Welsh inquiry into childhood obesity

Submissions were invited for an inquiry into childhood obesity in Wales. The deadline was Friday 3rd May 2013.

I submitted a response – it can be seen in full here – CO 15.

The last I heard was on 14th May 2013 when I received a letter from the chair, Ann Jones, saying that the inquiry had been put on hold. So it was out-of-the-blue that I today received an email with a copy of the report following the review.

As of the time of writing (26th March 2014), the web site lists the report as “in preparation”. I will share the recommendations from this 38 page report. Hopefully you’ll be able to view the whole document on line soon.

The all Wales obesity pathway

Before we look at the recommendations – we need to bring everyone up to speed with what is known as the all Wales obesity pathway. This is the current Welsh ‘strategy’ for dealing with obesity:

Level 1: Community-based prevention and early intervention focused on lifestyle advice and information (e.g. Change4Life)

Level 2: Community and primary care weight management services (e.g. MEND).

Level 3, Specialist multi-disciplinary team weight management services (e.g. Dr Haboubi’s clinic)

Level 4: Specialist medical and surgical services (i.e. bariatric surgery).

So, the current Wales obesity ‘strategy’ is Level 1 – industry sponsored fake food swap dietary advice; Level 2 – the cola/cake/biscuit/bagel/cornflakes adorned eatbadly plate dietary advice; Level 3 – attend a clinic to receive eatbadly plate advice in person; Level 4 – barbaric surgery so that you can’t eat properly. I jest, but not much.

You’d think that anything would be better than this. Here are the six recommendations that the committee came up with:

The recommendations

“Recommendation 1:Welsh Government should conduct a review of the progress of Local Health Boards in meeting the minimum service requirements for each level of the All Wales Obesity Pathway. Welsh Government should publish the results of that review in a timely fashion, including a timetabled action plan to address any gaps that are identified.

Recommendation 2: Welsh Government should ensure that level 3 services for children are put in place across Wales. The Minister should report back to the Committee on progress in a timely fashion.

Recommendation 3: Welsh Government should develop and publish an evaluation framework for its strategies relating to childhood obesity to ensure the performance of strategies can be reliably monitored against outcomes.

Recommendation 4: Welsh Government should continue with, and extend, the Child Measurement Programme, and indicate clearly how the data will be used to monitor and evaluate childhood overweight and obesity programmes.

Recommendation 5: Welsh Government should publish in a timely fashion a report on the actions taken by the new Welsh Government Cabinet sub-Committee looking at encouraging children and young people to participate in more physical activity, with reference in particular to: the impact of budgetary constraints on the provision of local authority leisure facilities; and the actions being taken to ensure that Welsh Government is working across departments to increase participation levels.

Recommendation 6: Welsh Government should explore how forthcoming legislation, such as the Future Generations, Planning and Public Health Bills, can be used to address childhood obesity. Ministers should report back to this Committee on his conclusions at the earliest opportunity.

This Committee will ask the Minister to provide an update on progress against these recommendations in September 2014.”

The committee didn’t re-look at the crisis and ask – what could and should we do to solve obesity in Wales? They didn’t take a fresh look at the epidemic. They didn’t challenge whether or not current advice is working. They didn’t look at proposals for new advice. They merely recommended lots of reviewing and lots of publishing and lots of demands for government/ministers/the minister to report back.

My submission was ignored. How do I know this? Because the report lists evidence taken into account at the bottom of each page and the following submissions are referenced:

CO 05 – Sustrans Cymru;
CO 16 – Royal College of Paediatrics and Child Health (4 references)
CO 21 – City and County of Swansea;
CO 22 – Public Health Wales (3 references);
CO 24 – Aneurin Bevan Health Board (3 references);
CO 25 – Royal College of Physicians (Wales) (4 references);
CO 27 – Betsi Cadwaladr University Health Board (2 references);
CO 30 – Cardiff and Vale University Health Board (2 references);
CO 31 – Wales Dietetic Leadership Advisory Group and Public Health Dieticians in Wales;
CO 38 – Academy of Royal Colleges Wales;
CO 42 – Public Health Wales;
CO 47 – Cwm Taf Health Board;
CO 48 – Sport Wales (3 references).

And the oral evidence from the minister and Chief Medical Officer (15.1.14) was referenced 14 times.

Notice that every body referenced is a public body. Current providers of public health dietary advice – from the minister and public health Wales to dieticians and council workers – have provided the reference base for this report. When the current advice isn’t working – you need to go beyond the current advisors for a solution.

My recommendations

You can read my advice in full from page 14 in my submission. The headlines are:

“These are the three urgent steps that we need to take to reverse the obesity epidemic in Wales. These will address adult obesity in Wales, as well as childhood obesity.

1) Reverse current dietary advice.

Tear down the eatbadly plate from every school and medical centre in Wales. Stop telling people to base their meals on fattening (starchy foods). Go back to knowing that starchy foods make us fat and sugary stuff even more so. All dieticians and dietary advisors need to be re-educated and re-trained. With relationships with soft drinks manufacturers and sugary cereal companies, telling the public to favour fake over real food (cereal, not eggs; margarine, not butter; low calorie drinks, not milk), dieticians are a merchandising force for the fake food industry.

2) Deliver one clear government message – Eat Real Food!

Real food is: meat, eggs and dairy from grass living animals; fish; vegetables; fruits in season; nuts and seeds. Whole grains are debatable as a real food. They have been introduced into the food chain in the blink of an eye in terms of evolution. They may be consumable in moderation, but most definitely should not be the foundation for childhood or adult diets. As real food is promoted, so processed food should be demonised concomitantly.

I use the following as an analogy: “If we have been eating real food for 24 hours, agriculture gave us large scale access to carbohydrates four minutes ago and sugar consumption has increased twenty fold in the past five seconds. I wonder which food is more likely to be responsible for the obesity epidemic or any modern disease…”

3) Eliminate conflicts of interest.

England naively believes that the obesity epidemic can be solved by working with the ‘food’ industry. The ‘food’ industry is part of the problem – never will it be part of the solution. Wales is in a unique position in this respect, as we have no economic allegiance to the fake food industry. We need not fear for withdrawal of government funding or ‘food’ industry jobs lost in our discrete nation.

We do however need to eliminate conflict of which governments may not be currently aware. Change4Life has been shown to be one such example. The British Dietetic Association should be kept at arm’s length, not given a monopoly on dietary advice, given their corporate relationships (past and/or current) with Danone, Abbott Nutrition, Birds Eye, Kellogg’s and The Sugar Bureau and likely more (they are far more secretive about their ‘food’ industry relationships than their American or Australian counterparts – likely ashamed of them).

The British Nutrition Foundation (BNF) was founded in 1967 and its web site says that this organisation “…exists to deliver authoritative, evidence-based information on food and nutrition in the context of health and lifestyle. Accurate interpretation of nutrition science is at the heart of all we do.” Here are their sustaining members and members.

Which set of advice do you think would more likely have an impact on the obesity epidemic?

Review, publish and report? Or


Posted in Gov. Policy, Obesity
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15 comments on “Welsh inquiry into childhood obesity
  1. avatar Stella Baker says:

    For me the core of your message centres around the sentence “when the current advice isn’t working – you need to go beyond the current advisors for a solution.” This is the nub of the problem. Goodness knows how much money has been invested/wasted in transferring from the food pyramid to the eatwell plate and all it’s attendant messages and how many ‘current advisors’ have been involved.

    So many people have based their careers and reputations on adding to those messages – people who are employed by the public bodies you referred to – the ones that were referenced – while your work seems to have been ignored (for now).

    For things to change, those people need to say “we were wrong and the advice we have been giving has been wrong for a long time.”

    The question is – will that happen? And, more to the point, do these people actually realise that they are wrong or are they blinkered by merely looking to the research backed by industry and drug companies which serves to confirm and validate their long held views. If they have spent their lives believing the current advice, will any of them shift their spotlight to other advice and be brave enough to embrace it.

    You have described yourself as a rebel, Zoe. The thing is, we need is people like you and all the other rebels who are trying to get the message across. It is starting to happen – slowly, slowly but once it takes hold It will spread like wildfire.

    The public will be angry. People who have had chronic illnesses and those who have watched members of their family suffer with obesity, diabetes, dementia and other metabolic problems will be angry. And the thought of the waste of public money will make people angry.

    Your message about our evolution in twenty four hours is a lovely simple one. People will be able to grasp that as a concept.

    Anyone worth their salt, during our long history of trying to get the truth out in the face of seemingly overwhelming odds, has just persevered and in the end, won out. The paradigm shift is coming, maybe sooner than we think.

  2. avatar Lynn Blake John says:

    I have just published two children’s picture books to help combat the crisis in childhood obesity and fitness. While these books aim to entertain children with humour and imaginative illustrations, the real purpose of these surreal adventures is to help combat the current crisis in nutrition and fitness.

    “Revenge of the Vegetables” is the story of Freddie, a boy who hates vegetables. One day when no one is looking, he throws his vegetables in the rubbish bin. The angry vegetables want revenge and Freddie has to run for his life! Can Freddie be rescued? And could vegetables actually be good for you? (A Welsh-English Version of “Revenge of the the Vegetables” will be published at the end of August.)

    “The Accidental Athlete” is a second picture book featuring the hapless Freddie. This time he hates sport and exercise. One day he sneaks off the playing field in the middle of a game — and the consequences are unusual! A badminton racket, a golf club, and a bicycle strike back. Will Freddie triumph in the end? Could exercise actually be fun?

    I’m writing because I think these books would help fight the terrible situation in children’s health today in a way which would actually be fun and involving for kids. Could you please take a look at these books and consider if they might be useful in your work?

    The books can be found at: http://www.amazon.co.uk/Revenge-Vegetables-Lynn-Blake-John-ebook/dp/B00MD0KZ5K/ref=sr_1_1?s=books&ie=UTF8&qid=1408707703&sr=1-1&keywords=lynn+blake+john and http://www.amazon.co.uk/Accidental-Athlete-Lynn-Blake-John-ebook/dp/B00ML85NSS/ref=sr_1_3?s=books&ie=UTF8&qid=undefined&sr=1-3&keywords=lynn+blake+john

  3. avatar Ali says:

    The problem is Zoe, you and all the rest of us who are trying to promote real food, is that we are battling against a very clever and insidious strategy.

    Get the people fat, sick, lazy and unmotivated and they won’t have any incentive to do anything more strenuous than open a packet….

    Horror of horrors, preparing REAL food takes time and energy, and besides who cooks these days? Oh yes, we like to sit on our backsides and watch ‘other people’ preparing it, but do it ourselves….?

    Interestingly, the ‘best diet in the world’ programme that was broadcast recently came to the conclusion that the healthiest diets are based on REAL food, and the closer groups adhere to their ancestral diet, the healthier they are. Unfortunately, those of us in the ‘first world’ have no concept of our heritage or diet as it has been eroded by mass migration and commercialism.

    Diet diktats bandy the word ‘nutrition’ around like a tennis ball. The back of packets and tins list the ‘nutrition’ in terms of protein, fat and/or carbohydrate content with seemingly no understanding that they are just the food make-up, not the nutrition! We are made of the elements and need the full quota of elements in order to thrive. Modern ‘holographic food’ does not fulfil the body’s nutritional needs, and unfortunately even some REAL food also falls into that category these days.

    It may look like a tomato, it may taste sort of like a tomato, but it is a virtual tomato……

    There’s education, and there’s education. There are qualifications, and there are qualifications. Both are based on opinion. And we all know there are as many opinions as there are people, so what gives any ‘body’ the right to assume their opinion is better than anyone else’s and dictate it to the masses at their expense? In that situation common sense has to prevail – and that is something sorely lacking in modern society….

  4. avatar Rob Elliott says:

    I love your 24-hour real food analogy – a great way to put things into perspective. It might be interesting to add how long’ veganism will save the planet’ has been on the radar, or perhaps it is so short a time that it wouldn’t register on your 24-hour timeline!

  5. avatar Lisa Chase says:

    What I think is so sad is that government officials just keep recommending “more of the same”. I watched a documentary the other night about an overweight 8 year old boy. The Child Protective Services were thinking of taking the boy away from his mother, stating that it was a “crime that she allowed him to get so fat”. But it looked like she was basically following government advice: the kid ate lots of carbs, potatoes and such, and seemed obviously to be addicted to them. The boy had a huge appetite, was constantly hungry, and the mother didn’t know what to do- (and no one was helping her). It’s a sad, sad world when people are threatened to have their child taken away; or others get stomach stapling operations; to deal with their obesity problem……when there’s a much more simple solution! Almost makes me want to cry…..

  6. avatar Robin Willcourt says:

    I’d like to share this. I have over 3,000 patients in a practice which includes many athletes. Much of what I do is about restoring normal hormone levels but that is not what I want to talk about.

    I now have over 100 men and women doing a combination of Martin Berkhan’s “leangains” and a Paleo derived diet. Most came to me for weight loss, some for Metabolic Syndrome, others to get rid of the mental fog they associated with eating grains/dairy (they themselves diagnosed that!) but they didn’t know what foods to substitute, as the all “knew” that grains and dairys were meant to be “good” foods and meat and saturated fat were “bad.”

    This produced a conundrum, of course. Their doctors advised more grains and fruit!

    After as few as 6 weeks, blood work shows that triglycerides go down, HDL goes up (so does LDL) and fasting and post-prandial blood glucose are lower in many. In a few, I have done insulin levels pre- and post-prandial and despite the blood glucose either not lowering or going down a little the post-prandial insulin falls by 20% or more.

    I have only had 6 months experience with this regimen but the change in the human is striking. Vibrant, clear headed, fat loss- up to 27kg in 6 months! I have to thank you Zoe, Malcolm Kendrick, Martin Berkhan, Andreas Eenfeld and Peter Attia. I show all my patients parts of your blogs and videos (my consultation lasts an hour or more) and they leave hopeful and amazed that everything they have been told previously is crap!

    Virtually all dump their statins: especially instructive to them is Pfizer’s own declaration on Lipitor: that by taking Lipitor a cardiac event occurs in 2% of “at risk” patients in three years vs 3% on a placebo! This information is, of course, in SMALL print.

    The HEADLINE IN PFIZER’S advertisement trumpeting the benefits of Lipitor states, “Lipitor reduces the risk of heart attack by 36%…in patients with multiple risk factors for heart disease.” You have to notice the asterisk next to this statement then go look at the almost unreadable small print below the ad.
    Absolute vs relative risk! Once this is explained to them they get quite angry that they have been lied to by us- the professionals.

    They all say, “but my doctor told me I would have no more risk of a heart attack, and if I didn’t take Lipitor it would happen in a couple of years!” I wonder what our statin loving Finn would say to this?

  7. avatar Andrew H says:

    It has been a continuous learning curve for me. I lost the weight very easily using one of the mainstream diet plans but it has only been thanks to your advice and that of BeyondDiet(Isabel De Los Rios) that I was able to develop a long term plan where I don’t have to ever go hungry and I can maintain my safe weight and, as I’m a runner, my running performance. Plus you also have a plan that is squarely aimed at men. Rare in the image conscious diet industry.

    Luckily I didn’t come across government advice till much later on but I’m shocked at how slow it is taking them to accept the obvious. Are they worried about liability?

    What do you think about the recent announcment that being overweight is the new ‘normal’?

  8. avatar Catherine says:

    If there was ever a recipe for a huge surge in eating disorders, I reckon this selection of “recommendations” is it! Extremely “timely”…..!

  9. avatar Tom Welsh says:

    Thanks, Zoe! However I think you’ll agree that the reason those remarks are funny is because they have a core of profound truth.

  10. avatar tz says:

    The modern, slow obesity plague seems like the old black death.

    Back then, they refused to consider rats and fleas, but instead killed all the cats.

    The response of the crony conspiracy seems to be to kill the dogs too.

    Fortunately, someone who really wants to cease being obese can find this information on the internet. It isn’t in the mainstream media, but I keep finding more links and sites to places that understand it is sugar and starch that are the problem.

    (And I did by your men’s book – It clarified a few things – thanks!).

  11. avatar Sandra says:

    I’m trying to do my bit for the cause Zoe. As a school nurse in Wales I am encouraged to use the eat badly plate! This is a conflict to my own belief. However, as I personally have rarely used processed food, instead of using the picture issued I use real ‘real’ food in health promotion exercises. This way I can also reduce the portion of the plate for carbohydrate and promote alternatives to bread and pasta such as quinoa & brown rice. It’s a slow process but I’m drip feeding the concept to my caseload.

  12. avatar Tom Welsh says:

    Maybe I should add a couple of intelligent comments about bureaucracy which seem relevant.

    “In any bureaucracy, the people devoted to the benefit of the bureaucracy itself always get in control and those dedicated to the goals the bureaucracy is supposed to accomplish have less and less influence, and sometimes are eliminated entirely”.
    – Pournelle’s Law of Bureaucracy

    “The simplest way to explain the behavior of any bureaucratic organization is to assume that it is controlled by a cabal of its enemies”.
    – Robert Conquest’s Third Law of Politics

  13. avatar Tom Welsh says:

    I think Tom Naughton, among others, have often cited Thomas Sowell’s dictum about The Wisdom of the Anointed. The Anointed decide, out of their infinite wisdom, what action will benefit us poor benighted peasants, and they then either force us to undergo it or put pressure on us to do so. When, in due course, this makes matters worse, they conclude that:

    1. The desired outcome has been missed because the stupid peasants didn’t understand; or
    2. The desired outcome was sabotaged by wicked people; or
    3. More of the same is needed.

    You are lucky not to have been explicitly singled out as one of The Wicked. Presumably their chosen remedy is (3) “More of the same”. We’ll see how that works out for them (and, unfortunately, for the poor children of Wales).

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