Are we really facing an obesity 'epidemic'?

[Psamathe]

http://www.worldobesity.org/site_media/library/resource_images/March_2014_Global_Trends_updated_4.pdf

This is based on BMI, but I doubt it's due to increasing muscle mass :(

The graph is very interesting as, whilst it supports the originally posted article's basis for a drop and levelling out in the obesity data, it does show that this is a very recent and short term change and one that has happened before and despite these little blips the trend is relentlessly upwards. In fact the drop/levelling out it just relative to a prior big increase so the moving average continues upwards.

Sort of destroys the entire basis for the originally posted article.

Ian

[squeaker]

A bit OT, but I was reminded of this....

[mjr]

I don't know about "class" etc., but I use two supermarkets near each other (as they sell different stuff and I want stuff from both). Wander round Waitrose and you would not even think about people having weight problems. Then do the Morrisson's bit of the shop and "hits you like a stone" - UK has a weight problem.

Yes, I've noticed these... well, almost... there's no Waitrose here... but recently I've been shopping in Morrisons more often for the tinned and dried stuff because it has a 40-ish-space cycle park while all three council-run cycle parks near Sainsburys had been dug up (despite the councils saying they wouldn't do that... sometimes I hate being right ) and there are some "healthy" or "wholefood" lines which they just don't have despite being a much bigger store. Snacks, sweets, booze, fags, ready meals? Loads of space, loads of different brands for the same stuff. Unsurprisingly, the customers do seem to reflect that, being rather larger.

A few years ago, West Norfolk was lambasted as one of the most obese populations in England. Since then, cycling has kept increasing (both in official statistics and in simple things like how often cycle parks are full or how many people you see cycling to/from things like Festival Too) and walking has done some odd things which the last government news release remarked upon (I think it was more people walking long distances than you'd expect from how many walk short distances - the cynic in me says that's because stuff isn't close together here). I wonder what the next fatness news will say?

[Psamathe]

I don't know about "class" etc., but I use two supermarkets near each other (as they sell different stuff and I want stuff from both). Wander round Waitrose and you would not even think about people having weight problems. Then do the Morrisson's bit of the shop and "hits you like a stone" - UK has a weight problem.

Yes, I've noticed these... well, almost... there's no Waitrose here... but recently I've been shopping in Morrisons more often for the tinned and dried stuff because it has a 40-ish-space cycle park while all three council-run cycle parks near Sainsburys had been dug up (despite the councils saying they wouldn't do that... sometimes I hate being right :roll:) and there are some "healthy" or "wholefood" lines which they just don't have despite being a much bigger store. Snacks, sweets, booze, fags, ready meals? Loads of space, loads of different brands for the same stuff. Unsurprisingly, the customers do seem to reflect that, being rather larger.

A few years ago, West Norfolk was lambasted as one of the most obese populations in England. Since then, cycling has kept increasing (both in official statistics and in simple things like how often cycle parks are full or how many people you see cycling to/from things like Festival Too) and walking has done some odd things which the last government news release remarked upon (I think it was more people walking long distances than you'd expect from how many walk short distances - the cynic in me says that's because stuff isn't close together here). I wonder what the next fatness news will say?

The weird thing is that "my" Morrissons has lots of excellent cycle stands. More than enough what I call "Sheffield" stands across the front of the store which is all glass and has the row of check-outs he other side - so anything untoward going on is in full view of staff and shoppers.

Waitrose on the other hand has totally inadequate cycle places. Not enough (a few bike and then you have to start using the trolly stands)) and insecure (anybody with an allen key can dismantle the stand in a few seconds!!) and hidden away (nobody would see a thief at work) with a few of what I call "wheel benders" also well away from people. Had an unbelievable "chat" with the Waitrose store manager about their inadequate cycle facilities pretty well: Gist of conversation:

Me: You have insufficient and inadequate cycle parking facilities.
Manager: What do you want us to do about it ?
Me: Put in more and better parking for bikes
Manager: We can’t
Me: Why not ?
Manager: No space
Me: Loads of space beyond the Cash Machines
Manager: We have the requisite number based on our shop floor area
Me: Then your calculations are wrong because there are demonstrably not enough
Manager (again): What do you want us to do about it ?
Me (again): Put in more and better parking for bikes
Manager: No budget
Me: Cheap to do, and if you had the same problems with cars it would be sorted as a matter of urgency.
Manager (again): But we can’t
Me (again): Why not ?
Manager: It’s a complex issue. It costs money.
Me: No it’s not. Get builder, Get bike racks. Install bike racks. Job done
Manager (again): But no space
etc. etc.
Manager: I’ll raise it at our Management Team Meeting

[mjr]

Manager: We have the requisite number based on our shop floor area
Me: Then your calculations are wrong because there are demonstrably not enough

We can check that bit against the Parking Standards for Norfolk. How big's the store? Even so, there might still not be enough to meet the need.

Regardless, the security should be put right. Is it Eaton? Maybe Norwich Cycling Campaign can help.

Me: Cheap to do, and if you had the same problems with cars it would be sorted as a matter of urgency.

Actually, that doesn't seem to be true any more. Two of the Tesco branches in King's Lynn (one Extra, one Express) are generating tons of complaints because they've screwed up their car parking, causing off-site congestion and conflict and they've been that way for over a year. I think they know the local councils (the planning and highway authorities) don't really want to spend the money fighting Tesco into line while their budgets are so tight. Tesco could fix the Extra any time they please, whereas the Express would need cooperation with the councils. Yet people blame the councils rather than Tesco... PR money wins again? Cycling to either remains fairly easy although there are far better local shops and market stalls if you're cycling.

Returning to the meat, it seems like many stores make it easy to be a motorist rather than be active and much as I like Waitrose, sometimes even they do lose the plot.

[Vorpal]

I found the Waitrose shops closest to me (Billericay, Sudbury) both have good stands and a positive attitude towards cycling. In addition to the stands by the store, there were others nearby. And Waitrose had (don't know if they still do) cycle trailers to borrow.

The only time I had any complaints, it was because trollers were parked up on the stands, and they sent someone out immediately to sort it, and I never had a problem there again.

I think that Waitrose in general is positive towards cycling, and takes customer service seriously. I would write to the corporate management and explain the problems (photos are good).

I had a positive response and action from Sainbury's by writing to corporate management in a similar situation.

[Bicycler]

http://www.worldobesity.org/site_media/library/resource_images/March_2014_Global_Trends_updated_4.pdf

This is based on BMI, but I doubt it's due to increasing muscle mass

The graph is very interesting as, whilst it supports the originally posted article's basis for a drop and levelling out in the obesity data, it does show that this is a very recent and short term change and one that has happened before and despite these little blips the trend is relentlessly upwards. In fact the drop/levelling out it just relative to a prior big increase so the moving average continues upwards.

Sort of destroys the entire basis for the originally posted article.

I don't agree with that interpretation. If we look at the decade 2004-2014 (the last recorded year) there has been slight growth. No other 10 year period shows anything like a comparably slow rate of growth. If we were to draw a line of best fit it would not be a straight line leading relentlessly upwards but a curve leading to a levelling out.

http://www.spectator.co.uk/features/9548142/the-big-fat-myths-of-our-obesity-epidemic/

Aha. Christopher Snowdon, denier par excellence!

Well, quite. I'm not going to say I accept the opinions he expresses but it is good for much repeated views to be challenged. The world needs sceptics. I fear views which are never criticised more than I fear the questioning of the truth. The truth can withstand questioning. If a view may not be questioned it is merely dogma.

...it’s longevity that really costs the NHS

is it? Fine! Get rid of all the oldies (myself plus a good proportion of members of this forum, all of whom no doubt cost the NHS £billions....

I'm surprised few people picked up upon this bit. It was part of the reason I posted this on the CTC forum. Time and again the claim is made that state expenditure on cycling/exercise/active travel etc. is more than justified by the massive savings to the state which a decrease in obesity will bring. Personally, I am happy that the state should take steps to promote longevity regardless of the costs of longevity. However, if it is genuinely the case that any savings will be offset by larger increases in expenditure associated with the increase in longevity is it really appropriate to claim the savings as a benefit?

[Psamathe]

http://www.worldobesity.org/site_media/library/resource_images/March_2014_Global_Trends_updated_4.pdf

This is based on BMI, but I doubt it's due to increasing muscle mass :(

The graph is very interesting as, whilst it supports the originally posted article's basis for a drop and levelling out in the obesity data, it does show that this is a very recent and short term change and one that has happened before and despite these little blips the trend is relentlessly upwards. In fact the drop/levelling out it just relative to a prior big increase so the moving average continues upwards.

Sort of destroys the entire basis for the originally posted article.

I don't agree with that interpretation. If we look at the decade 2004-2014 (the last recorded year) there has been slight growth. No other 10 year period shows anything like a comparably slow rate of growth. If we were to draw a line of best fit it would not be a straight line leading relentlessly upwards but a curve leading to a levelling out.
...

I did not mean to suggest it was a straight line, just that it is continuing to increase (i.e. the drop and levelling out over the last two years do not indicate it is on the decline nor "problem solved".

...it’s longevity that really costs the NHS

is it? Fine! Get rid of all the oldies (myself plus a good proportion of members of this forum, all of whom no doubt cost the NHS £billions.... :roll:

I'm surprised few people picked up upon this bit. It was part of the reason I posted this on the CTC forum. Time and again the claim is made that state expenditure on cycling/exercise/active travel etc. is more than justified by the massive savings to the state which a decrease in obesity will bring. Personally, I am happy that the state should take steps to promote longevity regardless of the costs of longevity. However, if it is genuinely the case that any savings will be offset by larger increases in expenditure associated with the increase in longevity is it really appropriate to claim the savings as a benefit?

I agree that it is reasonable for the state to pay for longevity through healthcare (in fact one might argue that a primary purpose of healthcare is longevity). But I wonder if there might also be financial aspects that could make longevity cheaper (or at least offset significant costs). If you stay healthy (e.g. cycle, eat well, etc.) then you are less likely to have to visit your GP, less likely to need secondary healthcare, less likely to need e.g. ongoing medication. Compared to somebody who leads a sedentary lifestyle, eats poorly, etc. who maybe gets type 2 diabetes, who needs long term medication and check-ups because of their lifestyle, etc.. Both groups will probably cost at end of life, but the healthier person who would statistically live longer might still cost less than the sedentary person who does not live as long. It would be a complex financial calculation, but I guess that statistically living longer suggests being healthier which suggests needing less healthcare and thus statistically costing the NHS less (at least less per year).

Ian

[Bicycler]

It's a plausible supposition, especially with the 'per year' qualification. Though the healthier may delay rather than shorten their years of reliance on the healthcare system.

One old lady I knew used to say (jokingly) that being healthier merely allowed you to live to an age when your body would fail. She was 93 when she died and had all kinds of things wrong with her for much of her last decade. Her diary was full of medical appointments and she was on an assortment of different pills. I do wonder if there is some truth to what she suggested, that we swap a premature death for a prolonged decline.

In truth I don't think the answer is all that important for policy because people are entitled to treatment whatever their age and public health ought to be prioritised regardless of cost. I just thought it was interesting to consider the cost of longevity. I hadn't previously given any critical thought to the claim that cutting obesity would be a financial benefit.

[Merry_Wanderer]

In answer to the original post, yes the UK is on the verge of an obesity epidemic. I am currently on the way home from France and as Al said earlier, there are noticeably fewer obese people in France. In my opinion this could be down to the fact that there certainly seem to be far fewer fast food outlets in France and that in general, the French take a much longer lunch break which gives them time to take their time eating and properly digesting food. In doing this the body has a chance to send the brain a message to say it has eaten enough. When I was a teenager 30 odd years ago I can't remember there being more than one or two fat people in my class at school. Neither were there any fast food outlets (except the chippy) locally.

Going onto talking about longevity costing the NHS billions, my Gran is 95 and lives in her own home. She takes pills to reduce blood pressure and she is not that nimble on her feet anymore but she does all her own cooking and is fiercely independent. She has never smoked and used to cycle on a single speed. She is slightly overweight (she says!) but looks good to me. My wife's Aunt and Uncle are the same age and similarly fit. I think that this is partly genetics and partly lifestyle choices

[661-Pete]

Our Waitrose used to have non-existent cycle parking ("chain it up to the railings") but recently a spanking new row of Sheffields has appeared . Well and good! However I suspect that the motivation may not have come from Mr Waitrose (or Mr Lewis?). The stands are not immediately outside the supermarket, but a few yards away, outside the neighbouring KFC outlet . Something paradoxical, there?!

[jamesoneil]

Figure 2.3 shows some recent flattening off in the growth of obesity. There's been a drop in admissions with a primary diagnosis of obesity, and a drop in prescriptions for obesity drugs. The number of admissions with a primary or secondary diagnosis of obesity has risen relentlessly.

I realise it is an older topic, but as someone who works in generating the data that is used for these 'Finished Consultant Episodes', I can shed some light on these statistics. The main reason that the ICD-10 Code "E66.9 Obesity, Unspecified." is not in a primary position is because it is not the main condition treated or investigated, for example, an obese patient who has gallstones removed will have obesity as a secondary diagnosis. That is if, as is often the case, obesity is even documented at all. Similarly, if a patient suffers from a co-morbidity whilst in hospital that extends their inpatient stay, the chances are that the co-morbidity becomes the primary diagnosis.

[axel_knutt]

How is the term 'secondary diagnosis' defined? If someone is in with gallstones, is it a matter of someone just noting "that patient is fat", or does there have to be some clinical consequence of the obesity? If so, would that condition have to have been serious enough to lead to a hospital admission in it's own right? The less objective the criterion for inclusion, the more likely other factors will influence the statistics. I recall how John Adams found that the figures for road accident injuries vary according to the number of police available for filling in paperwork, whereas the same is not true for road death stats.

[jamesoneil]

In the 'clinical coding world' from which the data is pullled, anything which is not the main condition treated is a secondary diagnosis.

The first diagnosis field(s) of the coded clinical record (the primary
diagnosis) will contain the main condition treated or investigated during the
relevant episode of healthcare.
Where a definitive diagnosis has not been made by the responsible
clinician the main symptom, abnormal finding, or problem should be
recorded in the first diagnosis field of the coded clinical record.
All other relevant diagnoses must be coded in addition.

Taken from standards and guidelines book published by HSCIC.

The inclusion criterion is solely based on documentation of BMI over 30, or a clinical statement that a patient is either overweight or obese is the only way that we are allowed to record that a patient is obese. Given that a large number of doctors seem to be reluctant to describe a patient as obese, I would say that it is extremely underreported. However, the index that we use to assign codes directs clinical coders to use the Obesity code when indexing 'Overweight'.



So for a patient to be admitted with obesity in primary diagnosis, they would have to be undergoing bariatric surgery.

[Manc33]

We're facing a "lack of knowledge about nutrition epidemic", the obesity is merely an after effect of this ignorance.

If you're overweight just get 300g of frozen peas, thrown them in a blender (has to be a good one that won't break), pour boiling water on so they are just covered, blend it, add salt, pepper, teaspoon of olive oil... that makes about a pint and it is like cement... drink that for breakfast and you might even get away with skipping dinner, because you just won't be hungry.

I did this and tried to "survive" on those pea drinks and I lost something like 2 stone in 6 months and I wasn't that overweight to start with. Went from about 12.5st to 10.5st.

Its not about calories or counting them as much as it is getting bang for buck out of the food you eat. So a pea drink is about as healthy as it gets whereas a cheese and onion pasty IMO takes your energy away.

I can be yawning my head off and have a pea drink, I can think better and stop yawning. If I am yawning my head off and have a filthy greasy pie or pasty, that's it, I am going to sleep, it knocks me out and when I wake up I feel annoyed for no reason, because I ate something but it had a negative effect, its tiring for me to even digest this stuff.

Nothing has got any protein in it. There's probably more protein in 300g of peas than there is in four potato and meat pies. Have you seen the amount of meat in those pies? You could separate it all out you'd have a little bit of meat like a pile the size of a 10p piece.

The Government doesn't want people to be able to think more clearly and have more energy, that is counter-productive as far as they are concerned and boy does it show. They tell us more about space and other inane claptrap than they do about nutrition.