It’s not the sugar making you fat, it’s the FAT!
While fat contains lots of calories the medical consensus is shifting from fat being number one enemy to sugar particularly fructose
Its easier to overeat with fat as its more energy dense but as above sugars are now seen as more important in weight gain
the key is a balanced diet low in sugar and do not run a calorie surplus
Are you sure?
Am I sure what my life was like in the 70s? yep, I am pretty sure. While chocolate and biscuits were available I was not allowed to eat them at will. Guessing that was just my life then.
Fat fingers this morning. As you were.
Am I sure what my life was like in the 70s? yep, I am pretty sure. While chocolate and biscuits were available I was not allowed to eat them at will. Guessing that was just my life then.
The same for me - and the big "food" companies did not pump all sorts of stuff with sugars in the same way as they do now. Yes they also pump foodstuffs full of fats and salt as well to make them addictive but hidden sugars and not so hidden sugar is a real issue and as above the medical consensus is shifting towards sugar particularly fructose being the main cause of obesity
High fructose corn syrup.
Going back to my childhood in the 80s, sure we had junk back then, but it was 1 packet of biscuits for my family of 5 to last a week.
High fructose corn syrup - a byproduct of industrial food processing used as a food additive. Its not "food" and is probably public enemy number one. Its put into all sorts of things to make it addictive.
NICE guidance
https://www.nice.org.uk/guidance/cg189
NICE ends to be fairly conservative and slow to react to changes in the medical consensus however you can be sure the information is valid and rigourous and free from a lot of the nonsense that is around diets
BMJ is a good place to look for information on the debate around diet. Summaries of papers ar usually free to access
Luckily our new health secretary Victoria Atkins, appointed in the reshuffle yesterday and literally responsible for creating policy on this issue will be making research into the link between high sugar levels in processed food and our obesity epidemic a high priority.
Being married to the Chief Executive of British Sugar will obviously provide no conflict of interest at all.
FFS
It's interesting that the 'slimming diet' industry is worth millions. People will spend a lot of money on products that deliver a quick fix. Sadly there is no quick fix. It means eating sensibly, exercising, drinking less alcohol and moving more.
Something I've noticed in the last few decades is families feeding their children carbs, lots of pasta and rice dishes. Not many children have veg (which is so easy to cook in a microwave), salads or fruit.
Too many sweets and treats made with corn syrup.
Also I believe in sitting down as a family for meal times. Many people are now eating on the go, walking around with finger food. Too many take-a-ways available. It's easier now to sit at a desk or at home just constantly snacking.
However it is important to have pudding, cake, biscuits, crisps, bagged snacks, chocolate or any treat, but only as a treat, just not all the time.
Obesity is a complex mix of challenges across societal beliefs and behaviours, our environment, hormonal influences and obviously food. There are huge numbers of people who try really hard to lose weight, do lots of exercise but really struggle and it is not because they lack intelligence or commitment, it really isn't very easy.
We use a motivational interviewing, collaborative, approach with patients, with the focus usually around pain and long term conditions, but obesity is often part and parcel of this. Although there are often commonalities (like the environment people live in), everyone is different and getting long term positive behaviour change is done in different ways for each patient, it has always been fascinating seeing shifts in thinking with patients as they explore their motivations and understanding of the life they lead now and the life they want to lead. There are also a lot of patients, who for various reasons, have no desire or ability to elicit any change.
We definitely need a lot more joined up systems thinking, including linking local government to the NHS and a shift in focus to long term outcomes instead of crisis management and treating symptoms of whatever ailments we have. This also needs a change in behaviour and education across society, it's a challenge to say the least, especially when there is a lot of money in the food and pharmaceutical industry.
Although I personally follow a high protein low carb diet, I don't think this is the only way forward. I suppose my views on diet are relatively simple, try to eat more real food (including fats), get enough protein (especially for older populations) and for the majority of people, cut down a bit on carbs, especially drinking them. It is more complicated than that and there are a huge number of discussions in the scientific journals about responses to different foods and how the food itself or combinations leads to overeating, and again everyone is individual. Even though they can often only focus on part of the problem, there are GPs across the country performing some fantastic work with patients when it comes to diet and we are getting to the point where we have a decade of data with real people making long term changes. Although a lot of these have headlines that say low carb, I would say it's more a focus on real food (and not being scared of fat!) and also supporting people in food choices on small budgets...I've posted links on here before, but Dr David Unwin, a Northern GP is a good starter to see how patients can get long lasting changes, improve metabolic health and lose weight with a simple approach to diet:
https://nutrition.bmj.com/content/6/1/46
If anyone is interested in more public facing resources, Dr David Oliver and Dr Kim Andrews offer a huge amount of information and support for patients (including an app), again the headline is low carb, but it is an eat real food approach:
Going back to my childhood in the 80s, sure we had junk back then, but it was 1 packet of biscuits for my family of 5 to last a week.
Same here, and you didn't touch them without asking first.
I’ve posted links on here before, but Dr David Unwin, a Northern GP is a good starter to see how patients can get long lasting changes, improve metabolic health and lose weight with a simple approach to diet:
Just to show how complex the whole picture is, as well as that information from Dr Unwin, you should probably read the report that the scientific advisory committee on nutrition released about low-carb diets for folks with T2 diabetes. Their conclusion are on page 14, it's not a clear cut as some "evangelicalists for low carb" would have you believe.
Just ordered this book https://www.amazon.co.uk/Eat-Well-Die-Slowly-Metabolic/dp/1838137807 after listening to a pod cast about evidence/lack of evidence/flawed science in nutrition. Claims (which I think are echoed elsewhere) that nutritional advice still used today about the balance of carbs vs fat/protein is based on biased studies from 50's and 60's, perpetuated and supported by vested interests in food industry. Looking forward to evaluating it.....
Its really not Tom. Yes the medical consensus is slow to change but the NICE guidence is the highest quality we have to go on and based on up to date data
There is a huge amount of quackery around this topic. Be very careful whi you believe and check them via independent sources
Their conclusion are on page 14, it’s not a clear cut as some “evangelicalists for low carb” would have you believe.
Low carbs seams to mean different things to different people, so it can be a confusing term.
I think the evangelists are the "keto" people, however the sensible advice is considerable reduction. So it isn't no or nearly no carbs, it might be 50 gramms of cooked brown rice or 4 baby potatoes as the carb portion of a meal, plus some "colour" vegetables which also contain carbs (and fibre).
This is going to sound sexist but its not intended that way.
Women getting more independence and more women drivers has a huge effect on obesity these days. When i was a kid my dad did the driving whilst my mum made do with buses & walking. Whilst my dad was at work we walked everywhere. To school, to the shops, to our friends house. We got the bus to town to help mum with shopping and we carried multiple bags for her to bring it home. We were as fit as fiddles and i imagine this 10,000 steps per day figure they bang on about was more like 20 or 30k.
Now we have mothers driving 250metres to bus stops to drop their kids off. Oh dont get me started on not using schools within walking distances due to 'performance'. If we got rid of 'performance standards' and forced everyone to go to their allocated schools all schools levels would rise, not just the selected few that the better off can afford to choose. Mothers then drive home or go to work. Kids no longer see fit and healthy attitudes from their mothers (Yes fathers as well but the person who would be there waiting for them from school was traditionally the mum) and in fact are being moulded into new, younger versions of their now, plump, low exercise, drive everywhere parents.
Everything that has been discussed about diets is of course correct.
@MSP really, read the conclusions. They essentially say, there's no real strong evidence for reduction in any carbs (they measured diets with almost no carbs to those that allow up 100g as "low carb") as being either good or bad for health or weight, or good/bad for disease reduction, or cholesterol levels over the long term. (over 12 months)
As @tjagain keeps pointing out, there's quackery and there's independently produced studies with evidence.
Going back to my childhood in the 80s, sure we had junk back then, but it was 1 packet of biscuits for my family of 5 to last a week.
On a similar note, we used to get a single tin of Quality Streets to last us all Christmas (a family of five). Granted they were significantly bigger back then, but these days they are piled high in the supermarkets from October onwards and people get through multiple tins (or plastics as they are now) each October, November and December. Then they put the Creme Eggs out before the new year has even begun...
for example the book TomB refers to above. I checked the author. a pathologist and virologist with a company selling "wellness"
I didn't look at her any further and at least she is a qualified medic of some sort but the fact she has a business selling " wellness" raises a small red flag
Maybe she talks sense, maybe she doesn't. I don't know having not looked beyond her qualifications
Before you believe any of this stuff research the author. Look for peer reviewed papers in reputable journals. look for critiques of their work
From the state of people I see waddling around at work, the future looks like diabetes will the norm.
It can't be nice carrying around so much extra weight, yet I hear people telling each other how great they look when they are obese.
It's going to take some serious cultural changes in order to make people reduce their calorie and alcohol intake. It's maybe too late for some so maybe we should be focusing more on the young.
@nickc have you had time to read that report and look at the included studies recently? It’s not a negative report on low carb even in its current form but the “low carb evangelists” wouldn’t even recognise them as low carb diets, 50 to about 300g a day if memory serves wasn’t it? There is also a lot more information now as the primary cut off for the report was 2018. Other international organisations have also updated similar reports, stuff changes.
I am really interested in what works in the real world with patients and if a healthcare or medical professional can help patients make meaningful and long lasting changes to their health then it’s to be applauded. If there are GPs doing it through high carb dietary approaches and that information has been published, then that needs to be shared too. People do get a bit evangelical when they’ve been doing something for many years and got nowhere then get excellent results with a different approach. A lot of lives changed. It doesn’t mean it’s the only or even best approach, but it’s the approach that works for them. 🙂
They essentially say, there’s no real strong evidence for reduction in any carbs (they measured diets with almost no carbs to those that allow up 100g as “low carb”) as being either good or bad for health or weight, or good/bad for disease reduction, or cholesterol levels over the long term. (over 12 months)
That is a specific report looking at impacts on people who have type 2 diabetes. Did you read the conclusions? because if you did you are misrepresenting them.
Conclusions From the evidence considered, it was not possible to assess the impact of a ‘low’ compared to a ‘high’ carbohydrate diet on markers and clinical outcomes of T2D in adults with T2D. This was because:
• the definition of a low carbohydrate diet varied widely across the primary RCTs, with prescribed carbohydrate intakes in lower carbohydrate groups ranging from 14 to 50% TE (median, 40% TE)
• there was overlap in reported mean carbohydrate intakes between the lower and higher carbohydrate diets in the shorter term (≥3 to 6 months) (13 to 47% TE in the lower and 41 to 55% in the higher carbohydrate diets) and in the longer term (≥12 months) (17 to 46% TE in the lower and 43 to 54% in the higher carbohydrate diets)
• according to categories of carbohydrate intake, reported mean carbohydrate intakes in the lower carbohydrate groups were moderate (26 to 45% TE) in the majority of primary RCTs. Comparisons, therefore, were largely between lower and higher rather than ‘low’ and ‘high’ carbohydrate diets. This limits interpretation of the evidence for any benefits or harms of a ‘low’ compared to a ‘high’ carbohydrate diet. Overall, the evidence suggests beneficial effects of lower carbohydrate diets for some outcomes (HbA1c, fasting plasma glucose, serum triacylglycerol) in the shorter term (up to 6 months). Since the shorter-term assessments did not report outcomes between 6 and 12 months it is uncertain if the suggested benefits are maintained beyond 6 months. Although there was no consistent evidence of reductions in body weight with lower carbohydrate diets it is not possible, from the evidence considered, to separate the effects of weight change from effects of change in carbohydrate intake. Lower carbohydrate diets may allow reductions in diabetes medication, but interpretation is complicated by inconsistencies in reporting and measurement of changes in medication use. No differences were observed between higher and lower carbohydrate diets on serum total or LDL cholesterol either in the shorter (≥3 to 6 months) or longer term (≥12 months). Evidence on HDL cholesterol was inconsistent in the shorter (≥3 to 6 months) and longer term (≥12 months). In general, there was no difference in adverse events between lower and higher carbohydrate diets but study duration did not extend beyond 12 months in the majority of primary RCTs.
92
The overall quality of the evidence base was limited by a number of uncertainties in the data, including: variability in the definition of a low carbohydrate diet; smaller than prescribed differences in reported carbohydrate intakes between lower and higher carbohydrate diets; inherent inaccuracies in estimates of self-reported dietary intakes; and lack of information on adherence to prescribed diets. An important limitation was that risk of bias was high or unclear in most of the primary RCTs that were included in the MAs. This reduces the confidence that can be placed on the estimates of the effects of lower carbohydrate diets on the markers of T2D and clinical outcomes under consideration. Another important limitation in the evidence base was that shorter-term studies did not assess outcomes beyond 6 months and few longer-term studies assessed outcomes beyond 12 months. The majority of participants in the primary RCTs were living with overweight (BMI ≥25 to <30 kg/m2) or obesity (BMI ≥30 kg/m2). It is not known if reported effects can be generalised to adults living with T2D with a healthy weight (BMI ≥18.5 to <25 kg/m2). It is not known if the reported effects of lower carbohydrate diets apply to individuals of different ethnicities since the majority of primary RCTs did not report ethnicity of participants and most were conducted in populations that were predominantly White. In those that reported ethnicity, none conducted subgroup analyses based on ethnicity. This report did not assess evidence on the effect of lower carbohydrate diets in the general population without T2D. It is not known if the reported effects of lower carbohydrate diets in adults with T2D apply to the general adult population without T2D. Several gaps were identified in the evidence base:
• effects of lower carbohydrate diets on individuals living with T2D from minority ethnic population groups was not considered
• no trials provided information about types of carbohydrate consumed (for example, wholegrain, refined grain, free sugars, fibre) or considered how this could affect the outcomes of interest
• the potential impact of increasing the proportions of other macronutrients (fats and/or proteins) to compensate for reduced carbohydrate intake in the lower carbohydrate groups, or the type of macronutrient (for example, saturated or unsaturated fats; plant or animal-based proteins), on markers and clinical outcomes of T2D was generally not considered
• few trials assessed adherence to dietary interventions throughout the study duration or considered how adherence might impact the outcomes
93
• few trials assessed longer-term effects (beyond 12 months) of lower carbohydrate diets
• no trials considered clinical endpoints such as diabetes complications, CVD events or mortality.
but these days they are piled high in the supermarkets from October onwards and people get through multiple tins (or plastics as they are now) each October, November and December.
Eat all the lovely sweeties say the manufacturers of lovely sweeties, but it's your fault if you get fat says everybody else...We really do have to move away from the "personal responsibility" message that the folks who're making zillions from selling us the shit directly or the folks who're making zillions of us re-enforcing the message that it's all our own fault, but here's this simple way of losing it all...
Dietary studies are a minefield because most are self-reported, and people are prone to not reporting their diets accurately. Plus, as noted above, there is no single definition of 'low carb' etc. We could be waiting a while before any consensus over the 'best' diet is reached.
Unfortunately, we're at the point now where the bulk of the population is addicted to calorie-dense, sugar rich foods, and possibly highly resistant to both insulin and messages asking them to change their lifestyles. As usual, corporations are happy to exploit weaknesses in the scientific data to continue peddling this stuff.
More sugar taxes and advertising bans are the bare minimum now. We need a concerted effort to remove this shit from supermarket shelves and to use schools to teach children the basic life skill of not poisoning yourself for the next thirty years.
More sugar taxes and advertising bans are the bare minimum now
As already stated we're going to need a new Health Secretary before there is any chance of that.
Also worth noting that any kind of higher or new tax is not a vote winner - especially if it relates to things that people really enjoy and see as a pleasure in life (no matter what the health consequences) - so wouldn't hold your breath on a change of government making any difference.
Health warning on food, would be good.
At least a better "traffic light" system, that allows green lights on unhealthy food because a couple of macro guidelines are met.
Treat food packaging and advertising like tobacco.
Increase school budgets for healthy meals for kids, make all school meals free, remove the sugary snacks and drinks from schools. I know that some moronic parents will be passing chippy dinners through the railing for their offspring, but I think the majority would be pleased with such policies.
When I first started reading "ultra-processed people" I thought the inclusion of marketing and corporate culture into the definition of ultra processed foods came over as misplaced and ranty. But on reflection it is a huge part of the problem that impacts on our diets in so many ways, and it is right to be part of the narrative even if it feels like a separate topic.
I am trying to eat a lot healthier and i try to fit in a few walks each day. I had eaten lunch but decided to do another 2-3km walk just to get some steps in which took me past B & M. Nipped in to get a chocolate bar (i work on calorie counting and tbh i was well in credit).
It was shelf upon shelf of either HUGE bars of chocolate for £1.50. Really, family size bars at best or packs of 4 like KitKat chunky for £1.50. I honestly could not find a Single normal sized bar. Ended up coming out with 4 x KitKt chunky bars and had to give the other 3 away as soon as i walked into work because i guarantee if i had kept them, i would have eaten 2/3/4 today.
Something needs to be done to force them to stop this.
Health warning on food, would be good.
Anything that puts the onus on individuals to take responsibility for the fact that we all live in a wildly unhealthy environment because: profit. Is going to be as successful as putting the calorie count of items on menus. (i.e. will make no difference)
At least a better “traffic light” system, that allows green lights on unhealthy food because a couple of macro guidelines are met.
Agreed - and manufacturers need to be stopped from saying that such-and-such product is only x% of your salt, y% of your fat and z% of your sugar allowance for the day if you only eat half of the contents of the packet of whatever it is you've bought – its misdirection and people are easily fooled into thinking they are eating a relatively healthy option when they are not.
I am trying to eat a lot healthier and i try to fit in a few walks each day. I had eaten lunch but decided to do another 2-3km walk just to get some steps in which took me past B & M. Nipped in to get a chocolate bar (i work on calorie counting and tbh i was well in credit).
It was shelf upon shelf of either HUGE bars of chocolate for £1.50. Really, family size bars at best or packs of 4 like KitKat chunky for £1.50. I honestly could not find a Single normal sized bar. Ended up coming out with 4 x KitKt chunky bars and had to give the other 3 away as soon as i walked into work because i guarantee if i had kept them, i would have eaten 2/3/4 today.
Something needs to be done to force them to stop this.
I disagree. Unless your local B&M is very different to mine, it is not exactly a local sandwich shop that you'd pop into for a sandwich and a diet coke at lunchtime so I wouldn't expect them to sell singles of anything. They sell multipacks at a good price.
Is your suggestion that nothing is sold in multpacks as you cant help eating the whole pack? If so, I hope you never walk into a Costo.
"just one wafer thin mint?"
Cars must be one of the biggest differences when comparisons are made with my childhood in the 80's to now. Most families I knew either didn't have a car or only had one per household. On my road now there is 2-3 cars per house some even more. There are so many satellite towns where driving is the only real option for commuting to work that a car becomes essential.
Another big difference is eating out, as a kid we only ate out a couple of times a year, now some people eat out more than once a week. Food in restaurants is made to taste good as it's primary aim, which means lots of salt, fat and sugar. Plus when you eat out you're more inclined to drink pop, or alcohol and have a dessert. Plus the portion sizes are generally pretty big.
All these little changes add up over time and must account towards the ever expanding population.
We saw this in France on our summer holiday, huge portion sizes.
It seems that the minute a child passes their driving test, they are given or have use of a car. As mentioned above we walked, cycled and took the bus as youngsters.
Children who walk to school tend to sleep better, concentrate more in class, will be slimmer and usually carry on walking to places in adulthood.
Food in restaurants is made to taste good as it’s primary aim, which means lots of salt, fat and sugar. Plus when you eat out you’re more inclined to drink pop, or alcohol and have a dessert. Plus the portion sizes are generally pretty big.
Depends rather on the restaurant the ones I frequent which are not chains tend to be perfectly normal portion sizes sometimes even a bit small
We saw this in France on our summer holiday, huge portion sizes.
In France, where?
This is not my experience of working in & visiting France for +30 years.
And for those demanding taxes on certain foods plus no multi-packs etc - just because you can't control yourself, why should I have to pay more?
And for those demanding taxes on certain foods plus no multi-packs etc – just because you can’t control yourself, why should I have to pay more?
All depends if you want to take any action to try and reverse the crisis that have been worsening for last 40 years I suppose. A LOT of people can't control themselves and when the crappest food is also the cheapest that is not helping them. Yeah, nanny state, whatever.
It seems that the minute a child passes their driving test, they are given or have use of a car. As mentioned above we walked, cycled and took the bus as youngsters.
Was the average/majority of 17/18 yearolds back then really making multiple 30+ minute walks or bike rides daily? (a bus, while greener and cheaper is not really healthier)
As mentioned above we walked, cycled and took the bus as youngsters.
And obviously didn't have 24hr access to very cheap, very calorie dense food on the scale that teenagers do now.
Really this all has to happen at a school (and ideally parenting - but good luck with that) level. Educate them about health from an early age, feed them properly at an early age, encourage daily physical activity in the school. Just normalise it for them.
Adults are already a lost cause (except the few of us who take up cycling etc; rare exceptions) - all current adults will be dead in 70 years which is completely insignificant to the big picture - but instilling the culture of health and caring about oneself has to be generational and it has to be through early years education - the formative years.
Bring people up to care about themselves and be inquisitive about how what they put into themselves affects them for the rest of their life.
I could have a skewed perspective because of where I live but I feel the current generation of ~25 and below are much more switched on. The cat is kind of out of the bag now, thanks to people like dr peter attia, dr rhonda patrick, etc, about the science behind good health vs illness (and it really is as simple as that: you're either making healthy choices or slowly but surely heading toward illness, there is no middle ground) - and the impressionistic young generation are picking up on it.
It has to be backed up in culture and policy. Individual [people/teachers] can make a difference, though. 1x passionate form tutor can influence 30x kids every single year, even if the 99 other teachers in the school were indifferent. While nothing of use is coming from the top, at the bottom we have the power to influence our own networks
Was the average/majority of 17/18 yearolds back then really making multiple 30+ minute walks or bike rides daily? (a bus, while greener and cheaper is not really healthier)
Exercise is likely a minor component of the obesity epidemic - it's basically all food intake.
https://www.sciencedaily.com/releases/2009/05/090508045321.htm
The common sense hypothesis that it's just cheaper, more accessible, calorific food is likely correct - probably with some discoveries to be made about environmental factors but they will be minor imho. What makes it an absolute entrenched bastard of a problem is the ratchet affect of weight gain. You can't go down anywhere as easy as going up due to significant metabolic changes that are hard to reverse. Like getting your car engine re-mapped except you can't change it back.
Crisps, sweets and fizzy drinks in France and Germany are almost double the price of the UK. Vegetables and fruit are around the same price.
yes – we all walked to and from School and sometimes to and from at lunchtime as well
how long was your lunch break if you could spend an hour walking home and back, and presumably eating lunch while there?
Really this all has to happen at a school (and ideally parenting – but good luck with that) level. Educate them about health from an early age, feed them properly at an early age, encourage daily physical activity in the school. Just normalise it for them
I was a governor waaaay back in the early noughties and this was already national schools policy back then. Kids were given lessons in cooking, we talked to them about healthy eating, and gave advice to parents about lunch box contents and even policed it (was as popular as you'd expect), and as for exercise you don't really need to encourage kids at an early age to run about like loonies. It all pales into nothing in comparison to the marketing efforts of food companies, even the primary aged kids could all name multiple snack/junk foods as they're exposed to it so early.
yes – we all walked to and from School and sometimes to and from at lunchtime as well
And How much Monster did you drink? how many 24hr garages/supermarkets did you walk past? KFC? MaccyD? The kids at the school local to me will tell you that Morrisons don't prosecute if the stuff you nick is under a tenner..
