According to The Daily Telegraph (28 May 2014) two thirds of the population should be sent to state-funded slimming classes run by firms such as Weight Watchers, in the hope that this will enable them to comply with new NHS guidance (1). The official advice from the National Institute of Health and Care Excellence (NICE) is that the cost of funding 12 week courses run by commercial providers – at around £50 per head – will be outweighed by the potential savings to the NHS if Britain can contain the obesity epidemic. The guidance represents the first official endorsement of dieting techniques employed by Weight Watchers and Slimming World and called for a dramatic expansion of such schemes. Apparently 64% of adults in the UK are classed as overweight or obese. NICE has concluded that if 10% of these enrolled on the scheme, the cost would be more than £100m per year.
Professor Mike Kelly, who is director of the Centre for Public Health at NICE, said: “About one quarter of men and women are obese and a staggering 42 per cent of men and 32 per cent of women are overweight. With every point you move up with the body mass index the risk of a range of serious health problems are increased. All sorts of things need to happen if we are to contain this epidemic.”
There are 3 fundamental assumptions which underpin these proposals, namely:
- Those who are overweight or obese, as determined by Body Mass Index (BMI) have poor health and an increased risk of a range of different diseases compared with those who have a “normal” BMI
- That weight can be lost successfully by calorie reduction
- That if weight is lost there will be an improvement in health
Although the above is accepted by the vast majority in the medical and public health professions, the reality is that the evidence to justify these statements simply does not exist!!!
Let me explain.
- The only reliable indicator of the standard of health is the all-cause rate of mortality. We would expect the lowest rate to be for those with a “normal” BMI. However a major study conducted in the USA by Katherine Flegal and colleagues found that risks of dying are slightly LOWER in the ‘’Overweight’’ category than in the ‘’Normal’’ one. The risks of those in ‘’Obese (Class I)’’ are only marginally increased, especially in those aged over 70 years (2).In a study conducted in Canada 11,326 men and women aged 25+years at the outset were monitored over a 12-year period commencing in 1994/1995 as part of the National Population Health Survey. The results provide confirmation of the Flegal work. Once again it was evident that those in the “overweight” category have a much lower chance of dying and therefore a greater life expectancy than those in the “normal” range. Even more interesting, it was found that that those in the “Class1 obesity” (BMI 30-35) also had a greater expectancy than those in the “normal range” (3).These are both high quality studies and certainly cannot be shrugged off because the results conflict with the current mantra. Further details can be found on Blog 10 (4).
- Weight per se as a risk factor for poor health has been grossly exaggerated. In the light of the above there can be no possible justification for advising a person who is “overweight” to lose some weight. Arguably the same consideration should apply to those who are mildly obese. However a person who is overweight/obese but also has diabetes (or raised blood glucose), hypertension and raised blood triglycerides is definitely at an increased risk of various diseases. But this would also apply to a person with “normal” BMI. It is extremely difficult to lose weight by the conventional approach of reducing the amount of Calories consumed. Research at Curtin University in Australia reported that 6 million people engage the services of a weight loss industry adviser every year. Of these, 80% fail to follow through the programme. Of those who successfully lost weight initially, 95% re-gained it within 1 year. What is especially pertinent to the NICE announcement is that an assessment of Weight Watchers in the USA found that only 6% of clients reach their goal weight at the outset but that less than 1% maintained the goal weight for 5 years(5). 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 (5).
- It seems to be an article of faith that losing weight must be beneficial to health. Paradoxically, there is convincing evidence that losing weight by Calorie reduction has the opposite effect (6). For example, a review of studies, which combined the results from a range of investigations concluded that:
“…the highest mortality rates occur in adults who have either lost weight or gained excessive weight. The lowest mortality rates are generally associated with modest weight gains” (8).
The fact of the matter is that the current approach just does not stand up to rigorous examination. There has been a total failure to analyse the relevant research and rely on assumptions which have never been substantiated. It is not the amount of food that is critical but the type. As I have pointed out time and time again, the recommendation to reduce saturated fats (SFAs) was wrong and as a consequence the conventional Healthy Eating advice is misleading. SFAs are needed for the organs of the body, especially the brain, to function effectively. By contrast the advice to increase the consumption of complex carbohydrates, coupled with the increased intake of sugar, has undoubtedly contributed to the increased incidence of diabetes and associated conditions. A diet which is low in carbohydrates and high in the right types of fat will improve the parameters of poor health and will invariably be accompanied by weight loss as an added bonus. Using this approach will be very much more successful than anything from Weight Watchers!
- K M Flegal et al (2005) Journal of the American Medical Association 282 (16) pp 1530-1538
- Heather M Orpana et al (2010) Obesity 18 (1) pp214-218
- Consensus Development Conference(1992) Annals of Internal Medicine 116 pp942-949
- R Andres et al (1993) Annals of Internal Medicine 119 (7) pp 737-743