Weight Britain

[Rob McCow]

I was reading this article on the BBC and I was horrifed by these statistics:

• Nearly a quarter of adults and 14% of children are obese, the latest Health Survey for England shows.
• By 2050 the figures are predicted to increase to more than 50% of adults and a quarter of children.
• Treating obesity and the conditions caused by it, such as diabetes, costs the NHS £4.2bn a year, Department of Health figures suggest.

50% of adults obese! That's absolutely horrendous. Even with all the government initiatives to get kids to run around a bit more at school, which really seem like a drop in the ocean compared with the scale of the problem.

It's kind of qualified by this statement:

And a report published in 2007, the government-commissioned Foresight report predicted that if no action was taken, 60% of men, 50% of women and 25% of children would be obese by 2050.

Where the key phrase is 'If no action was taken'. Of course some kind of action will be taken, but will it be enough?

I would argue that it is impossible to say where the responsibility lies for obesity. There's the individual, but there's also the ease of transport due to the car, a lack of opportunities to exercise in everyday life, the fast food chains and dominance of processed, fatty foods.

I certainly believe that the NHS should treat anyone regardless of their weight. Nobody should be treated as a second-class citizen when it comes to healthcare (or in general, actually).

Walking from Victoria Station each morning, I get presented with (in order) Cornish pasties, french pastries, chocolate bars, sausage sandwiches, Krispy Kreme doughnuts, more chocolate bars, M&S Healthy eating (!), Starbucks, Costa, Pret a Manger sandwiches, bacon sandwiches, 'Real' Cornish pasties, smoothies, the Camden Real Food Company and probably a few I've forgotten.

It can be argued that you need willpower to avoid snacking, but the amount of willpower that you need to exercise is immense if you want to make it past all of these stalls that are designed to be as tempting and as cheap as possible. We're dooomed, people!

Gymnasiums seem to me to be oppresive, expensive places. Members clubs for the super-fit where anyone below standard gets laughed at. Of course that opinion is wrong, but it's hard to shake that feeling. And in the Age of Austerity, is their room for sports and fitness clubs?

So how could obesity be tackled? Is there a solution? Or will the NHS have to invest in this equipment for their ambulances:

• Bariatric ambulances - Specially-designed vehicle crash-tested to take heavier loads and equipped with full-range of obesity equipment. Cost: £60,000 to £90,000.
• Wider stretchers - Different makes used. Most popular sits on trolley and extends to twice the normal width. Can take patients up to 50 stone (318kg) compared to 30 stone (191kg) normally. Also used in standard ambulances but cannot be extended to full width. Cost: £7,000 to £10,000.
• Heavy-duty adjustable stretcher - No wider than standard, but able to take heavier patients and has lifting mechanism so it can be moved up and down to make it easier to get large patients on and off. Cost: £7,000.
• Lifting cushions - Inflatable cushion which can be used to get people off floor. Cost: £2,500.
• Heavy-duty wheelchairs - Wider and stronger than standard. Cost: £400-plus.
• Hoists - Tend to be fitted in bariatric ambulances. Used to lift obese on to stretchers. Can take weights of over 40 stone (254kg). Cost: £4,500.
• Stronger tail-lifts - Capable of taking weights up to 75 stone (476kg). Cost: £800.

What do you think?

[Si Hunt]

I think if the government pays for people to attend Give Up Smoking classes and save the NHS money, it should also pay my gym fees so I can keep fit and similarly not be a burden on the health service.

Si.

[Philipnet]

But Simon,
you could go running for freeeee

[Lissa]

There is a lot of truth in what Si says. The leisure centre gyms in Manchester cost £17.99 a month to join and for that you get access to the gym, the pool and help from the gym staff. Compared with the cost of obesity drugs and related treatments that isn't bad value. It's about two and a half prescriptions per month. If the NHS could get a special rate for referrals it would be even less. It wouldn't suit every case but for those who want to do something but don't know where to start it might be ideal. There is no logical reason why a prescription should only be for drugs.

That said, for most people in that situation they should just walk every day. It's easy, low impact, effective and teaches you discipline because you can do it every single day.

[Si Hunt]

Walking just does your legs though. By running in a gym you can do it in a controlled, level environment and also apply some exercise to your arms and use weights etc. I do walk when I can, but it's a fraction of my fitness routine which needs to exercise my whole body.

I also don't want to suffer the indignity of being one of those joggers who puffs round the town in the rain while people in cars look at their poor, knackered expressions and make "stupid sod" faces.

Si.

[Larry]

you know I was watching the BBC news a couple of weeks ago and they had a report on how doctors were very worried about the large number of 10 year olds and younger in the U.K at risk of developing liver problems because they are so obese. Then the very next report was on the famin in East Africa, and the thousands of malnurished children who are starving and you're left thinking what a crazy world we live in while we in the U.K are to fat people in Africa are starving to death.

[Zbigniev Hamson]

While exercise is obviously "a good thing" and should be done to keep your heart and general levels of fitness up and develop muscle if you want to etc, it's not really necessary to stop anyone putting weight on. It's a simple case of eating the amount of calories you need to fuel the activity you do. If you don't go to the gym, or walk, or anything else, then you need a lot less energy to get through the day, so you should eat less. If you're getting too fat then you're eating too much, regardless of what you do. Getting the NHS to fund your gym membership isn't the answer.

[Si Hunt]

I actually agree with everything there, except the last line. The delusion that exercising = weight loss leads to many hopeful overweight people to the gym, and they never last. The trouble is that these people are overweight because they eat to much, and they eat too much because they have no self control or discipline. And the gym just worsens that, because it gives them an excuse. Not only does pottering away on the treadmill for half an hour not make them thin, it makes them think they have somehow "got ahead" so they go home and have a big chunk of cake because "I've been good and gone to the gym".

However, you even state yourself that exercising helps your heart and keeps you fit in other ways. So surely you are helping the NHS there by keeping generally healthy, fending off heart disease and muscle debilitation etc.

Si.

[Jason Thompson]

I would like to point out here, for the sake of balance, that being overweight or obese is not only a result of overeating. That would be true if everyone had the same metabolism, or if metabolic processes remained constant. They don't. Certain metabolic disorders can and do result in a disproportionate amount of the food you eat being stored as fat while less than normal is actually metabolised for growth and energy for exercise, and stress responses can also alter metabolism to lead to fat desposition rather than properly metabolising the food you eat for fuel. It is therefore quite possible for two people to eat exactly the same diet and live exactly the same lifestyle but still be vastly different in weight.

Yes, there is a growing 'obesogenic' environment, where it is easy to get food in large quantities and where exercise is less a part of everyday life and more something you have to make an effort to do. However, that does not mean that everyone who is overweight is so simply because they eat too much and exercise too little.

[Zbigniev Hamson]

However, you even state yourself that exercising helps your heart and keeps you fit in other ways. So surely you are helping the NHS there by keeping generally healthy, fending off heart disease and muscle debilitation etc.

Si.

True, I guess I just meant that the NHS funding gym memberships isn't the answer... for obesity. But on top of that, gym's are private businesses that also offer things like saunas and massages and I just don't think NHS money should be basically paying for people to join a private member's club. If there was some sort of community gym, or some generally fitness classes, or even some sort of grant to buy some basic fitness equipment for your home, then that would be a different matter.

[Zbigniev Hamson]

It is therefore quite possible for two people to eat exactly the same diet and live exactly the same lifestyle but still be vastly different in weight.

But that still means that the heavier of the two (assuming either of them is overweight) is still eating too much for themselves. It's still possible to tailor your own diet to your own needs. If you're putting on weight and don't want to, then eat less. Don't just eat the same as your friend is eating because they're managing to stay thin.

[Jason Thompson]

But that still means that the heavier of the two (assuming either of them is overweight) is still eating too much for themselves. It's still possible to tailor your own diet to your own needs. If you're putting on weight and don't want to, then eat less. Don't just eat the same as your friend is eating because they're managing to stay thin.

Congratulations. You have managed to miss my point entirely. Metabolic disorders can mean that disproportionate amounts of food are laid down as fat while less of it is used for fuel. In other words, in order to maintain your own energy levels at bare minimum you still put on weight because you are not metabolising the food correctly, and you are not necessarily able to correctly metabolise your own body's stores, so if you stop eating as much your body starts breaking down the wrong stuff first. It is possible to be fat but starve to death. It is NOT simply a question of eating less, or eating different food, because your body is metabolising it WRONG. If your metabolic pathways are screwed then losing weight or not gaining it in the first place is not necessarily that easy.

I am not saying that all overweight people suffer this problem, I am saying that NOT all overweight people are simply able to eat less/differently and exercise more to lose the weight because their own body doesn't work the right way.

[Zbigniev Hamson]

But you're describing someone with an obviously serious medical disorder, it's not really relevant when discussing the general weight issues of the general population. And it's certainly not relevant when discussin whether or not gym memberships should be on the NHS as gym memberships won't help such people anyway. You might as well be talking about silicon-based life-forms or people with no stomachs.

[Jason Thompson]

But you're describing someone with an obviously serious medical disorder.

No, I am talking about someone with a medical disorder that may not be diagnosed for some time, and which may have no other serious symptoms. I'm describing the possible consequences of other medications. I am describing any number of things that can lead to weight gain that are not simply due to poor diet and lack of exercise.

It is highly relevant when discussing anything involving public opinions and NHS treatments, because there are so many people who have this notion of fat people = greedy lazy gits who eat too much and don't exercise enough. Imagine you were overweight despite your best efforts and kept reading people discussing this with that attitude. Imagine if that made you too ambarrassed to go and seek medical advice because everything you read leads to to believe the doctor will simply dismiss you with a 'change your diet' response. Now think about how many in the 'general population' that might actually apply to.

I offered this as a balancing view, because you simply cannot assume people are overweight because they eat too much and that losing weight is necessarily a simple task.Gym memberships on the NHS won't help those people, but then neither will this prevailing idea of losing weight being a simple task.

[Zbigniev Hamson]

Well firstly, I can't just think how many people in the general population that might apply to, because I have no idea of the numbers. I would imagine it's quite a small fraction of people, but I don't know, so I can't just think how many it applies to. And secondly I was only saying it was a simple concept, not a simple task. In fact, even considering all this, I'd still say it's simple. It's relatively easy to work out, based on your size, weight, muscle mass, gender and level of activity what your typical daily energy requirements are (if you have access to the internet or a GP at any rate, but then just about everyone should have one or the other); it's then also relatively easy to keep track of what you eat and what the energy content of that is. If you then show a definite calorie deficit and are not losing weight, or show a balanced calorie amount but are noticeably gaining weight, then that strongly points to a problem of some sort such as you mention, and any Doctor worth his Hypocratic oath, when presented with such figures, should certainly not dismiss you. In fact he shouldn't dismiss you anyway really.

That doesn't mean some people won't have the mental capacity to do all that, or the self-esteem to see a Doctor, or whatever else, but those are all side issues and don't alter the fundamental truth of the simplicity of the core concept.

[Lissa]

All of which goes to show that there are lots of possible causes and lots of possible solutions which GPs should be able to prescribe on the NHS. The trend towards drugs - the ones that make you expell excess fat in a really gross way, as described in one of Kevin Smith's books - cannot be a good one as they are little more than puking up after meals but three feet lower. A month's worth of those pills must cost many times a local gym membership.

My girlfriend is a health pyschologist (which is a proper kind of psychologist not a made up one) and she's done a lot of research into weight loss programmes and how effective or otherwise they are. She's part of a project to give GPs more options to help people with weight problems and to help them discover the underlying causes of obesity. There does finally seem to be a trend within the NHS towards investing in prevention as well as cures. So much of being overweight is psychological rather than physical so a lot can be achieved with a large number of people (not everything with everyone) through behaviour modification.

[Jon Masters]

I think I may....have a friend who may be stout

As Lissa says, for many obese people (as opposed to just a bit overweight) the issue is more psychological than anything else. For them the problem lies in the same 'pleasure-reward' system that other addictions are based on, like gambling, smoking, drugs etc. No-one goes around suggesting that all alcoholics could sort themselves out if they just had a bit of willpower and the media shouting 'Lush' at them all day.

[duncan]

I am border-line obese. I'll admit to that. I have had a problem with contolling my weight for the last 10 years or so. Who's fault is that? Mine!

I do what I can, when I can. We try and eat low fat, we try not to have too many takeaways, I walk to and from the station. Foodwise, I have cereal for breakfast and salad for lunch.

Where I let myself down is that my job involves sitting at a desk for most of the day. I work right next to St Jame's park in central London but do I go for a walk at lunchtime? No I don't. When I get home, I have my dinner and am then settled into my armchair for the evening. I need to exercise and I need to do it frequently not when I can be bothered.

We have a treadmill at home and late last year, I lost a stone and a half when I did something about it but I then had an operation on my leg and I shot back up to 16 and a half stone again. Fortunately, I have no obese related health problems aprt from osteo arthritis in both knees and have to say that the heavier I get the more painful they get. I could have medication if I wanted it, but, I already know that weight loss eases the pain.

I am off on holiday in just under 2 weeks and the plan is to get back on that treadmill when I come home and to stop making up excuses about having a home to run and the kids to look after.

[Rob McCow]

For them the problem lies in the same 'pleasure-reward' system

For most people, the instant gratification of eating a steak, mars bar or even an apple is a lot easier than the long-term benefits of exercise. Plus the concept of instant gratification is ingrained in our society by advertisers and banks.

It's a bit like buying something on a credit card. You get the pleasure of recieving your purchase right away even though you know it will cost you later. Never mind that it's usually far more rewarding to save up for something.

The trend towards drugs - the ones that make you expell excess fat in a really gross way, as described in one of Kevin Smith's books - cannot be a good one as they are little more than puking up after meals but three feet lower.

Are you going to deny pharmaceutical companies their enormous profits? How VERY DARE you?!

[Jason Thompson]

those are all side issues and don't alter the fundamental truth of the simplicity of the core concept.

Core concepts are always simple. It's the 'side issues' that make for the complications in dealing with the main problem. That doesn't mean you can just dismiss them as irrelevancies. If that were true then we wouldn't have such convoluted taxation systems, rockets wouldn't be fiendishly complex pieces of machinery, the car would be a couple of seats on wheels with an engine bolted on, I wouldn't have had to spend nearly six years with a team of people trying to develop a medical device based on the simple premise of antibody interactions, and the obesity epidemic could be cured by banning chocolate.

[Zbigniev Hamson]

Core concepts are always simple. It's the 'side issues' that make for the complications in dealing with the main problem. That doesn't mean you can just dismiss them as irrelevancies.

I can dismiss them as irrelevancies to the point I was trying to make, if not to the world at large. But this has all drifted some way away from that anyway now. All I was saying was that gymns aren't a necessity for weight loss (for "normal" people without a metabolic condition) and that therefore I don't think gymmembership should be funded by the NHS.