Telling obese patients it’s up to them to change their lifestyles will not work. If the NHS does not help, charlatans peddling harmful diets will step in, says Drew Payne
At the end of August, Conservative shadow health secretary Andrew Lansley said people should stop being given ‘excuses’ for being overweight and take more responsibility for their lifestyles, exercise more and eat more ‘healthily’. The month before, the British Medical Association called for obesity to be no longer classified as a medical condition but as a ‘lifestyle’ problem.
This might not sound a big matter – it might even sound sensible – but underneath is a dangerous message. If you’re overweight, it’s your fault – and it’s your responsibility alone to do something about it. Both these attitudes are divorced from the responsibility of helping people lose weight.
Mr Lansley wants people to take responsibility for their weight, which is fine if he is going to offer help to do so. Just telling people to exercise more and eat ‘healthily’ is not enough.
What is eating healthily? What is the right balance of fats, protein, carbohydrates and fibre? What should your daily calorie intake be and how do you measure it?
These simple questions are not easy to answer. We are bombarded with advice. How easy is it to get five portions of fruit and vegetables a day? Also, in deprived areas, often the only affordable food is tinned or processed.
Recently I was asked to write a sample menu for a ‘balanced diet’, and it was far harder than I thought. It isn’t a case of eating equal amounts of protein, vegetables, dairy products and so on – it is balancing your diet so that you obtain the right amount of all the food groups. Simple information is not easy to find. I pieced it together from five sources. Many people do not have the time to do as much searching as I did.
The British Medical Association wanting obesity reclassified as a ‘lifestyle’ problem is very alarming. If it succeeds, obesity will no longer be a medical problem and the NHS will no longer be required to treat people for it. It’s a lifestyle problem, so it’s the person’s fault.
Adult obesity in England has reached 24% and shows no signs of decreasing, yet health services seem barely concerned about this. If any other health condition, with all the serious problems that go along with it, had a prevalence of 24%, there would be an outcry.
Most people do not need expensive drugs and surgery, such as stomach banding. We have a model with the success of smoking cessation services. We need to give people advice on how to eat a healthier, balanced diet and give them support to do so.
As nurses, we have so many of the skills to do this, and we have already done this in other fields. We don’t need to be dietitians to help someone to lose weight.
As health services do not seem to be interested, people have been forced to look for help and advice with their weight and diet elsewhere. Into this vacuum we have seen the rise of nutritionists, ‘diet doctors’, detoxing and fad diets.
These have little or no evidence behind them and many people pushing them have poor or questionable qualifications. Many of these diets are very unhealthy; they have high fat and protein contents (such as the Atkins diet) or very low calorie intake (such as the cabbage-soup diet or the maple-syrup diet) and cause weight loss by controlled starvation.
Fad diets might seem harmless and a passing fashion but some have proved dangerous. A woman was left permanently brain damaged by The Amazing Hydration Diet. This ‘detox’ diet involved drinking very large amounts of water and reducing salt intake. When the woman started vomiting, her nutritionist told her that it was a normal part of the detoxification process. But she later had a massive fit because of the electrolyte imbalance in her body, which left her brain damaged.
Nutritionists like this are the ones who are filling in the gaps as health services seem so uninterested.
Giving good advice and support, nurses could make such a difference in tackling this 24% obesity rate, the way we have in other fields. Health care seems to have had little effect in cutting obesity but what do we expect with the effort we have put in so far?
Drew Payne is audit and training nurse, Infection Control Solutions and a freelance writer
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