The medical profession’s prescription for the nation’s obesity crisis

Back in April 2012, The Academy of Medical Royal Colleges announced that they were launching a review into the UK obesity crisis. The initiative was launched in a front page article in The Observer 15th April 2012. The idea was that the body that represents 220,000 doctors in the UK would seek evidence from any individual or organisation that wished to contribute to the debate. An excellent initiative. A great opportunity and yet, having seen a copy of the report yesterday in preparation for media interviews today, tragically, a completely failed chance to do something that really could make a difference to the obesity epidemic.

I made a submission to the steering group – I posted it in full on line on this site yesterday.

The press release and the full report can be found here.

THE 10 KEY RECOMMENDATIONS

The 10 key recommendations from the report, or the campaign as it wants to be called, are as follows – they are grouped into three areas. (These 10 recommendations are verbatim, as they appear in the document).

Action by the healthcare professions

1. Education and training programmes for healthcare professionals: Royal Colleges, Faculties and other professional clinical bodies should promote targeted education and training programmes within the next two years for healthcare professionals in both primary and secondary care to ensure ‘making every contact count’ becomes a reality, particularly for those who have most influence on patient behaviour

2. Weight management services: The departments of health in the four nations should together invest at least £100m in each of the next three financial years to extend and increase provision of weight management services across the country, to mirror the provision of smoking cessation services. This should include both early intervention programmes and, greater provision for severe and complicated obesity, including bariatric surgery. Adjustments could then be made to the Quality and Outcomes Framework, providing incentives for GPs to refer patients to such services

3. Nutritional standards for food in hospitals: Food-based standards in line with those put in place for schools in England in 2006 should be introduced in all UK hospitals in the next 18 months. Commissioners should work with a delivery agent similar to the Children’s Food Trust to put these measures into place

4. Increasing support for new parents: The current expansion of the health visitor workforce in England should be accompanied by ‘skilling up’ the wider early years workforce to deliver basic food preparation skills to new mothers and fathers, and to guide appropriate food choices which will ensure nutritionally balanced meals, encourage breastfeeding and use existing guidance in the Personal Child Health Record as a tool to support this.

The obesogenic environment

5. Nutritional standards in schools: The existing mandatory food- and nutrient-based standards in England should be applied to all schools including free schools and academies. This should be accompanied by a new statutory requirement on all schools to provide food skills, including cooking, and growing – alongside a sound theoretical understanding of the long-term effects of food on health and the environment from the 2014/15 academic year

6. Fast food outlets near schools: Public Health England should, in its first 18 months of operation, undertake an audit of local authority licensing and catering arrangements with the intention of developing formal recommendations on reducing the proximity of fast food outlets to schools, colleges, leisure centres and other places where children gather

7. Junk food advertising: A ban on advertising of foods high in saturated fats, sugar and salt before 9pm, and an agreement from commercial broadcasters that they will not allow these foods to be advertised on internet ‘on-demand’ services

Making the healthy choice the easy choice

8. Sugary drinks tax: For an initial one year, a duty should be piloted on all sugary soft drinks, increasing the price by at least 20%. This would be an experimental measure, looking at price elasticity, substitution effects, and to what extent it impacts upon consumption patterns and producer/retailer responses

9. Food labelling: Major food manufacturers and supermarkets should agree in the next year a unified system of traffic light food labelling (to be based on percentage of calories for men, women, children and adolescents) and visible calorie indicators for restaurants, especially fast food outlets

10. The built environment: Public Health England should provide guidance to Directors of Public Health in working with Local Authorities to encourage active travel and protect or increase green spaces to make the healthy option the easy option. In all four nations, local authority planning decisions should be subject to a mandatory health impact assessment, which would evaluate their potential impact upon the populations’ health.

My response

I was due to be on BBC Radio Wales at 6.05am this morning to talk about the report, but the BBC went out on strike at midnight, so it will likely be rescheduled for tomorrow. My points on the campaign are as follows:

*      This was a great initiative – the Academy of Medical Royal Colleges represents the views of the majority of the UK’s 220,000 practising doctors – this was an incredible opportunity to make a significant difference to the biggest public health crisis that humans have ever faced. It has tragically failed.

*      Professor Terence Stephenson, the chair of the steering group, says in the opening remarks “There is no single simple solution – if there was we wouldn’t be in the position we are now.” I disagree. We just need to go back to eating what we ate before we created an obesity epidemic. Make no mistake – this crisis is of our making.

*      The report describes this epidemic in the Executive Summary as “It is a problem that has crept up on us…” I disagree. Obesity increased almost 10 fold in the UK in the three decades following the change in public health dietary advice. This did not ‘creep up on us’. We made it happen and we need to admit that we were wrong and return our dietary advice back to what it was.

*      The major cause of the obesity epidemic is our public health dietary advice. The introduction (1977 USA, 1983 UK) of advice telling us to “base our meals on starchy foods” (foods that we previously held to be uniquely fattening) has made us fat and sick. The majority of the 10 key recommendations are about extending and reinforcing current dietary advice and increasing the army of dietary advisors to give this advice – this will only make the situation worse.

We need  to admit that our current dietary advice is wrong. That the government ‘eatwell’ plate is a shocking diagram – the antithesis of healthy eating.

The idea of a campaign to extend these ‘nutritional standards’ into schools and hospitals horrifies me. It will make matters worse, not better. We need to completely change our dietary advice before telling one more person about it. Every dietician needs to be retrained and to go forth with evidence based advice alone (which excludes “five-a-day”, “carbs are good” and “fat is bad” – none of which are evidence based).

*      Three recommendations are along the right lines, but still wrong:

–      6. Fast food outlets near schools: It’s a good idea to make sure that children have minimal access to junk. However, school dinners, based as they are on nutritionally poor and fattening carbohydrates (pasta, pizza, potatoes etc) are no different to what children can get outside the school gate. Here’s a sample menu – this was just the one at the top of the google search – I didn’t have to look for a particularly bad example. You can probably find your own local authority’s menu on line – they seem to be proud of serving pizza, pasta, chips, ketchup, chocolate brownies, ice cream, cake, jelly and other junk to our next obese generation.

–      7. Junk food advertising: This is the right idea, but the report names the wrong foods – saturated fat, salt and sugar.  This shows that the Academy of Medical Royal Colleges is ignorant about the basics of nutrition…

Saturated fat is a natural component of the most nutrient dense real foods on the planet (meat, fish, eggs, dairy products, nuts, seeds, olive oil, avocados etc). We cannot eat or avoid saturated fat alone. Every food that contains saturated fat also contains monounsaturated and polyunsaturated fats. There are no exceptions. Saturated fat should not be targeted in any circumstances. One of the 15 steering group members, Professor Mike Lean, has a nice little side line doing low-fat pizza – gotta keep fat in jail eh?

Salt is irrelevant to obesity. It is another natural component of real food. Water contains sodium – should we tax water?!

The standard trilogy of saturated fat, salt and sugar is ignorant. The three occur together 15 times in the report – this is like putting Luke Skywalker, Yoda and Darth Vader together. Only sugar is an issue. Any product containing sugar should be banned or taxed out of the reach of most consumers.

–      8. Sugary drinks tax: Right tax, but with three caveats:

a)    This is not new – Sustain called for a 20p per litre tax on sugary drinks on 29th January 2013. Kelly Brownell called for them back in 2009.

b)    Any call for a sugar tax needs to include sweeteners, or the ‘food’ industry will just replace one bad thing with another.

c)     The tax needs to be much higher than 20% to have any effect. A study in the British Journal of Nutrition, March 2011, suggested that a 10% tax on sugared drinks would possibly decrease consumption by 7.5ml per person per day. That’s barely a sip. I would at least double the price of any product containing sugar OR sweetener.

Lest we forget, the British Dietetic Association were one of the 60 supporters of the Sustain campaign for a sugary drinks tax. They have a can of cola on their plate of role model healthy eating – yes – that eatbadly plate!

It is so tragic that the doctors of the UK have missed this opportunity to make a difference. Nothing in this report will halt, let alone reverse, the obesity epidemic and a number of the measures will actually make things worse.

Also, we didn’t need a 60 page report – we just needed the medical profession to come out with those three little words – Eat Real Food!

The first reaction to the campaign

From the 10 recommendations, the BBC led on the call for a fizzy drinks tax. The call for foods high in “fat, sugar or salt” to be relegated to after the 9pm watershed also got a mention, as did the fact that recommendation 2 calls for extra money for weight loss surgery (don’t get me started on that one!) The bariatric surgeons on the steering group, Professor Mike Larvin and Mr Vivek Chitre, wouldn’t have minded the call for £300 million over the next three years for surgery. Dr Rachel Pryke, another member of the steering group, has written to the BMJ in the past expressing her concern over the lack of access to barbaric surgery.

The print media (Guardian, Times, Daily Mail) have similarly led on the fizzy drinks tax.

However, if you watch the BBC report, you’ll see the biggest problem of all – the government has responded to the initiative already by saying its focus is on working with the ‘food’ industry to get companies to voluntarily reduce the calorie content of their food.

As Dilbert used to say “we are doomed!”

Posted in Dieting, Gov. Policy, Media comments, Obesity
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14 comments on “The medical profession’s prescription for the nation’s obesity crisis
  1. avatar ecarG says:

    Ack . . . read my post. Sorry for the horrible grammar. Auto-spell check is not my friend! I cleaned it up.

    Here is the dilemma, from a front-line perspective. The medical profession, including dietitians, (in the USA), study disease. Usually when people/patient’s come in, (not all cases of course), they have been in a state of dis-ease for quite some time and the focus is on life preservation, often with an air of Dawn of the Dead about it.

    With that being said, all of the docs that i know, when asked about HEALTH and how to achieve it, don’t know the first thing to advise patients on how to accomplish this. They study disease, NOT health! Typical “health” recommendations include Colonoscopies, PAPS, mammograms, and eating from the food pyramid. Seriously? Most of these are screening tools. NOT preventative tools. But they will argue you to death, they ARE doctors, afterall, that these are preventative by virtue of early detection . . . .alas. Dietetics is no better! They are expert at formulating TPN feedings for sick people in the hospital, but have memorized the same food pyramid that the doctors did.

    When any type of discussion is introduced about the topic of health and what that means usually results in discrediting of the new information. Why? Medicine, in fact ALL health care factions here in the USA, are founded on rote memorization of outdated protocols set up by the accrediting bodies of each specialty area, which results in suppressed information AND ability to introduce new topics for exploration. I cannot tell you how HAPPY i was to have discovered your work, it’s about time!

    There are newer programs popping up that DO revolve around health and the students learn the various modalities (or tools) to empower people with to achieve optimal health that are not based upon the food pyramid or disease. The health care industry has its head so far up its you-know-what here in the USA, that most if not all healthcare practitioners would debunk this information without ever looking into it. Medicine has become Religion at this point!

    The purpose of this circuitous post is to ask 1) is it even possible for the Church of Healthcare (in the USA) to get take it upon themselves to join the game? Unless they find a way to make money from it, NO. If enough people get on board and discover for themselves this updated and relevant information (as i have), then they will as a way to keep money flow. But heads up, the medical industry are not always the most creative, out-of-the-box thinking folks! They do and will balk.

    They are invested in the current paradigm – its almost a belief system. . I have introduced similar things and have been dismissed as irrelevant. I have studied physiology, anatomy, and biochemistry for over 10 years and within these “professions”, the new is really not welcomed. The marketers will tell us otherwise. I gave up because of the lack of support and difficulty traversing the system.

    So it is going to take people off the grid, with the knowledge and ability to communicate to people individually (like the books published, YouTube videos, and websites) along with individuals taking responsibility for themselves. The US medical system develops and cultivates codependence and a shirking of personal responsibility of its patients/consumers. I could go on and on. As a healthcare practitioner, here in the USA, my hands are often tied as to what i can say or do. My regulatory boards protect the public from me, and so i am forced to work within this accrediting agencies protocols and rules.

    Getting off the grid is easier said than done.

    Thanks for your work and for your voice! Elated at discovering your work! There is hope. I am reading your books and would be interested to know more about any of your research that’s available.

    Thanks!

  2. avatar ecarG says:

    Here is the dilemma, from a front-line perspective. The medical profession, including dietitians, (in the USA), study disease. Usually when people/patient’s come in, (not all cases of course), they have been in a state of dis-ease for quite some time and the focus is on life preservation, often with an air of Dawn of the Dead about it. With that being said, all of the docs that i know, when asked about HEALTH and how to achieve it, don’t know the first thing to advise to accomplish this. The now standard dietary myths that seem to be being debunked (finally!) and a colonoscopy, PAP, or mammogram are standard fare on the menu (by the way these are screening tools and NOT preventative). When any type of discussion is introduced about the topic of health and what that means usually results in discrediting of the new information. Why? Medicine, in fact ALL health care factions here in the USA, are founded on rote memorization of outdated protocols set up by the accrediting bodies of each specialty area, which results in suppressed information AND ability to introduce new topics for exploration. In a doctorate program i have since quit, i discussed the effects of the American Diet on health factors and was set upon by the administrative leaders of the program as being a threat. This is what REALLY happens behind the clown-suit mask, folks. I cannot tell you how HAPPY i was to have discovered your work, it’s about time! The purpose of this circuitous post is to state that truly, to think or expect the medical profession to get behind this or to take it upon themselves to join the game, might be a long shot. They are invested in the current paradigm, alas. I have introduced similar things and have been dismissed as irrelevant. I have studied physiology, anatomy, and biochem for over 10 years and within these “professions”, the new is really not welcomed, as we may all believe. So it is going to take people off the grid, with the knowledge and ability to communicate to people individually (like the books published, YouTube videos, and websites) along with individuals taking responsibility for themselves. The US medical system develops and cultivates codependence and a shirking of personal responsibility. I could go on and on. As a healthcare practitioner, here in the USA, my hands are often tied as to what i can say or do. Getting off the grid is harder than it sounds.

    Thanks for your work and for your voice! Elated to that we can bust through the BS.

  3. avatar Byron says:

    Zoe,

    While I agree with your views on health and nutrition, I strongly disagree with your views on taxing sugar drinks. I also disagree with regulating where fast food restaurants (or any restaurant) can be located. This mindset is the same view that the government has on looking out for the best interest of the public. Whether you are right or not does not justify taking rights away from people or businesses, in my opinion. This is a slippery slope that should be avoided at all costs.

    This may seem contradictory since I totally agree that people would be healthier without fizzy drinks and fast food, but I think we should all have the right to eat or drink whatever we want. My family eats healthy meals 99% of the time, so why should I have to pay more for a soda on a date night on a special occasion? Freedom should come with the right to make good and bad decisions. For example, I believe we should have the ability to drink too much at a bar and drive home, while I think doing so is a TERRIBLE idea and should result in punishment by law! Personal responsibility and rights should always exceed the law/rules. If not, we are all subject to the whims of whomever is in charge. Education is what changed my family, not rules, laws, or mandates from my government. Prohibition didn’t work (for us in America), nor will taxing silly things that some view as unhealthy.

    For example, as a Christian I believe the Bible is the roadmap to a fulfilled life. However, if a Christian were president, I would not agree with taxing non-Christian actions, nor penalizing any view that is contradictory to the Bible. I believe the actions of a few can change the hearts of many. Your blog and articles are a great source of information for me and I agree with most of what you say. Keep up the good work, and please try not to encourage people to take away our rights regardless of whether they are healthy or not.

  4. avatar Katherine says:

    For Jason and others with a limited perspective on food policy, politics, and national diet…

    I don’t have information about the history of food politics in the UK, but it is an irrefutable fact that since the late 1900s the USDA has been working hard to convince US housewives specifically and consumers in general that it is more scientific, healthy, and time-efficient to purchase prepared foods, while to prepare your own food from basic ingredients is at best a waste of time.

    This propaganda campaign has been so successful that hardly anyone prepares most of their own meals routinely. Most children grow up in households where everything that can’t be eaten directly out of the package is at least ready to heat and eat. Home cooking has become the domain of the upper middle class, people with time on their hands to relearn it and money to spend on expensive high quality ingredients that will never be accessible to working people. It’s sad, because many people in that position are unable to comprehend the economic factors that now prevent working people from making realistic positive changes in their way of eating.

  5. avatar Jessica says:

    Jason, the issue with this idea is that the government/medical profession have decided that since there is nothing wrong with the medical advice, that if people get fat, it must be their fault since the ‘good’ advice is out there and everyone should know it. So they will start to take away treatment and help for obese people on the misguided notion that if you are fat, it’s your fault. Whereas the horrible, frightning truth is that people are being given advice which will only lead them to gain weight.

  6. avatar Lee says:

    Jason

    I used to unwittingly follow the EatBadly plate without being to interested in the subject and didn’t really have much in excess of its recommendations (i.e. I had Shreaded wheat with semi-skimmed milk for breakfast, ham sandwiches for lunch and dinner with potatoes, pasta or rice and then I’d have a pudding and maybe a “chocolate” biscuit). My alcohol consumption was also within Government guidelines i.e. 1-2 pints per night spread out over the week). I was always 13.5 to 14 stone and always had high blood pressure. This went on for 15-20 years.

    Now that I keep my booze, sugar, bread and pasta consumption low and get about half of calories from animal fats (i.e. minimise Omega-6 polyunsaturated fats), I’m always 11 to 11.5 stone and have “Ideal” blood pressure.

    The food I now eat is much tastier compared to the floor sweepings that are shreaded wheat and the tasteless dry stuff that passes for bread. I can’t bear either these days and I’ve only been doing this for 6 months.

  7. avatar Patricia Cherry says:

    Zoe Harcombe sure makes a lot of sense! I wonder what the state of Jason’s health is? Of course she is not wanting to go back in time, just wants to stop the mad gallop towards the abyss of obesity, type 2 diabetes and other illnesses that have increased in the last thirty years since The Food Industry cashed in on the stupid idea that eating low fat was healthy. Because the Western World ended up in the hands food designers who got people addicted to eating junk.

  8. avatar Mat says:

    Jason – I’m not sure if you are a troll or being serious..

    If troll.. F for effort

    If serious – Oh dear….

  9. avatar Jason says:

    I think your article here is utter rubbish. The eatwell plate is good advice, people just are not following it. It’s not a case of going back to old nutrititional advice, rather becoming more active and eating less processed foods. Jobs have become more sedentary and meals have turned in to high fat, high sugar microwave messes that are easier for everyone due to an increasingly busy lifestyle. You seem to basically want it to be back in a time when men were working physically exhaustive jobs for 10 hours a day while the wife stayed at home and cooked fresh food for the family. This isn’t the world we live in and you don’t seem to know what you’re talking about.

    Also, there will never be a time when fizzy drinks are just doubled in price overnight to prevent obesity, the food industry wouldn’t allow it. It’s a lot more complex than just changing a price tag.

    I agree with you on one point though, the fact that the report was a missed opportunity to do anything new. Most of the recommendations are just older guidelines or action that has been called for before. The report which aims to be new and innovative while starting a campaign could not be further from doing so. It is just another obesity reported which will be left to gather dust on the report. The exact situation it set out to avoid.

  10. avatar Mark Struthers says:

    Oh dear, the medical profession and its leadership have let us down again. An excellent critique, Zoe!

    PS. I wish I could think of something polite to say about Professor Terence Stephenson. But I can’t.

  11. avatar tz says:

    Clarification – by “sweeteners”, do you mean other forms of sugar (HFCS), or saccharin, splenda, stevia, and other low/no carb or calorie substances that are sweet?

  12. avatar Jessica says:

    And yet there seems to be some vague movements in the right direction. Teaching people to cook from scratch – we do seem to have a vague generation who don’t know how to cook fresh food, and they are teaching the next generation to open packets. Food nutrition will at least tell people what food is what, e.g. potatoes are carbs not vegetables and so on. Then hopefully when people like you come along and say the problem is lots of potatoes, you won’t be met with “But I eat five portions of potatoes a day – surely that’s healthy?!” I read some of the “Intermittant fasting” book which at least also stated that sugar and carbs should be cut down entirely. It still waffled on about calorie intake but appeared to agree that “a calorie is not a calorie is not a calorie”. If a calorie is equal, then surely we can eat 500 calories of sugar and we’ll be fine? No, the authors said we must choose low GI food. Natural food. Which was really good until he suggested that low GI food would include “Carrots, air popped popcorn or an apple”. *sigh* It does suggest though that the concept of all foods not being equal is slowly creeping in, just without giving any credit to those people who have campaigned for years to tell the truth – sorry, Zoe!
    Artificial sweetners have a safety valve all of their own. They have a disastorous effect on…erm….down below unless you use Stevia. Even then, if it’s mixed with the wrong stuff (certain sugar free chocolate) – same problem. What I don’t understand is that sweet shops sell sugar free sweets to children with no warning. Hope the children have self-control! I don’t see a mass increase to using artifical sweetners as becomming more of an issue in the future for that reason – but I am open to be corrected. I eat them in moderation and I’ll take the health issues as and when.

  13. avatar Catherine says:

    Zoe – I can only think of one thing to say about this “report” – AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAARRRRRRRRRRRGGGGGGGGGGGGGGGGGGGGGGGGGHHHHHHHHHH!!!!

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