Media items about obesity

Hutan said:
doctors do not receive enough education in nutrition and weight-management
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To be fair we all receive education on nutrition in high school. Evidence on nutrition and weight management has not been particularly enlightening. Weight management is multi-facetted and while there can be biological causes, there are also situational, habit and emotional causes. It is often too easy to stuff yourself and exceed the needs of your body. Meals at a restaurant are very often 3-4 times the calorie intake a normal meal should be. Then there are cultural pressures to eat not only ethnic, but also within a family. Weight management should get a higher focus in mainstream medicine at the same level as smoking cessation. It doesn’t.

You can blame the doctors all you want, but i think the medical system (and the funding bodies) are just as guilty to not fund more time in prevention and in building physician/ patient relationship beyond pulling the prescription pad and pressing on getting a pap smear
 
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@Hutan

Agreed. There are several points in this article that are right, as you've noted.

@Jonathan Edwards

I think you may mean this article gives people who don't stick to their diet an easy out?

I think this article points out the attitude and assumptions that many, including some in medicine have towards overweight people, and that it may guide treatment, or the lack of it. This same point has been raised about the Newton et al study on another thread; link at intro to this thread.
 
I did not receive any education on nutrition in high school - if it wasn't going to be in an exam they didn't teach it.

In high school I learnt that 2 slices of school pizza was better than one, that all of the desserts were horrible, and that monster munch was not a suitable snack to eat with snakebite (a pint of mixed lager and cider).

I was stick thin in high school - it was the 70s, everyone was.
 
Milo said:
You can blame the doctors all you want, but i think the medical system (and the funding bodies) are just as guilty to not fund more time in prevention and in building physician/ patient relationship
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To be clear, I'm not blaming doctors. I totally agree that the health care system of 15 minute 'what is your problem, here's a quick fix' consultations isn't working well. Obesity is a big complicated problem.
 
DokaGirl said:
I think this article points out the attitude and assumptions that many, including some in medicine have towards overweight people, and that it may guide treatment, or the lack of it.
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I don't understand that though. It points out that the medical profession have things roughly right - obesity is a major health hazard and the only way to deal with it is eat less.

Doctors may seem unsympathetic but it is difficult to know what they can do if food availability and advertising wrecks any chance of people actually dieting.

The basic premise that diets do not work is highly misleading and I think irresponsible. They work perfectly well if they reduce calories and are stuck to.
 
@Jonathan Edwards

Agreed, overweight and obesity are major health problems. Absolutely. If I was a physician, I would be very frustrated with trying to help my patients overcome the pressures.

We have a social structure that on the one hand encourages fitness and weight loss or control, and on the other pushes high calorie foods. Everywhere we look we see how situations can impede weight loss, or maintenance of weight loss. Diets do work if stuck to. But, there can be a lot of barriers to success.
 
Jonathan Edwards said:
I don't understand that though. It points out that the medical profession have things roughly right - obesity is a major health hazard and the only way to deal with it is eat less.
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I think it depends what you mean by less. Fewer calories & realistic portion sizes certainly. Mainly, I think learning to eat differently.

I wasn't taught about what I should & shouldn't eat or anything about nutrition at school. It was assumed we would learn that at home.

Growing up we had what I now perceive to be quite a carb heavy diet, having said that, until one got sick both parents lead very busy & physically active lives. All my siblings played some sport even though I wouldn't have described us as a terribly sporty family. That was just normal then. None of us were overweight.

I gained weight after I got sick, having been fit and slim before. I also learned that when my dose of levothyroxine needs to be increased or reduced (& that happens at least once every year, usually more) I carb crave.

When I'm in PEM, I carb crave and feel really put off by a plate of veg or salad that would normally appeal.

However, what and how I eat has changed. Ultimately, that made a big difference. When I keep the levels refined carbs and sugars down then I don't want them as often and am happier with a smaller portion when I do indulge. I slowly lost 4-5 dress sizes (dress sizes varying wildly by brand). I eat a lot of small meals. Eating this way certainly wouldn't suit everyone.

Ultimately, I don't think dieting primarily to lose weight works. Partly because the type of diet can feel punitive in the long term or is simply too drastic to be maintained. I think making changes to promote good health and feeling physically better might be more effective.

There is an awful lot conspiring against people trying to maintain a healthy weight. Food manufacturers make more more by "adding value" i.e. processing food and they have a lot of lobbying power. Once you start adding things best described by a chemical formula to food, even if those chemicals may occur naturally in some foods and aren't toxic, it can change the way the body then digests the food.

Many city flats are now designed without a kitchen beyond tea'n'toast making facilities so you either rely on microwave meals, takeaways or eat out.

My generation 's lifestyle (ME aside) is quite different to my parents' lifestyle. Generally, not so active and more processed food. When still working and on a diet as recommended by my dietician, it was extremely difficult. Already lugging laptops and CDs, phones and files about, dragging a premade lunch about with me wasn't always possible. - my laptop bag alone weighed nearly 3 stone.

Then there's the emotional or psychological burden. As a teen I have some experience on the other side of this. I had cycles of unexplained weight loss and weight gain. My GP put it down to exam stress, summer school holidays etc, even though the pattern didn't matched up to this theory. Notably he never did a thyroid function tests and years later I found this cycling of weight gain and loss is a sign of developing thyroid disease.

My mother worried about the weight loss side of it and wondered if I was developing anorexia - I wasn't, I was still eating. Unfortunately, and rather stupidly, she tended to raise this at mealtimes. I cannot tell you how irritating that was. Just to annoy her I'd avoid eating with her.

Then there's the judgement side of things because if someone criticises or mocks you because of physical appearance then it almost certainly feels like they are attacking you as a person. Perhaps ME patients are better placed to understand this given the judgmental prejudice we have faced.

I think obesity, nutrition and lifestyle is an area that could genuinely be improved using biopyschosocial methods. You have to address all areas that affect weight, oddity and fitness to be really effective. Unfortunately, that would mean actually doing some.proper work and possibly standing up to powerful lobbying groups so I guess that'll be put in the "too hard" bin and individuals will continue to bear the brunt of moral judgement.
 
Invisible Woman said:
I think it depends what you mean by less.
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I mean less. I diet that way and it always works with effort. I agree that surgery things and fatty things like crisps can be addictive but as long as you eat less of everything than before you can guarantee to get into negative balance.

I have talked about weigh to countless patients and arguing that you should eat different things like fruit and vegetables seems to me the main way people avoid actually eating less and so stay overweight. People complain salads are too expensive - but by definition eating less is cheaper.
 
I am of course speaking as n=1 @Jonathan Edwards.

In my own case deliberately reducing the portion of carbs from a meal or omitting them altogether and replacing with more fruit and veg worked for me.

I agree I did it alongside other measures like buying salad plates that match my dinner plates so my plate still looks full but is that bit smaller. The fact remains, I do fill up more on fruit and veg - well veg actually as I'm careful nit to eat too much fruit.

Fresh fruit and veg are more expensive. They are the most expensive part of my weekly shop and I don't go for all organic or prepackaged, pre diced or anything.

When you are used to eating a carb heavy diet and have a low income then BOGOF deals on pizzas and so on are doubly attractive. They seem very filling initially, though I reckon you 're more likely to feel hungry sooner, and cheap.

I very rarely eat anything like pizza now, but if I do I eat less of it because the portion of salad goes on my plate first, I would allocate my portion / slice of pizza. I can have as much as I like but only after I've eaten my salad. Usually, by then I don't want more anyway.

A 6 pack of crisps probably costs less than 3 apples. I reckon that if you have 3 kids a lot of parents see that as 6 portions of food as opposed to just 3.

Again I rarely have crisps (& I really love 'em - crisp sandwiches were a delicacy in my youth!). IM has them every now and then, they're in the cupboard, but I only allow myself a bag once I've eaten my fruit portion for the day. By then I'm no longer hungry so don't.

That being satisfied by something that is "not-carb" takes time though. It is only eating that way for a while that stops the craving for carbs.

I was a 20-30 a day cigarette smoker and giving up cigarettes was really hard but giving up refined carbs and sugar (I gave them up under supervision from a dietician) was harder, much harder.
 
Creekside said:
I've heard a lot of Canadians returning from trips to the US say that they were amazed at the size of American meals; much larger portions than served in Canadian restaurants. What's the caloric difference between a typical French meal and a typical US one?
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It’s no myth.

I live in the USA, and not even in the south. Portion sizes are such that a restaurant meal was really two meals even when I was a normal-ish health. Now, one full restaurant meal is enough calories for about two days and I’m not speaking of the brands known for huge portions.

That means if I get delivery and exercise a little… actually a great deal… of discipline, I have 3 to 6 meals per one delivery. But some foods are still excess; I can’t cut a juicy cheeseburger into pieces small enough to make each into one meal size. Sadly.
 
I come from a family where if you couldn't put it in bread (and butter) then it wasn't considered food - the only exception being porridge, which came in bowls, the smallest used of which was the imperial version of a 1L bowl.

As I said I was stick thin - I didn't go above 10 stone until I was 18. I was not into sports and the only 'exercise' I got was walking, with the odd 'short' bike ride. I considered a pack of fruit shortcake biscuits a snack.

From my perspective people didn't start getting heavier until the late 80s, early 90s - when health, fitness and dieting became a thing, and foods were altered to make money from these fads.

Unfortunately those fads took over, and the more they did the heavier people have become.

So I'm firmly in the camp that people have got heavier simply because we are no longer eating natural foods, and instead mainly eating heavily processed stuff.
 
Wonko said:
From my perspective people didn't start getting heavier until the late 80s, early 90s - when health, fitness and dieting became a thing, and foods were altered to make money from these fads.
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I think the obsession with fat really didn't do anyone except the food industry any favours.

To improve the taste they added salt and sugar.

Instead of mashed potatoes with lots of lovely butter, pasta was a great low fat, healthy choice. I reckon appropriate amounts of fat promote being satisfied after a meal. To get that feeling people ate more carbs and possibly then also chucked some extra cheese on anyway for good measure.
 
On the USA side, fast food is cheap, high in calories and ubiquitous, as is food advertising. Corn syrup and sugar and fat are added to processed food and fast food freely.

Most of the population is less active than in decades past. More people in cars, working longer hours.

Food is used as emotional comfort as the stresses of increased divorce, job loss, and the general frantic pace of competition increases. There is less of the slow ritual family dinner where food is consumed over an hour or more, allowing for the sensation of satiety to prevent over-eating.

The average BMI of adults in the US has increased from 1970 to now, not withstanding the more recent continuous blare of fitness advertising.

The urge to eat is hard-wired in brains. It takes more effort to reduce and change food consumption habits (formed in childhood some of them) than to keep eating as usual despite a decrease in metabolic rate as one gets older.

I don't know how to lose this rather thick layer of pandemic fat, but I'm thinking about it.
 
Mij said:
Fats and carbs don't make you fat. It's all about portion size.
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My weight started to rise rapidly just before my ME developed (a link there?). My solution was to simply reduce my meal sizes. That worked really well, and I fairly quickly dropped back to my previous 'normal' weight, and continued to drop. I also learned that cutting too much fat from one's diet can cause the body to switch to famine mode, so keeping a moderate fat intake is helpful for weight management.
 
DokaGirl said:
Granted, they mean good basic food, like vegetables.
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One thing I've noticed is that it's getting hard to find basic foods. On my last trip, I wanted to try some lamb, and the store only had one package of chops and two larger cuts. I used to see frozen legs cut into chops, but couldn't find those now. I guess the space has been given over to higher-profit processed meals. Lots of other foods that used to be on the shelves are now gone. It's a cycle: more processed foods make people cook less, which means stores carry less basic stuff, which means that it's harder to cook meals.
 
I live in the city and I can't tell you how many take-out delivery guys I see when I'm out for my walks in the evening in the last 7 years. Tons. Tons of pizza boxes stacked outside on garbage night. They must be making a fortune now with Doordash, Ubereats, Skip the Dishes . . .
 
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