The U.K’s Obesity Crisis: Education is the answer

I was so pleased to watch Dr Ranjan Chatterjee on BBC Breakfast this morning, discussing the need for GP’s to be educated further in how nutrition and exercise can improve people’s health. I agree wholeheartedly with this as I believe there needs to be some wider strategies looked at to reduce the overspend in the NHS and enhance people’s lives through improving their health across the U.K.

There are many conditions that can be improved or prevented by using nutritional intervention, however, the one condition that is solely brought on by a lack of good nutrition and unhealthy lifestyle is Obesity. Obesity is the most potent risk factor for Type 2 diabetes. It accounts for 80–85 per cent of the overall risk of developing Type 2 diabetes and underlies the current global spread of the condition.

I found these statistics on the Diabetes UK website and they really are quite alarming:

  • It is estimated that more than one in 16 people in the UK has diabetes (diagnosed or undiagnosed)
  • There are 4 million people living with diabetes in the UK.
  • Around 700 people a day are diagnosed with diabetes. That’s the equivalent of one person every two minutes.
  • Since 1996, the number of people diagnosed with diabetes in the UK has more than doubled from 1.4 million to almost 3.5 million.
  • Today, there are almost 3.5 million people who have been diagnosed with diabetes in the UK (2014)
  • By 2025, it is estimated that five million people will have diabetes in the UK.

Furthermore, other conditions stem from having Type 2 diabetes such as cardiovascular, kidney and eye disease, amputation, depression, neuropathy, sexual dysfunction, complications in pregnancy and dementia. So, we can see that with just this one condition the impact is multi-faceted and is whilst the number of individuals with obesity is rising, likely to cause further stress on the NHS.

As a BSc degree trained Nutritional Therapist, I am required to carry out Continuing Professional Development, at my expense, each year to be a member of the British Association for Applied Nutrition and Nutrition Therapy, as their Code of Conduct is such that we, as therapists, must keep our knowledge up to date according to the latest research available. Why then are doctors not enforced to do this as part of being a member of the Health Professions Council? 

In my training, I was taught how nutrition can be used to prevent long term health conditions, as well as, overcoming or improving existing health conditions, many of which are digestive disorders, anxiety, depression, obesity, joint pain, migraines, type 2 diabetes, hypothyroidism, the list goes on. We do not diagnose or suggest to cure but recommend protocols backed up by rigorous scientific research. In my training, we were taught where to find reliable primary source research on nutritional intervention studies that have been and are being carried out continuously to prove that good nutrition and lifestyle are an effective treatment for a healthy life. The main issue is that there is not enough funding available to carry out the necessary large scale research required by the NHS, after all, there is no expensive drug to sell at the end of it and no profits to be made. Did you ever see an apple advertised on television? Sadly, without large scale, evidence based, peer reviewed and recognised scientific research, the NHS will not entertain it but hopefully with advocates like Dr Chatterjee spreading the knowledge the trend will eventually change.

So imagine we wave a magic wand and the doctors are educated in how nutrition and lifestyle can improve individual’s health and they offer this advice during their short appointment times, would the patients take this advice? In my experience – No, not everyone would.

There needs to be a multifaceted approach from helping the patient to change their mind set through a technique known as Motivational Interviewing, how to cook healthy meals, how to budget in order to cook healthy meals, what their emotional and physiological triggers are that persuade them to choose an unhealthy lifestyle over a healthy lifestyle, do they have access to exercise, do they have time, are they functionally able to cook and exercise? These are some aspects that I have come across in my clinic as a Nutritional Therapist. Quite often my clients know what they should and should not eat and what they should and should not do, however, the motivation is not always there and sometimes external factors can be preventing them from change too.

I was discussing this with my husband and used the example of “Recycling” – 20 years ago the UK did not know the word “recycling” nor could many be bothered to participate in this activity in order to save the environment and since then the importance of it has been drummed into us in order for us to do our bit. I remember some of us did and some of us didn’t so nowadays we are made to. The councils have given us the education (leaflets) and resources (purple, brown and black bins) in order to improve our environment together. There is still more to do but it is a start. My husband pointed out that we did not have a choice as our rubbish is not picked up if it is in the wrong bin or we are fined. Good point. So this new regime was adopted by the public through authoritative means, as well as education.

I can see that this method does already happen in the NHS such as when operations are only offered to patients who carry out smoking cessation or liver transplants to patients that abstain from drinking alcohol. However, does this approach work? Well, not really because that person is still costing the NHS money if they do not comply.

Individuals need a multi-pronged approach as I mentioned above to support, educate and guide. We need the “buy-in” from the individual themselves to want to make changes and stick to them. Had they been educated from a young age about nutrition, preparing quick, healthy meals within tight budgets then perhaps it would have prevented the problem of obesity in the first place so it is not too late to put in place some changes at the grass roots level.

Why not change the curriculum to include educating children about how to lead healthy lives. In Home Economic or Food Technology classes teach the children how to make nutritious meals not just biscuits and cakes or pizza. Curriculum changes could also include obligatory fitness lessons for sixth formers (I notice PE no longer is offered now that my daughter has gone onto her A levels); lessons in how to look after oneself at university or college on a tight budget; lessons in the benefits of following a healthy lifestyle (right food, sleep and exercise) with regards to your concentration levels and capacity to learn effectively. There are so many ideas if we think outside of the box.

Many children grew up being “treated” using sugary food by their parents if they did well at school or won a competition in sport so psychologically many of us still use this reward system as adults and this can be where it has created weight issues in later life. Food is an integral part of our lives, it is used to celebrate (birthdays and Christmas), commiserate (comfort eating), reward (“I deserve this”) and stress so it is important to understand the complex psychologically issues that go hand in hand with obesity.

As a volunteer I offer my Nutritional knowledge to a community garden group in my local town of Hitchin where I work alongside a Horticultural Therapist. We teach 12 individuals each week how to cook, budget and choose their food for the week using what we have cultivated within the allotment. We tie in the “From Farm to Fork” approach and they learn where food comes from, what it needs to grow optimally much like how their body requires the correct number of nutrients to function. Each week we measure their progress and discuss with them as a group and individually how they can make further lifestyle changes to reach their goals. For whatever reason these individuals did not receive the education they needed to stay healthy when they were young so these workshops are of great use to them now. Interestingly, confidence has been a big factor in preventing these individuals from adopting a healthy lifestyle. Many did not know how to cook for themselves and were afraid to try on their own at home so instead chose convenience foods and processed microwave meals which are high in sugar, salt and fat.

Over the past year the group have all lost weight and one lady has come off her medication for Type 2 diabetes – this was one of our “WOW” moments. This works. It may not be part of an expensive scientific research project – although we are recording everything but the system is working. The members of the group enjoy the activity, meeting new friends and supporting one another together. Now multiple this project across the UK in every town and we would be helping thousands of people to led healthier lives, furthermore, why not incorporate more nutrition and lifestyle education at varying levels: doctors, teachers, and employers. By looking collectively at the resources around us and at what else is working, as a nation we should be able to come up with the answers and make substantial savings in our beloved NHS in order that it works more effectively for our future and the generations to follow.

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