breaking the obesity cycle
Jenny Bryan and Rachel Newcombe
In 1980, less than 10% people in Britain were obese. Since then, the figure has trebled. Estimates suggest that over half of all adults in the UK – a massive 24 million – are overweight or obese. There are also about 700,000 obese children in the UK.
© Getty
Weight problems start young. In a study of Leeds schoolchildren, 20% of nine year olds and a third of 11 year old girls were overweight. One in ten of the primary schoolchildren in the study were obese. Easy access to food and lack of exercise at home, at school and at work are widely held to blame for the nation's growing weight problem.
It's been called a national epidemic, though Dr Andrew Hill, former chairman of the Association for the Study of Obesity and a Professor of Medical Psychology at the University of Leeds, dislikes the word.
'It makes it sound like it's catching – that you can go to someone's house and waking up the next morning and find you've put on 10 stone. Obesity isn't like that. It's something that creeps up on you. It happens to people who put on half a stone a year for 10 years,' he explains.
obesity – a health risk
Someone is said to be obese if their body mass index (BMI) is over 30. Being obese doesn't just make it harder for them to find clothes that fit, it means they are more likely to have a heart attack, type 2 diabetes, high blood pressure, osteoarthritis and some forms of cancer.
Obesity takes an average nine years off an individual's life expectancy, and it is this increased health risk rather than the excess weight itself which specialists such as Dr Hill believe should be the focus of obesity management. The days of encouraging people who are very overweight to lose five or six stone are coming to an end. Instead, the way out of the obesity 'epidemic' lies with more realistic and achievable goals.
realistic goals
'We need to encourage overweight and obese people to lose 5-10% of their body weight over a year, and to maintain it. Research has shown that those who are most successful make several small adjustments to their weight and exercise pattern. We live in a "quick fix" society but losing and maintaining weight loss is a slow process,' says Dr Hill.
Instead of trying to stick to harsh diets, he recommends that people who are overweight take small steps towards greater control of their food intake – substituting a piece of fruit for a chocolate biscuit as their mid-morning snack, changing their choice of food at mealtimes, reducing the amount of food they eat outside the home, developing a new social life around sports or exercise.
'If all the people who are overweight or obese could just lose half a stone as part of such changes we would see important improvements in public health and, at a personal level, these people would feel much better about themselves, about being in control of their eating and improving their social activities,' Dr Hill points out.
Crash diets may achieve short-term weight loss but, without a change in long-term eating and exercise habits, it's unlikely to stay off. Some specialists believe that people with a serious weight problem – and their doctors – aim too high, too fast.
An obese woman who is 5'6" and weighs 190 pounds (86kg) may be disappointed if she only loses 20 pounds (9 kg) because her BMI will still be 27.5 – making her overweight. But she has achieved a 10% fall in her bodyweight – something which the World Health Organisation recognises as a significant achievement. Indeed, it considers that a 5% fall in bodyweight is well worth having.
Dietitians recommend trying to lose 1-2 lb (0.5-1 kg) per week – something which requires a change in energy balance of about 1,000 kilocalories per day.
Ideally, this should be done through a combination of eating less and taking more exercise. Energy intake can be reduced by about 500-600 kilocalories and energy expenditure increased by about 400-500 kilocalories. Women and inactive men need about 2,000 kilocalories per day to stay the same weight, men and very active women about 2,500 kilocalories. So a reduction of about 500 kilocalories in food intake is far from starvation rations.
The first few days of a diet can be very encouraging, and people often find they can lose more than 1 kg in their first week. This is because early weight loss has more to do with reduced water and glucose stores (glycogen) than loss of fat. Quite simply, reducing your food intake by 500 kilocalories gives you a bigger weight loss when you're using up glycogen than when you're using fat. When you're burning glycogen, you'll lose about 1kg for every 1,000 kilocalorie deficit you manage to achieve in energy balance.
But you'll only start to break down fat once glycogen stores are depleted and, when you're burning fat, you'll need to achieve an energy deficit of 7,000 kilocalories for every 1kg you lose in weight. So after that first week on the diet, your weight loss will probably fall back to the target of 1kg per week.
Whatever diet you choose in order to reduce your calorie intake, be sure it stays within the overall rules of healthy eating, low on fat, high on carbohydrate, fruit and fibre. Aim to eat three meals a day. If you miss meals, you're more likely to feel hungry and need to snack. Dieting is not just about losing weight, it's about establishing a healthier pattern of eating which you can continue long after the diet is over.
surgical intervention
Not everyone is able to lose weight through dieting and exercise and there are instances where surgery becomes the only option. According to a review in the medical journal, The Lancet, the number of weight loss ops performed has increased five times over the last five years. Although a last resort for many people, it appears to reduce the risk of death for morbidly obese people by between 29% and 40%.
Weight loss surgery is not an option available to everyone. Guidelines produced by the National Institute for Clinical Excellence (NICE) state that you have to have a BMI of 40 or over to be eligible for surgery. The only exception is people who have a BMI of 35 or over and are suffering from an obesity-related health condition such as diabetes, high blood pressure, heart disease, arthritis or asthma. Patients have to have tried all other treatment options first, including medical therapy, be fit enough to undergo the surgery and have an anaesthetic.
It's a form of major surgery, complications can occur and there are risks involved. In fact, being obese makes surgery more risky. But if you're severely obese to start with, there are risks with remaining in that state of health too, so it becomes a case of weighing up the risks and benefits of each. Anyone considering surgery will be advised carefully by their doctor or surgeon so they understand the risks from the beginning and know what is involved with the surgery.
Dr Colin Waine, chair of the National Obesity Forum, says, 'For a small section of people, surgery can bring huge benefits. Some people are so at risk that they are going to die from other causes without surgery.' However, he emphasises that surgery is only applicable for the 'more extreme end of the spectrum' and shouldn't become an easy way out for people who are overweight.
types of operations
There are various types of weight loss operations available and patients are advised by medical experts as to which would be the most suitable to them. Two of the operations often used are gastric bypass surgery and stomach stapling (vertical banded gastroplasty).
Roger Ackroyd, a consultant surgeon at Thornbury Hospital in Sheffield, explains what's involved in a gastric bypass operation. 'The upper stomach is either stapled or divided to create a small gastric pouch. The small intestine is also divided at a lower point and is joined to the pouch.' This makes the stomach smaller and removing part of the small intestine – bowel – it makes the digestive system shorter. 'This means that food will no longer enter the main portion of the stomach, but instead will bypass this area and go directly to the bowel.'
'Gastric bypasses help weight loss by restricting the amount of food that's able to be eaten and affecting what is absorbed,' he added. People who've had a gastric bypass have to eat smaller meals and as the food passes through the body in a different way, fewer calories are absorbed.
Stomach stapling operations work slightly differently. 'With stomach stapling, no part of the stomach is removed. Staples are placed across the upper stomach to create a small pouch with a narrow outlet. Around this we place a silicone band. The band restricts the amount of food that can be eaten and, if the patient eats too much, it may make them vomit,' he said.
In 2001, Roger had only eight obesity surgery patients. Last year he conducted over 400 operations.
Studies show that people who've had gastric bypass surgery on average lose about 66% to 75% of their weight within two years. Sadly, the surgery does carry risks and complications do occur – some during the operation and others after, as was the case for Renee Williams, the 841-pound Texas woman who was the largest female ever to undergo gastric bypass surgery. There's a one in 100 risk of someone dying from gastric bypass surgery, but for many of those considering the operation, it's a risk they're willing to take.
help and info
Channel 4 is not responsible for the content of third party sites.
organisations
British Dietetic Association
5th Floor Charles House
148/9 Great Charles Street Queensway
Birmingham B3 3HT
Tel: 0121 200 8080 (Mon-Fri 9am-4.30pm)
E-mail: info@bda.uk.com
Website: www.bda.uk.com
The professional association for dietitians. Offers impartial advice on nutrition for good health, how to combat disease with diet and suitable
diets for food-related problems.
Mary Hart Centre for Eating Disorders (Scotland)
3 Sciennes Road
Edinburgh EH9 1LE
Telephone: 0131 668 3051 (usually an answerphone service)
E-mail: info@maryhart.co.uk
Offers psychotherapy and counselling aimed at helping change eating habits and attitudes. Has a range of self-help manuals on types of eating disorders, causes, self-help, plus a publications list.
BEAT (formerly Eating Disorders Association)
103 Prince of Wales Road
Norwich NR1 1DW
Adult Helpline: 0845 634 1414 (Mon-Fri 10.30am-8.30pm and Sat 1pm-4.30pm)
Youthline: 0845 634 7650 (Mon-Fri 4.30pm-8.30pm and Sat 1pm-4.30pm)
E-mail: fyp@b-eat.co.uk
Website: www.b-eat.co.uk
Provides information, advice and publications on all aspects of eating disorders including anorexia nervosa, bulimia nervosa, binge eating and related eating disorders. Operates a UK-wide telephone helpline for people with an eating disorder, their family, friends, and professionals, along with a youthline that offers information, help and support for young people aged 18 years and under.
Overeaters Anonymous
PO Box 19
Stretford
Manchester M32 9EB
Tel: 07000 784985
Website: www.oagb.org.uk
Fellowship aimed at men and women whose lives have been affected by compulsive behaviour around food such as overeating, anorexia and bulimia. Offers encouragement and advice to anyone affected by an eating disorder. For details of support groups, please write or contact the 24-hour answerphone.
websites
Association for the Study of Obesity (ASO)
www.aso.org.uk
Dedicated to the understanding and treatment of obesity, offering a focus for obesity research and treatment in the UK. Provides factsheets and general information on obesity for journalists, the media and researchers. Also has an Obesity Resource Information Centre (ORIC).
Feed Me Better
www.feedmebetter.com
Rubbish food at school? Get involved and start a revolution in your school dining hall.
Foodfitness
www.foodfitness.org.uk
Part of a Food and Drink Federation (FDF) campaign, this website evolved from an increasing awareness and recognition of the public health problem of obesity. Contains information and healthy lifestyle tips.
Gastric Bypass Operation
http://en.wikipedia.org/wiki/Gastric_bypass_surgery
Online community encyclopaedia offers information on the nature of this operation, the surgical techniques involved and the potential complications. There are also links to other useful sources of information on the subject.
Jamie's School Dinners
www.channel4.com/life/microsites/J/jamies_school_dinners
The website that accompanies the ground-breaking Channel 4 series. Includes a downloadable action pack specifically for parents and a link to the Feed Me Better campaign website.
Obesity-Online
www.obesity-online.com
A multi-disciplinary forum for research and treatment of massive obesity, including plastics, psychiatry, endocrinology, nutrition, nursing, dietetics and allied health. Contains information about obesity, and the health risks.
Slimming World
www.slimmingworld.com
Contains information about dieting, plus healthy tips, success stories and recipes.
Weight Watchers
www.weightwatchers.co.uk
The site gives information to those seeking weight loss advice as well as explaining the weight loss services that the company provides.
reading
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Eating Well for Optimum Health by Andrew Weil (Shere, 2001) |
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Food Addiction by Kay Sheppard (Health Communications, 1994) |
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The Hungry Years: Confessions of a Food Addict by William Leith (Bloomsbury, 2005) |
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Check out the help and info section at the end of help me please for details of other organisations, websites and further reading on eating disorders.
(July 2001, resources updated March 2005)
