Latest UK initiative on obesity
We have just heard of yet another initiative by the UK Government to tackle obesity. A joint announcement by Public Health England (PHE) and the Department of Health states that the plan is to devise a
“calorie reduction programme to remove excess calories from the foods children consume the most” (1).
“Adults currently consume on average between 200 to 300 calories too many each day and children are following suit, with food more readily available than ever before. Reducing calorie consumption from sources other than sugar is critical to reversing the worrying obesity trend, which shows:
- 1 in 3 children are either overweight or obese by the time they leave primary school;
- More children in the UK than previously are being diagnosed with type 2 diabetes, some as young as 7:
- Children from disadvantaged backgrounds are more likely to be obese.”
This all sounds fine. The only trouble is that it will not work. There is absolutely no reliable evidence to provide a justification for this strategy. There is no programme, which uses calorie reduction that has successfully reversed obesity anywhere in the world.
Calorie reduction does not work
The big problem with reducing calories is that it is essentially semi-starvation, which is invariably accompanied by hunger. As long ago as 1959, Albert Stunkard and Mavis McLaren-Hume reviewed the available studies (2). At the outset they stated that weight-reduction programmes are based on the assumptions that they are effective and that they are harmless. However they concluded that:
“The results of treatment for obesity are remarkably similar and remarkably poor”
They reported that only 25% of the subjects had lost as much as 8kg on their low calorie diets, while only 5% successfully lost 16kg. This was in line with his Stunkard’s experience as a physician working with 100 obese patients that were prescribed “balanced” diets of 800-1500 calories per day. He found that only 12% lost 8kg and one patient managed to lose 16kg. Even more significantly, two years after the end of the treatment only two patients had maintained their weight loss.
Those experts in the field persist in advocating calorie reduction despite the fact that there is a lack of evidence that the approach is successfully. At the same time the cases of failure continue to pile up. In the “Handbook of Obesity” by three of the leading authorities, George Bray, Claude Bouchard and Philip James it is stated that:
“dietary therapy remains the cornerstone of treatment and the reduction of energy intake continues to be the basis of successful weight reduction programs.”
However they go to accept that the results of such calorie-restricted diets:
“are known to be poor and not long-lasting.”(3).
In the early 1990s a technology assessment conference in the USA evaluated the widespread attempts to lose weight. The following conclusions were reached:
- At any given time, up to 40% of women and 24% of men are trying to lose weight;
- Those who successfully remain on the weight loss programmes usually lose about 10% of their weight;
- Up to 2/3 of the weight lost is regained within 1 year;
- Almost all weight lost is regained within 5 years;
- Weight loss is associated with increased mortality;
- Many who are not overweight, especially young women are attempting to lose weight; which may have adverse physical and physiological consequences (4).
What exactly is the problem?
It is pretty obvious that there is a fundamental flaw in the rationale used to justify these strategies. Quite simply the assumption is that the body acts like a calorimeter that many of us used in our physics classes at school. The reality is that the various nutrients are broken down in very different ways in a series of biochemical reactions. Effectively this means that the processes by which fat, protein and carbohydrates are utilised to release energy are totally different. Hence it is ludicrous to assume that they can all be regarded in the same light. This has been described and explained by Judy Barnes Baker in this guest blog (5). To make matters worse, the body has its own protective measures that in brings into play when food is restricted by increasing the efficiency of utilisation of the available food. This of course makes weight loss even more difficult.
So what is the answer?
The key is quality not quantity. It is the type of food consumed NOT the amount that is absolutely crucial. I have posted numerous blogs which conclusively demonstrate that a diet that is low in sugar/carbohydrates and high in healthy fats (LCHF) is beneficial to those with diabetes , especially Type 2 Diabetes (T2D) (6). Invariably those who achieve success in treating their diabetes lose weight as well and what is more the weight stays off permanently. Dr. David Unwin has many patients who can testify that this approach is extremely effective (7). In fact all of this ties in very neatly with our current knowledge. The crucial concept is insulin resistance (IR), which is the critical factor that can result in the development of a range of common chronic diseases/conditions, including T2D, obesity, heart disease, cancer and Alzheimer’s Disease. IR is caused by high levels of insulin in the blood. The primary cause is excessive consumption of sugar and carbohydrates. In order to deal with the high content of sugar in the body the pancreas has to increase the secretion of insulin. Hence the solution is obvious, reduce the intake of sugar and carbohydrates. If this is done then it follows that there has to be a corresponding increase in the consumption of fat.
Why are we in such a mess?
Our problems started with the vilification of fat, which was completely unjustified but that is another story. However the fact remains that the recommendation to reduce fat led inevitably to the advice to increase consumption of carbohydrates. It is highly relevant that the present obesity crisis commenced at about the same time as the authorities devised the official advice to reduce the intake of fat. So the smart way to make progress would be to reverse that by advocating LCHF. It is somewhat ironic that those who attempt calorie reduction do the exact opposite since invariably fat is reduced because it is a concentrated form of calories.
It is unbelievable how those in government and senior positions in the medical and health care professions cannot see what is so obvious. They seem to be incapable of facing up to the harsh realities of persistent failure. The consequences for so many individuals are disastrous for their personal well-being and it is difficult to estimate the costs for medical treatment, which are undoubtedly very high. We can only hope that as more people understand and appreciate what is going on, pressure will be generated, which will force the authorities to adopt policies based on sound science. As a result there will a genuine chance of achieving the objectives to conquer obesity and related diseases.
- A Stunkard and M McLaren-Hume (1959). JAMA Internal Medicine 103 (1) pp 79-85.
- Cited by G Taubes in “The Diet Delusion” Vermilion London
- Consensus Development Conference (1992). JAMA Internal Medicine 116 pp 942-949.