Obesity and the NHS

[Saracen]

I'm a bit late to this discussion, but one thought that crosses my mind is about "free" gym memberships for the obese, courtesy of the NHS, and that 6tought is that, in my view, it simply won't work.

First, again in my view, most obesity problems (and I exclude genuine medical conditions which, though relatively rare, do exist) are far more about what you eat and how much of it you eat than they are about exercise. Yes, clearly exercise is critical to health and overall condition, but if you're cramming loads of crisps, cakes, chocolate etc down your throat, then virtually no practical mount of exercise is going to burn that off.

Secondly, gym usage is every bit as much about mental attitude as it is about cost. Quite a proportion of people that take out gym membership use it a handful of times, then it gets less and less, then they stop going, and that's when they have paid for it. The human condition is that generally, if it doesn't most you anything you don't value it, or at least, nowhere near as much.

In my view, the vast bulk (excuse the pun) of obesity problems are to do with what gets eaten, in what quantities. Someone I knew thought nothing of buying a 6-pack bag of crisps, and eating the lot in one sitting (usually in front of the TV). And that was NOT an isolated incident. Or of buying a multi-pack of biscuits and, again, munching though them until they've gone.

The result, a relatively small (as in short and light-framed) person ended up at, IIRC, 27 stone. And it caused huge problems. I won't go into them all, but essentially, this person, in their 30's, was told, in no uncertain terms, that they were causing huge system damage, damage to organs, and all sorts of complications that that they were, literally, not just wrecking their own quality of life but eating themselves into an early grave.

Harsh message, bluntly delivered, but true.

So, that person stopped eating crisps and biscuits. And I mean stopped cold. Portion sizes of meals when down, gradually but steadily, and the snacks between meals went from several bags of crisps to an apple or other fruit. They were still allowed chocolate, but as a weekend treat in the form of a small bar bought on a Friday, not as a 1kg slab, several times a week.

And what happened? Weight done from 27 stone to 16 stone, over the course of a few months.

And, as a direct consequence, some major breathing problems went away, they've gained in a sense of general well-being (i.e not feeling listless and knackered, 24/7) in a direct way to the weight coming off, they're more mobile, walk more easily, are having less joint problems and pain, so get out more and exercise more anyway, because even walking to the shops doesn't hurt as it used to.

With this person, that blunt message worked. It caused a change in what they wanted. And that's the critical bit. If you are obese, you have to really want to resolve that, because unless you do , nothing else is going to work. But if you do, it often is possible. Not easy, and it may well require help, encouragement and monitoring, and will will probably be damn hard over a period of time, but it can be done and it can be done with free gym membership.


To my mind, this issue with the cost of ambulances to cater for the obese is the tip of the iceberg. Yes, it's not cheap, but in terms of the costs of all the other medical implications of a national tendency to serious excess weight, it's a pimple on the backside of the problem.

The real problem is how you change the national mindset. How you get people to want to help themselves by watching what they eat, and especially, how you do it without seeming like a patronising nanny state. The state has to tread quite carefully in how it does this, or it could be counter-productive.

I also don't think taxing fatty foods is the answer. Not everyone that eats a fast-food burger or buys a packet of biscuits has a health problem, and for large numbers of people, you could quadruple the cost of burgers or biscuits and they'd have enough disposable income to carry on regardless. To really address the problem, you have to find a way to make people want to change how they feed themselves. You have to change mindsets, and attitudes, behaviours and habits. There's no guarantee the carrot will work (again, excuse pun) but the stick almost certainly won't.

It stands to reason, really. If this problem was easy to solve, it'd have been solved by now. There are no easy answers, and certainly, no easy top-down answers.

[tiggerai]

Not true at all. You can have a perfectly good discussion without using insults and derogative terms to group all types of people together without knowing the reasons as to why they are the way they are.

I have no problem with the discussion going on here, people are allowed their own opinions, but I (and some others who have posted the same) do have a problem with the insults. There is simply no need for it and is against the forum rules.

Allen,

I have taken your thoughts on board, renamed the thread and warned others about continued use of that word in this thread.

As voluntary moderators (at work, on my lunch break) we just do not have time to correct every single instance of a word. We have, in the course of this thread determined that it is derogatory and other members will have learnt from that.

As per the rules, any post from this post onwards, having been politely warned, using the derogatory term will be moderated. I DO NOT have time to go through every post in this thread changing the words. It's not a personal attack on any member, it is more a term that, even some Obese people use as a term for themselves, but should be approached in a more sensitive way in a topic like this.

Everything has context.

Thanks.

Tiggerai

[Alex]

My perspective on this was that plenty of people know being obese is bad for their health, and know they should lose weight, but need something to make them actually go on to try and lose weight.

Comparing this problem with smoking, like obesity and losing weight, a large proportion of smokers want to give up, just keep putting it off. It has been shown many times in medical literature that even a simple 5 minute conversation at a hospital/GP visit about smoking has a definite effect on smoking cessation. A referral to a smoking cessation clinic, made by a GP/hospital doctor has as much, if not more effect as nicotine replacement - if you have both nicotine and a smoking cessation referral you are more than 10 times as likely to give up. This is all on the basis of a recommendation made by a doctor/nurse duing a visit to the GP/hospital, which would not have happened off their own bat.

I am not aware of any research into what proportion of overweight people would like to lose weight but I'd be surprised if it wasn't a high proportion - but as with most large challenges it's difficult to know where to start. This is where I feel that th NHS is getting on top of helping with smoking cessation, but has next to nothing with obesity.

The free gym idea was just part of a general theory that we should have something to help people to lose weight. Just advising people to lose weight rarely works, but I would imagine that a weight reduction clinic, with facilities like having a dietician in clinic as well as access to some form of exercise would help. Not just exercise, as has been said, anyone can go for a walk, but organised exercise, as part of a group or 'training partner'/'weight loss' partner could be a lot more effective.

I'm not saying it would work, but it might, and I think warrants further research. Whether it works or not, my point is that the NHS needs to offer something to obese people - saying 'you need to lose weight' in a diabetic clinic rarely works, but perhaps 'this is the help we can offer you to lose weight' might.

[TooNice]

As to fatties, ok I am not exactly light myself, being 6'2" in height I would be well over the average weight even if I wasn't. Ok not 25 Stone, however thats less of a "stretch" for some people than others. People are also taller on average than they used to be, particularly Females as it was common to give girls drugs (even 30 years ago) to stop them growing when they reached "normal height". As it was seen it could be a problem for them finding a husband... !??!!?!?

But overweightness and obesity (as defined by a BMI of 25+ and 30+ respectively) do take height into accounts. At 6'2", you can be as heavy as 195lb without being in the overweight category. Yeah the system is broken for the really muscular and visibly low fat, but for many people, especially those not borderline in between two category, it's not too bad. But you can always get your body fat estimated using a couple other methods, but I think when people refer someone as a "fatty" in an intentionally derogatory manner, they are not talking about a big guy/gal. They are talking about someone who have fat spilling out of their jeans/t-shirt. [That's my guess at least]

At 25 stones, someone who is 7ft tall is already 50lb into obesity. Keeping height into perspective it might not be considered morbidly obese, but 7 feet is exceptionally tall. Take it down to 6'4" (far more common yet well still well above average), and 25 stones is over 100lb into obesity!

On a more serious note - wasn't an airline proposing to charge people an airfare based on their weight over a certain amount? After all, I weigh about 65Kg and if I fly (say) Easyjet) I get charged for a 20Kg suitcase. But someone of heavier build than me (say 150Kg pays the same basic fare although they have more mass on their own than me my case combined.

I have to say that it annoys me quite a bit too, especially given how much airlines charge for going overweight with your luggage. Though I direct the frustration more towards the airlines policies than the fact that there are a lot of people heavier than me and my overweight luggage combined.

@Alex: I can see multitude issues with offering the idea of free gym, some covered by myself, others by Saracen. If such issues were to be implemented, for free, I think that at the very least I think there needs deterrent (i.e. punishment, e.g. a fine) for those who do not attend the gym in a pre-agreed regularity.

But given that I feel weight loss is more diet than exercise, at least in the early stage, I think that to be effective, you may need to guide them on every step. A camp for the obese where there is a strict exercise and diet program would probably work best, but while some of the morbidly obese may not be working anyway, a lot of people who are obese are probably relatively functional members of society with jobs, and it might be unpractical to ask them to take 3-6 months off to fix themselves up. Yet without something like this, you still run the risk that after a gym session, they go have a huge meal negating staff and their own efforts.

I think that the source of the problem is partly cultural, and I have not the faintest idea how that may be changed. Many may want to lose weight, but do they want it as much as people from other countries? Well, perhaps it is unfair to suggest otherwise, since I have no figure to suggests I don't think there is any chart regarding people getting out of obesity ranked by country. But the fact that so many allow themselves to reach this stage would suggests on top of my head, there are less social/cultural pressure for people not to reach obesity.

[TheAnimus]

Not true at all. You can have a perfectly good discussion without using insults and derogative terms to group all types of people together without knowing the reasons as to why they are the way they are.

I have no problem with the discussion going on here, people are allowed their own opinions, but I (and some others who have posted the same) do have a problem with the insults. There is simply no need for it and is against the forum rules.

One mans insult is another mans perfectly valid word.

Ultimately if someone has a problem with someone calling them "Obese" they are going to have a problem with someone calling them a "fatty" or "welsh".

You can't just endlessly censor such ideas, myself I'm on the overweight end of the BMI, so am technically a fatty, just not a fatty fat fatty. I have no issue with the term at all.

[nibbler]

NSH classifies me as obese incidentally

[Allen]

That's nice that you don't get offended by insults, but just because you don't find them insulting does that mean they should be acceptable?

I'm sure racists wouldn't find half the words they use to describe people who aren't from their ethnicity insulting, so should they be accepted here for the same reason?

[Moby-Dick]

Can we keep this thread about the topic please ?

[mcmiller]

NSH classifies me as obese incidentally

im classed as fat according to the BMI although my body fat % would say otherwise

[piggeh]

You wish to put tax hikes on staple foods?

This may not go down well.....

Point is, these 'staple' (carbohydrate rich) foods have been shown to cause obesity more than 'high fat' foods.

Exercising to lose weight is not ideal either - you need to eat more to get fuel to your cells immediately after (eg "working up an appetite") so you tend to eat more and defeat the purpose of exercising.

[TheAnimus]

do you have any links for the carb rich diet thing? Because the fact is you have to eat a fair amount of those, vrs a little of say mars bars.

ultimately these people don't do enough exercise for their food intake, yes your body will tell you need more, but here is an idea, don't do it. Its a simple in vs out.

Its the old addage of most people just having too much food, myself I eat quite well but my portion size is too large.

[Rob_B]

my portion size is too large.

Fnarr fnarr...

Regardless of how it is achieved (ie diet or exercise) it does seem to be down to a simple calories in/calories out approach (although there are some who don't agree but I'm not sure their ideas are any better)

Look at the guy who lost weight on the Twinkie diet not so long ago

[SeriousSam]

There is something in science called the "Borlaug paradox" which essentially states that rather than emolliating environmental pressures, advances in production efficiency actually make things worse. Basically there comes a point where the farmer moves from the point of producing to survive to one where they actually make money, subsequently expanding their operations to generate more money in an effort to make their lives more comfortable.

This may sound somewhat perverse but if you look at the development of human society then you can see similar examples all over the place. Rather than using advances in science and technology to make the lives of a small population more comfortable we have instead expanded into having a huge population where the pressure to create more efficiencies is even higher. Then rather than using these advances to ease the pressure we'll just expand further making things worse.

Now what does this have to do with "Obesity and the NHS"?

Well simply put we as a species have a serious issue with restraint and in an era of food surplus in the UK and "free" healthcare to deal with the adverse consequences of overconsumption is it any wonder that in general we are turning into a nation of overweight and unhealthy layabouts.

As for a solution it just doesn’t exist within the constraints of our existing society. Ultimately we will either have to completely rethink our notion of how we approach life or it will be forced upon us by global events. If I were a betting man my money would be on the latter as we like our creature comforts to much to give them up voluntarily.

[TooNice]

Re:Culture: http://www.globalpost.com/dispatch/j...e-law?page=0,0 and http://www.theatlantic.com/food/arch...ines-fat/29830

Whether you think the idea is completely mad, it does seem that a strong pressure against obesity prevents people from getting that big in the first place. And that's despite eating rice 3 times a day (re: staple food). As TheAnimus said, portion size is key. And discipline. And I don't buy the exercise being counter-productive to weight loss. Sure you eat more after strenuous exercise, but one only need to be disciplined enough not to eat more than the calorie burnt during exercise.

Weight loss aside, there are other benefits to exercising, so even though I believe it's possible to weight through diet alone, I would not suggest avoiding exercise. Though I may suggest getting a kitchen scale and weight everything you put in your body for a while, and to stay very disciplined.

[oolon]

So long as you can control, the need for sugar based drinks after a work out etc, its got to be good. Exercise increases the rate of metabolism in the body so you burn of standing still and the worse thing to do is to skip meals as the body very efficiently shuts down the systems its not using, so if you get more of your daily requirements from fewer meals you should be eating even less! I believe the body stores 2 days energy supply as well. So people who over eat, would need to starve for 2 days before fat is even dipped into, going back to eating before would instantly throw the body back into over supply and done no good but to make people miserable.

[peterb]

do you have any links for the carb rich diet thing? Because the fact is you have to eat a fair amount of those, vrs a little of say mars bars.

ultimately these people don't do enough exercise for their food intake, yes your body will tell you need more, but here is an idea, don't do it. Its a simple in vs out.

Its the old addage of most people just having too much food, myself I eat quite well but my portion size is too large.

The Atkins diet is high fat low carbohydrate and followed closely leads to weight loss - not very good for the heart though)

The adage "take more calories in than you burn and you put on weight" is very simplistic. It isn't the calories that you take in through the mouth, it is how those calories are absorbed in the gut and metabolised inb the body. Simple carbohydrates (like sugar) provide 'instant' energy and excess is laid down as fat after being metabolised in the liver. Alcoholics typically exhibit 'fatty liver' because alcohol (a simple carbohydrate) is metabolised in the liver, and is why heavy drinkers get a beer gut - even if they eat little fat. High sugar intake can also lead to type 2 diabetes - also a problem for alcoholoics. Complex carbohydrates are slow energy release foods.

The time of day foods are eaten also makes a difference - the old say "breakfast like a King, lunch like a prince and eat dinner like a pauper" has some sense - a large carbohydrate meal before going to bed (when the energy won't be burnt) is more likely to lead to weight gain. However those training will need high carbohydrate diets to give energy and high protein to give the amino acids to lay down muscle fibre.

However it is also true tghat once put on, the fat will only be metabolised to provide energy if the body cells can't get energy from regular food intake.

Having had a weight problem myself (trying to put it on after a massive weight loss because of a medical condition which caused poor food absorbtion) my dietician did remark that putting on weight is a lot harder than shedding it, although I'm not sure I'd entuirely agree - which is why I have nothing but praise for those HEXITES (and others) who have taken control of their eating habits and lost weight - and any support that they get is a good thing.