What can be done to encourage healthy living?

Went to France in July, not many fat people there. What do they do differently?

Going to guess you were either:

-Paris for the Olympics

-Alps for biking

-Camping for family holiday

None of which is likely to give you a true demographic cut through of the French population

Went to France in July, not many fat people there. What do they do differently?

Less poverty.

Poverty is as old as civilisation but the obesity epidemic is a totally new phenomenon so there is obviously more to it than that.

What if we started by closing down Greggs – I am sure no one from this parish would be affected?

Poverty is as old as civilisation but the obesity epidemic is a totally new phenomenon so there is obviously more to it than that.

Yes. The obesogenic environment in which we live which is a relatively modern phenomenon. But poverty is still the biggest risk factor for being overweight.

Poverty is still the biggest risk factor? Or poverty is now the biggest risk factor? If the latter, what has changed to make this the case?

(I am just thinking back to when I was at primary school. The only fat lad in my class – his dad owned a taxi firm. All the kids who were on free school meals were as thin as rakes. Co-incidentally – or not? – burgers/chips etc were never on the menu in the canteen.)

Going to guess you were either:

-Paris for the Olympics

-Alps for biking

-Camping for family holiday

None of which is likely to give you a true demographic cut through of the French population

Camping FTW! 🙂 We were off the campsite every day, still not many fat people about, in towns or countryside.

There is overwhelming evidence that education and other interventions that rely on personal agency are ineffective at tackling obesity at population level. There are, of course, some individuals who are exceptions to this, but obesity is not fundamentally a knowledge-deficit problem – it is, as @Kramer and others have made clear, an environmental problem that results from obesogenic physical, economic, social, and policy environments.

If the obesity epidemic was driven by a lack of willpower we would have seen reductions in willpower across populations commensurate with the growth of the epidemic; we have not. The rise in obesity over recent decades has predominantly been driven by changes in environments, largely driven by corporate actors, not by a collective loss of moral fibre or increase in stupidity.

Simplistic responses focused on small numbers of actions have failed and will continue to fail; obesity is a complex problem driven by multiple interacting factors. Reversing the trends in a way that no country on the planet has yet achieved requires engaging with this complexity, acknowledging the magnitude of the challenge, internalising the harmful externalities generated by many corporations within the food and physical activity systems, and accepting that the dominant approach of attempting individual level behaviour change is only able to make a tiny dent while also widening health inequalities. We need major structural responses to these and linked problems, such as those of air pollution and environmental degradation, if we are to have any chance of reversing this hugely harmful and growing epidemic.

So the answer to the original question of ‘what can be done to encourage healthy living’ is to stop trying to ‘encourage’ it and to start addressing the multiple problems with the environments that overwhelmingly shape our behaviours.

 If the latter, what has changed to make this the case?

The obesogenic environment. Supermarkets, restaurants, cafes, coffee shops, takeaways, suburbia, lack of public transport etc.

But people are much more prone to this if they’re poor.

If the obesity epidemic was driven by a lack of willpower we would have seen reductions in willpower across populations commensurate with the growth of the epidemic; we have not.

I don’t believe that to be true at all, and the article you linked doesn’t provide any evidence except saying “We believe it is implausible”.

Surely it’s obvious that we now have massively more choice in junk foods which is far easier to get than previous generations, and massively more numbers of distractions i.e. mobile phones, video games & now Netflix etc that keep some people stuck indoors rather than outside?

@zilog6128

I don’t believe that to be true at all,

What don’t you believe to be true? That obesity isn’t down to a lack of willpower?

Fair point about the Rodgers et al paper @zilog6128. However, I’ve been working on obesity for almost 20 years but both Boyd Swinburn and Bill Dietz, who co-authored that paper, have been in this game for much longer. I’m not going to rely on an appeal to authority so by all means challenge their conclusion, but if you wish to argue that mass decreases in willpower are indeed a plausible explanation for the global obesity epidemic please provide evidence to back up your claim.

that it’s not a factor at all in the new obesity epidemic, given that it is so much easier to get hold of junk food nowadays and there are so many diversions designed to keep us from leaving our homes, that previous generations didn’t have!

I’m confused @zilog6128 – it seems that you agree with me about (1) the absurdity of lack of willpower as an explanation for obesity, and (2) the importance of the obesogenic environment. Apologies if I have missed something here…

Surely it’s obvious that we now have massively more choice in junk foods which is far easier to get than previous generations, and massively more numbers of distractions i.e. mobile phones, video games & now Netflix etc that keep some people stuck indoors rather than outside?

It’s not more calories/less movement simple , it’s different types of calorific intake made from edible non-food products that are designed in a way that often fool the body into thinking it hasn’t had them – so you can eat more, and it’s difficult to judge by looking at it how energy dense it is.  I think  food science is way way beyond where most folks think it is. Folks aren’t moving any less than they used to, and expand the same amounts of calories as our ancestors did, our food environment has changed wildly though.

It is very easy now to eat 3 or 4 times your energy need without really consuming a whole lot. There are some coffee and drinks at all the coffee shops that are easily 800-1000 K/cal, and it’s just a drink, add a sugary breakfast cereal, a takeout pizza for your tea and some booze…Robert’s your father’s brother.

it seems that you agree with me about (1) the absurdity of lack of willpower as an explanation for obesity, and (2) the importance of the obesogenic environment.

(1) I think that “willpower” is a huge factor – but not that collective willpower has somehow decreased for some reason, but that it is just harder to resist as there are so many more easy options these days.

(2) yes, this is one of the biggest factors I think – but I do think that it can be combatted, and education is a part of that.

@zilog6128

that it’s not a factor at allin the new obesity epidemic

In the short (1 year) and medium (up to 5 years) term willpower does have an effect on weight, although it is small and not nearly as much as people think, however in the longer (greater than 5 years) term it has almost no effect at all.

@nickc – I agree about diets, food science, and food environments, but while I accept that there is disagreement about physical activity (PA) trends there is good evidence of declines in PA and increases in sedentary behaviour over recent decades

I ended up teaching a bit of ‘food technology’ in the late 90’s and early 00’s.  It  got pretty grim – literally ‘designing’ a pizza topping by coming up with a variety of ways to arrange pepperoni.

I’m out of date here and know its definitely got better already but the curriculum really needs a modern take on Home Economics. Yes, teaching cooking (but not lots of super sugary apple crumble) but also a huge emphasis on how to be a better consumer of food. The aspiration should not be to fill colleges with people wanting to go on catering courses and be on masterchef, but just to buy well and be better at cooking if their circumstances allow. Too many people have a huge black spot of unknown unknowns around food and nutrition.

Got to confess I’d then go further – as part of the reform I might well end up shipping out any food tech/ home economics teachers left and start again. I’m also changing the management of that the department and bringing it inside what is currently the PE department. Only a lot of them would be going too. Too much emphasis on team sports that an astonishingly small percentage of the population continue with into adulthood. A lot of the team sport stuff (which I liked as a kid as was good at so I’m not anti it for those reasons) get pushed into activity after school clubs if you want it.  The main aim  of the whole department would be to prepare kids for healthy living (food, rest, activity & moderation of the bad shizzle) as an adult, modelling it for them as children ready for adulthood.

There’s a fair bit of evidence that the amount of movement you do has very little impact on your daily calorific requirements though.

I was in Brittany a couple of months ago. Plenty of fat people there….  But then it’s not a wealthy area.

And their supermarkets are more full of crap than British ones! Getting hold of organic/locally grown produce was a nightmare. All the veg is bigger and greener and shinier, but healthier? Gimmee stunted, gnarled Sussex smallholding fare any day!

Oh, and food in French hospitals is just as crap there as it is here! The rumour of a Glass of wine with dinner is just that…

Sorry, but education and move more eat less have been comprehensively debunked as an effective intervention.

How about eat less of the wrong stuff?

If you are slim, good for you, it’s likely to be down to a combination of genetics and the fact that you live in a less obesogenic environment.

So does eating less of the wrong stuff put you in a less “obesogenic environment”?

Anecdote time. I’m sure you’re right about genetics. My dad was skinny and I have been all my life. As an adult my weight has been pretty constant irrespective of what I eat, apart from a period where I was doing a lot of weight training for rock climbing and put on about a stone (muscle I hasten to add). After retiring my weight dropped quite quickly by about half a stone where it has remained. I put it down to fewer bought sandwiches, bacon butties, curries, cakes, pints whilst waiting for the train home from work. Is that moving to a less “obesogenic environment”?

I am aware of the poverty/junk food trap.

There is @Kramer, but one aspect of the failure to engage meaningfully with complexity that I referred to earlier is that much public health research persists in applying linear models of cause and effect to complex causal pathways strewn with feedback, adaptations, and non-linear interactions, and fails to take account of Rose’s prevention paradox.

I won’t bore you with details of my epistemological concerns about the evidence base, but even if increased activity really does have little effect on overall energy expenditure part of the response should be to tackle the environmental factors that promote adaptive homeostatic sedentary behaviours.

There’s a fair bit of evidence that the amount of movement you do has very little impact on your daily calorific requirements though.

Eh?

Want to post up this “evidence”?

@suburbanreuban

 Getting hold of organic/locally grown produce was a nightmare.

I feel your pain. 😉

@intheborders not really, it’s come from my reading around the subject rather than one specific source, but feel free to google it.

One problem is that NHS weight loss advice is quite politically tainted (something must be done!) and IMV based on out of date research. Other doctors, including my own colleagues disagree with me. But I’m fairly confident that they’re wrong.

The line I currently use is that exercise (of pretty much any type, but a variety is best and resistance becomes more important as we age) has many, many benefits, but weight loss is not one of them.

@slowoldman – it sounds like you’re slim because you have a genetic propensity for it?

Part of the problem is that for years we’ve been asking slim people how they remain slim and for the vast majority of you the actual answer is because you were lucky in the genetic lottery.

After retiring my weight dropped quite quickly by about half a stone where it has remained. I put it down to fewer bought sandwiches, bacon butties, curries, cakes, pints whilst waiting for the train home from work. Is that moving to a less “obesogenic environment”?

Yes. It’s much easier to resist temptation if it isn’t wafting under your nose every day.

@lorax – point taken about prevention vs treatment, and AFAIK there is some evidence to suggest that increasing population activity can reduce incidences of obesity.

Thanks @Kramer.

The Foresight report from 2007 was called ‘Tackling Obesities‘. At the time I thought this use of the plural was a silly conceit, but I now think it’s spot-on. Just as we use the word ‘cancer’ in the singular to refer to multiple different conditions, with different risk factors, natural histories, treatments, and outcomes, so obesity is in fact a multitude of different manifestations of a wide range of behavioural, genetic, physiological and other factors.

I was in Brittany a couple of months ago. Plenty of fat people there….  

Same – not nearly as many where we were as you’d see in the UK.

What can be done to encourage healthy living?

Hide the biscuit barrel in my office.

After retiring my weight dropped quite quickly by about half a stone where it has remained. I put it down to fewer bought sandwiches, bacon butties, curries, cakes, pints whilst waiting for the train home from work. Is that moving to a less “obesogenic environment”?

Funny that, I’ve been pretty much housebound for 6 weeks due to knee Bursitis and I’m nearly 10kg lighter.

Ive used the rowing machine a bit with one leg but I’m nowhere near as active as normal.
There has been less pasta and potatoes in my diet and Ive drunk more water, beer intake is similar though.

Obviously no Meal deals or sneaky breakfasts like when I’m out on the road.

Even when you think you’re eating healthily…………………..

One of the most troubling consequences of the agrochemical revolution was the nutritive difference between the intensively grown fruit and vegetables of today and their equivalents 60 years ago. According to the government’s own data, between 1940 and 1991 the typical British potato “lost” 47% of its copper and 45% of its iron. Carrots lost 75% of their magnesium, and broccoli 75% of its calcium. The pattern was repeated for vitamins. A study in Canada showed that between 1951 and 1999, potatoes lost all of their vitamin A and 57% of their vitamin C, while today’s consumers would have to eat as many as eight oranges to obtain the same amount of vitamin A their grandparents did from a single fruit.

From https://www.theguardian.com/lifeandstyle/2007/may/19/features.foodanddrink

‘Treats’, ‘treat yourself’,  ‘treat grab bag’, all these words are everywhere. I’ve had a hard day at work, why not treat yourself, a cake, a biscuit, a takeaway etc. But the treats are huge, family sized, supposedly sharing packs. No child wants to share these.

As a child of the 60’s and 70’s most of us were thin/slim/not fat. The poorest family in the road were the thinnest (possibly undernourished, no car, so walked everywhere). We did have treats but only one. Maybe a child’s sized milkyway, not the great big bars or bags we have now.

Also I’m a firm believer in sitting down for meals, at meal times, also not eating in between meals. not wandering around the streets eating snacks all day.

Clothes sizing is way out. A size 10 is really a size 14. physiologically  making one think they are slimmer/thinner than they really are.

As children we walked to school. Did games, played out in the street/park/garden.

The slim family on our road, walk their children to school, let them play out (there’s always an adult to keep watch), cook simple meals that have veg and salad on the plate . The fattest family on our road, drive their children everywhere, have takeaways almost every evening and they keep their children in, playing on their tablets/gagets, they are not short of money (unless they’re in huge debt from all the stuff they buy).

As mentioned above it really is all about education. Being able to get cheaper fruit veg and salads would help, encouraging children to grow something edible and learning how to cook.

As children we walked to school. Did games, played out in the street/park/garden.

We played football on the – not yet opened – M1 southern extension at the end of the road, crossed the east coast mainline for shits and giggles and broke into the local factory’s canteen of a weekend and stole their biscuits… It gave us a basic grounding in nutrition and running away from the police and hiding in bushes that a lot of the youth of today are sadly lacking. A lot of fat kids wouldn’t be half so chubby if they were encouraged to commit minor crimes and other infractions and run for it.

Clothes sizing is way out. A size 10 is really a size 14. physiologically  making one think they are slimmer/thinner than they really are.,

And have you seen the size of cars these days? No surprise that a lot of the automotive companies are owned by the same people as ‘BIG FOOD’, increasing the size of their products is yet another way of tricking people into thinking they are smaller than they actually are. Why else do you think Americans are both the fattest people on earth and drive the largest cars?

As mentioned above it really is all about education. Being able to get cheaper fruit veg and salads would help, encouraging children to grow something edible and learning how to cook.

I tend to think a lot of it is about people being time poor tbh. We need to give out more time on the NHS.

There’s a fair bit of evidence that the amount of movement you do has very little impact on your daily calorific requirements though.

Really?  On my big bike ride Iost 2 stone eating 4000ish calories per day

We played football on the – not yet opened – M1 southern extension at the end of the road, crossed the east coast mainline for shits and giggles and broke into the local factory’s canteen of a weekend and stole their biscuits… It gave us a basic grounding in nutrition and running away from the police and hiding in bushes that a lot of the youth of today are sadly lacking. A lot of fat kids wouldn’t be half so chubby if they were encouraged to commit minor crimes and other infractions and run for it.

😀

That made me laugh a lot and brought back a lot of memories of a misspent youth, thanks

The line I currently use is that exercise (of pretty much any type, but a variety is best and resistance becomes more important as we age) has many, many benefits, but weight loss is not one of them.

So I have a group of around say 50 people (probably more) who I know who are keen cyclists, mostly male tbh but also women. Not one is obese, some a bit bigger and many very skinny. Is this just luck on my part? They all hang out in cafe’s all the time too which are obesogenic environments…..

Exercise clearly makes a difference the problem is most don’t do anywhere near enough.

@tjagain – part of the answer is about the difference between evidence at individual and population level. Your big bike ride represents pretty unusual behaviour, so those kinds of effects don’t show up across a population where very few people are that active. There’s also evidence (such as that from John Speakman) that shows very limited changes in physical activity levels over time, and some studies have shown an activity homeostasis effect where high levels of activity in one part of people’s lives are compensated for by sedentary behaviour at other times and/or adaptations in basal metabolic rate.

However, those studies mostly involve small numbers of people, and as I said above they tend to be based on a narrowly conceptualised model of cause and effect. So I agree with you – physical activity is not only hugely valuable in and of itself, it is also an important factor in energy balance and thus weight status.

@anagallis_arvensis I suspect there may be some selection bias in your population sample…