Obesity Survey

[Fizzwizz]

I offered to do a presentation to their obese patients who were being considered for bariatric surgery ... the following day, she told me that following her chat with Dietetics, she had been informed that my offer was 'Not appropriate.'

Indeed, this is because the opinion and success of one person is meaningless. Medicine is evidence based. The evidence has shown from case studies of thousands of people that dieting is over 10 times less successful. To have you stand up and talk would be like my Grandad lecturing about the 40 woodbine he smokes everyday obviously not being harmful because he's 90 and never had a days illness in his life. For him that's true, but for the thousands of others whodied at 60 with lung cancer ...

Even if you're right and low carb was more successful than anything else, it would not become a treatment option until it is proven in evidence and the long term effects/consequences better undertood. Unfortunately the evidence is not there. Low carb apparently has similar success rates to Weight Watchers when you look at the statistics from thousands of people.

... Just for safety again, I'm speaking here about general weight loss and not the control of diabetes.

... Fizz

 

[Fizzwizz]

Actually that isn't my experience. I have been offered surgery without me even asking about it... No counselling etc or dietitian advice so...

This what depend on what you call being offered surgery. Being offered it by your GP is not being offered it, it merely means you are referred to a surgeon who will give you a medical and prioritise you. If you are fit enough, and high on the priority list you will be offered councelling and then possibly an operation date. Bariatric surgery is managed by a multi-disciplinary team and not a surgeon alone. You will be expected to speak to a dietician, councellor, and specialist nurse, before your funding can be approved. The funding is scarce too, most are refused even though they have been referred by their GP and fit the NICE criteria.

 

[fergus]

this is because the opinion and success of one person is meaningless. Medicine is evidence based.

I completely agree. In the words of David Hume, we are more likely to meet a thousand liars than one miracle. However, there is significant evidence of the particular efficacy of carbohydrate restriction as a treatment for diabetes and obesity surely?
The work by any scientists such as Magnus-Levy, Bauer, Pennington, Bruch, Le Magnen to name but a few suggests a perspective on these conditions that seems largely ignored or forgotten now. More recently, studies such as the one from Duke University last month suggest a line of research that ought to be pursued a lot more vigourously than it is.
My worry is that there is such a determination not to recognise the effectiveness of carb restriction that it is in effect discouraged. This, in diabetic terms, is certainly a common experience despite the clear wording in things such as the BNF which recommend carb restriction as the first line of attack, before oral medication, after diagnosis of type 2 diabetes.
This wording perhaps dates from a time when carb restriction was considered clearly and rationally, not as it is today.

All the best,

fergus

 

[candy1567]

Hi All

Isn't this a case of the medical v's the social model.

Performing weight loss surgery is the first step on a long platform, if your one of the lucky ones your wound will heal quite quickly and then your left with a life changing scenario

I would imagine most are not prepared for what it entails and those of us who are over weight dream of being able to shop on the high street and pick clothes off the peg without looking into this with both eyes open.

For most who qualify for this type of surgery the after effects psychologically must be devastating and they have not been taught a healthy way of living never mind eating. Its all about retraining you brain.

How can loosing a percentage of your stomach teach you about a balanced diet, it doesn't and you diet after surgery is certainly not healthy, and while i agree it is sometimes necessary it shouldn't be regarded as a fix.

 

[Fizzwizz]

For most who qualify for this type of surgery the after effects psychologically must be devastating

This doesn't appear to be the case, of all the post bariatric patients I have seen all were extremely happy and glad they had the surgery. The only moan I ever came across was that they hadn't lost all their excess weight (55% - 75% is usual). Many have some adverse effects like feeling sick after meals, or stomach ache after eating, but despite this they were still happy they had the surgery. In fact most were excstatically happy. They are a few too, however, who have serious complication, and there have even been deaths. This is usually in the very unhealthy, and the stats aren't very different for other operations (or childbirth). Understanding the likelihood of complications is very important though, and must be explored with your surgeon. It is often the bad results we hear about, the many good results are not. In fact, many actually hide the fact their weight loss is due to surgery.

and they have not been taught a healthy way of living never mind eating. Its all about retraining you brain.

There is no evidence to suggest that is correct, stats show that 95% of people who lose weight regain it in the long term

How can loosing a percentage of your stomach teach you about a balanced diet, it doesn't and you diet after surgery is certainly not healthy, and while i agree it is sometimes necessary it shouldn't be regarded as a fix.

Contrary to popular belief, unbalanced diet is not the main cause of obesity. Many people are more overweight and far unhealthier due to poor diet, but obesity is due to hunger. Adopting a healthy diet may help you lose weight, but it's not going to help a 24 stone man regain a healthy weight. The premise that obesity is caused by by eating junk, and doing no exercize is the very prejudice that is worsening the situation.
The next time you go into your works canteen look around. You'll see the slim 13 stone man tucking into chips, burgers, and apple crumble, followed by a can of full sugar coke. Behind him you'll see a 20 stone woman eating a salad an drinking water.

Speaking for myself, I have a very healthy diet, last year I ran the LLanelli 10K race, and I used to teach sports science at a local college. I have pictures of me climbing a Scottish munro, all at 22 stone.

Being obese we're constantly being told we eat rubbish, we don't exercize, and we deserve to be fat because we can't say no. We're told this so many times we actually believe it, lowering our self esteem, feeling that we are responsible for obesity. We're not,. Obesity is a metabolic disease. Those with it suffer the extreme health consequences, and the judgement of those who don't have it.

 

[Thirsty]

Fizz, my obese, non-diabetic wife fools herself all the time by embarking on a diet, cheating by not following it, and then blames the diet for her failure to lose weight.

This seems to be fairly common.

Yes?

 

[Fizzwizz]

Fizz, my obese, non-diabetic wife fools herself all the time by embarking on a diet, cheating by not following it, and then blames the diet for her failure to lose weight.

This seems to be fairly common.

Yes?

Yes, very common. But the blame is neither with your wife nor the diet. She is driven by the metabolic process of homeostasis to over-consume. The reason people fail is because hunger nags them to eat. People trivialise the power of this, they shouldn't. It's why 95% of diets fail.

there is no secret to dieting. The theory is simple, eat less, excercize more, lose weight. Sounds simple, but people dieting are in a constant state of hunger. Obsese people seldom know the feeling of satiety. In fact I'd wager many can't remember the time they felt the pleasure of being full and content, without the pangs of guilt.

Your wife is obese because she is nagged by her hunger centre to over eat. This doesn't happen with non-obese people, so they think it must be over indulgence. Overeating is not the fault of the individual, your wife has about as much control over her eating as you do over breathing at half your rate. You can do it if you try but you'll not keep it up for long because your body will nag you to take more breaths.

Living with hunger is bad enough, but blaming someone for giving in to their need to satisfy their hunger is cruel. If she were not afflicted with obesity she would be able to eat what she wants when she wants, because she'd want it less!

 

[fergus]

Obesity is a metabolic disease.

Ah! Now here I completely agree. Since obesity is almost inevitably associated with hyperinsulinemia, and insulin levels are also low amongst slim people, there is a strong argument that this must be the fundamental metabolic defect. When you then factor in that elevated insulin levels effectively disable the fat metabolism and predispose towards lipogenesis, then surely the measurement and control of insulin must be in the front line of dietary strategies for weight loss? But it isn't. In fact the opposite is true, patients seem to be routinely advised to restrict their intake of fats and increase their carbs. This can only worsen the metabolic imbalance.

Now, if obesity truly is a metabolic disease, then surely the focus in its treatment must centre around the metabolism and the restoration of homeostasis? Bariatric surgery may have a place, but it surely can't address the fundamental problem?

fergus

 

[Fizzwizz]

Now, if obesity truly is a metabolic disease, then surely the focus in its treatment must centre around the metabolism and the restoration of homeostasis? Bariatric surgery may have a place, but it surely can't address the fundamental problem?

That is indeed correct, bariatric surgery doesn't correct the fundamental problem. Like most medications It's the treatment of the symptom. I've never suggested it was anything other. I must point out that as a trainee doctor my main focus is on treatment not on cause. My research looks at the best form of treatment for a major health issue.

There is hope that one day the metabolic cause will be understood, and one tablet will cure all, but right now there isn't.

I get the sense from reading through some posts that many people feel academics are looking in the wrong place for the answer. They probably are, but it's also worth noting that obesity is a multibillion pound industry. $40 bn spent yearly in the US alone on diet products. A cure for obesity is a ticket to major money, so rest assured there are thousands of very smart scientists working on this issue worldwide with backing from wealthy business. No stone will be left uncovered. If little work is being done on a certain area it's because it's priority on the list of likely causes is low.

Hopefully one day we'll have an answer.

 

[fergus]

You're right Fizz. If $40bn is spent anually on diet products in the US alone, then perhaps some are doing very nicely out of it? The food and pharmaceutical industries certainly are.
I'm not a conspiracy theorist, honest, but if homeostasis via insulin reduction is part of the cure, then there's certainly more money to be made in not finding it?

All the best,

fergus

 

[saz1]

I'd just like to say that in my case hunger isn't the answer to my (past) eating at all! I ate when not hungry just for the sake of eating. Actually I have very rarely been hungry, its about self control or lack thereof and stuffing my face with the wrong foodstuffs, and the amounts I eat. Naturally when you stretch your stomach, the feeling of hunger can attack easier but in my experience around me its mostly self control, and denial too.

 

[Fizzwizz]

I'm not a conspiracy theorist, honest, but if homeostasis via insulin reduction is part of the cure, then there's certainly more money to be made in not finding it?

It would be difficult to hold together a conspiracy on a global scale. There are indeed some who will lose a lot of money if obesity is cured, but this won't deter those who stand to make millions

 

[Fizzwizz]

I'd just like to say that in my case hunger isn't the answer to my (past) eating at all! I ate when not hungry just for the sake of eating. ... but in my experience around me its mostly self control, and denial too.

I think we've been told we're a victim of our own self control so many times we believe it. You use words like "self Control" and "Denial". These are conscious decisions, weight control isn't supposed to be conscious. Normal weight people don't think about what they eat, they automatically eat when they need to, and stop when they don't. Hunger makes them eat, satiety makes them stop. It's effortless which is why slim people don't understand why we keep eating.

You say you eat for just the sake of it, if you were truly sated you wouldn't be able to. Have you ever eaten a meal so large that the thought of food is off-putting? Normal weight people feel like this after a normal meal. Their satiety centre says ... NO MORE, and it continues to say no more until it's really time to eat again!

If you are 'denying' yourself food you want and using 'self control' your satiety centre isn't switched on ... this is hunger.

The prejuduce that over eating is a lack of self control is one of the things I'm keen to abolish. Having the self control to stop eating junk is one thing, having the self control to stop eating is something totally different.

 

[Trim]

To Fizzwizz

Good luck with your exams, have you heard of the EndoBarrier which started in the States and is being tested in Holland, it is basically like a 60 cms condom which forms a barrier in your upper intestine and has been tested on patients waiting for Roux-en-Y Gastric Bypass surgery with very promising results it lowers weight and reduces or even cures type two diabetes and of course is less expensive and safer than Roux-en-Y.

 

[Fizzwizz]

Good luck with your exams, have you heard of the EndoBarrier

Hi Trim
Thanks for the good luck, I'll be glad to get them out of the way. If I don't get a pay packet soon I'll be sending the kids to school with two left shoes on.

I must confess I don't know much about this procedure. I think I remember seeing or hearing reference to it. I'll definitely take a look into this after I've finished my write up. My deadline is Monday, and I've got so much more to write.

Thanks ... Fizz

 

[fergus]

Good luck with it from me too, Fizz.
It would be good to carry on the discussion when you have more time.

All the best,

fergus

 

[ally5555]

Fizz - I see you are working in Swansea - i think they are only doing around 20 ops per year.

There are muliple factors why people gain wt - actually working in the field my take is that may be there is a metabolic process that is to blame but what about the mountains of food some people are eting - sadly a fact the theorists overlook.

Go and talk to the dietitians - they see people regularly eating more than double their requirements - with very high fat intakes and alot of sucrose.

I also think in general that people are getting less and less active - that is an underlying cause. Exercise programs may not work because for the rest of the day most people are sitting down !
There is no doubt that unless people want to change you will not make any progress.
My worry is for the kids who are over wt and parents who are feeding them rubbish!

The causes are multiple - and not every overwt person develops insulin resistance, hyperinsulinaemia and changes in bs - we cannot explain that can we. if 50 % of the poulation is overwt then whay are we not seeing this in practice!

Surgery is not the answer for the vast numbers and dealing with the issues why people eat is. Often it is due to lack of understanding, boredom etc.
Often tacking the issues around overeating will bring success but there isnt enough help out there .

 

[Thirsty]

ally, I wonder how much difference exercise really makes. I used to work as a landscaper, and that's really heavy duty stuff. Being self-employed, I'd often work 12 or even 14 hour days during the Summer but was still constantly overweight. Following a change in diet after diagnosis, even though I was no longer working, the flab disappeared very quickly; I lost around 4 stone in less than six months. My weight has remained fairly stable ever since.

Any thoughts?

 

[ally5555]

thirsty - you were prob still eating more than you needed. I think until you start actually looking at the nutrients in food , like you are now , you consume more than you think. I often get people to weigh their food and they are eating alot more than they think.

I don't have a problem with my weight and I eat everything except junk but I am on the go all day - I never seem to sit still - maybe 5 mins here to type again and then I am off again! If you actually analyse how much physical activity the average person does its very little - pedometers show that some struggle to a 1000 steps a day.

 

[TheTartanPimpernel]

Why indeed is it that obesity as a problem appears to be growing?

It surely can't simply 'be metabolism. If it is then we have to look for what is affecting metabolism in the wider population.

Do, perhaps, many people eat more and become obese simply because more is readily available?

I was brought up during the post wars years of rationing and a weeks sweets on the coupon would not come near what might be found in a packet of whatevers. One bar of Fry's 5 Boys and a couple of ounces of 'Jube Jubes' - and that was it for the week. I now see kids at the cinema 'Pick and Choose' with more sweets for a short film session that I and my cohort would see in many months. Then there is the large Coke and the 'barrel' of popcorn. But the expectation is that we can afford so we can consume.

Likewise, family meals were wholesome but basic albeit and for someone who lived in a City that meant Chicken twice a year (but at least real chicken) generally a meat or fish dish but with lots of carbs in the form of bread and potatoes in the then known form of 'fillers'. Budgets were such that you ate at 'family' mealtimes and you ate what was put in front of you. No fridge or larder raiding, no 'browsing'. Nothing spare in the larder.

Perhaps somewhere within the 'modern' approach the source of the problem. Little Jimmy does not like X, y or Z so he can have a Pizza or a few burgers made with mechanically extracted goo and a tub of ice cream and, and, and. The fridge in many households is invariably full, or near to full and, most likely, full of the kinds of things that are 'convenient' and/or 'sweet' an/or convenient in the meaning of convenience meals. Then comes the '****** it' factor I'll just phone for a Chinese, Indian, Pizza - almost all of which are no different in composition from the purchased and stored convenience foods.

Perhaps, therefore, much of it is down to a 'lifestyle'. Without being critical of 'lifestyle' if food was less readily available then perhaps people might eat less. The culture of packing the house with ready accessible food available 24*7 might reduce the free selection and browsing culture.

I have 'lost' more than 2 stone. I used to eat out 3 or 4 times a week at lunch time, French and two small courses, to take me out of my office - an enforced break. I then had a family meal in the evening. All good stuff meat or fish and plenty of veg, invariably with a pudding of some sort. I did not think that I ate unhealthily or had any problems - I had been the same weight for nearly 30 years.

The difference, perhaps its because I now have smaller portions and in no small way was the diabetic diagnosis. No longer is there any temptation whatsoever to have the sweet, because its available and 'needs to be eaten'

Alternatively 'out of sight out of mind' is an expression that comes to mind. If it ain't there I can't have it. We now shop as we would in rural France - on a daily basis for planned meals. Bonus, less food waste and a household where both the diabetic adults are well within control with levels between 4.6 and 6.0.

Back to basics anyone?