4 1GT Tuesday July 28 2020 | the times
times2health
Dr Mark Porter
Saying ‘Get on a bike’ will
not solve the obesity crisis
A
nother year, another
obesity strategy.
And one that has
prompted many
a wry smile. An
overweight prime
minister with a long
association withcycling and who has had a close call
with Covid-19 looks the nation
squarely in the eye and tells us to
lose weight by getting on our bikes
because, among other benefits, it will
help to protect us from the pandemic.
Luckily there is more to the latest
tweak of the government’s strategy on
obesity than bikes on prescription.
While details of all the measures have
yet to be revealed, they include better
labelling of food and drink, restriction
of fast-food advertising, banning
supermarket offers on unhealthy
foods, and more NHS resources. If
this campaign is to succeed, though,
we must avoid the pitfalls that have
hindered progress in the past.
So what have we learnt from
previous attempts to slim the nation?
First, that while people living in the
most deprived households in the
UK are more likely to be seriously
overweight, those in the wealthiest are
affected too. Indeed, according to the
UK Health Survey, the proportion of
men who are obese is similar at both
extremes — 26 per cent among the
poorest and 24 per cent in the richest.
The difference is more striking for
women, at 31 per cent and 20 per cent
respectively, but the message is clear:
no household is immune. And the
long-term trend is worrying, with a
steady rise in the prevalence of obesity
across the social spectrum over the
past three decades.
Second, there is much more to our
expanding waistlines than the oft-
quoted sloth and greed. Our changing
environment matters too, particularly
ease of access to unhealthy and
fattening food and drink, something
that from an evolutionary perspective
we are poorly adapted to cope with.
And this obesogenic environment
is where central policy can have a
serious impact, influencing everything
from the quality of school meals to
fast-food advertising and pricing.
Next, people like me need to stop
skirting the issue. Surveys of GPs and
other healthcare staff reveal that
many are worried about offending
their patients based on past
experiences of mentioning “the
elephant in the room”. Highlighting
someone’s weight, and the impact that
it is likely to be having on their health
— everything from arthritic knees to
heart attack and stroke — requires a
gentle touch, but must not be avoided.
Research has shown that “scaring”
patients doesn’t work. You might think
that ill health, or the threat of it,
would be enough motivation for
people to look at their diet and
lifestyle. However, unless done very
carefully, it can be counterproductive.
The trick is to highlight the issue
sensitively and then ask what you can
do to help — the carrot tends to work
better than the stick. It is important
not to blame the individual — they are
where they are and you can’t change
the past. What matters is the future.
Still, health problems can be a
powerful trigger with the right support.
The largely nurse-run NHS Diabetes
Prevention Programme in England, for
people with borderline blood sugar
levels that suggest they are heading for
full-blown diabetes, is a case in point.
Nearly 90,000 people had been
through it by the beginning of this
year and lost 185 tonnes between
them. This is only an average weight
loss of 2kg each over a 9 to 12-month
period, but it is a glimmer of hope.
There is not much point in
encouraging people to lose weight if
you don’t have much to offer them
other than the standard advice of
do more and eat less. The very
overweight do have limited access to
psychological counselling and bariatric
surgery (eg gastric bands) on the NHS,
and these work well. However, at the
moment all I can offer most of my
patients is subsidised membership of
Slimming World or the local gym. The
government’s new initiative promises
to change this, but we await the detail.
And while encouraging more
exercise, such as prescribing bikes or
gym membership, is an important part
of any obesity strategy, you can’t run
off a poor diet. It is what you eat that
matters most and a change in diet
must be at the core of any successful
weight-loss programme.
In my experience most of my
overweight patients consume far too
many carbohydrates — anything from
refined sugars to starches in bread and
pasta — and switching to a lower-carb
diet seems to be one of the more
successful approaches (particularly for
those at risk of diabetes).
Perhaps the most important change
for everyone involved — politicians,
healthcare professionals, schools and
parents — is to lead by example by
practising what we preach. Let’s face it,
raising the issue during a consultation
is all the harder if you are three stone
overweight yourself.
I mention parents because parental
weight is probably the biggest single
determinant of whether a child will
go on to be obese. The link is
multifactorial and dependent on
nurture and environment, but it
starts worryingly early in life.
Indeed, there is now plenty of
evidence that early programming in
the womb predisposes a developing
baby to obesity later in life. If you are
pregnant and overweight — as are
half of all pregnant women — it is
not just your health that may be
adversely affected, but that of the next
generation too.
And while considering leading by
example, I can’t help wondering if the
chancellor, Rishi Sunak, may be a
better figurehead for Johnson’s new
initiative. I know he has a lot on his
plate at the moment, but anyone who
looks as if they could still fit into their
little brother’s suit at the age of 40
must be doing something right.If you have a health
problem, email
drmarkporter
@thetimes.co.ukI can’t help
wondering
if Rishi
Sunak may
be a better
figurehead
for this
than Boris
Johnson
Major new research has identified the
key lifestyle changes that could stave
off dementia. John Naish asks the
experts why each one is so significant
H
ave scientists
discovered the
lifestyle Ten
Commandments
for fending off
Alzheimer’s disease?
An extensive analysis
of previous study
evidence has resulted in the creation
of a list of ten strategies we can adopt
to stave off the most common form
of dementia, which accounts for
two-thirds of cases. These range from
maintaining healthy blood pressure to
staying intellectually challenged.
The list was published last week in
the Journal of Neurology, Neurosurgery
& Psychiatry by an international team
who crunched the results of 395
high-level studies on Alzheimer’s risk.
The report’s lead author, Jin-Tai Yu, a
professor of neurology at Fudan
University in Shanghai, says: “The
system of meta-analysis that we used
creates the highest level of medical
evidence. All the risk factors we point
out can significantly influence the risk
of developing Alzheimer’s.”We certainly need preventive help.
Dementia affects about 850,
Britons and is the UK’s leading cause
of death, according to the Alzheimer’s
Society. It remains incurable and we
have no drugs that are proven to stall
its progress.
It’s worth noting that experts
caution that the evidence on
preventing dementia through lifestyle
is only associative rather than
causative. In other words, studies
of people without dementia have
found a number of common habits
and characteristics. Yet no studies
have shown that if other people copy
them, their incidence of Alzheimer’s
subsequently falls.
As Robert Howard, a professor
of old-age psychiatry at University
College London, says: “These findings
are interesting, but we need to be
aware that none of them is proven
by clinical trials to reduce the risk
of Alzheimer’s.”
Dr Mark Dallas, the associate
professor in cellular neuroscience at
the University of Reading, is far more