Obesity

Obesity (More in Chapter 8)

There was very little control from the EU in relation to obesity. We are the fattest country in the EU. We already have enough control to improve the situation. It must be part of any discussion about our future food and farming. In the book Bittersweet Brexit, it shows how we came to adopting the (US) Dietary Guidelines which demonised fat - that favoured processed corn products in the USA.
"Overeating could be the most rational response in a dysfunctional, uncaring, unequal, unnaturally commercialised society." Yasmin Alibhai-Brown

Class Issue


It is poverty, not individual choice, that is driving extraordinary obesity levels. "Obesity is not just a matter for nutritionists: rather, it is a product of social inequality and requires a collective social response."
Check out Paul Heaton and Jacqui Abbott singing about in 'The Fat Man'.
Is 'fatphobia' a class issue? "Eating problems and social class are inextricably linked. Being healthy is a symbol of privilege... On the opposite side of the spectrum, fast food and obesity have come to be associated with those on a lower income."
Jamie Oliver says "For families on the breadline, eating healthy food is secondary to eating at all.”
SNAP incentives in US (like a coupon, token or debit card) simultaneously increase consumption of nutritious produce and stimulate local economies by unlocking demand for fruits and vegetables. Moreover, when linked to local agriculture, the benefits expand to support the foundation of local economies. See Preston Model for more

Globesity


The Lancet asked (April 2018) "how is it that obesity has nearly tripled worldwide since 1975?". Obesity was first noted in late 1970s in USA. “It is implausible that each age, sex and ethnic group, with massive differences in life experience and attitudes, had a simultaneous decline in willpower related to healthy nutrition or exercise”, but rather that it is important to consider factors that have a mass exposure, are widely distributed, and act with short time-lags. The US farm bills in the 1970s appear as a strong candidate, which led to a rapid increase in food production and thus an increase in food portion sizes; accelerated marketing, availability, and affordability of energy dense foods; and widespread introduction of cheap and potent sweetening agents, such as high-fructose corn syrup, which infiltrated the food system and affected the whole population simultaneously. This observation might well extend to other countries, such as the UK and most European countries—as most populations have been exposed to similar substantial changes in food supplies, with consequences for dietary patterns." This echoes the chapter on obesity in my Bittersweet Brexit book!

Schoolchildren

Record number of severely obese (BMI = 40+) school children Levels of childhood obesity have remained fairly stable in recent years, but a new analysis, from Public Health England, shows that severe obesity has been on an upward trend over the last decade - now one in 25 (over 20,000) on leaving primary school. With a national average of 4.1% children severely obese, there are 4.9% in Blackburn, Accrington 4.7% and Burnley 4.5%. Over the hill in posh Ribble valley it is 1.4%.

Did more fat people vote for Brexit?

Here is a curious finding. The top ten districts voting to 'Leave' in the Referendum are associated with high proportions of obese adults, while top ten ‘Remain’ districts are much leaner. This result does not correspond with obesity and poor districts. One suggestion is that it may be driven by personality traits that characterise both ‘Leave’ voters and obese adults. I’m not sure about that, as the top three ‘obese’ districts are in the fens with the plantations, and the bottom three in East London with no fields. But I’ll leave that to you to decide.
Leave voters prefer 'well done steaks', Remain 'medium rare'. Surveyed in April 2017 about the environmental impact of eating meat, 24% of Leave voters said they were “very unwilling” to consider “eating less meat and fewer meat products in the future”. Only 9% of remain voters felt so strongly carnivorous.
Theresa May seems startled with chips while Ed Miliband struggles with a bacon sandwich. Leave voters overwhelming declared that Ed Miliband eating a bacon sandwich was far worse than Theresa May’s chip-eating face: 76% said Ed looked worse; just 6% said Theresa. Remain voters were more evenly matched, with a quarter saying Theresa’s chip moment was worse, and half plumping for Ed.
The question that needs answering is: "Why do we consume more ultra processed foods in Britain than any where else?"

Processed Foods


A study of 19 countries has found that the UK has the most ultra- processed food per household amounting to over 50% of dietary energy. "A significant positive association was found between national household availability of ultra-processed foods and national prevalence of obesity among adults..each percentage point increase in this availability resulted in an increase of 0·25 percentage points in obesity prevalence." More The UK Dietary Guidelines are pre-occupied with reducing fat levels urging us to consume only around 10% of dietary energy as fat, and virtually 'ignores' ultra-processed foods. More in Bittersweet Brexit book.Study of over 100,000 people in mid forties found that with every 10% increase in proportion of diet coming from ultra-processed foods, this increases overall cancer rate by over 10%. Further work is suggested as whether these results are due to " nutritional composition, food additives, contact materials, and neoformed contaminants". The ultra-processed truth bout 10 of our bestselling foods.

BMJ Could we agree to demonise processed food not saturated fat? "Clarification of the distinction between processed food and saturated fat could provide opportunity for agreement that processed food is unhealthy, while saturated fat is a natural part of most natural foods."

Fats or Carbs?

The book - in the science section - went into some detail looking at the history of how the dietary guidelines were produced and how the 'fat makes you fat' gained so much prominence over sugars being the main culprit for obesity. The UK is the most obese country in Europe - whether or not we Brexit.Big new study of 135,000 people 'found no evidence that below 10 percent of energy by saturated fat is beneficial, and going below 7 percent may even be harmful.' Moderate amounts of fat (35%) when accompanied with lower carbohydrate intake (50-5%) provide best balance. PURE study in The Lancet. Science Daily summary
Low fat diet could kill you says Telegraph. Oxford Professor Susan Jebb, the government’s former obesity tsar, the findings supported UK guidance, “This is a thumbs-up for UK recommendations which advise up to 35 per cent of energy from fat and an average of 50 per cent of energy from carbohydrate - of which only 5 per cent should be sugar." I wish these were the recommendations, but Public Health England (PHE) clearly believe otherwise.. As, Dr Alison Tedstone, chief nutritionist at PHE said a high fat diet could lead to weight gain and increase the risk of heart disease. “We recommend a balanced diet based on starchy carbohydrates, while reducing total fat intake and swapping saturated fats for unsaturated fats.” That is the recipe of the dietary guidelines that has led to - not cured, obesity.
Full fat milk could reduce strokes - by over 40% The study of 3000 people over 22 years, using various biomarkers, found that "dairy fat, contrary to popular belief, does not increase risk of heart disease or overall mortality in older adults. "In addition to not contributing to death, the results suggest that one fatty acid present in dairy may lower risk of death from cardiovascular disease, particularly from stroke." The researchers said that low-fat dairy foods such as chocolate milk and low-calorie yoghurt often include high amounts of added sugars which may lead to poor heart health.
Vindication of cheese, butter and full fat "The average American in the 1970s drank about 30 gallons of milk a year. That’s now down to 18 gallons"
Both low and high carb diets increase risk of early death. Medium carb diets (40-70% as recommended by most) not included in observational study. "what counts most is the type of fat, protein, and carbohydrate".

Big Sugar

How to take on 'Big Sugar' and win says "“Parents are literally killing with kindness...In Britain, one in 10 children are already obese when they arrive at primary school at the age of five. That doubles to one in five when they leave primary school, aged 10 or 11. And the most vulnerable are the poor "Sugar Association paid in the 1960s the equivalent of $50,000 to three Harvard scientists to review existing research. The Sugar Research Foundation set the review’s objective, contributed articles for inclusion, and received drafts. Published in The New England Journal of Medicine (in days before you had to declare any conflicting interests), it critiqued the evidence linking sucrose to coronary heart disease - helping policy makers off of that path. "The attention turned to fat and away from sugar".
Global Energy Balance Network a non profit organisation, backed by Coca Cola to tune of $1.5 million last year, aims to promote a new “science-based” solution to the obesity crisis: To maintain a healthy weight, get more exercise and worry less about cutting calories. More on 'Energy Balance'
Eat to Run Dan Saladino meets the runners convinced low or no carbs is the way to peak performance based on Prof. Tim Noakes advice. He was found not guilty of misconduct bought by Association of Dietetics South Africa.
Take part in Sugar Smart September Gather stories and case studies from individuals, get other organisations more active in your campaign and spread the word.

Sugar Tax

What you need to know. Introduced April 2018. 50% of manufacturers already reduced sugar content - so much so that the Treasury has reduced its estimates for tax revenues to below £1/4b. The tax is to help improve primary schools' sports. The trouble is that sugar may be replaced with sweeteners - which are as bad for obesity and diabetes.
Others fudge saying 'eat more fruit and vegetables and more fibre, forget the fat v sugar debate'. But this ignores the obvious issue that most people think that fat is the problem - because that is what is shouted at them all the time.
Town in Mexico with little drinking water. Coca cola everywhere and so is surge in diabetes. If diabetes were an infectious disease the cola plant would be closed down.

Guidelines

NICE guidelines

GPs must refer almost two million overweight people for NHS cooking and exercise classes at £435-a-head. Classes are a mix of one-to-one and group sessions where patients are taught healthy recipes and the importance of eating fruit and vegetables. I predict this wont be very effective. Because 1. Education part sounds well meaning, but if based on the Dietary Guidelines, it will not be effective, as has been shown in the past - they do not work - see Chap 8. They do not address refined food reduction enough, and lump ‘fats’ into equation, whereas consumption up to 30% energy intake is sensible. Let's see what happens after a year - the project needs to be evaluated.
2.While working with of ‘Our Life’ 'Talking Food, Taking Action' we visited areas of deprivation to discuss with people why they didn't eat better. It wasn't because they didn't know they should eat more vegetables, but because of access. Sometimes they are not there (Cleator Moor) but also because there are ‘too many takeaways’ i.e. cheap already prepared readily available food. Not a matter of knowing, but being surrounded by obesogenic environment.

Eatwell Guide

UK's official guide - produced by medical profession for public guidance. Could it 'actually be harming us?' BBC Food Programme.

Plates, Pyramids and Planet

This FAO report "evaluates government-issued food guidelines from across the globe, looking in particular at whether they make links to environmental sustainability in addition to promoting good eating habits." They found only four countries who did. These included Sweden who emphasise more plant based foods. "Brazil’s guidelines stand out for emphasizing the social and economic aspects of sustainability,... and to avoid ultra-processed foods that are not only bad for health but are seen to undermine traditional food cultures."

Childhood Obesity plan 1 year on.

Government's version 'world-leading obesity plan' 1 Children's Food Campaign differs saying' It is shocking that the Department for Education has been allowed to disregard the commitments it made in the Childhood Obesity Plan. A search party may be needed to track down any signs of progress the Department has made. The list of inaction includes ....2 The Healthy Ratings Scheme for primary schools is yet to be drawn up, despite the promise to bring it in from this September.3 The Secretary of State for Education was tasked with leading a campaign encouraging all academies and free schools to meet the School Food Standards, but this has not happened.4 The Standards themselves have not been revised to meet new nutritional guidance.5 The revised early years menus have not been released either, despite assurances they would be.
2 years on sugary snacks to be banned at checkouts and halve childhood obesity by 2030

3/4 million new cases of cancer world-wide attributable to diabetes and high BMI Lancet

FAO EU FIRST

Partnership between FAO and the European Union (EU), whereby the EU invests €8 billion in over 60 countries 2014–2020 period to improve food and nutrition security and sustainable agriculture. The FAO supports an institutional environment in which investments have tangible impact. (Check that they blame animal fats nearly as much as processed food - although they do recognise it's damage.) What is the UK going to do instead/as well?
Policies for healthy lives - a look beyond Brexit says "Promoting a health-in-all-policies approach to post-Brexit arrangements could put centre stage the protection and promotion of the public’s health. "