What is obesity and how can we beat it? National Obesity Awareness Week

Whether it’s being more physically active or keeping a closer eye on what we eat, even small changes can go a long way to promote healthy living. Healthwatch Dorset volunteer Richie, who studies Nutrition and Behaviour at Bournemouth University, is here to share some of his ideas.

Obesity

At any time other than the 25 of December, would you add sausages wrapped in bacon to an exceptionally large roast dinner, follow it up with a stodgy, liquor-filled pudding that you previously set on fire, then wash it down with hot red wine?

Perhaps you would, or perhaps you’re vegetarian, tee-total, or Muslim and you’d never do some of those things. All this serves to illustrate the variety, cultural complexity, and sometimes irrational nature of our consumption. If December is traditionally the UK’s month of gluttony, then January is the month of moderation, and it coincides with Obesity Awareness Week, an invitation to digest a very real issue.

What is obesity and why does it matter?

The condition of obesity is defined by an excessive accumulation of body fat that can cause health issues such as type 2 diabetes, stroke, coronary heart disease and some cancers, it also puts individuals at greater risk of experiencing severe symptoms of infectious diseases such as COVID-19.

Obesity can adversely affect quality of life through symptoms such as breathlessness, snoring and joint pain. It can also lead to psychological issues like depression, anxiety and low self-confidence, all of which can exacerbate the problem.

The NHS defines an individual as obese if their body mass index, or BMI, is 30 or above. However, BMI is a crude indicator of a person’s body composition, and because the location of fat is an important indicator of health risk, waist measurement or more sophisticated methods of assessment are commonly sought in addition.

Aside from the health risks, governmental sources estimate that we’ll be spending nearly £10 billion of the NHS budget on overweight and obesity by 2050 (1), with other societal costs at nearly £50 billion.

What are some challenges to overcoming obesity that we should be aware of?

A militant personal trainer might tell their obese client that they need to cancel Christmas, move more, and eat less in order to create a calorie deficit (to use more energy than they consume).

While there is some fundamental truth behind that advice, it’s not particularly helpful, practical, or motivating for the majority of people struggling with obesity. Said personal trainer would likely not tell a client to perform a technically perfect squat without some indication of how to do so, or without considering the client’s current strength when selecting an appropriate lifting weight. A similar focus on the method and individual differences ought to be applied to nutrition, and an understanding that not all calories are digested equally (2) would help to shift the advice from nutrients to actual, real, edible foods!

Fat loss is challenging, there is no wonder-pill, and the January tradition of fad dieting often advocates oversimplified, quick-fix solutions to weight issues which are unsustainable and may even be unsafe if they omit entire food groups. Such diets often highlight ‘sins’ or ‘cheat days,’ which can promote divided thinking, an unhealthy emotional relationship with food, and lead to feelings of failure when the rules are breached.

Having said that, short-term, well managed, restrictive diets can be effective for rapid weight loss and even the accompanying remission of early-stage chronic disease (3), but the addition of sustained lifestyle advice and support is key to avoiding relapse into obesity for the majority of people.

The most important factor in the effectiveness of a particular diet is adherence to it (4), so if you tell somebody that they have to eat celery you have to be sure that they like it, have access to it, can afford it, deem it culturally acceptable, know how to prepare it, and aren’t going to give it up after a week. This food screening process is shortened significantly when the suggestions come from the dieter rather than being dictated purely by the coach. This collaborative goal-setting method also promotes greater self-sufficiency, empowerment and, crucially, adherence (5). Remarkably, adherence also improves when people aren’t told to just eat celery.

What’s already being done and who can help?

In the UK it’s well publicised that we should consume a balanced diet with plenty of fruit and vegetables, stay hydrated and limit our alcohol intake; we should avoid trans fats, high salt contents and too much processed food.

It’s longstanding advice and people generally know some of it (if you need a reminder, here are the national guidelines). The tricky part, as ever, is translating our knowledge into action.

Recently it was announced that unhealthy snacks will be banned from UK supermarket checkouts to reduce the likelihood of impulse buys, a behaviour change psychologist might call this 'restructuring the physical environment'.

The national change won’t be implemented until 2022 though so you can try restructuring your own physical environment by substituting some unhealthy snacks in the house with nuts or seeds for example. You may be inclined to snack less often and if you do it’ll likely be richer in vitamins and minerals, with a higher protein and fibre content which make you feel full.

Both that suggestion and the governmental scheme won’t please or help everyone because they cannot account for individual circumstances, but there are organisations dedicated to unearthing the techniques that work for disparate individuals. Locally, and to that end, LiveWell Dorset is a free lifestyle advice and coaching service funded by the council. They offer six x 20 minute one-on-one telephone coaching sessions that help people take positive first steps towards improving their health.

Another organisation that provides personalised, evidenced-based, and effective weight loss support is Second Nature. They offer an initial three-month App-based programme alongside daily assistance from qualified dieticians and nutritionists, and subsequent follow-on programmes for continued support.

In summary, obesity is an important and complex issue but fortunately it’s preventable through lifestyle and habit change, and help is available in this country. Lasting dietary change is a process that tends to come gradually, involves lapses, and should allow for the continued enjoyment of food. So whether people are driven by the carrot, the celery stick, or likely more complicated behavioural mechanisms, there’s never been a better time to do something about obesity, it is January after all!