The UK Releases a Pie-in-the Sky Plan to Tackle Obesity

Last week, the UK released a pie-in-the-sky plan to address their obesity problem.

Although, I’am sure it is well-intended, I find it impossible to fathom that anyone with even an ounce of knowledge of the complex, multifactorial, chronic, and often progressive nature of obesity should in this day and age still fail to understand that the proposed plan, which includes the usual talk of changing the food environment (largely by appealing to personal responsibility) and a 12-week weight loss plan app [sic], focussed on healthy living (read, “eat-less-move-more”), is about as likely to noticeably reduce obesity in the UK population, as taking out a full page ad in The Sunday Times stating that “Obesity is bad!”.

Let us for an instance assume that millions of UK citizen download the app and somehow manage to lose 12-pounds in 12 weeks. Why on earth would anyone expect this weight loss to be “permanent” (never mind have lasting health benefits)?

After all, if there is one single thing that decades of obesity interventions have taught us, it is that, short of bariatric surgery, there are no “permanent” weight loss solutions (and even surgery is by no means a guarantee!). This is exactly why any serious analysis of the published science on this issue today generally ignores any study of less than 12 months duration – because the results of anything shorter are entirely irrelevant in terms of informing long-term obesity management.

This is not because you cannot lose weight in 12 weeks – of course you can! But because it should be well known by now that it will take most people less than 6 weeks to put it all back on.

This is not because they are stupid, or not-motivated, or simply don’t get it, or lack will power, or are not trying hard enough – it is simply because of the fundamental biology of how bodies regulate body weight.

As I never cease to explain to my patients, “bodies like to gain weight but don’t like to lose it”. Today, we not only understand the complex and powerful biological mechanisms that defend the body against long-term weight loss but also that these very same biological mechanisms virtually guarantee weight regain (except perhaps in a handful of the most dedicated individuals).

So, as the UK embarks on a NHS-sponsored nation-wide exercise in yo-yo dieting, one must wonder about who exactly came up with this plan and why they either failed to consult with or decided to ignore the many excellent obesity experts that the UK happens to have. Hey, oddly enough, we currently even have a UK President of the World Obesity Federation, who is probably embarrassed by this plan. Why were these experts not listened to?

I cannot but notice the stark contrast of this plan to the recent declaration of obesity as a chronic disease by the German Bundestag and the call for better access to evidence based obesity treatments for Germans living with obesity. If other countries can do this, why does the UK remain stuck in the stone-ages of ineffective obesity policies.

If there are indeed subtle nuances in the UK plan addressing any of my criticisms, I must extend my sincere apologies to the authors. I probably missed them because I simply could not bear to read through the entire document for fear of popping an artery.

@DrSharma
Edmonton, AB