There is so much that we still don't understand about obesity. It's a multi-factorial, complex condition resulting from a combination of environmental, lifestyle and psychological partial hereditary factors. We know it is on the rise in both adults and children in the UK, and that obesity associated health problems cost the NHS more than £5billion every year. As a dietitian actively working in the NHS and private practice, my colleagues and I actively contribute to reducing this figure. When I read a recent article in The Daily Mail, I was less than impressed to see the comments from Prof. Susan Jebb. In essence, she insinuated that the rise in obesity rates are solely due to genetics and the prevalence of unhealthy foods.
So what do we know about genetics and obesity? I'm not an expert in genetics by any means but my understanding is that genetic disorders such as Prader-Willi Syndrome (PWS) and Bardet-Biedl Syndrome (BBS) can directly cause obesity. One in every 15,000 children born in England has a genetic condition called PWS. A genetic defect that happens by chance, PWS results in a constant feeling of hunger and desire to eat food. It's extremely stressful for parents and carers to treat and is linked with behavioural challenges and weight gain if left unmanaged. There is no cure for PWS; but children, adolescents and adult can achieve a healthy weight, albeit challenging. BBS is another rare genetic condition that is characterised by a number of symptoms including obesity. Prevalence rates vary on where you live and Europe ranges from 1:140,000 to 1:160,000 of livebirths. I wouldn't classify either condition as common, hence my surprise at Prof. Jebb's comments looking at these figures.
In terms of diet, it's true that we are surrounded by a growing amount of convenience foods, which are high in calories, fat and salt. Fizzy drinks and fruit juices are available everywhere we go and it is very east to get hold of food 24 hours a day from 'drive-throughs' and takeaway restaurants. The Food Industry is playing a part with the 'Responsibility Deal'; however I feel there is a lot of extra work that still needs to be done here.
The constant access to food is an environmental change that has occurred in recent years; however, as adults, we have to be responsible for the choices we make. If we choose to consistently eat foods that are high in fat, calories and salt and lead a sedentary lifestyle, unfortunately weight gain is a result of this lifestyle. More often than not, people experience a gradual weight gain over time and may not be fully aware of their lifestyle and that it needs to change.
As a dietitian, the challenge is to educate people on healthier food choices, activity and lifestyle changes. Doing this in clinic on a one to one basis is excellent and, provided you have enough time, you can really drill down and identify the changes that need to be made. Offering enough support to your client basis is essential and regular sessions achieve this very effectively. Group sessions and weight loss programmes are also another excellent way to reach numerous people and these are often widely available on the NHS. Not only do they offer nutrition education, peer support of group members is also key. Sharing stories can be inspirational to others and can show them safe, active weight loss is achievable. Reaching people on a large scale is more challenging as a dietitian and national guidelines, recommendations and key messages from key stakeholders are key. In my opinion, this is why advisors for NHS England and other national bodies should be very careful with their comments on obesity. They should have an excellent understanding of the causes and treatment options before making sweeping statements that appear to undermine the seriousness of the problem.
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