We can’t just ignore the F word

stick_figure_overweight_scale_1600_wht_3853It seems it’s not PC to use the word fat about someone – or even the clinical term obese.

New NHS guidance says school nurses and public health official have to tone down the way they tell parents their child is overweight.

The NHS doesn’t want parents to think their parenting skills are being criticised (even though they are) and that letters sent to parents should be “non-judgmental and positively phrased”.

So the new letters, redesigned after consultation with parents and experts, contain no references to obesity and its potential consequences such as heart disease or cancer.

So even if your child is very overweight, or obese, the letter will only refer to possible effects on self-confidence and facing health problems later in life – nothing specific.

Campaigners at the National Obesity Forum say they are horrified that such letters have been sent in the past rather than speaking with parents face to face and offering “tough love” and calling a spade a spade.

Last year more than a million children were measured at school and almost a quarter of children in reception year were found to be overweight or obese. By year 6 this had risen to 1 child in 3. Almost 10% of children were clinically obese when they started primary school and the percentage had doubled to 20% by the time they left.

The Observer yesterday reported on a 10-yr old girl weighing more than  24 stones (with a BMI of 71) and an 11-year old boy who weighed 23 stones (with a BMI of 84). I know BMI has been discredited of late especially for athletes and muscular people but given that the normal range of BMI is between 18.5 and 25 and over 40 is considered morbidly obese, you have to admit the weight of these kids is scary.

But back to the NHS advice: Public Health England said it had “listened to feedback from parents and local authorities and as a result the template letter has been simplified to make it easier to read and more personal”.

This sounds like a load of  PC rubbish to me. How is it more personal? Which parents have they listened to? Isn’t it better to upset a few parents if you are potentially improving their child’s health?

Obese people  – and 26% of the UK population falls into this category – are at a higher risk of hear disease, diabetes, cancer and joint problems and obese children also run the risk of being bullied. If you count overweight people they make up 60% of the UK population.

Contrast this softly, softly approach with Mayor Bloomberg in New York. He’s been trying to change things by banning super-size sugary drinks ie 16oz and over. He’s had his decision overturned in an appeals court which thought he was over-reaching his authority. The soft drinks industry is fighting a strong rearguard action similar to the tobacco giants.

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Diets only work for 10%

A court case in France recently highlighted the dangers of dieting. Dr Pierre Dukan is a best-selling author whose protein-based diet is followed by Hollywood celebrities and who basically says you can eat as much as you like from a limited list and you don’t need to count calories.

In the opposite corner, and being sued by Dukan, was Dr Jean-Michel Cohen, another dietician, who says slimmers should eat a limited amount of most things and exercise regularly.

Cohen was being sued for saying that there is a whole slimming industry, including doctors, profiting from these ideas, but he also upset Dukan by saying that the Dukan diet is a potentially dangerous rehash of old ideas which can increase cholesterol and lead to heart problems and breast cancer. 

The case was eventually settled out of court but a report from the French health watchdog Anses surveyed these diets and 13 others and concluded that they all had dangers and weaknesses and that people would be better off just following a balanced diet. (Mothers with daughters take note!)

More than 80% of people who tried book diets put back their weight and more a year later and the head of the nutrition service at the Pasteur Institute actually said; “slimming makes you fat”.

And last Summer an article in the Sunday Times (24/7/11)providing more scientific proof that diets don’t work.

That won’t stop the diet industry’s efforts of course or the newspapers and magazines promoting them. British women start on average 3 diet regimes a year and spend £25k on diets over their lifetime. If you think you know all about diets try this BBC quiz

One in four UK adults is overweight or obese and 16% are trying to shed weight at any one time. The problem is basically that once you gain weight it’s there to stay. Fewer than 10% of people who diet keep the weight off, the other 90% put it back on within a year. There are some advantages to dieting as you probably eat more healthily and may exercise more but yo-yo dieting is not good for you.

The Medical Research Council’s National Survey of Health & Development followed over 5,000 men and women from birth in 1946, and 20,000 people born in 1958. They measured weight and blood pressure and assessed lifestyles.

Interestingly both groups started putting on weight in the 1980s and since then people have been increasing in weight throughout their life. Men tend to put weight on steadily but for women it starts slowly and accelerates in their mid-30s (perhaps after having children?).

The Health Survey for England (2009) shows that 14% of kids and 25% of adults are obese and at least the same percentages are overweight. Excess body fat leads to a higher risk of diabetes, heart disease, arthritis, and cancer.

An endocrinologist, Professor Nick Finer, was reported suggesting that we have not evolved to tackle obesity as it has only become a problem since the mid-20th century. Previously there would have been an evolutionary advantage to be able to store fat in our bodies.

Even the idea of a set point for weight no longer seems true as it becoming overweight can rest it to a higher level. So there must be a ratchet effect if losing weight doesn’t reset it lower.

The government has been encouraging people to lose weight to combat the obesity epidemic and has encouraged GPs, pharmacists, and dietitians to offer weight loss programmes.

Researchers have now compared the NHS-provided programmes with private sector provision. Overweight patients selected by their GPs  in South Birmingham were offered the chance to be referred to a weight-loss programme paid for by the NHS. Half of the patients were referred to NHS programmes and half to commercial slimming clubs: WeightWatchers, Rosemary Conley, and Slimming World.

The greatest weight loss was 4.4kgs after 12 weeks for patients who attended Weight Watchers. The NHS programmes achieved a weight loss of only 1.4kgs. despite being 50% more expensive than the private slimming clubs.  After a year the figures for weight lost were:

  1. WeightWatchers: 3.46 kgs (4.43 kgs after 12 weeks)
  2. Rosemary Conley: 2.12kgs (4.23 kgs after 12 weeks)
  3. Slimming World: 1.89kgs (3.56 kgs after 12 weeks)
  4. NHS provision: 0.83kgs (1.37 kgs after 12 weeks)

One reason for the private slimming club success is that the dieters went back to them every week. This may not have been the case with the under-resourced NHS.

As the figures show people couldn’t maintain their early weight loss over a full year. Other research has shown that people  achieve their maximum weight loss after six to eight months and there appears to be a natural plateau effect. It seems people find it hard to stick to a diet for longer than 6 months and the majority give up.

Clearly dieting alone is not enough. Eating more healthily is a side effect of dieting which is to be encouraged but exercise rarely gets a mention. If people were fitter they would be able to exercise more and attain a healthier body weight as well as strengthening their bodies and having more flexibility. This in turn would make them healthier – a virtuous circle.

Fat or just passively obese?

Fat or just passively obese? Jamie Oliver, since parting company with Sainsbury’s, has moved on from being the healthy school meals enthusiast to a wider stage according to a report in the Observer this weekend.

Along with nutrition and health experts he is trying to get the UN to take obesity more seriously.

He says “Pre-packed convenience food is seen as a symbol of being modern in developing countries but the problems it causes are long-term and costly”. It is particularl … Read More

via Mike the Psych’s Blog with permission