Looking at the government’s new obesity campaign, the effect of coronavirus, diet programmes and long-term weight loss. With, Dr Chinnadorai Rajeswaran (Raj), Consultant Physician (Obesity, Diabetes & Endocrinology) to find out.

About Dr Rajeswaran (Raj)

Raj is speaking on this topic in more detail for healthcare professionals in an upcoming webinar with Oryon Develop. Find out more details and book on by clicking on the button below.

The British Government announced its new obesity strategy on 27th July 2020 in an attempt to push the nation to get ‘fit and healthy, protect them against COVID-19 and protect the NHS.’ This new strategy is being launched alongside Public Health England’s ‘Better Health’ campaign, which is set to encourage people to adopt a healthier lifestyle.

Coronavirus has reminded everyone of the importance of looking after their health. A nation of healthy and productive individuals is vital to the government’s post coronavirus recovery plan. As the government begins to implement its post lockdown economic restart, it needs to address the well documented fact that our nation has a long standing, serious obesity problem which has been highlighted by COVID-19.

A staggering 63% of adults in the UK are overweight and 50% of these are obese. One in every three children who leaves primary school is overweight and one in five is living with obesity.

However, the government’s new strategy to beat obesity has been criticised by the medical profession, eating disorder bodies, and many others.

The government proposes the following: –

• All TV advertising of foods high in sugar, fat and salt will be banned before 9pm
• Calorie counting will form the basis of their strategy, including instructing restaurants to include calorie counts on their menus
• Alcohol labelling will also include the number of calories contained
• End of ‘buy-one-get-one-free’ deals on unhealthy foods high in sugar salt and fat
• ‘Traffic light labelling’ – green for nutritious foods and red for unhealthy foods
• The NHS’s Weight Management Service to be expanded to help people lose weight, eat better and get active
• Incentives for GPs to assist patients with weight loss, exercise and social activities

Dr Chinnadorai Rajeswaran, Consultant Physician (Obesity, Diabetes & Endocrinology), is obviously pleased that the government is finally recognising and addressing this issue but says, “We are long overdue a campaign to reduce obesity – after all, we have been in an obesity epidemic in the UK for a number of years now. It is very welcome, however there are some issues.”

A staggering 63% of adults in the UK are overweight and 50% of these are obese. One in every three children who leaves primary school is overweight and one in five is living with obesity. This condition is costing the NHS over £6 billion per annum in treating obesity-related illnesses.

Counting calories

Listing nutritional and calorific information is a great way of keeping people informed and helping them to make healthy choices in supermarkets, restaurants and pubs. However, there are many factors involved when it comes to making life choices. People are generally influenced by those with whom they live and socialise; if these groups choose unhealthy food then, in all likelihood, everyone in these social groups will follow suit. Also, some people may not want to change their dietary habits.

Numeracy and literacy levels are needed to decipher the nutritional information and it has been shown that those from deprived backgrounds may struggle to understand the labelling information.

Raj points out another issue with counting calories for weight loss, “Calorie-counting is an outdated method of weight-loss. To start with, there is a 20-30% error margin anyway, but more importantly – as a child soon gets bored with a new toy – the vast majority of people lose enthusiasm for calorie-counting. The key to healthy weight-loss is creating lifelong habits, much like with exercise. The trick is to make sure that the form of weight loss that you are undertaking is sustainable in the long term, which is why so many diets simply don’t work; people go about them enthusiastically but sooner or later lapse, whether they actually notice it or not.”

“Obesity itself is an outdated term. There is a growing contingent of professionals who would like to see ‘obesity’ relabelled as ‘ABCD’ – that’s Adiposity Based Chronic Disease.”

Traffic light system

Extensive research has shown that while consumers may look at food labels, many don’t process the information they are seeing and do not make food or purchase choices based on calorie content or health. The government needs to educate the public so they can understand the labelling and what constitutes a healthy diet.

More affordable healthy foods

The government’s plan to stop all unhealthy foods being advertised on television before 9pm is not going to solve the problem. A 2019 government study showed that a junk food advertising ban would only reduce people’s daily calorific intake about 1.7 calories. The end of buy-one-get-one-free offers on products, such as biscuits and chocolate, will certainly alleviate the problem and the government should encourage food stores to have these offers on fruit and vegetables instead, making them more affordable.

Sadly, many deprived areas have a large concentration of fast food outlets and convenience stores that stock very little fresh produce and healthy food. Unhealthy food options are frequently cheaper and full of additives and preservatives, giving the impression that they are tastier than healthy foods. Supermarkets and food stores need to be encouraged to improve access to healthy, affordable foods and to slowly reduce the unhealthy foods that currently stock their shelves.

High drop-out rate in weight loss programmes

It’s a fact that there is at least a 50% drop out rate in those who start weight loss programmes. Raj discusses the principle reason for this: “There is a 50% dropout in all weight-loss programs. The main reason for this is a lack of empathy. Obesity itself is an outdated term. There is a growing contingent of professionals who would like to see ‘obesity’ relabelled as ‘ABCD’ – that’s Adiposity Based Chronic Disease. [see https://journals.aace.com/doi/pdf/10.4158/EP161688.PS] What this does is tackle the common conception that obesity is purely a lifestyle, and repositions it as what it really is – a chronic disease.”

Raj explains the meaning of adiposity: “Adipose tissue is commonly known as body fat, and it produces hormonal responses to signals sent from organs. For this reason, it is known as an endocrine organ. If you have ABCD your adipose tissue is causing you a problem – if you have too much of it your hormonal response will be unbalanced. This can, in effect, be labelled a chronic disease in itself.”

“It’s important to know that weight gain/loss is not solely related to diet. We need to look at the root causes of hunger; for example, if a patient is eating fatty foods at night, we need to address their insomnia, and this will help them cut down on late night binges.”

The sensible approach to weight loss and a healthy body

Our hormones act as chemical couriers that regulate our bodily functions; they are just one fact that puts us on the path to obesity.

Raj explains that “putting on weight is neuro-hormonal, which means it is habit-forming. Your gut hormones send messages to your brain and this is what creates habits; the way to approach weight-loss in the long-term is to change those habits. How to do that? Incremental change is key. Making small changes and then continuously reviewing the effects of the change is the best way to create lasting habits.”

GP practices are being incentivised from 2021 to ensure people who need to lose weight receive adequate support. There will also be a roll out of newly developed apps and online tools to assist with obesity related illnesses such as diabetes. The government also plans to release a free 12-week weight loss app. But is this enough?

Raj is adamant that healthcare professionals need better training in how to deal with obesity. “The first step is education. Obesity is an epidemic partly because of the lack of education for healthcare practitioners. There is definitely a need to place more emphasis on learning about weight-related topics in all areas of healthcare; this would help practitioners approach their patients’ health more holistically.”

Raj also points out that there are many factors involved in overeating, many of which stem from insecurities or stress which manifest themselves in different ways. “It’s important to know that weight gain/loss is not solely related to diet. We need to look at the root causes of hunger; for example, if a patient is eating fatty foods at night, we need to address their insomnia, and this will help them cut down on late night binges.” It’s vital that everyone who is suffering from obesity is given the opportunity to discuss his/her fears and trigger factors.

Many people are totally unaware of how their body functions and that is why Raj firmly believes that “explaining to patients how their body works will help them fully understand the steps they can take to maintain or reach a healthy weight. This helps prevent them from giving up in the short term (and therefore the long term).”

The British government’s strategy has been welcomed but, as can be seen, it needs to go a lot further to ensure the issue of obesity is tackled once and for all.

About Dr Rajeswaran (Raj)

Raj is speaking on this topic in more detail for healthcare professionals in an upcoming webinar with Oryon Develop. Find out more details and book on by clicking on the button below.