NOF tackles the 'obesity epidemic'
The National Obesity Forum (NOF) presented their annual conference, chaired by Professor David Haslam, the Chair of the NOF and a well known author, as well as a physician in obesity management.
And the programme lived up to its title ' Tackling the Obesity epidemic' . Presenters ranging from Diane Abbot, the Shadow Minister for Public Health, Matthew Capehorn the Clinical Director of the National Obesity Forum, to Jack Kreindler a Health and Human Performance Consultant, entertained and educated the audience with a variety of strategies and opinions about how we can all support our patients by encouraging practical approaches to the prevention and management of overweight and obesity.
Susan Jebb, head of Diet and Population health at the Medical Research Council, confirmed that the new NICE policy document, which aims to support effective sustainable and community wide action to prevent obesity, is grounded in the population approach concept; There is undue pessimism in the health sector about obesity. So what if most people put the weight back on? There are still health benefits from even temporary periods of weight loss because there is less exposure to the metabolic consequences of obesity.
We need to get our own house in order and stop giving out mixed messages. Local authorities need to respond to local need. Is treatment being prioritised over prevention? The new obesity strategy is the new call to action but it is not massively different to the previous healthy lives guidance. We cannot just focus on children alone; we have to also focus on those adults who are overweight, and who are overweight parents of overweight children. The new documentation will support this.
Diane Abbot, the shadow health minister reminded the audience that the present governments places too much emphasis on personal responsibility, without acknowledging that many people do not have the social capital or skills to tackle their own obesity. In an elaborate analogy comparing the governments fight to combat typhoid on the streets of the capital, she demonstrated how the governments vision for improvement will focus on giving Public Health back to local authorities thereby beginning to address Michael Marmots social determinants of ill health.
But she also emphasised that the new localism must not give way to a fragmentation of services leading to more dis equity and ill health among those who are least able to cope with the effects of the economic down turn which leads to a spiral of lack of exercise, poor quality cheap food consumption and deteriorating health.
But obesity is not just about eating.... Professor Greg Whyte, a Consultant Physiologist, presented a very compelling case for ' The fitter you are the less likely you are to die young' . The risk of cardiovascular disease decreases with increasing fitness, and even morbidly obese individuals have a lower risk of cardiovascular mortality if they are fit. Our society is in the middle of an epidemic of sedentary death syndrome; the inactivity is killing us. Understanding the relationship between improving aerobic capacity and muscle strength is key to beginning to tackle diabetes, heart disease, asthma and cancer. Even psychological factors also improve with exercise; low self esteem, depression and mental illness can all improve with even a modest increase in physical exercise.
But humans are more than eating machines who have to move our working parts to stay fit. The very dynamic Damian Edwards, a lead behavioural trainer, then informed the audience about the power of health beliefs. Every thought we have is underpinned by deep fundamental beliefs, and irrational beliefs can cause deeply flawed thinking leading to dysfunctional behaviour. Cognitive behavioural therapy ( CBT ) challenges harmful thoughts and beliefs by encouraging people to replace them with helpful ones, empowering patients to reframe their behaviour around healthier choices.
Obstacles to obesity management include the attitudes of the very people who are supposed to be providing the care. Although there are many opportunities to get the message across, weight management is very hard, and although the condition is increasingly ubiquitous, health care professionals seem to lack the tools to deal with obesity both in primary and secondary care. Ian Lake , a GP with a social interest in preventative health, laments the fact that
Nothing on the patients discharge summary from hospital ever mentions obesity. Yet this metabolic disease and its consequences underpins so much of the ill health of our nation today. There is also a growing body of evidence that certain foods make people more vulnerable to cancer. Fibre, fish, red and processed meats all play a major role is colorectal cancer aetiology in addition to alcohol intake, obesity and low physical activity. As health acre professionals we often fail to get this message across.
Hospital shops selling sweets is like police stations selling burglary equipment.
Hospitals don't seem to have got the message; shackled by private finance initiatives they seem powerless to promote the healthier lifestyle message; lobbying parliament should be mandatory for all concerned health care providers. We need more funding, educating the educators about the true causes and ,a agent of obesity is fundamental to tackling the problem.
And We are all getting older at a much younger age, claimed Shahrad Taheri, a Consultant Physician specialising in Sleep Apnoea. People die from Coronary Heart Disease and cancer with their diabetes and obesity. There is still much undiagnosed morbidity in society, and Obstructive Sleep Apnoea is a major, and largely unrecognised cause of road traffic accidents, as well as a powerful driver of diabetes, hypertension and heart disease. There is treatment but this is not available to the undiagnosed. And many people, aware that their snoring may be indicative of an underlying disease, do not come forward for a diagnosis to be made because they are ( correctly) concerned that they could lose their driving licence and they ( incorrectly ) think there is no treatment. CPAP ( Continuos positive Airway Pressure) is a very effective, if intrusive treatment.
This whole day challenged the audience to think more carefully about obesity management. We cannot afford as a society to be so dismissive and judgemental about obesity and the medical, psychological and social consequences of this very complicated disease. Collaboration between local government, primary and secondary care and certain private organisations is the only way forward. Nudging our way towards a healthier nation is not enough.
The audience of the NOF annual conference joined in a lively debate between Lord Richard Bradford , the Chairman of the restaurant association, and Tam Fry the honorary media spokesperson for the NOF. The audience narrowly voted for the motion that we need supportive legislation , we need the Nanny State to intervene in the toxic expansion of the nations waistlines, and we need to act now before it is too late.
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