UKC

Call for obesity to be reclassified as a disease - This is the headline. 

https://news.sky.com/story/call-for-obesity-to-be-reclassified-as-a-disease...

Here are some quotes: 

"Talking exclusively to Sky News, the Royal College of Physicians (RCP) said until obesity is recognised as a disease, rather than a lifestyle choice, its prevalence is unlikely to be reduced."

"Sarah Le Brocq, 36, is obese and supports the reclassification of obesity as a disease, insisting her weight is not down to a lack of willpower or a lifestyle choice."

"She said: "Too many people look at other people who are overweight or obese and think it's their fault, that they made that choice. But I can tell you, I haven't chosen to be like this, obesity is something that has happened to me."

Now, maybe i'm a little too simplistic for this world but if you didn't eat too much food wouldn't it be impossible to become obese?

I totally accept that different people have a genetic predisposition to certain body types. The whole ecto, meso, endomorph. I for instance will never be a stick thin ultra runner without some serious work, my body just doesn't naturally want to be there.

If you're 25 stone it sure as hell didn't happen through eating a normal diet. I ate two helpings of syrup sponge with custard today, once for breakfast (night shift) and then again at midnight and its not exactly that unusual of a thing for me to do yet im only (!) 77kg. 

You must be blessed with a high metabollocks rate.

Dear me,

Yep I'm sure she used to be a super fit, slim girl with a healthy diet and vigorous exercise routine. Then after catching this horrible disease (possibly by getting too close to a near by McDonald's) she woke up the following day being obese. 

I'm sure there are a small percentage out there who have some weird medical issues meaning they can't process fat like normal people or whatever, but the other 99% of over weight people out there, it is undeniably a matter of life style choice.

When you boil it down, it's simple physics, energy in Vs energy out and that's that. Obviously if you want to be healthy then you need to consider what you're eating not just how much and exercise will help keep you fit and healthy physicaly. 

Her argument is like me saying I've got "hairy face desease" due to not shaving. It's not willpower it just happened to me, I never wanted  a beard. It's just shaving is to too much like hard work. Sometimes I have a go but then it just grows back, there is nothing I can do. 

It doesn't really matter how we characterise or name it, it is a huge societal  problem and anything that helps, should be used. There is a point though to calling it a disease when it is intrinsic to the way children are brought up. I wonder, do you blame all the children obese at 9, 10, 11 and 12 for their situation? 

Well it just shows how little you know - no need for a weird disease at all, just a thyroid disorder can do it and as you get older and have thyroid problems it is rather strange just how many other people will turn out to have the same problem and it can take a long time to get it properly regulated and even then the body's production of the relevant hormones can vary with time.

I know about this now despite having such a high metabolic rate when I was in my 20s that I could eat endlessly and hugely and still be 10 and a half stone.   Not exactly virtuous

I would blame their parents for the way they bring them up which further shows it isn't a disease but a manifestation of lifestyle choices, albeit choices by proxy on the part of the children.

So how to do explain the exponential rise in thyroid problems we have seen in the last decade or two and why, if its "as you get older", are there so many obese children?

I too could eat for England in my 20's when I weighed 10st4lbs. I'm now 50 and still weigh 10st4lbs, not because my metabolism hasn't changed, it certainly has but because along with my changing metabolism I've changed my diet to a much healthier one and one of smaller quantities which incidentally is also cheaper.

Genius idea, and heres why;

Reclassify obesity as disease,

Absolve people of their personal culpability,

With impossible expectations, they seek medical assistance to cure them,

They are told that a new wonder drug will cure them,

Due to sheer volume of demand they must collect their prescription from the Greyhound stadium

Their prescription (a packet of Hari-placebo) is taped to the hare

They follow the hare until they are cured

Job done.

Option to self fund from betting on who gets to the Hare first.

My metabolism seems to have slowed to a point where I even go out in winter without any breakfast other than a spoon of natural unsweetened yoghourt and eat little on the hill, sometimes only a drink of hot chocolate, have a normal meal (rather smaller than I would have eaten earlier in life )when I come home and still don't lose weight.   I would be delighted to be your weight.

Of course there are more obese children and there is a big problem there - my reply was about it being a weird or rare medical condition for a tiny number of people not being a true case.  I rather think that there is more diagnosis of thyroid problems now and I suspect the medical profession is  more turned on to it - There seems to have been a suspicion of under diagnosis for quite a while.  Thyroidectomy is not so rare either as treating hypothyroidism seems to be preferred to the risk of not removing a malignancy

As Pec said, have we had some sudden massive increase in thyroid disorders in the last decade or so? If so what is causing it, sounds like it's something which needs looking into pretty urgently if it was.

But regardless of medical issues, if you locked literally anyone in a room for a week with no food I guarantee you they would be lighter when they came out, no one can use energy to live yet maintain the same mass. Obviously not advocating that but it highlights the point.  As for metabolism in general, larger and fatter people burn more energy per minute than smaller / slimmer people do, even at rest. Simply by the fact, there is more body mass to maintain, So more to heat, more to pump blood to, more to keep alive at one time. The physics of obesity are simply, the real problem to tackle is the mind. It's people's lack of motivation and willpower to commit to a lifestyle change and stick to it which is why people can't lose weight.

Last year I decided I was getting a bit podgy (78kg at 6 foot) so I decided to lose weight, I stopped eating as much crap and less overall and sure enough over 4 months or so I went down to 71kg, and I've stayed at 71-72kg since simply because I didn't go on a diet I made a permanent change to my lifestyle. Anyone can do it, they just need the sustained mental focus.   

Part of being an adult is taking responsibility for your choices in life, a choice not to drink too much beer/wine, a choice not to eat too much processed high calorie low nutritional value food, a choice to do no physical activity.

64% of adults in the UK are classed as being overweight, or put another way that’s 29,508,608 people. For a minority of unlucky sods they have conditions, physical (like a thyroid disorder) or psychological that make weight control exceptionally difficult, what excuse does everyone else have and why should the NHS pick up the tab for those piss poor choices if being fat is reclassified as a disease?

If it affects 2 thirds of the population, then regardless of where you perceive the fault to be, it is worth while for the NHS to try and solve it! That has to be to the greater good and long-term cost saving for NHS. 

I saw an interesting programme on gut bacteria, mostly on it's effects on allergies, but it also talked about one case related to obesity. It was a woman who had always lived a healthy lifestyle and was a healthy weight. She got ill and needed a feacal (sp?) transplant, so got on from her daughter, who was very overweight. After the transplant, her life returned to normal but she became really overweight and couldn't keep it down. So, maybe there is more to it than smug lifelong skinnies like to believe.

Im afraid lm on the side of the energy in vs energy out brigade here. Notwithstanding the genuine illnesses which are doubtless affecting some percentage.

I have a propensity to put on weight and I like beer and have a sweet tooth. If I did this continuously l would be massive, quickly. 

I was approaching 13.5 stone in September after injury stopped me running for some time. Come October I decided to cut the booze completely for a month and vastly increase my running. By November I was below 12.5st at 5 8". Im stocky so will always be heavy for my height.

I went back to drinking in November but kept the running and even after Xmas excess Im still 12.5st. Im not going full dry Jan but will cut down to nights out only and will maintain the running and have a target of 12st by Feb 1st. 

Believe me,  l would be very overweight if I drank to excess all the time and didnt run but I sometimes have to drag myself out the door even when the fire is lit and there's a nice red in the kitchen. Or when I didnt feel perfect, like yesterday. Its hard, very hard at times.

You have to start somewhere. About 8 years ago, before I had run a single km I was very overweight and had become too complacent and decided enough was enough for the sake of my wife and children, and my health. I started to run (replace run with whatever you can do) very short distances and count my cals via myfitnesspal. Before I knew it I was running 5 and 10ks and the weight literally fell off.  This in itself is a huge motivator, to get to the point of enjoyment and achievements rather than chore.

Now its different. I run for pleasure and fitness but also to allow me to enjoy a hearty meal and few drinks without worryingtoo much.

If I can do it,  with my lack of willpower and self control, anyone can.

Clearly not, or they would! It's not like people haven't been told this!

You sound like you have a similar make up to me. I have fluctuated between healthy and obese, but even at my lightest i was still chunky built. I build chunky muscle very easily, so I am a bulky build at any weight. 

With a lot of work, I can keep myself in a reasonable place. I have only put on a couple of KGs over Christmas, and it will take me a couple of months of being very careful to loose them. I don't drink at all, don't like it.

I am fortunate that I have a low stress life, so easier to loose weight, don't work nights or have kids keeping me up all night, can afford to buy good quality food and have the time and knowledge to cook real food. With all of these advantages, I can manage my weight with quite a lot of effort.

A lot of people might say the same about alcoholism but I'm not sure it's as simple as that.

You don't think that being a greedy bastard might be an inherited trait?

The NHS is overstretched and under huge pressure as it is. It is already picking up the tab for the whole raft conditions that come with being obese/overweight, conditions that are largely entirely avoidable or can be minimised and mitigated against through healthier lifestyles. Quite frankly I think the service is having the piss taken out of it and perhaps we should be adopting a Kennedy-esque approach of 'ask not what your NHS can do for you but ask what can you do for your NHS'. Reclassifying a largely entirely self inflicted condition as a disease simply removes responsibility from the individual and replaces it with victimhood. I'm all up for funding of prevention strategies, educational campaigns, better regulation of fast/convenience food industries, bans on advertising etc but at the end of the day the target of those campaigns need to step up and get with the programme that just expecting the NHS or some 'other' body to step in when your health begins to catastrophically fail is not an option.

There will always be outlier unusual cases that buck the trend. I am willing to bet though that there is a very strong correlation between the 'smug lifelong skinnies' and them adopting better then average healthier lifestyle choices. Nothing smug about it, just sensible.

I disagree. If you want it enough you have to make the changes.  If someone looks in tbe mirror and dislikes what they see they have to make the choice. If they have no underlying health issues and are mobile then they can do it. 

Regrettably, I think they obviously don't want it enough.

But if the NHS doesn't treat it as a disease and work to prevent it or at least prevent it worsening, it will cost more in the long run. So it is a way of reducing the burden.

No, there are a lot of smug skinnies. In the OP; "I ate two helpings of syrup sponge with custard today, once for breakfast (night shift) and then again at midnight and its not exactly that unusual of a thing for me to do yet im only (!) 77kg."

I agree. There can be a lot of smugness.  I try to show that wirh effort positive impact can be achieved but its hard and requires constant commitment. For me at least.

And that's where the big problem lies. If you are trying to juggle looking after kids, working shifts, worrying about where the rent payments are coming from, maybe you don't have the educational level to follow a recipe etc, then it becomes impossible. It takes a lot of effort for people who have the luxury of time and money.

By classifying it as a disease, there is more effort and research put into the prevention of it. They did the same with gang violence in Glasgow, they classified it as a public health issue and treated it as a health condition. It worked, and London is now looking at replicating the same model. I know it's not quite the same, but it's similar. 

People need to stop being so self righteous about these sorts of issues. Rather than the smug 'Just stop doing it' comments, actually look at how hard it is for someone who is NOT in your situation! 

And outside of the afore mentioned campaigns and legislation that are already in place, what do you expect the NHS to do? This is the crux of the matter, how do you help people who despite being aware of the risks of obesity refuse or only make token efforts to do anything about it (as is largely the case now)?

Looking at J Whittaker's profile it would appear he is an active mountaineer/climber under 30 who I assume is spending his weekends or a few nights a week down the wall/gym or generally leading an 'outdoors' lifestyle, it's not rocket science to assume that his increased calorie expenditure from these activities allows for his somewhat unusual breakfast choices. I can 'get away' with having a blow out curry and a few pints every so often and eating a large lunch at work most days, I can do that because I am currently training 6 days a week, not because I am smug.

Self responsibility seems to becoming an unpopular concept these days .People dont just wake up one day weighing 25 stone a lot of calories have been consumed to get there. The claim that this level of obesity is caused by a very low metabolism is used with little or no scientific evidence but if you say it loud enough and often enough it becomes 'common knowledge'. However there is a problem with the 'nutrition industry' with lots of contradictory views and it seems to be populated with more than its fair share of charlatans.

That's 2 1L Sigg bottles full of water to carry!  

Like you I drink very little, can't afford to generally.   But I do sleep badly, a curse and the worse I sleep the worse it makes keeping weight off.   I believe it has been shown that sleep affects insulin resistance, yet another complication.   Believe me I have tried for decades and now I manage and live with my sleep problems but I probably very rarely get more than 4-5 hours per night.

That is another change in life that can happen with getting older.  Exercise does not help in getting to sleep

Well you are only 40

Come back and tell me that in 20+ years

Many people who are overweight have developed a complex relationship with food, usually following difficulties in their attachment with main care givers as children. These people have learned that they cannot rely on people to sooth them when upset, and so find another way of self soothing, and for some this is food.... Reliable, readily available and cheap. Until these people understand why they eat and find another less harmful alternative they are stuck. Making them feel bad and reducing it to energy in versus energy out, misses the complexity of this and is unhelpful. 

I am 44 actually (need to update my profile), and I have noticed my metabolism slowing already and have made adjustments to my lifestyle to accommodate this fact because I don't want to become overweight. All the masters men and women (veterans) down my rowing club in their 50s/60s/70+ are of an 'in shape' persuasion despite having I assume much slower metabolisms then me, I shall be following their lead!

I wish you luck with it, it's an uphill struggle.

At that point he will have to reduce his caloriesbor increase his training. Its a choice he will have to make. Isnt that the whole crux of yhe matter.

Most of the fat people I'm aware of don't cook much at all, rather phone for takeaways to be delivered to their front doors so they don't even have to haul their fat arses half a mile down the road to Dominoes for their 12" Hawaiian. They suffer from low willpower and no enthusiasm for exercise combined with a set of delusions about the reasons for their weight problems.

I don't disagree that we should treat it as a public health issue but not by adding to the workload of the NHS. How about legislating on the calorific value of packaged foods, taxing sugar more heavily, restricting the installation of elevators and lifts in public buildings etc.

We frown on excessive drinking and take active measures to restrict consumption outside of the NHS, smoking too. Why should over eating be treated any differently to over drinking?

I think you are conflating the minority here with the majority of the people on the high street. Are you saying that most overweight people have mental health issues?

Well, that is a question better answered by professionals. But for starters, fund further studies into the effects of gut bacteria on weight (see my previous post on that one). One of the lines in the OP's article says that once some has been overweight, they are very unlikely to maintain any weight loss that they achieve. Why? Further studies into physiological and psychological reasons for this could help a lot. It might also give more clout to groups trying to limit what kinds of foods are available in and near schools, banning junk food ads, promoting better labelling on food (stopping things which are low fat being branded as diet when they have elevated sugar to compensate for it). Hormones also have an effect on metabolism, so further research into the effects and potentially whether there are some hormonal treatments that could be made available. 

I'm sure there are health professionals with much better ideas than mine, as it's their area of expertise!

I do all those things, and can't have a blow out without it having a big knock on effect. It is still smug to boast about it, just because you happen to have lucked out with your physiology!

The OED definition of disease is:

“A disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury.”

Under that definition one could define Obesity as a disease but I think that is false reasoning.  Obesity is not a single vector like meningitis or diabetes it is a condition that has various factors in its causation which are required in order to suffer from it. 1. Physical link to reduction in metabolism, 2. Mental health, 3. Access to food. Historically low metabolism was good. In period when food was scarce the ability to build up fat reserves was an absolute life saver. Indeed being fat was once considered a sign of good health and wealth.  The problem we have in the west is an abundance of food, cheap and easily accessed, which turns useful low metabolism into unhealthy obesity. Tie this in with increasing mental health issues and low self esteem and for some people you have a perfect storm of unhealthy life style.  To my mind classifying obesity as a disease ducks the issue of how our society works.

The flip side is of course anorexia which is described as an eating disorder and serious mental health condition. Obesity is the same in reverse.

"We frown on excessive drinking and take active measures to restrict consumption outside of the NHS, smoking too. Why should over eating be treated any differently to over drinking?"

Would you wish the damage caused by "excessive exercise" be treated the same? Not sure how many replacement joints we climbers have had nationally, but if my friends are anything to go by, quite a number.

I am saying that it's a complex issue and that the psychological factors are being ignored by many people when discussing this. I think overweight people are demonised and told to eat less in the same way that depressed people are told  to "pull themselves together", and that this is a common feel to these threads about food on UKC that does not happen when depression is discuused...which is interesting. Not all people who are overweight have mental health issues, but many, if taken in it's broadest sense, will have.

For the record im not skinny. I was trying to make the point that you can eat sweet treats and not get massive, to get massive you hsve to seriously and consistently over eat. I train on average 3/4 times per week to maintain my fitness.

The big mystery to me is how things have changed since my youth. Then, hardly anyone (about 1 in 1000) was overweight, let alone obese. Surely the genetics of the whole country could not have mutated so much in that time? Surely half the nation could not have developed over-eating psychoses in that time? Surely the food now is not worse than it was then?

No I would categorise this as potentially child abuse by the parents/adult in charge, the same way I would if a western child was suffering from scurvy and rickets

Food is more readily available than when I was young (not sure of your age), advertising is everywhere, we are richer and busier than ever, and the food is more processed and so probably is "worse than then".. It is a complex problem and not simply about people suddenly developing "over-eating psychoses"

I have not lucked out with anything, I get fat when I don't exercise or eat and drink too much, much like everyone else. I have put on a few kilos over Christmas as I stuffed my face with processed pork products, chocolate and Guinness. My diet is back to what it normally is and I am back down the club training, I imagine by the end of Jan I shall be back to my pre Christmas condition. That is not being lucky with my physiology, that is just me making the necessary changes to drop the weight I have put on.

A number of people I work with spend most of the week working their way through those Asda tubs of brownies/flapjacks and various other sweet snacks that are brought into the office. To the best of my knowledge they dont do any regular exercise and they are all overweight.  Are they unlucky with their physiology?

I help out with the various 'learn to row' courses down my club, we are not an elite club and are less selective in our recruitment so we end up with people of all shapes and sizes and varying ages, many of whom have done zero exercise for years. At the end of the eight week course all these novice rowers are visibly leaner with improved cardio and strength. Are they all lucky with their physiology?

Out of the 29,508,608 people who are overweight or obese in this country how many are unlucky with their physiology?

It’s a metabolic disease. We live in an obesegenic environment. 

Do we blame people who catch measles for getting too close to other people with measles? 

We make it very hard for people to make the right choices, it takes effort. The human being has evolved to be extremely energy efficient. Being someone who craves exercise and doesn’t eat much is not our normal state. 

I live 3 miles from where our running club meet. I run there and back. We have members who live within a mile and drive. We meet at a sports centre where people will park in the roadway outside the entrance rather than park and walk 100m to the gym. 

The problem is you lump 72million people into one generalised bucket of how to excercise and fuel. That’s never going to work. It’s far too complex. We are not machines. 

As soon as you stop excercising your muscles start to waste. If you have no muscles you have no way of burning energy. You start to lay down fat. Your physiology is against you. 

What do we do on a daily basis that forces us to excercise and build muscle? Nothing, society has put up barriers to walking and cycling. 

However much we might dislike the fact, social stigma is a powerful motivator. Considerable social stigma has been attached to smokers, smack heads and teenage mothers and we've seen big falls in all those categories. Much talk of obesity and alcoholism as afflictions over the last two decades has seen incidence rocket.

It's commonly recognised that we give ourselves excuses to behave badly... "I've had a bad/stressful/upsetting week, so I deserve a drink/fag/cake, even if I know I shouldn't". Isn't it natural that a similar mechanism comes into play at a wider societal level if people are given a disclaimer for their choices?

In Glasgow, treating/addressing violent crime in the same way one approaches a disease or public health problem led to a reduction in deaths and injuries.

Who knows, if people didn't jump onto their judgement horses, we might get someway towards solving obesity too? 

They didn't judge the individuals, but looked into all the causes for it, and gradually addressed them all.

And equally muscle growth can be stimulated and maintained through regular exercise! You can lose the fat that you have gained.

What is stopping someone from walking as a form of exercise?

There is an awful lot of infantilising on this thread

Our whole built environment has been altered to a car-centric, long commute, desk bound, out of town shopping, stay at home eating pizza in front of Sky, environment. 

Excercise is now seen as something special you do to stay fit rather than a part of your daily existence. Look at this thread. Look at the people proclaiming that they actively take part in excercise to ensure they don’t get fat. Look at the people who actively seek out foods that compliment a healthy lifestyle. 

These should not be things you have to choose to do, or are hard to do, they should be part of life for everyone. 

All true but the problem with this thread is that it is too general and therefore there are too many generalisations and generalised assertions.  Perhaps the discussion needs a defined scope, perhaps limiting it to obese healthy children and young otherwise healthy adults before other factors cloud the issue.

The people in the 'blue zones' of the planet, where people live longer and healthier lives, all have being active as a natural part of their daily lives, too. They might walk to work or cycle, and do gardening by hand rather than using mechanical help, all sorts of things which are a natural part of their day. 

I think there is quite a bit of confusion on this thread. I simply picked your post because you made what I see as the central mistake nice and briefly:

Whether some condition should be considered a disease is not dependent on its aetiology. Whether you are obese due to genetics, your own life style choices, those of your parents, drugs screwing up your gut microbiome, hormonal disbalances, you name it, does not affect the essential characteristic that being obese is in itself unhealthy, and will, if untreated, cause further health risks and predictable complications such as type II diabetes. So, above a certain threshold (which is certainly debatable, especially if BMI is used as the criterium), fat people are sick, i.e. suffering from a disease, defined as a condition which should be treated.

The reclassification of obesity as a disease is not a moral judgment (i.e. absolving obese patients from any responsibility for their lifestyle choices, after all the poor dears suffer from a disease...), but from evolving insights in the effects of obesity on the health of the individual patient, and more importantly the burdens of widespread obesity for society and our health systems, that make it necessary to treat this condition.

With luck and especially if started early such a treatment may indeed consist simply of life style changes (e.g. my own dry January, only 4 weeks to go until my next pint...), or it may require additional interventions, but that cannot be the relevant criterion.

That the "moral" point of view is irrelevant can also be nicely illustrated by comparison with other conditions. No one would doubt that small cell lung cancer and COPD are bona fide diseases, even though both are almost invariably caused by "lifestyle choices" the patients made at some point (i.e. smoking or taking up a job involving certain hazardous substances).

Let's not even start talking about the arthrosis in fingers, knees, or toes caused by climbing.

CB

I'm broadly on the 'calories in, calories out' side...

... However ...

Obesity in Children: In 5/6 year olds, we've gone from ~1 to 1.5% obese in the 70s, to ~3% in the 90s, to 10% in 2018. By 11, 20% of children are obese and a further 14% are overweight.

Obesity in Adults: In 1970 ~1% were obese, in 1990 ~15% and in 2018 26% are obese. ~62% of adults in the UK are overweight or obese (the numbers in the Sky article are a misquote of the WHO report and understate the growth of obesity in the UK).

We are getting fatter, we are getting fatter younger, we are getting fatter faster and to a more extreme extent. This growth is obviously unsustainable (you can’t have 110% of your population overweight)… However…

To me, what this means is clear: we have engineered a society where the easiest choice, and from a certain perspective the most rational choice, is to be unhealthy. In the NHS, the concept that’s currently discussed is the ‘obesogenic society’; that the path of least resistance leads to obesity. Drive to the supermarket, cook ready meals, don’t walk, don’t run. Healthy choices require effort, rather than being the default. Humanity hasn’t fundamentally changed since the 70s; the world has. All of this is exacerbated by households where both adults are likely to be in full time work, probably working more than 37.5 hours and having experienced minimal wage growth in the last decade, whilst raw food costs have increased. If you squeeze people’s time and budgets, you squeeze their capacity for long term planning.

Now, none of this justifies calling obesity a disease.

But let’s take a step back. The obvious parallel here is with addiction. The ‘disease’ model of addiction didn’t arise because of some medical breakthrough; its origins are in trying to stop the moralising around addiction and to stop the general public equating addiction with sin. As long as addiction was seen as a form of sin, of evidence of a character flaw, what was the point in medical intervention? The disease model wasn’t about establishing that there’s some definite underlying aetiology, but in recognising that the condition was amenable to both cures and methods of prevention.

Obesity is not the same. However, the idea that you can just simply think of obesity as evidence of a lack of willpower or self-control is flawed. Even if it's fundamentally true at the individual level, it’s not going to help solve the growth in obesity and the consequent growth in obesity’s cost for the NHS and, therefore, the extent to which it costs us all via taxes.

I agree. The trick is how do convinced people they have to change their life style, they aren't big boned, slow metabolism etc.. without making a percentage of them have other problems like bulemia, anorexia etc..

It's easier to help the next generation with some radical changes in school, so better habits are learnt early on. 

Overall, I'm rather with you on this - it's pretty obvious that if you eat more calories than you use, you're going to put on weight - but I accept it's more complex than that for some people, for a range of reasons.

However, in a vast number of cases, people just don't seem to be able to take responsibility for their own/childrens health in the first place, which is why we've ended up with things like the sugar tax.

My Mum, until she retired, was a senior practice nurse with extra qualifications in treating diabetes (among other things) and used to despair at talking to patients in general about their weight and and seeing the same patients at the next appointment that still hadn't lost any weight, but with every excuse under the sun as to why they hadn't.

That’s the million dollar question really. If you accept that lifestyle factors have driven the obesity epidemic, then that’s what you’ve got to focus on changing. You could build and staff 1,000 new gyms tomorrow and provide everyone with access to them, free of charge, but I doubt it would slow down the growth in obesity.

I think we have to look to societies where the level of wealth is similar but obesity is lower. But we’re talking about population level social engineering, which isn’t always massively popular. Flip side, we’ve already allowed it to happen over the last four decades, sometimes on purpose, sometimes by omission.

For various reasons, one starting point would be to stop building our physical environments around the car.

Agreed. Education isn’t my strong point (so I have no idea if this is happening already), but I’d like to see an increase in practical and theoretical education around food and cooking. Also, more PE. I used to firmly be in the ‘competition is good’ camp, but right now, I would be extremely happy if every kid left education knowing that they enjoy some kind of physical activity.

The problem is that you can expect a reasonable number of obese 40 year olds to live for another, say, 35-40 years, potentially with diabetes, hypertension, vascular dementia, joint issues, etc. Whether your concern is public health, or public finances, that’s a timebomb.

I think my biggest issue from the article is the comment from the interviewed obese lady saying she didn't choose to be that way.

Nonsense, if you're properly obsese (and i mean grossly, not just a little chunky), which she appears to be then she absolutely chose to eat that much food and as a consequence is morbidly obese. Getting to that size takes a consistent overloading of food. Admittedly ive eaten like a pig over the festive period but it would take me eating like that on a daily basis for years on end to reach that weight. It is 100% a choice if you're 25 stone for instance. 

To paraphrase Ewan McGregor - Choose a hamburger, choose crisps, choose a big f*cking dairy milk every night, choose sitting on that couch watching mind-numbing, spirit-crushing game shows, stuffing f*cking junk food into your mouth. Choose life.

I'm not sure there are significant differences. I checked some time ago and noted a relationship between BMI and income.

Note also that diabetes is increasing rapidly in China and India as people get richer and eat more and trade in bicycles for cars.

My highly unscientific theory is that people have a fairly fixed appetite and the recent abundance of food allows them to eat as much as they want while exercising much less.

I think you are right.

Poor countries - high BMI means wealthier

Rich countries - high BMI means poorer

Obviously that's averages.

Work and leisure both more sedentary and computer based (says man on sofa using tablet).

Obesity is reversing increased lifespan so it is serious enough to be a disease.

I think you’re wrong. And you’re massively misunderstanding how the human body and mind work. 

It’s more like she didn’t choose not to be that way. 

It's no more a disease than being super fit. It's almost always a consequence of lifestyle. Eat better, exercise more.. problems goes away. That's not a disease. Nobody who eats a modest balanced diet and exercises catches this disease?

FWIW you can be a non-stick-thin ultra runner   Endurance isn't massively related to weight - I said I'd complete an ultra before I ran a 20 minute Parkrun and I wasn't wrong

At your level of activity (if you're posting on here I'm guessing you are not sedentary) yes.  But if you sit on the couch...  Running usually keeps my weight manageable, but if I get injured the weight can pile on VERY quickly if I'm not paying attention.

Metabollocks...bollocks about bollocks?

Would agree... when I'm training lots or doing long distance stuff my body weight is down to 85kgs.  But, body fat is low plus rested heart rate and blood pressure are down too. 

Resting heart rate may or may not be a guide...mine is in the 40s or low 50s most of the time and that's been the case since I was a kid even before I did any running (I got called dead at a first aid course once )

Choice is kind of a slippery concept, though. The way you talk about it implies that people have rationally considered all the consequences of various courses of action and picked the one where you think the benefits outweight the negatives. But while we might do that from time to time, I'm not sure that it applies to every little day-to-day choice that we make, including a lot of the decisions that contribute to our weight - what shall I have for dinner, shall I open a beer after work, shall I chill out in front of the telly or go for a run etc. In those cases, we seem to act fairly instinctively, and a lot of people seem predisposed to pick short term concrete benefits (having a quick, tasty dinner and a relaxing evening) over long term incremental ones (being generally healthier).

This is why even people who are fairly thoughtful and motivated about fitness often have to use various strategies to hack their decision making - have a running partner, make a diet plan, don't keep sugary snacks in the house, track your 5k time week-on-week, don't drink on worknights - rather than relying on their long-term goals to keep them on the straight and narrow. And presumably a lot of the point of treating obesity as a disease is that you can intervene by getting people doing more of that sort of stuff, which will probably be more cost effective in the long-run than just saying "have you tried choosing not to be obese" and waiting until they come back with heart disease or diabetes.

Apart from you can cure T2 diabetes by eating better and exercising more.

Funny how this 'disease isn't so prevalent in places like Yemen where food is more scarce.

Quite.  It does actually take quite a lot of willpower - and not everyone has that.

I was talking about obesity, not diabetes. You can be thin and diabetic, or overweight and not. Although obesity increases your risk. Obesity isn't the disease, diabetes is.   

Whether we consider it a disease or not doesn't change the nature of the thing.

im struggling to see why anybody cares how we call it.

in any case it seems to fit the definition of "disease"

Oxford dictionary : "A disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury."

neither were heart attacks during the sieges of Stalingrad and Leningrad but neither my father nor his brother chose to make themselves drop dead without warning at 61 and 59 respectively, nor other relatives on their side, no more than my grandmother chose to need ECT. They lived reasonably healthy lives with the odds loaded

It's possible also that work ethic contributed and that is not necessarily a conscious choice

Yes, just checked again and there's a good correlation between BMI and income. I don't know if you can view the graph directly without downloading the software but its here on the brilliant gapminder website: https://www.gapminder.org/tools/#$state$time$value=2008;&marker$axis_y$...

That said, average male BMI in Japan is 23.5 and in Britain it's 27.4 while income is pretty much the same so perhaps we should eat more sushi and fewer pies and pizzas.

There is some research into the effects of diet on your genes and it's highly possible that the nation's genes did alter as a result of wartime rationing.

Also there's an order of magnitude more sugar in our diet today, it's being added to everything!

I don’t think you can. You can put it into remission but once you have it, you have it for life. 

I don't think you can change your DNA mid life? 

A whole generation learnt to be satisfied with what they had and not waste an ounce of it. 

I’m not sure about people who excercise a lot having to worry too much about food choices. 

Calories in and calories out is a massive oversimplification. 

I exercise a lot. When I’m training, not only am I not hungry, but the energy I take in is being used to repair muscle damage and strengthen bones. 

I can’t sit still, I can’t even watch TV. I need to be busy. 

When I’m not training, I eat, I feel tired and I’ll sit around.

The only problem with these beautiful graphs is that they are ten years out of date. At lot has happened in ten years, particularly in the UK. (Remember when the UK was respected for being reasonably sensible?)

I'm pretty sure some of that is starting with the trend to make breastfeeding mothers 'top up' with artificial milk if their baby is losing weight.  It's very obvious that the fattest babies are those fed formula.

Hmmm, I don't see many fatties in photos of concentration camp inmates. If your cake hole gets more use than your arsehole you're gonna be a fatty!

In related news, a friend of mine just posted on social media that he now weighs 156kg (he's 6'7") and is going to do something about that (he knows it's his lifestyle). 156Kg!! That's like me walking around with my missus on my shoulders all day.

People dis the Bodymass index pointing to how all top rugby players are technically obese because they're so heavy with muscle, but it's not about fitness, it's about not wearing out your body. Carry too much weight for your height and you're going to give yourself problems.

https://www.nature.com/news/starvation-in-pregnant-mice-marks-offspring-dna...

Moralising and self-congratulation on this issue are rife.

Here's 3 examples of people I know well:

1. Me. Not fat. I was brought up by thin parents who took me out walking and to the swimming pool and fed me healthy food. Never ate junk food. As a teenager, I wasn't sporty but I started working out for vanity/self-confidence reasons and then doing e's and whizz on a weekend. Being a lean, muscly lad was important to me feeling alright about myself, and going out and getting high was more fun because of that. I mention this because it's not something that normally earns you moral points... As an adult I got into climbing and these days I'm always either climbing or out on the fells - it's who I am, it's what I like doing. Staying thin for me is incredibly easy, because of all the events that led up to me being a thin, climber dude who's always eaten healthy and enjoyed exercise. I don't like junk food or sitting on my arse (well not for too long, I spend a lot of time on the internet and do a sedentary job...).

2. My friend with really bad mental health problems. Was an athlete when young, since an injury 20+ years ago she hasn't been able to do sports, she's got chronic pain and a whole swathe of mental health diagnoses. She's on stacks of meds, which have weight gain as one of the major side effects, she can't work or drive, she freaks out when she goes out anywhere. If she can get through the day without something terrible happening for her it's an achievement, and losing the weight is a pipe dream.

3. Another friend who's a film maker and his major passions in life are art, culture and food. He loves cooking indulgent food and drinking, lives in inner city manchester and doesn't do any exercise as far as I can tell. He's getting fat and will die early if things carry on like this. He "should" use his will power and whatnot to sort his health out - it would be better for him and the NHS if he did.

So, what's the point in moralising? Shall I sit here congratulating myself on my personal brilliance while castigating my mates who've ended up with obesity problems? Should we treat the two friends the same or shall we "feel sorry" for the first because it's "not her fault"? And what's going to make someone who doesn't have any desire to go to the gym or go running, but loves cooking french food with loads of butter and cream change his lifestyle - anyone know the answer?

There is no way to categorise people into the the "deserving" and "undeserving" fat, nor is there any point in doing so. Each person has their own personal history and mine has led me to being thin and outdoorsy and it's not because I've got "will power" or have somehow worked hard not to be fat. It's just the way my life's panned out, my genes and the environment I grew up in. Same for the fatties. The question is just, what's the best way to deal with the problem? If classifying obesity as a disease will direct funding into effective public health initiatives and otherwise save human misery, then I'm all for it. If it will make things worse then I'm not. But proclaiming that people should "take responsibility" as if that's a solution to the problem is just a way to self-congratulate and not bother thinking about what the best solutions to the problem might look like. 

I was breast fed, no formula. I was also known as the Michelin baby, for good reason!! We moved to California for a while when I was a baby, and I had a suntan but in between the folds of flab I was white. I was a proper fat baby. 

This reminds me of a conversation with a work colleague, who’s wife worked as a practice nurse at the local GP surgery, a few years ago. Apparently, she’d been discussing obesity one day with a couple of the GP’s and had queried whether there was any merit in some of the reasons many overweight patients gave for their apparent inability to lose weight (metabolic rate, being ‘big boned’ etc. etc), when one of the doctors quipped in a stern voice “there weren’t any fat people in Belsen”. Harsh words, though it does make you wonder...

If someone can think of a way to get the population fit and healthy which will be hugely profitable for big business and require no public investment then you're onto a solution. The reason we're fat is because a lot of people make a lot of money by selling products that stimulate the reward pathways in the brain that we evolved when fat and sugar were scarce. 

Here's an idea: bring back the old style coca cola with cocaine in it. That'll stimulate the nucleus accumbens like nobody's business, make a shitload of money and make people thinner as it reduces their appetite and increases their productivity at work. It'll f*ck their hearts right up, but you can't make a capitalist omlette...

all bets are off when comparisons are made with a regime designed to starve and work people to death.  From a Doctor that was a shockingly callous and ignorant comment

Ho wait, there were doctors of some type experimenting in the camps

It's a bit like condemning someone for dropping dead of heart disease and blaming them because starvation leads to a reduction in heart disease.

Thank god for the different attitude of the NHS team in the Open Heart Surgery Live

So the gene expression of the yet born generation changes, but not the DNA sequence of the unborn or the mother.

But I think it is a bit early to say I was born during rationing in ww2 that's why there are diabetics in my family now. As many of them probably have poor diets and are over weight etc. Tough to separate correlation and causation. 

And malaria isn't so common where there are no mosquitoes. 

The sugar tax doesn't go far enough imho. Crank it up to tobacco levels. 250mil a week for the NHS. You can put it on the side of a bus...

I remember that Belsen type comment when I was growing up so it must have a widespread, if totally inappropriate thing to say?

Not related to that, but I do think this is a parenting issue to some degree. I am always amazed when I see a family eating out in a pub and the young kids have ordered full portion adult meals. I guess at home they also eat the same meal size as mum and dad?

When I took my kids out for a meal they always had kids portions until they were genuinely grown up. To be honest that was also about the cost as 5 adult meals would blow a significant hole in the holiday budget!

If kids grow up eating far too much food, leave alone the wrong food, from a young age they will find it hard to change the habit in later life. 

Examples of famine or massively mistreating people (putting them under disgusting levels of stress and cruelty, with severe disease without treatment) is just irrelevant and just debases the quality of the valid arguments in this thread.

But the kids menu is crap. Chicken nuggets and chips or sausage and chips! There should be small portions of normal meals instead. I'd take them too if they were an option as restaurant meals are bigger than I need, but as we have a lag time before we feel full it's too easy to eat all of it when we don't need it

My post to John referred to the nation's genes altering as a result of rationing, not a specific adult's genes.

There are people who disagree and Gary Taubes seems to be the main representative of this group.  Apparently, 500 calories of Mars bars is not the same as 500 calories from meat and vegetables...  The "energy balance" theory could be in the process of being debunked...  What Taubes argues makes logical sense to me (even with my fairly limited A-level understanding of Biology) - the insulin response to different foods differs, so it matters not only how much energy one consumes, but also what types of food that energy comes from.

That is reasonable, also the way calories are calculated for food is not the same as the way your body burns them. But ultimately it's energy in, as in energy the body can process from food Vs energy you use.

Diet is important though, if you eat just one 1500cal big Mac meal a day you'd probably loose weight over time but I doubt you'd be healthy. 

Taubes is not being particularly honest with the evidence  

https://thescienceofnutrition.wordpress.com/book-reviews/

Not the DNA, but what bits of DNA are marked as permanently active or inactive, which is at least partially inheritable (a process called epigenetics). 

The effects of malnutrition vs. excess sugar supply in mothers both prior to pregnancy, but especially during pregnancy, on biasing the mode of nutrient use (use it all for energy or growth, or maximise storage) are amongst the best documented examples of epigenetic inheritance in humans. 

Wartime rationing typically provides the best examples, because the timelines are unambiguous and the cohorts large...

CB

edit: just saw your other post. Clearly, for your family specifically, it is hard to say whether their diabetes is caused by epigenetics. For the population as a whole, it is easy. The number of diabetes cases at current nutrition levels is certainly higher than if their had been not food shortages in the generation of parents or grandparents.

This is even more extreme in populations who have survived on a nutrient restricted diets for much longer, and are then switching to western food (e.g. certain South Pacific islanders). In these cases, some of the effects are likely due to actual genetic selection for efficient nutrient storage.

If you don't have the educational level to follow a recipe, you are illiterate and need to attend literacy classes.  I suspect this is a vanishingly small number of people.  If you want a healthy diet, you don't even  need to be literate - TV and radio have bombarded us with healthy eating advice, encouragement, and suggestions for decades.  It is by no means impossible, although I accept that for those who are illiterate and deaf and without friends or family, it would provide some serious challenges.

By classifying cancer as a lifestyle choice, we could cut funding for research and save a lot of money.  Playing with the language and redefining words to make some fat people feel happy and justified is a very dangerous game.  Redefining words to attract funding is no less irresponsible.

Think about messing with language in other areas: we could redefine graffiti as a crime against the state comparable to treason, redefine speaking against the government as terrorism, or redefine provocative art as assault.  

I don't care that it's hard, and I suspect many others don't care either.  You've got to do something hard?  Boo-hoo.  We all have to do hard things, usually multiple hard things at the same time, things we have to do but really don't want to.  Most people respond to this by doing the hard things.  Doing it for their families, or for their communities, or for themselves.  And some decide they'd rather have another doughnut, because that's a lot easier and it brings me comfort.

Reclassifying the latter group as innocent victims is (with the exception of genuine thyroid cases and the like) factually inaccurate and linguistically unwise.

Have you got any good links? This sounds very interesting. 

Morning Jon, happy new year!

I touched on this further up the thread, public health campaigns to do more and eat less are not working effectively if at all, education is not working, tweaking advertising rules is not working, sugar taxes etc is not working. Most people know that being overweight is not healthy, that has been the background message for decades now. We can continue to try and alter the environment that help people make healthier choices but that is only part of the solution.

But you cannot dismiss or underplay individual responsibility as a factor when talking about obesity. No one is being physically forced to overeat and to be less physically active. The state can only "enable" and "empower" individual decisions so far, at that point the individual has to step up. How far can the state intervene in personal lifestyle choices before they are accused of nanny-ism or overreach?

If people, despite the ample dire warnings are still doing nothing about their size do we move towards more direct action, force everyone to do park run every weekend, ban all fast food? Should my office ban snacks and should the canteen stop serving fry ups? Because lets be honest that is probably what it is going to take if we remove the 'personal responsibility' element from the equation.

The days of mass employment in physically demanding jobs are largely long gone unless you want to bring back ship building, coal mining, steel manufacturing and de industrialise the agricultural sector.

Why would I want to do that?

Most of the issue is ease of car transport and length of commute coupled with desk bound jobs. Washing machines, dishwashers and microwaves mean we don’t even have to stand while doing basic chores. Pushing a vacuum cleaner around is about as hard as it gets - even they are being replaced by robots. Everyone has a remote control so don’t even have to move to change Chanel on the TV.

Hunter gatherers walked between 6 and 10 miles a day. Every day. Now people are proud if they’ve done 10k steps. 

Maybe - maybe not.  I have previously read and considered the criticisms of what Taubes is saying and I'm open-minded, although from what I have read and heard on various podcasts, it maybe isn't as simple as him being dishonest.

The latest I heard was that Taubes was seeking a panel of people who disagree with his views to involve them in a large-scale study design.  The theory being that if they are involved with the design of future studies, they will find it more difficult to discredit the findings.  Sounds like a pretty honest approach to me.

I'm not sure what you are advocating. You have in a number of posts described how we were all more active in the past due to a combination of more physically demanding jobs and the absence of labour saving technologies. You lament how keeping fit is now something you do as opposed to something that occurs during the course of your day. What are you proposing or are you just making observations?

I would have thought that the evidence suggests that, in this regard at least, most people do not respond by doing the "hard things". And I'm not sure what's to be gained by saying that you don't care about it being hard - I don't know how that's going to encourage people who struggle to make the required lifestyle changes. 

Just back from States. Way greater obesity than here. No pavements, few parks, no rights of way. Very obvious that changing this sort of thing would encourage exercise as part of people's everyday routine. Although the UK does better, I am sure similar societal changes could still be made to encourage activity. 

There is no debunking "calories in -vs- calories out", it is obviously true.  The problem with it is that it's also so ludicrously simplistic that it's effectively meaningless.  That's what you get when you try to use basic physics to account for biology.

As you correctly point out, there are relationships between BMI and income, and there are different trends between and within countries.

However, if you filter the gapminder graph so that it shows only Europe, you'll see that France, Italy, Germany, Denmark, the Netherlands all have similar income and a better national BMI. Of the 45 European countries, only 7 have a higher BMI average.

Within the UK, there is a strong relationship between income and BMI. Adults overweight varies from ~80% in Northampton, to 37% in the City of London (the borough). However, there's more at play than just income. London dominates the low obesity numbers; but regardless of the wealth of the area. It becomes even muddier if you look at childhood obesity; suddenly East Riding, North Somerset and Barnsley are all in the top 10.

This is a worldwide problem most pronounced in developed countries. However, that doesn't excuse the fact that the UK is worse than most other developed countries, and that areas of the UK have half the obesity rates of others says there is something we can do about it.

Currently obesity and obesity related diseases costs the NHS £7bn per annum. If you, for example, invested that money in better public transport outside of London, how much could we save?

Edit: On Gapminder, take the graph you have above, filter for Europe, highlight the UK and hit 'play', so you can see the change through time. In 1980, only four countries were thinner (not that this is necessarily a good thing) and we have the same BMI as France. Now, only 7 countries are fatter. This is a worldwide problem, but we are suffering worse than many and if we're not careful we'll end up following the same road as the USA (currently ~75% overweight or obese). 

And even worse, psychology, sociology, and epidemiology...

CB

Yep. People generally are affected by their environment. Maybe they shouldn't be, like some of the paragons posting on here, but they are. And because of an increasingly obesogenic environment more people get fat, leading to poorer health including increased risk of cancer, yadda yadda. 

So, yes the questions are how to change behaviour (to increased pie avoidance) and change the degree to which environments are obesogenic, and we don't yet know the best ways to do this. It's clear that increasing costs of worse for you stuff is part of an answer - if only by making manufacturers put less sugar in stuff as we see where sugar taxes are imposed. Increasing alcohol costs reduces consumption at the margins (going by economic evidence, not the 'obvious init?' brigade). Reducing use of private transport also helps. Lots more ways to design things to nudge folk in the right direction, but no magic bullet and lots we don't know.

That all said, I'm ambivalent about the 'disease' label, and medicalising something that is just part of everday life. In fact no, I'm not ambivalent. It's a bad idea.

Obviously not true, as was pointed out on other threads, different foods will be absorbed differently.

The example given, eat 1 Kg of coal, your body won't be getting 27000 kJ of energy!

Extreme I know but it serves to prove a point. Unless you're going to try and tell us ALL foods calories are absorbed as energy.

I refer you to a post I made yesterday, as I think you are missing the point. Yes, obesity is largely due to a combination of sugar surplus, lack of exercise, and weak discipline.

However, classifying obesity as a disease is not about a moral judgement about the reasons, and even less about absolving obese people from their lifestyle choices. It is a largely financial judgement of whether increasing obesity places such a burden on our society and health systems that it becomes a problem in need of treatment. Causation, whether it is lifestyle, genetics, bad luck, etc., does not even come into it (even though if will play a large role in picking treatments, which may e.g. include "slimming camps" like the one a colleague of mine currently voluntarily attends, which is certainly no fun).

According to your definition, lung cancer, essentially always caused by the "life style decision" to start smoking, would not be a disease. 

CB

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2515569/

No street parking within several hundred metres of school would be a good start point. Good for parents and setting habits early for kids. 

Scrap morning assemblies, religious or otherwise. Share the extra time between maths, science and sport lessons. 

I think you've missed my point somewhat.

"Calories in -vs- calories out" still holds, and that's as good an example as any of how it is both true and meaningless.  If you survive you will either be 1kg heavier, or something very close to the 1kg of coal that went in will come out again.

Yes, nothing I disagree with.

While playing around on the gapminder site last night I also graphed BMI against life expectancy. I expected to see life expectancy reduce as BMI increased. It didn't. What it did show was that Life expectancy increased with BMI up to a certain value and then levelled off. I imagine there's a lot more to it than that but it seems that, worlwide, we should be more concerned with increasing BMI in maybe 20 or 30% of the world's countries than reducing it in the rest if we are concerned with increasing life span.

a high bmi might not drastically reduce your life expectancy, but I bet it increases the financial cost of achieving it. We are very good at keeping people alive who would have previously died aged 50-70 years old. 

That’s taken into account with the values given. Usually they use 4Cals per gram of carb and 9Cals per gram of fat. Although fibre does affect fat so there is a small amount of inaccuracy in high fibre/low fat food.

How many grams carbs and fat are in 1kg of coal? I suggest the food label would read 0Cals. 

Remember that  1 food Cal is 1000 heat calories. 

I think we can all agree that the large and increasing number of overweight people in the UK is a big problem, it's bad for the health of the people which in turn is bad economically with the knock-on effects of increased NHS costs and reduced productivity form unhealthy workers (sick days, time off etc).

The real question is, what can we do about it? Whether you class it like a disease or not we still have to solve the problem of convincing millions of weak-willed fat people to radically change their lifestyles.

Mean first of all we have to consider personal freedoms. Quite a lot of people like food, and are happy in their fat bodies, I doubt they will be too pleased if at their next doctors' check-up they are issued a ration book, banned from buying food conventionally and sent to a mandatory exercise camp for a year.  

I'm all for nudging people into fitness, but I can't see how the government could do it really. I thought maybe the craze for fitbits and Strava type apps would have got lots of people more active but it doesn't seem to have put much of dent in the huge wave of obesity we are seeing.   

As for environments not being suited to exercise I don't really understand that, fit people live in all manner of environments. Unless your front door opens directly onto the M6 anyone can go for a run around the block or get a bike and ride around the streets. I can understand maybe some city centres aren't ideal cycling locations but in all but the biggest cities you can soon cycle out into a rural area if you need to get out of the traffic. 

The only real correlation I see is low education/poverty. Mean even if you're dirt poor you can still run and being unemployed you'd have plenty of time to do it. So it's really just low education and likely a poor upbringing people don't see the point of or benefit of staying healthy, its effort now for gains which aren't immediate so they don't bother. As for how you solve that, I've no idea, hammer it home at schools and abandon the current adult generation probably.    

I wanted to clarify the conclusion that 'cancer is preventable' as the web site proclaims (but then goes on to modify).

Yes it is possible to prevent some cancers and lifestyle choice plays a big part in this. But many things are hard to avoid, environment being one, genetics being another and infection the third.

There’s a lot of dramatic statements on here about the severity of the problem in the UK.

Has nobody ever been to Florida?  They’ve just accepted it with oversized toilets and obesity reinforced chairs in restaurants and a booming business in oversized zimmer frames and electric mobility scooters.  Edit:  how can I forget?  As well as “to short for this ride” tests at amusement parks they have seats mounted before the queue so you can check you’re not to fat for the ride.  Staff also have giant oar-like spudgers to lever morbidly obese customers out of seats on some rides.

Things could be a lot worse in the UK.  Especially if we’re forced to import a lot of their growth hormone laced beef post Brexit...

So now would be the time to address the problem, no?

Before we get to that stage.

Did I say otherwise?

I’m not sure we will.  My text above is based on Florida in the mid 90s - over two decades later and we aren’t there yet.  

Yes of course.  

Its a massive oversimplification, as is the nasty attitude on here towards fat people.  

This news is another excuse for the UKC holier/slimmer than thou lot to bash people.  

I suppose it makes a change from complaining that they can’t take extra climbing gear on holiday as a reward for being skinny.  

What’s unbelievable about Florida is that they don’t have an NHS. Maybe the government don’t have to worry about the cost? Get fat and ill, you pay for it. Twice. Of course that paved the way for loads of conspiracy theories about big food and big pharma being in league with each other.

One of my beliefs has always been that people treat the NHS as a safety net. Doesn’t matter if they get ill the doctors will just fix it for free. Then I can lose weight. It’s not a main driver but it must figure in some people’s minds along with I’ll lose weight later, I’m too busy right now. 

Some places it is however some do kids portions of their menu. A certain pub in Eskdale used to do smaller portions of all meals.

But given the choice would I have wanted to overfeed the kids just so they could eat steak and kidney pie? Nope. 

And the calories within the coal will still be within the coal, not used by your body to either make fat or energy.

You might be saying this I'm not sure, people tend to think what goes in, versus what's used is the problem, but obviously, they seem to discount what's actually used by the body and what's not (i.e. crapped out at the other end)

It also assumes that everyone is the same and that fat/calories/protein/carbs are equally taken up equally by everyone, obviously this isn't true either.

An example of the bullshit were supposed to swallow was on TV last night, Food Unwrapped, I think.

Comparing 1Cal spray to cooking in oil, the present stated, he'd used three squirt of his oil, so 3 Cals, while the other woman used 36 times more calories in oil because she used cooking oil from a bottle.

The fact that most of the cooking oil stayed in the pan seemed to pass everyone by, not even mentioned. She could have used 36 gallons of oil, and if the same amount of it went into your gob as the 3 squirts of 1Cal, it would have had exactly the same effect.

in the case of coal some maths teachers would argue it is never "in" you as we are toroidal equivalents

As I wrote earlier. The chemical formula for coal is C. There may be calories but there are no Cals in it at all. 

"Up" you then

are you sure? There maybe C in coal but that's not all it's made from, otherwise it wouldn't burn, and you'd be right.

I dont think that analogy works.  Obesity isn't the disease here, T2D is, heart disease is, etc.

Lung cancer is a very real disease needing treatment otherwise the likelihood will be death yet you can smoke for a long time without having lung cancer.  The early warning signs are breathlessness, coughing, mucus, lack of energy or being able to climb stairs etc.  At this point a person should make positive changes to stop a very challenging and addictive product.  Lung cancer is the end point along a long line of warning signs.

Interestingly, obesity follows a similar pattern in that it in itself is the warning sign across a continuum, starting from many similar warning signs starting from eating too much (the Friday night fag) to becoming a little overweight (the coughing in the mornings) through to clothes not fitting, lack of energy or ability to undertake normal daily tasks such as walking or climbing stairs.  The end result is the disease which will ultimately need to be treated.  Obesity in itself doesn't necessarily need to be treated as people live OK with it and often die without needing other treatment, as with many smokers, therefore doesn't need to be treated in that sense.

You are limiting the amount of oil available to be absorbed in the cooking process. The food won’t absorb ‘just enough oil to cook in’ it will absorb as much oil as it physically can. Regardless of how much is left, more will be absorbed. 

What?

Do you mean a thousand cal is is a kcal?

Well. Not entirely. It’s a hydrocarbon. C137H97... 

It doesn’t contain fat or carbohydrate so it has no Cals, only calories. If you put a food label on it it would say 0Cals. 

Yes. One food Cal is one kcal. 

But a fried egg doesn't absorb any fat. Cooking bacon actually releases the fat from the bacon, if you cook it long enough,

What if there's more? If none is absorbed then how can you disregard this?

If that's what they we testing then they should have noted that, the only thing they had that would have absorbed fat were hash browns, and no body really likes them any way.

I don't see how you can do anything else. Regulating and taxing the living shit out of the obesity industry is the most obvious way. 

I think it's meaningless. I literally don't understand what it means other than "I wish other people to behave differently" - how does wishing change anything? Do all the thin people just sit at home typing "take personal responsibility" on a keyboard and then waiting to see what difference it makes to public health outcomes?

If you want something to change, you've got to do something in order to change it. Wishing's just not an effective strategy. If effective public health policy is nanny state, then (as usual) I'm all for it.

You haven't explained how we're going to put 'personal responsibility' into the equation! Just saying the words isn't a way of making people change their behaviour, especially if you just say them to thin people. And saying that to fat people is...a public health campaign in itself! 

Lots of what ifs. The demonstration was presumably to prove a point and they just chose a cooked breakfast to prove the point. 

There’s a school of thought that switching to vegetable oil to cook everything in instead of beef fat has fuelled the obesity crisis. 

I would probably grill the sausage and bacon and then use oil to cook the egg. There would definitely be excess oil on the egg when it went on my plate and that would be mopped up by bread. 

Only because it's been abused, a food Cal "should read 1 kcal".

https://www.medicalnewstoday.com/articles/263028.php

No "what ifs" at all, simple what happens in a real life situation, but you seem intent on arguing differently, that's your prerogative, obviously.

Interesting you mention medication.  A favourite pill given out like sweets these days for heartburn/acid reflux is *prazole (there are lots of different ones) - you can even buy it over the counter.  One of the side effects is weight gain, though the mechanism of this isn't quite understood.  Taking it for a month made me put a stone on without changing eating habits, and when I stopped it the uncontrollable weight gain stopped and I was able to lose it again.

You've also got the older but similar Zantac (I forget its generic name) which is quite good for causing depression and itching.  Yet that's OTC too.

1 Cal (big c) = 1000 cal (little c) = 1 kcal.

Absolutly preposterous.  Between that mess, Therms and BTU all clinging to life one despairs.

What on earth is the basis of that?  For that to be true, everyone would have to eat fried food every day, and they patently don't.

Yes, but only so you can fry the egg in the fat and then soak in to the fried bread.  

Yes.  And having come out they are then 'calories out'.

I am

Well quite, and that's the nub of the oversimplification that makes the "calories in -vs- calories out" thing as useless as it is technically correct.

You can if you like, but it's not compulsory, you can just as easily leave the oil in the pan.

After he fell his bike and split his nose and mouth open (and lost several teeth), a relative went 'pre diabetic' for type 2, in his theory because all he could eat was fruit and ice cream for ages, and he's gone back to normal again. 

Then we agree, which is nice

I agree.  I'm not saying don't classify it as a disease on moral grounds (although there is a case to be made there) I'm saying don't do it on linguistic grounds.  Being obese is not a disease, it's (mostly) a consequence of bad choices.  My main point was about language.  My secondary point was about morality.

I don't know what country you're in but the labels on my food in the UK don't use "Cals" as any form of energy measure, we have kcal and kJ.

Also, the daily recommended intake is in kcal and kJ, there's no mention of Cal.

The title of that article, Cancer is a Preventable Disease that Requires Major Lifestyle Changes, seems to be a case of over reach, to put it mildly.  Can it really be the case that cancer is almost totally preventable with the correct lifestyle?  I'm inclined to doubt it.

Just for the sake of argument, though, let's say the article is entirely correct and " 90–95% [of cancers] have their roots in the environment and lifestyle".  Why do dogs and hamsters living in low pollution areas with a healthy diet, plenty of exercise, and no alcohol die of cancer? 

And if we're going to compare cancer with obesity, there are further difficulties.  I wish I had a cure for cancer.  I do have a cure for obesity.  It's called eat right and exercise.  If you're not one of the genuine medical cases, it's going to work.  'But I caaaaaan't' is fine as an attitude. But what you also can't do is redefine the language to make you feel special.  

Obese people can cure themselves, have the knowledge to do so, and ample encouragement.  Cancer patients cannot cure themselves and often succumb to the disease despite their best endeavours.  The two really are not equivalent.

Ask anyone how many calories they should consume in a day. 

They will say 2000-2600. 

Your 1 Cal spray actually has 500 calories per spray if you look at the advertising literature. So it technically should be called 0.5 Cal spray. 

It's a massive over simplification, just as is your just get on with it attitude and your assumptions.  

They do. 

Crisps for a start. 

Then there’s a whole mirriad of dressings and processed food that lists vegetable oil as a ‘hidden’ ingredient. It’s highly calorific. 

*Frylight contains 1kcal per spray. 

Which one are you looking at?  

Many do, although it isn't commonly thought of as fried food.  How many recipes start by softening onion/garlic and browning meat by shallow-frying in oil?  In most of those cases, all of the oil used is then incorporated into the dish.

That doesn't make them right!

A lot of people might suggest I look a the "pacifics" of the problem, and while I know what they mean, it doesn't make it correct.

as for Frylight http://www.frylight.co.uk/ go to the bottom of the page.

"*Frylight contains at least 30% fewer calories and 30% less fat than regular oils and dispenses 1kcal/0.1g fat per spray. 5 sprays of Frylight (0.5g fat/5kcal) can replace 1 tablespoon of normal oil (15g fat/120kcal) in shallow frying."

Which is why scrambled eggs are worse than fried eggs, from a fat content point of view.

Well, we could smother obese people in warm cloying waves of boundless compassion and see if they get any thinner.  Or we could persuade them to take some responsibility for themselves and see how that works out.

I'm not wildly optimistic about either option having an effect, but of the two I'd say the latter was rather more humane, as it affords people the prospect of self-improvement and subsequent self-respect (not to mention improved health) whereas option 1 butchers the language in the name of sympathy.  A bad road to go down, in my view.

Sorry. You’re right. It’s 0.5g of fat. 

It’s still called 1 Cal though. 

At the end of the day the commonly used terminology is what counts. Regardless of which is scientifically right.

Your frylight spray says “With each spray containing only 1 calorie” in large print. Then in the small print says it’s actually 1kcal.

Regardless 1kg of coal is 7 kCal of heat energy but 0 kCal of food energy and would be labelled as such. 

Neither works particularly well. 

Enable them to make the right descision by making the wrong descision hard or impossible to make. 

Sounds good.  May I ask how that would work in practice?  (Please note, this is a genuine question respectfully asked, not a snide commentary).

There’s the current stick method of blunt tax  on sugar in drinks. 

There’s a good carrot in cycle to work scheme and tax incentives on new office buildings that have showers and bike parks. 

More cycling networks and parking in towns so that people that can cycle are encouraged to. 

London ‘Boris’ bikes.

That’s 4 off the top of my head that are already in use. 

Essentially you need to rebuild the environment to encourage activity instead of making it easier to be lazy. 

Think outside the norm.

How about piezo electric stairs on the underground that generate electricity as you walk up them. You have sepearte turnstiles for stair users which gives you a discount on your ticket (pays for your labour used to power the lights or something) 

By reallocating road space to dedicated cycle paths on the Dutch model and away from cars you have a combined carrot and stick, of course.

Ha, well in my case it's because I tend to add cheese to my scrambled eggs, but that's besides the point

You utter swine. I have given you a dislike.

Agree with you there

Possibly in some cases. Alternatively pretending being fat is some hugely complex thing is giving perveyors of fad diets and useless pills to exploit people. 

Or weight watchers (social club for over weight people).

If it worked, it should in theory be out of business by now. 

It does work, the Mrs has lost loads, she'll disappear if she keeps at it!

Presumably there's an endless supply of fatties (for the want of a better word that I can't think of!)

Long term?

Their business model seems to rely on repeat custom, not recommendations to new customers. 

All my opinion so I fully expect to be torn to shreds but I'm convinced the chances of the 'Obesity Crisis' getting any better are minimal. 

We seem to be on a second generation that have been almost entirely sedentary from birth. My age group (late 20s-30s) were probably the first to be properly inactive/poor diet in huge numbers. Now we're having kids being raised in the same way or even worse.

Yeah I've had plenty of family members go to the various different ones. Some of the diet plans seem like pish but simply having a goal and being checked each week seem to work and keep people motivated. 

The branded biscuits or whatever are a different matter and just an excuse to keep eating crap.

Not really, they are separate diseases, one triggering the other. Not uncommon, really, just think of HIV infection / AIDS causing Kaposi sarcoma or Candida pneumonia, both with their own pathogenic agents but the latter two not affecting healthy persons without the former (or other causes of immune suppression).

Consequently, addiction, whether it is to legal drugs like alcohol or nicotine or illegal ones, is for a good reason already classified as a disease: A condition that is likely to affect patient health and merits treatment. Of course, the latter is a judgement society has to make, and will change over time (the classification of homosexuality as a psychiatric disease being a notable example). 

That is all there is to the definition, taking etiology into account leads down a slippery moral path (the obvious example again being whether homosexuals should be left to die of AIDS, as it gods punishment for their sins. This was in all seriousness proposed by fundamentalist churches in the US in the 1980s), and obvious absurdities such as "lung cancer as a life style choice".

Indeed, the current "official catalogues" of diseases (ICD10, the draft ICD11, and the psychiatric manual DSM-5) also already list gambling and internet addiction as bona fide diseases!

I fail to see the difference in principle to treating obesity as a disease, a sensible step IMO.

CB

... or, say, introduce a sugar tax. Much easier to argue for politically and to counter "nanny state" type criticism if the purpose of this measure (or any other unpopular but effective measure you can think of) is to treat an epidemic of a disease.

As I stated in my post above, other conditions like substance, internet, or gambling addiction are already classified as diseases, largely precisely for that reason.

CB

I disagree, according to all relevant criteria that defines a disease obesity should be classified as such, same as substance, gambling, or internet addiction. What should change is our sloppy use of language, and emotional overtones when discussing the topic. Linguistics should follow biomedical science, not vice versa.

CB

It isn't. But it does make you feel good about yourself if you moralise over others without knowing anything about their circumstances.

It works by creating a group of like minded people with a common aim. It’s a very simple basic concept. 

It doesn’t alway address the underlying psychological problem that is causing the weight gain. Hence when people achieve their target and leave the ‘support’ group, they gain weight. 

Losing weight isn’t just about exercise more and eat less. 

As I understand it groups like weight watchers and slimming world have an issue in that although people loose weight, it goes back on, with extra, as soon as they stop dieting.  Yo yo dieting is a big problem.  

Is smoking a disease?
Is going over your recommended alcohol limits a disease?
Is not eating your five a day a disease?
 

Which to me proves that counting calories, different colour foods, good or bad, sins etc..  isn't the solution. You don't need a PhD as a nutritionist to know what is healthy etc.  

The problem is lifestyle, diet and denial. If weight watchers etc was a club where they met and exercised for an hour it would be more beneficial. I wonder how many drive to their meeting etc.. 

Sorry. It's a bug bear with me. I have an in-law who isn't small, they blame it on mild bi polar being unable to get out and exercise..  but have no problem go out for cocktails, big meals, concerts, having a full time job, multiple holidays a year etc.. and because of their 'condition' I'm led to believe they get their club membership free through a doctors referral. And yes they are yo yo dieters. They'd be better of with a psychiatric referral, as I imagine that's where the problem of eating, self esteem, confidence... etc could potentially lie.

Now there I agree.

I think the park run concept has done more to tackle obesity and the underlying causes than any slimming club. 

There are a lot of vested interests in selling cheap, easy to produce and addictive food and also in the diet and exercise industry. Both industries leverage on our human nature our insecurities and natural mental drivers, the whole will power thing is a  a red herring and only works for some people. There isn’t much money to be made in solving the problem and plenty to be made from selling us junk food and gym membership and “clean” living woo.

if you were to transport someone from the 1940’s to modern day times and take them to a petrol station they would probably ask when did sweet shops start selling petrol.

The Real Causes Of Depression Have Been Discovered, And They're Not What You Think
https://www.huffingtonpost.com/entry/opinion-hari-depression-causes_us_5a6a...

The whole will power thing is stupid, it’sit doesn’t work for most people and we are seeing a generation now who are obese before the concept of will power is even a thing

They're behaviours not conditions. Read the definition again. 

Interesting article. 

I think part of the difficulty of trying to solve the obesity epidemic is that there are several causes which all manifest in the same way.

I put on weight incredibly easily, and I like chocolate and all things sweet. So for me, it's nothing to do with emotions, it's probably closer to a smoking addiction. Sadly, even a moderate amount for me piles on the weight, even though I am highly active. It is about will power for me, but I reckon I am probably in a minority in that.

For others, it's linked to emotions, as your article suggests. 

For some, it's lack of education or finances to make good choices. 

For some it's part of an other medical condition or side effects of medications.

There are probably many other causes too, these are just off the top of my head 

Absolutely. 

The rise in obesity is systemic, cultural and economic. It's very easy to blame the individual - in fact this is encouraged on a cultural level. This is analogous to the way we are made to feel both guilt and virtue around our environmental impact on the world, while being actively encouraged to consume.

Nobody is implementing root cause solutions, because too much money is on the line. 

Rosemary Conley did exactly that, exercise based weight loss group but I don’t think they run any more.  Don’t know why.  

Willpower is pretty ineffectual against the weight of society, those who have it have either been equipped with the tools at an early stage or have a motivating factor (for climbers it’s gravity and even if you have it those nothing to say it can’t be derailed by mental or physical problems.

as someone that has kids I see the the pressure that surrounds food and the shit that is tempting kids and parents, god knows how many hours of my life  I have wasted saying NO NO to breakfast “cereals” that begin with the word coco and this isn’t just with the kids but my wife (who is less stubborn about this than myself) 

It’s only a “treat”

go on “treat” yourself say the adverts

my rule is unhealthy treats stay out of the shopping basket and the house.

if you want a cake, get a single slice on your bike ride or at the climbing wall, don’t buy the whole cake and keep it in the fridge at home because you’ll eat it all the same goes for chocolate. 

No one throws cake/chocolate in the bin but everyone regularly throws mouldy uneaten veg in the recycling that’s how our brains are wired.

speak for yourself if you can be so wasteful

ha ha. I have given you a like.

Not really as it's obviously confusing, surely proper usage is what counts There is no kCal of food energy, it's all calories of energy. The fact you choose to call it something else doesn't make it right.

kcal or Cal it's a measure of energy, not "food" energy, it's all measured in the same way.

The fact you stated 1kg of coal is kCal, only goes to reinforce how confusing you've made things. If Cal is "food" how can you state kCal for coal?

Despite that though, the point I was making is not all calories you put into your gob as absorbed by the body. Different foods and food combinations, are absorbed differently.

I could have just as easily stated kJ and it would have been just as valid.

Or are you suggesting there are kJ of heat energy and kJ of food energy.

While I agree with the general point of your argument (ie that society makes it hard to resist "treats"). The way we eat food and waste food is an interesting thing.

On veg: we rarely if ever throw out veg simply because (unlike other people we know and this is true) we do not throw out week old veg because it is a week old. We use it all up and cut off any mouldy bits. People are conditioned to go by sell by dates and if their isn't one they panic. I frequently take veg off someone we know simply because they don't believe they can use them up that week.

We do keep chocolate in the house. Those 85-90% bars one square of an evening is plenty. But if we ever try a square of "ordinary" milk chocolate then the whole bar vanishes in no time.

Blimey, that's strong willed, even bars that strong get eaten quickly by me, I'm a dark chocolate/cocoa fiend.

I think you’re the only one confused. 

Food is always quoted in Calories, the fact that they mean kcal is neither here nor there. It’s what people use. 

The calories they put on the labels are only the calories from fat and carbohydrate that are accessible through digestion. If you had a teaspoon of petrol in the ingredients it would have 0 calorific value to a human and not be included in the calorific value of the food. They don’t set fire to your plate of food and see what the heat output is. 

I’ve tried to explain it several times but yes. Food calories are different to heat calories. 

One kg of coal has no food calories in it. 

I regularly ignore the dates on veg if it looks/smells okay then it’s fine to eat. My point is more on how our brains are wired and I’m sure the virtuous inhabitants of UKC will throw out the  chocolate cake long before a mouldy carrot.

As a cyclist if I come in from a long bike ride and I open the fridge and I have instant rich calories staring at me it takes a superhuman degree of willpower not to eat a double portion of cake or one biscuit turns into five. That’s natural that’s how we’re wired, we’ve removed the exercise part but most people if they open the fridge will go for chocolate cake.

If it’s not there willpower isn’t required, a pot of pre prepared yoghurt and Alpen will get me past the hunger cravings.

The not throwing away chocolate cake that is part of the problem, if you go to tesco’s 1 donut costs 60 pence a pack of 4 including the excessive plastic packing costs a pound, we are programmed not to pass a bargain up so most “sensible” shoppers will go for the 4 pack. The shopper now has to either consume 4 times as many calories or throw food away or share the love with their ever expanding children. It’s like drug dealers giving freebies of smack out.

I'm with you there. I like the occasional chocolate cookie but around me I can only buy them in Lidl as a single item. Elsewhere they are in packs of four or five, which I would eat even though I only want one.

It looks like you are wrong - it is food calories that are measured. And pedantry over Calories vs kCalories... really!? 

https://www.scientificamerican.com/article/how-do-food-manufacturers/

Yes. Apparently 'cancer corridors' are are present along side motorways, if people live within a certain distance.

I probably am, it's happened before, but look on anything in your cupboard, not on an American web site and then tell me what units they use for energy quantities.

If you read the link you've posted, they've managed to get the prefix for 1000 wrong, it's not K but k, so I might not be the only one that's wrong.

In the US this might be fine, but we're not in the US and you wouldn't be wanting, or arguing, about going to the garage and getting 6 imperial pints to you gallon of petrol.

Yes, we all know the scientific unit is kcal (or kJ) but everyone says calories and understands. Quibbling over this is like cyclists insisting road tax does not exist.

(poor of SA to get prefixes wrong,  I agree. They have j not J for Joule too) 

I thought this was an interesting take on the issue:

https://www.theguardian.com/society/2019/jan/05/truth-obesity-five-fat-myth...

The two essential points I take away from that are:

People overestimate the calories they need and they underestimate the calories they consume. 

And

For whatever reason, people have trained themselves to enjoy sweet/fat foods. Part of the blame can be laid at the feet of the producers. Producing ever sweeter foods, which increases consumption, which increases profits. 

Call it a conspiracy theory if you like but if you can get people eating more then you sell more. There’s no drive to get food producers to sell less. This is even more of a problem when one of the government’s jobs is to get British producers selling more and another one of their jobs is to reduce obesity. A conflict of interests. 

That is interesting, ta.  I'd seen it already but but was put off reading it by the click-baity headline.

Smoking, no. Nicotine dependence, most definitely (according to the most relevant definition, i.e. being classified as a disease by the WHO). Same goes for alcohol and other drugs, so why not for food?

Loving chips and burgers as such is of course not a disease, but a behavioural pattern that makes a person eat (junk) food to levels affecting their health (as revealed by the resulting obesity) is self evidently pathologic.

CB

Very much the case with fast-food portion sizes, where the cost of raw materials is such a small proportion of the price the customers are paying. 

Offer them a "super-sized" portion for a slightly higher price than a standard portion, they feel like they're getting a right bargain while the profits go up because you're using more raw materials but your other costs remain roughly the same.  After a while the "super-sized" portion just seems normal and you need to up the ante.  Rinse and repeat for a couple of decades, and before you know it it has become quite normal for people to buy chips and fizzy drinks by the bucket.

I just looked up the Morgan Spurlock film and I'm a bit shocked how long ago that was.  Scary.  (I went to see it at the cinema.)  Worth a watch for those who've never heard of it.  Think of it as a 'gross out' comedy.

https://en.wikipedia.org/wiki/Super_Size_Me

That's a really good article. It's in line with the research around obesity, both physical and psychological aspects. My only criticism is that it's written from an individual or perhaps clinical perspective, and only briefly touches on the epidemiological nature of the problem in society at large. 

I liked this line, and felt it should be expanded upon:

"Our society makes it very easy for us to delude ourselves. People who exercise regularly are seen as “fitness freaks”, “sports fanatics” or similar, while “normal” people are the ones who lead physically inactive lives."

Recognising the societal nature of the problem is not to absolve overweight and obese people from responsibility: as with anyone who smokes / drinks to excess / abuses drugs and so on, personal change is required. But it's vital to understand why obesity is increasing, in order that society itself can make vital changes toward improved overall public health, and preventative medicine. We've seen similar cultural changes towards tobacco addiction, so it's not really a huge leap.

Most things that kill people in developed nations are influenced by lifestyle. Of course they're diseases.

He is very wrong about metabolic rates varying enormously between people.    I find it hard to credit how much my own has varied through my life.  If that range exists in one person then how different can different individuals be?

That's not accurate, sorry. The author of that piece was speaking about basal metabolic rate or BMR - the calories consumed at rest i.e. what is required to keep a person alive. Such non-activity energy expenditure is mostly accounted for by thermogenesis, with work of breathing, digestion of food, thinking, cellular repair etc. also playing their part. BMR is flexible to a small degree, but is only really influenced by how much fat-free mass one has. If you gain muscle, BMR increases (a bit) and vice versa.

Activity levels can vary hugely throughout life - in fact that's very normal. But the author is correct to say that variations in one's BMR, are not sufficient to account for large increases in fat mass.

I think a majority of the posts have acknowledged there are exceptions, so perhaps lighten up on name calling. Remember, one example does not make an argument!

As you say, there is always more to it. No one here is claiming expert knowledge but we all know that for a majority, IT IS a lifestyle choice...

I have have had Hyperthyroidism (Graves disease) and went from 63kg to 55kg for approx 6 months and had to buy a new wardrobe until it sorted itself. I'm glad I didn't get Hypothyroidism, especially being a climber!

Metabolism can up or down regulate depending on hormonal milieu. Fat is a hormonally active organ soonce you've been obese those empty fat cells will signal they're empty. Your 'lipostat' doesn't know if you are 'a fat person dieted down to normal' or a 'thin person starving'. Empty fat cells just keep signalling all the same.

https://www.nytimes.com/2016/05/02/health/biggest-loser-weight-loss.html

I've often wondered if the increase in thyroid issues over the last 20 years has anything to do with exctasy / MDMA use in the 80's, 90's and 2000's. I had Hyperthyroidism (Graves disease) and was diagnosed 3 months after I started climbing at 43. I did sh*tloads into my late 30's on and off for 20 years )

When I was younger and inactive by comparison with now (I discovered the mountains in my 20s and took a decade to reach anything like my fitness level now) I could consume a truly enormous Sunday lunch with seconds, pudding etc - my main interest in that period decades ago was electronics and computing and I took little exercise but was 10 and a half stone.  After the enormous meal I referred to I would become sleepy and want to doze, feeling a huge sweaty heat for an hour or so after which ~I would get up starving hungry!

Nothing like that happens now, modest meals and far more activity and I just put on more weight!

I can't run up mountains but I do tend to run down them for a significant  portion of the descent

burns nothing off

Never touched anything like that in my life

A quick google suggests that hyperthyroidism and pilling are a bad combo, but nothing about one causing the other. I think a couple of studies have been done looking at how people like you (heavy club drug users who've now settled down) were getting along these days, with a focus on depression and cognitive whatnot. Didn't turn up much - just normal people with jobs and families experiencing roughly the same level of misery and dysfunction as everyone else.

I don't disbelieve you, but suspect the explanation lies somewhere within a couple of main themes which would apply to many adults over the age of 30. 

- You are probably underestimating how active you were when you were younger. Despite the fact you're fitter now, I suspect your overall activity levels are reduced. You probably walked an awful lot more or used a bicycle for transport, as more of your destinations were local (and you may not have had access to motorised transport). You probably sat down a lot less. And finally, you may have still been growing.

- You are probably overestimating the overall calories you consumed when you were younger. Just as fitness is not equal to activity, huge meals are not necessarily indicative of an excessive calorie intake, especially for an active and growing person. You wouldn't have eaten such meals three times daily for any extended period, as you would have become obese. 

People really were more active 20, 30, 40 years ago, and youngsters especially so. This is known in the literature as NEAT: non-exercise activity thermogenesis. Our modern lifestyle, and the often-inevitable 'progress' into sedentary, office-based work for many people, contributes to a huge net loss in such activity overall.

Exercise is vital for all sorts of reasons including maintenance of body composition. However overall, fat mass is governed by diet and non-exercise activity.

Due to the nature of my work I transition between quite active and physical work and office based sedentary work, I keep pretty active myself but I have seen people who have moved from active work to sedentary work literally ballon over a period of months.

As someone who's involved in Scouting (and so know and have known quite a lot of teenagers) I have noticed many times over that when young people learn to drive (and it's a novelty, so they drive everywhere and stop walking/cycling as a mode of transport) they very quickly balloon.  Only the ones who are very active anyway (i.e. runners, people who cycle as a hobby etc) seem to manage to keep it off.

My work is sedentary (IT) and I mostly work from home, which means any exercise I get has to be deliberate rather than incidental, so can be quite challenging at times to keep it up.  While I prefer my current job to the one where I could do that, I do in a way miss living half an hour's bike ride from work (in an office with showers) as I used to a number of  years ago.

It's nothing like that, but never mind. The argument was about "food" calories and heat calories, which are the same thing, but like I said never mind, good forbid people should use the correct nomenclature. Anyone can use exactly what they want, that's up to them, but they not going to convince me I'm wrong, because "everyone" know what they are talking about.

Agree, at least that's something, but we all know what they mean

Cheers Jon, I have just been down that route and concluded much the same.

As a serious question and for the sake of Monkeygirl etc, I don't ask this to be smug or say, 'ooh look at me'. I'll ask out of a very serious curiosity.

Many people have openly claimed that they will eat if food is put in front of them and will eat more than they need. I have always eaten what I need. When I get to that point, I put down cutlery and stop. I literally have no desire to eat another mouthful. My body tells me that is all it needs. On rare occasions I do eat even a little more I feel lethargic.

Does anyone else experience this? I'm not concerned that in this one aspect of the millions that describe our humanity, that I am a little aside from the norm, but I personally find it quite interesting. I have sat next to friends that have eaten 3 times the amount I have in amazement because I just don't understand why/how they do it. I hope this comes across as a humble and genuine enquiry. Cheers all.

Do you have a rough idea of your heart rate when doing this? Activity causing your HR to operate between 125-150bpm will take energy from fat stores. I find walking at 6-7kph does this very well. Running at over 150bpm will take energy from carbs. (The BPM figures are useful approximations. We all have our own personal brackets near to these figures).

If you are going reasonably hard you may be in the carb burning phase which wouldn't help with weight loss too much. Just a thought..

Food calories and heat calories are the same thing when it comes to measuring what they both do. Raise the temperature of 1 gram of water by 1’C  

The number of food calories in a substance are not the same as the number of heat calories in that substance. 

The number of heat calories are the number of calories you get when you burn it. 

The number of food calories are a calculation based on fat, protein, carbohydrate and fiber in that substance. 

Therefore food calories and heat calories are not the same thing when it comes to food labelling. 

The fat burning zone is a bit of a myth 

https://www.google.co.uk/amp/s/www.washingtonpost.com/amphtml/lifestyle/wel...

i was under the impression it was seized upon by gyms and gym equipment manufacturers as a selling point. People could get the feel good factor of thinking they were helping themselves whilst not actually going through much discomfort. Another example of societal factors trapping people, most people who paid for gym membership would have been better off having a brisk free lunchtime walk

Or got of the bus a stop early 

 weightloss for me always involves some elements of anaerobic exercise either sprint sessions on the bike or running and weights.

It's a calculation that works out how much the food would raise the temperature of the water if burnt.  

I think that not everyone has the message about having had enough coming through correctly.  This is probably what we need to look at rather than shaming people.  

See the Scientific American link above. It is more sophisticated than that.

To convert fat your body needs excess oxygen. If your muscles are using all the oxygen during intense sessions you aren't burning fat whilst exercising. 

The reason people think it doesn't work is the fact you actually have a lot of energy stored in fat and doing the occasional few miles slowly won't have any impact on a person who is still over eating. They will have small muscular and cardiovascular improvements but their body fat level won't change. Fat level might increase if after their 3 miler they think they have earned their mars bar. 

It’s a complex calculation that works out how much the water would be raised if you only burned the carbohydrates, fat and protein and makes an adjustment for energy locked in fibre. 

1kg of coal has no ‘food’ calories in it. No carbohydrate, fat or protein. A label would say 0kcal but if you burned 1kg of coal you would get 7k kcal.

Kiroman claimed that not all calories in food  are available to us. That’s a correct claim. However the label on the food that tells you how many calories are in it, already is adjusted for that and only includes the calories that are available to the human through digestion. All of those calories will be absorbed and either expanded as energy in the muscles and brain or stored as fat. 

But they wouldn't, and that the point I was making, or at least trying to.

Considering there are no two people the same when it comes to almost any other measure, you seem to be suggesting, we all absorb calories the same and that's the end of it.

We all have different gut flora and transit times, they way people chew and the time they take to eat their food differs too, and yet your suggesting this makes no difference. There are studies on twins who ate the same food but gained weight differently one skinny the other obese and this was put down to gut flora,  so on the one hand you're telling us it's more complex than just measuring the calories in a substance, while on the other you're suggesting it's simply what you poke into your face that matters.

I'd say it's complex for both of these.

Yes. What happens to that energy that’s available is going to be different from one person to another. Some of that is down to gut fauna, some of it is hormones, etc etc. However - it will either be used to gain weight or it will be used to provide energy unless there is something seriously wrong with your digestive system.

The energy in is still the same for everyone. 

You could just as easily say lactose intolerant people won’t process milk, but that’s a completely different point. 

In a normal functioning human being. Energy in - energy out = increase in weight. 

You've stated that the measurement of calories is complex , when it's probably the easiest part, you burn some substance and measure the heat given off.  You then go on to simplify the most complex part, there are so many different variables, and state it's a simple formula, when it so obviously isn't.

I'd suggest you have this completely the wrong way around, but I can see you're not going to be convinced, so I think I'll leave it there.

What is a "normal" functioning human being, I'm not convinced there is a normal.

Not at all. You were trying to simplify the first part by saying you ‘just burn some substance and measure the heat given off’, they do not do that. Otherwise your example would give 7k kcal for a kilo of coal.

calories in - calories out = increase in weight. That’s indisputable. The calories out part is the only complex part. 

A normal human being is one who exhibits no symptoms of disease. ie pretty much the entire human population who doesn’t have a metabolic disease. 

And yet, when taking medication, there's a massive list of side effects which might occur, in some people and not others. But of course we're all the same.

You only have to look at alcohol to see how differently it affect some people in comparison to others, why the difference there?

I’m not sure you’re following. 

The energy going in will either be absorbed or burned. Where else will it go? 

Different people will absorb it or burn it in a different balance depending on a whole host of factors. Eg muscular people will burn more of the energy as heat, just standing still, while fat people will absorb the energy and get fatter. 

That kg of coal will not be absorbed or burned as it has no calories that the human being can utilise. But it won’t even be labelled as having those calories in the first place. If your sandwich says 450 kcal on the label, those 450 kcal will be used somehow. 

If you drink a pint of beer, that alcohol has to be processed by your liver. End of story. How your body reacts to the products that it is broken down into are pretty standard and will be slightly different for different people depending on a whole host of factors. But your liver will break it down, it won’t just pass through your system. 

Its a very simple well known calculation and is 100% correct. The complex bit is how and where the calories are proportioned out and why. 

It can be crapped out for one, it can be used by the bacteria in your gut and not transfer to you at all.

People digestive tracts work very differently, I've worked in sewage treatment plant and seem it first hand!

So the simplistic, food in - energy used = weight gain is bollocks!

Alcohol, can be pissed out, not all of it is processed by the liver and broken down, it can be detected in urine.

You've also missed out what happens with combinations of foods, again alcohol is a great example. Drink alcohol on an empty stomach and you'll get one effect, drink the same amount with a meal and it'll be totally different.

Since there are these obvious differences and wide ranging effects why do you presume food is the only thing that's different?

If the gut fauna are breaking down the food then they will either be increasing in mass or generating heat. If the gut fauna turn it to heat and stop the food from being processed by you then you won’t put on weight  

Alcohol mostly passes into your bloodstream directly through the stomach wall and is removed by the liver. 

You can burn sewage. It’s the food that you can’t digest. That’s where your kg of coal would sit. 

Burn 1kg of coal you’ll get 7k kcal of heat. Eat it and then excrete it and you’ll still get 7k kcal of heat. 

Burn a 450 kcal sandwich and you’ll get a lot more heat out of it than 450 kcal. The extra will be the same as you would get if you burnt your excrement after eating that sandwich.

The fact that some people put in weight and others don’t isn’t because some people don’t digest all their food. 

Which is exactly my point, so it doesn't correlate to food you put in your gob = energy for your body to use!!

But you will admit that people don't all digest their food in the same way?

Here's a little experiment for you , take a kg of peanuts and wash them down with water, chewing as little as possible, then follow thi with a kg of sweetcorn taken the same way. The next day (other transit times are available) have a look in the pan after you been to the bog this will demonstrate how people's chewing regime will alter the calories available for weight gain, and how available that may be between any two people, and that's only the start of it.

Does she get a say on the matter?

Strangely, (according to your theory) chewing more appears to get you more calories from your food. But studies have shown that people who chew more are leaner. 

Fair point. Bad choice of confectionary. marathon? (old school). 

More of a Curly Wurly and Yorkie man myself

No contradiction. Chewing more intensily may help extract more nutrients from a given amount of food, but chewing longer makes you feel sated earlier, causing you to stop eating after taking up a smaller amount of food in total.

CB

Not me, unfortunately.  I'm am at least a little bit hungry pretty much all the time, and not gaining weight requires a fairly modest but constant effort of willpower.

It wasn't a theory merely an observational fact, not everything that goes in you gob is used by your body, and this can obviously be a factor in why people might be different, which in turn demonstrates why a simple equation of energy in - exercise = fat, doesn't hold true, there's a myriad of other factors at work, including food combinations which can either increase or decrease the calories absorbed by the body.

Not strange at all really, people who chew more take longer to eat a meal, usually, giving their body more time to tell them they are full.

I tend to eat what's on my plate, it comes from not wanting to waste food, I think.

But I also don't tend to fluctuate in weight much, I've gone up in steps from around 10.5 stone aged 18-35, then 12st  until aged about 45 ish and now around 13 to 13.5st.

I can have long period of next to no exercise and long periods of enforced exercise (work), with either lots of food (and beer) or little food not necessarily coinciding with activity levels, but my weight remains roughly constant.

It’s energy in - energy out, not, energy in - exercise. 

Are you actually hungry, though, or just bored? I often feel like eating, but usually if I think about it it's more a desire to be chewing something tasty than an actual need for food. If I've got something sufficiently distracting to do I can sometimes go a surprising amount of time without the urge to stuff my face

Woah!  Just for a second there I thought it was 1984 and you were my mum. 

I know what you mean about just feeling like eating because you are bored, know the feeling and appreciate that it can be quite difficult to tell the difference sometimes.  But actually hungry, I think.

A powerful testimony right here: https://www.theatlantic.com/amp/article/579832/

Heartbreaking.

Yes people eat for all sorts of reasons, it's not simply because they'r lazy or stupid or both.

A friend of mine was molested as a child, she started eating because she knew the bloke doing it to her hated his fat wife, so that started her on the path of self loathing and despair, which continues to be a battle today.

She's one of the cleverest people I know, and she's now scared that if she looses loads of weight she'll have loads of spare skin etc.

It;'s all very sad, and not easy to understand, but it's certainly not simple.

loses

Sorry, I think you're one of the intelligent posters on here whose opinions I respect but loses/looses does my head in.

Exactly.

The reason why morbidly obese people behave as they do is as worthy of scientific investigation as the reason why some  skinny people starve themselves to death.

If it means that  severe obesity is classified as an eating disorder on the same scale (spectrum) as anorexia, bulimia and so on  it can only be a good thing.

If she does it gradually enough she might not have any? The daughter of a family friend was unhealthily overweight, and she'd walk downhill to work each day, approx 3 miles or so, and over time she gradually shed the weight and her skin has changed inline with it. She's a 'normal' shape and size now, perhaps a 14 (at a guess). 

In the context of a lifetime, it taking 3 years or so isn't so long...

Telly programme shown on BBC4 last night:  https://www.bbc.co.uk/iplayer/episode/b07fys2y/horizon-2016-11-why-are-we-g...

'Horizon', so it's not particularly um..  technical, but there's some interesting stuff about gut flora and wotnot. 

(Is it me, or has 'Horizon' been 'dumbed-down' a bit over the years?  Could just be nostalgia, but I'm sure you used to have to pay attention and concentrate a bit to keep up.)

Interesting, I will try to get somewhere with a TV licence to watch this. I have heard a few speculative ideas about gut bacteria affecting weight etc. Does this go into it deeper? Have there been bigger studies into it?

Good lord no. 

They meet and interview a person in the US who had a faecal microbial transplant to treat a severe c-diff infection.  She had always been slim, the donor was her obese daughter.  The treatment was stunningly effective for the c-diff, but she began to dramatically gain weight immediately afterwards. 

From that they segue into a piece about a trial apparently underway to investigate the possibility that using faecal microbial transplants to alter the gut flora might be an effective treatment for obesity for some.

Back in the UK they discuss it a bit with someone researching gut flora from a similar perspective over here. 

You might find it interesting, but if you already know something about this stuff probably not very informative.

Not just obesity but rickets from lack of sunshine and massively stretched bladders in gaming teenagers who ignore the need to pee and whose bladders end up flabby like a deflated balloon.

Sounds like the same story I saw a while back. It was part of a programme (may also have been Horizon, certainly of that style) on gut bacteria. It was mostly looking at its effect on immunity and children with multiple allergies, but it also had this story on it. 

I have done a little internet searching on the subject (nothing very indepth) and it looks like there have been some small studies. Maybe it's an area that will get more attention at some point, as it sounds like it may have an effect on a number of areas of health.

I also read a BBC article today on fibre and its effect on weight.

https://www.bbc.co.uk/news/health-46827426

You serious?! Oh my, that's scary. Does it make them incontinent? I might share this with kids who won't pee when out on the hill. I tell them about urine infections etc and dehydration from not drinking, but a flabby deflated balloon bladder might be an image that does the trick!!

Busy day and relying on spell check, which didn't flag it up

I think a lot of the success in this area depends on age, but even so, it's the perception of what might happen, i think might be part of the issue.

@Deepsoup I watched that program too, very interesting and obviously confirmed it's not just a simple matter of  eating too much , when genetics and gut flora seemed to be factors involved.

Since there are a number of factors in most things in life that affect humans, I can't see how it's simply a matter of how much food you poke in your face, while this is eventually the root cause, there are more complex issues between individuals and the combinations of foods, environment, gut flora (or lack of it), etc. which will make one person fat while another stays thin.

They also interviewed a set of twins, who had very different levels of a particular bacteria, one fat and on skinny, but you're right Horizon has dumbed down, I think it's getting bet than it what a few years ago, when they seemed to think using a steady cam was a substitute for facts and science, but it's not like it used to be in the old days

Unless it's us of course

The gut flora research is so interesting and definitely needs further study. I read yesterday that we carry 10 bacteria for every one of our human cells, and in fact - get this for a statistic! - 99% of the DNA in our bodies is bacterial. We are only 1% human!

I strongly suspect the classification of obesity as a disease is linked to the gut microbiome. We get our initial doses of good bacteria from the birth canal of our mothers, and from her milk. In a world of increasing c-sections and formula milk those bacteria aren't being passed on. So perhaps we are seeing children being born for whom healthy gut flora has literally been bred out of their family line. Luckily there are things we can do to improve gut flora (just as there are things we can do to treat other diseases), one being let our kids play outside and get dirty in a natural environment. (Although as the average child in Britain apparently now has less outdoor time than a prisoner, this may be an uphill struggle...)

It would also be interesting to see if the amount of highly processed food that many people now eat is part of what is changing the gut flora. Maybe the additives have an effect? Maybe the excess of sugar has an effect? Maybe the excessive use of cleaning products in our homes? (I'm certainly not guilty of that one! Lol). There must be a wealth of stuff to look into surrounding it. 

Studies in Austria and Canada have shown that rural kids grow up with less allergies, asthma etc... and it isn't purely down to reduced air pollution. 

City living, with obsessively clean houses and parents who produce hand gel for their kids every 5 mins isn't likely to help them develop a tolerance for anything. 

Yep, and some research from last year seems to indicate that childhood leukemia is linked to (caused by?) a lack of exposure to common germs in early infancy.

Not just you. I too think it has been dumbed down and is also made in a way to make it "more exciting"  eg., odd camera angles, rapidly changing images. I agree there was a time when you had to follow it carefully to get the ideas.

Dave

I thought I saw a piece recently about the food you eat not affecting your gut fauna with as much as is thought. In particular debunking the good bacteria yoghurts as a waste of time and money. 

Yep. Antifragility. Check out Jonathan Haidt's book where he talks about parents being ENCOURAGED to expose their newborns to peanut derived products. The outcome was 3% developed a peanut allergy compared to 73% in the control group; Avoiding peanuts leads to peanut allergy. You need to prime your immune system early on.

There are lots of old Horizons available on archive to watch now and it is amazing how much information content some of the ones from the 70s have, rather than spending the money of shiny analogies, coffee table glossy images and facials of the presenters and trips all over the world.

on reflection perhaps that should have been faecials!

One of my favourites is the moment the UK woke up to the coming microprocessor revolution - Now the Chips are Down from 1978/9, something which caused such consternation that the government launched the Microelectronics Education Programme/Microelectronics for All initiatives that saw blue board systems put into schools from Unilab and eventually the Computer Literacy project leading to the BBC micro

Not entirely. Much of the resistance or absence of asthma was put down to additional exposure in the countryside, not what they weren't being exposed to in cities.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069066/

What, they're the same thing, surely? If people are being exposed to additional things in rural areas, they're things people are 'not' being exposed to in the cities...?  

Which is what I posted. ''The increase in allergies in cities is meant to be down to fewer air born 'bits and pieces' which challenge the immune system, which one finds in rural areas.''

Edit: You could have an argument with an animal which just wanted to be friends.

It's not just bacterially CLEAN food, it's food made from the basic commodities that contains preservatives, which inhibit oxidation and bacterial growth. What must that be doing to our guts?

Drink more real beer, I say.

I say something on telly the other day , which suggested premature birth is a factor in allergies and asthma, sorry can't remember where this was though.

Thanks Wercat, I didn't know old Horizons were available.

Dave

My understanding on what I read about yoghurts is that while you are healthy, they make no difference. However after a stomach bug or a course of antibiotics, the current advice (I think, it changes all the time!) is that then natural yoghurt does help.

I read something else saying that certain foods feed certain gut bacteria and therefor encourage them. So they may not directly give you the bacteria, but eating the right things could feed and encourage the good stuff that is there. I am not a biologist, so can only really understand the dumbed down articles, so this may not be the full story!

Well according to last night's Horizon one solution is for fat people to eat the shit of thin people. They called it faecal transplants and had film of such a procedure being carried under under general anaesthetic using something resembling a Karcher power wash hose but you get the idea. While watching it I was reminded of an Irvine Welsh story and that Monty Python sketch about being an ear wax donor.

No, it's not just you. I used to enjoy Horizon when it was more proper science program rather than the "tabloid" science it seems to be these days.

From what I understand, fermented foods are meant to be beneficial (eg sauerkraut, kimchi). Also eating a wide variety of plant types, and as much of the plant as possible. The harder-to-digest bits - such as apple peel, broccoli stalks, the green of leeks instead of just the white - go further down into your intestine before being digested. This feeds the bacteria living in your lower gut and ensures a larger overall number of good bacteria in your system.

Thought the same about the Royal Institute Christmas Lectures from a couple of weeks back: a long time spent to explain a few facts by way of, as you said, 'more exciting' methods e.g. a horse brought on to the stage, the ubiquitous round of applause after a member of the audience has managed the simplest and most mundane of tasks to 'help' with a demo. Yes, I know it's aimed at a youngish (teen?) audience but surely they aren't all that slow on the uptake? Saying that, I thought Brian Cox's lecture a few years ago was really well done.

Not really. 

If you live and play outside rurally, encounter more animals... you will digest a large range of bacteria etc.. Or breath in a greater volume of pollen etc.. 

As opposed to say vehicle fumes in cities. 

So as i said the resistant comes from additional exposure to different natural things, not the avoidance of certain types of man made ones. 

The jury seems to be very much out as pro-biotics covers a huge area and no one knows much much of them you’d have to consume. 

From today’s BBC news; it’s all about Fibre. 

https://www.bbc.co.uk/news/health-46827426

I think a lot of programmes went mass market more than a decade ago. Chasing viewing figures, rather than in depth content. Countryfile being another. 

That, but also the effect of gut flora over 'eating too much' - how much you feel hungry and when you feel full.  I think a lot of people of the "just eat less" school of thought are failing to appreciate how difficult that can be to do.

I thought it was really trite when they asked the professor doing that 'twins' study what the other twin could do and he produced a load of dishes of 'Mediterranean peasant' type food by way of an example of what she should be eating to boost the numbers.  (And patronising - more to do with the 'dumbing down' of the programme I guess.)

But on reflection, it's interesting that maybe there's a kind of 'positive feedback' going on there.  If eating a 'healthy' diet is something that encourages the 'good' kind of gut flora, which in turn reduces appetite, changes the nature of food cravings etc.  It's the sort of reinforcing mechanism that leads to relatively minor changes having bigger than expected effects - perhaps where someone having a bit of a poor diet might end up piling on *tons* of weight rather than the little bit you might expect.

Yes, although I've seen studies showing correlation between good gut flora and a healthy weight, it's never been clear how much is causation and in which direction it's running! As you say, a positive feedback loop seems very likely.

I did something similar but less dramatic a few years back.  At that point in my mid '40s I'd been more or less fit at various times, had made a conscious effort to get into shape a few times over the years by hitting the gym and shedding some fat while gaining muscle mass.  (And while not losing, perhaps even gaining, weight.)

It suddenly struck me that I really was a bit tubby, and had been in denial about it for a while.  I cut out the takeaways, reduced the beer intake, upped the exercise and over the course of probably about 8-9 months or so dropped about 2 and a bit stone.  Actually quite easily, I was really surprised, I'd always thought it would be really difficult to lose weight.

I stuck with the changes in diet, but have never weighed portions, counted calories or any of that.  About this time last year I realised I'd fallen out of the habit of weighing myself every day and while I hadn't been paying attention had put about a stone back on again. 

Started weighing myself every day again, and since I'd bought a second-hand Garmin watch on here a wee bit previously and started using it to track runs, put the numbers in to the website each day.  It's interesting to look at the 'last 12 months' chart now, it's a very jaggedy line with daily fluctuations but there's a clear trend as that stone comes off again steadily between Dec 2017 and about June 2018.

Since then it's been a bit of work, much harder than initially losing that 2 1/2 stone odd was, to maintain my weight where it is now.  I'm slightly hungry just about all the time.  If I eat until I feel full, my weight is going up.  Consequently, I'm thinking about what I can eat, when I can eat, etc., probably more of the time than is really healthy. 

I'm quite well educated, mental health is ok, have a decent amount of disposable income and a fair bit of free time - it's really easy for me to imagine how a change in circumstances could make it extremely difficult to keep the weight from piling back on.

So, even though just eating less is undoubtedly necessary for lots of people, I see that the "just eat less" school of thought lacks nuance to the point of being completely useless from a public health point of view.  There is a big difference between "it is easy for me" and "it is easy for anybody".  Furthermore, "it is easy for anybody" is not the same as "it is easy for everybody".

If relatively minor changes to diet can influence the gut flora and in turn lead to a change in the way appetite etc., is experienced that seems really interesting.  I think I'll have a look at that, maybe try a few little experiments, see if I can reduce the workload on my feeble willpower a bit and give myself a better chance of staying in decent shape long term.  If I find something that works for me I won't care if it "really" works, an effective placebo will do nicely.

There was a brief mention of another interesting and counter-intuitive thing in that programme - how the environment in the womb can effect the way genetic factors are expressed.  Certain genes being 'switched on' or 'switched off' in the developing fetus according to the diet of the mother at the time.

It suggests another kind of positive feed back loop I guess.  Almost a kind of heredity.  A mum with a diet that has a lot of highly processed foods might be more likely to have a baby who will grow up to be more susceptible, so perhaps a child more likely to gain weight, or likely to gain more weight, than you might otherwise expect just from the eating habits of the family as a whole.

It does away with the old science-fiction trope of "aliens obtain DNA sample, clone human".  It seems the aliens are going to have to clone thousands of different species to produce an adult human that wont just die immediately.  We're not only the products of an ecosystem, we actually are an ecosystem.