If you listen to the audio of Prof Taylor in the Lancet you will see where I get my take on his views.
He is asked about the growth in Type 2 in the UK.
He makes such statements as "the weight of the population is steadily rising:"
"everyone is carrying a few extra pounds"
"people are 1 1/2 stone heavier than 30 years ago"
"this is completely shocking"
"its a matter of food consumption"
"not contents of food more the quantity"
This is where I think he is missing the point. People don't develop Type 2 because they are overweight.
Being overweight and/ or having visceral fat is another symptom of a deranged metabolism where insulin function is impaired. Get the insulin function under control and you stand a far better chance of "reversing"/ "putting Type 2 into remission" or however you want to put it.
Such statements as its about the quantity not the contents of food sound to me remarkably similar to Daily Mail type quotes.
I would say that it is all about the contents of the food. But then again I would....
I'm posting this for everyone but quoting you as you seem to have the biggest beef. I've put some time into doing a transcription of that audio. It's not word-perfect but I think it's a faithful representation of the interview. Here it is with my own take on various points:
* [When asked about what the current guidelines are for dealing with Type 2 in the UK]: "Typically [in normal healthcare practice], a person with a new Diagnosis of Type 2 would be advised to lose some weight and exercise more and to change their diet. They might be referred to a dietician. Quite often Metformin tablets would be provided. That's the general thrust of the current guidelines."
My take: this brings into focus that ALREADY Type 2's are told to put some effort into diet, weight and exercise. This is not a new thing, so if one objects to it, focussing all the debate against the DiRECT study is too narrow.
* "The intervention in DiRECT was to have a distinct period of weight loss, aiming to lose about 15% of body weight. On day 1, we stopped all anti-diabetic tablets. People were excluded if they were already on insulin just for reasons of simplicity."
My take: That's a fair point, but also it would be good to mention the duration of Type 2 and why long-duration patients were excluded.
* "The treatment didn't end there. After the weight loss period, we had a very carefully controlled, stepped, reintroduction of food, and that was crucial to lead into the long-term weight management which reflected behavioral input, in order to try to modify long-term habits and keep the weight down."
My take: He's clearly recognising the importance of lifestyle change and saying that this isn't a quick fix.
* [When asked "How successful was the approach?"] "The headline figure was about half of all the intervention group achieved remission at one year. Importantly, keeping that remission up to the one year mark. That's the headline figure and very exciting, but what is even clearer, behind the headline, is the effect of each amount of weight loss. If people achieve the target of losing 15kg, then 86%, nearly 9/10 people, achieve remission. Over 10kg then 73%. And so, as we went down with the weight loss, so less and less people achieved remission, and of course with no weight change, there was no remission."
My take: It seems a little simplistic, and I'd like him to cover the fact it doesn't work for everyone. But you can't expect a scientist to get results like this and not focus on weight loss. He's only getting a short interview so he might as well deliver the big message from his own studies.
* [Asked "If people gain weight again will it return?"] "I would say it's virtually a certainty. We can now see very clearly what is causing Type 2. It's very much a matter of an individual having more fat in the body than they can cope with, and it's silted up in the liver and pancreas. By the approach used in DiRECT, we know from our basic studies, that the fat in the liver and pancreas, will be scooted out and these organs return to normal function. So if the fat is allowed to get back into the body and re-accumulate, then it is a virtual certainty that Type 2 will develop. That's why we talk about remission and not cure."
My take: Again it seems a bit too simplistic - i.e. he should be mentioning the fact that it doesn't work for everyone, and that there are competing theories about Type 2 that don't agree it's "all" about beta cells being turned off by fat.
* [When asked about the possibility of the new approach being rolled out as standard medical care] "Importantly, there was ongoing support for the individuals in the study, so they could come back and see the practice nurse every few months for ongoing support. We know from other studies that ongoing support is really one of the most important parts of prevention of weight regain."
My take: None, I just might as well put the quote here since I've made the effort to transcribe it.
* [When asked if there is anything the government could be doing to help people with their weight management] "I think the urgency of the current situation whereby the weight of the population is steadily rising - IT'S NOT PEOPLE BECOMING GROSSLY OBESE - THAT TENDS TO BE FOCUSED ON BY NEWS PROGRAMMES - it's a matter of everyone carrying extra pounds that they wouldn't have been carrying even 30 years ago. The hard fact is that the average man and woman is a stone and a half heavier than they would have been 30 years ago. That's a shocking statistic. This has got to be grasped and acted upon, but at the present time the message is rather confused. We have to realise that this is largely a matter of food consumption, certainly physical activity can help, but we do need legislation to regulate the activity of the food industry, not so much in the contents but the quantity of food provided, some of which is extremely unsuitable and runs against what we need to achieve as a country, which is a reversal of this steady increase in average weight."
My take: 1) He was ASKED if the government could do anything, so he's bound to think in terms of trends that the government may be able to influence, such as population weight 2) The bit I've put in capitals shows that he also has a problem with Daily Mail mentality. 3) I think he's being too simplistic focusing on food quantities rather than contents.
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Overall, I can understand people's objections to some of it, but also I think his message has been misrepresented / misunderstood / missed in parts.