You do realise that BMI is a statistical tool and not a diagnostic one right?
According to the NHS report, Statistics on Obesity Physical Activity and Diet 2018, 26% of adults are classified as obese. When you look at the split between men and women that numbers get even more interesting, a higher percentage of women than men are obese (26% for men, 27% for women) but a higher percentage of men are classified as overweight than women (40% for men versus 30% for women).
So what does this tell us?
Considering the UK is sixth in the world obesity rankings (with the United States topping the charts) the situation has given rise to some controversial headlines, with national newspapers such as The Independent and The Guardian dedicating significant space for the discussion, but could it be that we've got the question of obesity completely wrong, or at least looking at it from a skewed perspective?
The 2018 NHS report holds the key, and on further examination (rather than just sound bites from news reels and click bait headlines) could it be the very way in which the conversation around obesity, and creating strategies to deal with it, be a part of the problem?
Consider the opening statistic I gave you from the NHS report, 26% of adults are now classified as obese, when you take into account that is a 15% increase since 1993 it sounds like a lot.
If that continues exponentially then we are certainly heading for an obesity epidemic, just like the experts predict. Yet you'd be missing one important fact also stated in that report, obesity levels in adults have been similar since 2010. No drastic increase, in fact it's stabilising.
Now lets look at admissions to hospital. For admissions into hospital where obesity is the primary diagnosis there is an 8% increase since the 2015/16 report, with 3 out of 4 admissions being women. When it comes to hospital admissions where obesity is a secondary admission there was again another increase, this time of 18% (women accounted for 2 out of 3 admissions). Here's where it gets fascinating.
Barbiatric surgery is often used to facilitate weight loss (though it is often used for other health conditions) It includes stomach stapling, gastric bypass, gastric band maintenance and sleeve gastrectomy ( ). Barbiatric surgery is used for for people with a BMI of over 40, or those with a BMI of 30 - 40 and secondary diagnosis such as type 2 diabetes, or heart conditions.
There NHS has seen an increase in this type of surgery too, in fact a 5% increase than in 2015/2016. Yet the report clearly states that this is still a 23% decrease when at it's peak in 2010/2011.
So now lets talk about medication for a moment.
"401 thousand items were prescribed for the treatment of obesity in primary care in 2017. That is 10% less than in 2016 and continues a downward trend since a peak of 1.45 million in 2009.
In real terms, the Net Ingredient Cost (NIC) to the NHS in 2017 the cost was 6.9m GBP, which has fallen from 9.9m GBP in 2009 and 51.6 million in 2007.
That's a 87% decrease in cost - so either the NHS was paying
an exorbitant amount for prescriptions or all of a sudden a lot of obese people suddenly
Now consider that since 2001, death rates from heart disease and stroke have halved for both men and women in the UK, yet the rate of obesity in adults have remained at similar levels since 2010, you can see that something doesn't quite add up.
Are we turning now to less radical non-clinical interventions?
That could very well be. But what does the report tell us? 39% of adults were actively using a weight management aid - with the second highest being gym and exercise. Diet clubs, NHS services and local weight management programmes were at the bottom of the list. There is clearly room for improvement here.
Obesity is now "disease of the poor" and experts warn it's because healthy food is too expensive
That was an actual headline from the UK tabloid newspaper, The Daily Mirror. This belief was also propagated by celebrity chefs such as Jamie Oliver, who was quoted as saying that,
"Obese poor think in a different gear.
No, for real. That's apparently a legit quote. If you want to continue to feed the stereotype of fat people being, stupid, lazy, ignorant, poor and incapable of helping themselves, this would be a great way to do it.
Lets dehumanise obese people, and slap them in one big box so that that we don't have to deal with the complex reality of the situation. Here's the thing, the NHS report doesn't exactly support this view of obesity being related to class - not when it comes to adults anyway.
The report highlighted that with adults obesity and area deprivation varied between women, but not so with men.
What does this look like? 38% of women were obese in deprived areas compared to 20% in less deprived and affluent areas. But when it came to the men, regardless of deprived area or class status the prevalence of obesity levels remained pretty consistent at around 25 - 29%.
So what does this potentially tell us about obesity in adults? That income level is not defining, and other factors such as gender come in to play.
Poor people being fat, lazy and incapable and "wired differently" is an easy narrative trap to fall in to. But that doesn't make it right, and doesn't make it ok.
So how did we get to this? Well, when the NHS report looked at the levels of childhood obesity is noted that childhood obesity had fallen in reception year, but increased in for Year 6 since 2009/10. They then mapped this across to deprived and less deprived areas and found that the higher prevalence was in deprived areas.
This is something that needs to be addressed. But I strongly believe educating on food that is readily accessible and how to make better food choices that are within your budget, without having to resort to snorting wheatgrass and pissing prana energy is key.
Not only that, but we need to take a 360 degree approach. I wonder ow many people have had a traumatic life event, such as a death, abuse, fleeing from war or relationship breakdown and felt their life fall apart at the seems, with their self care spiralling out of control.
Simply telling them that,
"You need to eat less calories. That's why you are fat - and get more active ya lazy bastard"
Isn't going to be the most effective strategy, nor the smartest one.
Plus, what experts not working in the trenches often fail to realise is that there is a false belief that your diet needs to be perfect. Not so.
Most people already know that they aren't going to be perfect - so why try? Or if they do, it is an "all or nothing" approach, and when they fall off the wagon, they resort to eating habits that impair their health.
Your diet doesn't need to be perfect. You just need to remember that your nutrition exists on a continuum
Worst option ---------->Better Option-------------> Best Option
Do what you can, with what you have, and start where you are. If it's not simple it's not sustainable.
So what's my point? I'm not one hundred percent sure. I'm just here to clear up some myths and provide perspective.