lower carbohydrate groups were moderate (26 to 45% TE) in the majority of primary RCTs. Comparisons, therefore, were largely between lower and higher rather than ‘low’ and ‘high’ carbohydrate diets. This limits interpretation of the evidence for any benefits or harms of a ‘low’ compared to a ‘high’ carbohydrate diet. Overall, the evidence suggests beneficial effects of lower carbohydrate diets for some outcomes (HbA1c, fasting plasma glucose, serum triacylglycerol) in the shorter term (up to 6 months). Since the shorter-term assessments did not report outcomes between 6 and 12 months it is uncertain if the suggested benefits are maintained beyond 6 months. Although there was no consistent evidence of reductions in body weight with lower carbohydrate diets it is not possible, from the evidence considered, to separate the effects of weight change from effects of change in carbohydrate intake. Lower carbohydrate diets may allow reductions in diabetes medication, but interpretation is complicated by inconsistencies in reporting and measurement of changes in medication use. No differences were observed between higher and lower carbohydrate diets on serum total or LDL cholesterol either in the shorter (≥3 to 6 months) or longer term (≥12 months). Evidence on HDL cholesterol was inconsistent in the shorter (≥3 to 6 months) and longer term (≥12 months). In general, there was no difference in adverse events between lower and higher carbohydrate diets but study duration did not extend beyond 12 months in the majority of primary RCTs.
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The overall quality of the evidence base was limited by a number of uncertainties in the data, including: variability in the definition of a low carbohydrate diet; smaller than prescribed differences in reported carbohydrate intakes between lower and higher carbohydrate diets; inherent inaccuracies in estimates of self-reported dietary intakes; and lack of information on adherence to prescribed diets. An important limitation was that risk of bias was high or unclear in most of the primary RCTs that were included in the MAs. This reduces the confidence that can be placed on the estimates of the effects of lower carbohydrate diets on the markers of T2D and clinical outcomes under consideration. Another important limitation in the evidence base was that shorter-term studies did not assess outcomes beyond 6 months and few longer-term studies assessed outcomes beyond 12 months. The majority of participants in the primary RCTs were living with overweight (BMI ≥25 to <30 kg/m2) or obesity (BMI ≥30 kg/m2). It is not known if reported effects can be generalised to adults living with T2D with a healthy weight (BMI ≥18.5 to <25 kg/m2). It is not known if the reported effects of lower carbohydrate diets apply to individuals of different ethnicities since the majority of primary RCTs did not report ethnicity of participants and most were conducted in populations that were predominantly White. In those that reported ethnicity, none conducted subgroup analyses based on ethnicity. This report did not assess evidence on the effect of lower carbohydrate diets in the general population without T2D. It is not known if the reported effects of lower carbohydrate diets in adults with T2D apply to the general adult population without T2D. Several gaps were identified in the evidence base:
• effects of lower carbohydrate diets on individuals living with T2D from minority ethnic population groups was not considered
• no trials provided information about types of carbohydrate consumed (for example, wholegrain, refined grain, free sugars, fibre) or considered how this could affect the outcomes of interest
• the potential impact of increasing the proportions of other macronutrients (fats and/or proteins) to compensate for reduced carbohydrate intake in the lower carbohydrate groups, or the type of macronutrient (for example, saturated or unsaturated fats; plant or animal-based proteins), on markers and clinical outcomes of T2D was generally not considered
• few trials assessed adherence to dietary interventions throughout the study duration or considered how adherence might impact the outcomes
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• few trials assessed longer-term effects (beyond 12 months) of lower carbohydrate diets
• no trials considered clinical endpoints such as diabetes complications, CVD events or mortality.
but these days they are piled high in the supermarkets from October onwards and people get through multiple tins (or plastics as they are now) each October, November and December.
Eat all the lovely sweeties say the manufacturers of lovely sweeties, but it's your fault if you get fat says everybody else...We really do have to move away from the "personal responsibility" message that the folks who're making zillions from selling us the shit directly or the folks who're making zillions of us re-enforcing the message that it's all our own fault, but here's this simple way of losing it all...
Dietary studies are a minefield because most are self-reported, and people are prone to not reporting their diets accurately. Plus, as noted above, there is no single definition of 'low carb' etc. We could be waiting a while before any consensus over the 'best' diet is reached.
Unfortunately, we're at the point now where the bulk of the population is addicted to calorie-dense, sugar rich foods, and possibly highly resistant to both insulin and messages asking them to change their lifestyles. As usual, corporations are happy to exploit weaknesses in the scientific data to continue peddling this stuff.
More sugar taxes and advertising bans are the bare minimum now. We need a concerted effort to remove this shit from supermarket shelves and to use schools to teach children the basic life skill of not poisoning yourself for the next thirty years.