Obesity cuts: trimming costs, not fat


Obesity poses one of the greatest threats to public health. Government plans to cut back on anti-obesity funding are dangerous. With evidence that reducing body weight improves health and saves the NHS money the cutbacks seem nonsensical. The introduction of a sugar tax has shifted the levy to the food producer to manage obesity, but to truly tackle an epidemic we must have a better strategy. We must understand why obesity is a problem, which barriers we must overcome and how to do so.

What is obesity and why should we fear it?

Obesity is defined as having a BMI of >30. This measure is derived from your weight and height and is a crude estimate of ‘fat’. Like any tool, it has its limits, and is less useful in the very tall, those who are short and those with a lot of muscle. It is known that with increased BMI (ie fat), there is an increase in intra-abdominal, organ and blood fat which is associated with numerous health problems. The ideal BMI is between 20-25. Risk of disease increases exponentially as you reach above.

Obesity increases the risk of developing type 2 diabetes, heart disease, sleep apnoea, arthritis, hypertension, cancers and many other problems. It increases other risk factors contributing to disease, which together increase the risk of death greatly. Increased weight exhausts the heart, batters joints, reduces exercise and creates a vicious cycle of disability and further weight gain. Diabetes, high blood pressure and obesity are old friends in causing early death. In health, there isn’t much jolly about being big.

The causes are multiple, ranging from endocrine (gland) disease, to medication use, to genetic susceptibility. Depression, stress and loneliness create habitual eating through neurological reward circuits. Evolutionary drives toward eating large meals have led us to survive in dire times, and even in this day and age of high-calorie and availability we have not changed. Simply put, if you eat more calories than you burn, your weight will go up, your body will struggle and your risk of illness will increase. We are built to gorge. The current national burden estimates up to 25.6% of UK adults are obese. Take a look around – it’s clear. The battle of the bulge wages on and we are not winning.

How do we tackle obesity?

To fix a problem we must know its cause. The contributing factors to weight gain are disease state, use of medications, diet, exercise and motivation. Barriers to weight gain can be external (such as access to gyms, diet) or internal (lack of motivation.) By creating a plan to tackle each, we can make strides in fixing the problem. National projects, such as those championed by the NHS, attack fat at multiple levels. We will not cover medical causes of obesity here, just those that everyone can benefit from changing. The rest needs medical help.

Increasing exercise burns calories. A national guideline suggests greater than 30 minutes of moderate exercise five times a week as a minimum. Simple measures such as taking the stairs or walking an extra bus stop can be enough. Five minutes here and there will add up quickly. Joining exercise groups, trying new sports, and going with friends improves outcomes by removing the loneliness of exercise, creating an inspirational and social environment. The greatest barrier is that first step. We work well in teams, so team up.

Diet is trickier. The availability of cheap, high-calorie foods in a busy day-to-day life makes gorging out easy. Studies have shown that fast food is highly addictive, so the odds are stacked against you. Combine this with a brain that loves to eat, and we have trouble. Healthy eating takes discipline and planning. So plan meals ahead and avoid taking money out at lunch. Take temptation out of the picture. You will be surprised how quickly the pounds melt off when you suddenly drop 300 calories by having a packed lunch over a Starbucks mocha, muffin and melt. A diet rich in vegetables, low GI carbohydrates, protein and healthy fats will go a long way. Avoid sugars and alcohol.

Future directions

The above is not rocket science, but without the information, resources and support it may as well be. Government initiatives have been very successful in helping people to change, but with a growing population in times of austerity, where fast food is cheap and time is short, we need funds more than ever. Until that happens, articles like this are the bastion of improvement. I challenge you to learn more and take that first step to helping your health and the health of your family, and to help preserve the NHS. And if you can, jog to your local MP’s and kick up a fuss. We are all in it together.

I have included a simple guide below for those looking to get started. Those in bold are my essentials. Let me know how things go.

Dr JANAWAY Weight loss tips*


  • Aim for 30 minutes of exercise a day.
  • Work in groups.
  • Vary exercise to prevent boredom .
  • Talk to a personal trainer and make a plan.
  • Record your progress.
  • Make small changes.
  • Weight lifting is great for increasing metabolism.
  • Interval cardio is better than long-distance.


  • Reduce food intake by up to 300 calories a day and measure progress.
  • Prioritise vegetables, low GI carbs and white protein (chicken, fish).
  • Plan meals in advance, bulk cook and use Tupperware® . Experiment with seasoning.
  • Drink plenty of water.
  • Avoid sugars, alcohol and smoking.
  • Allow yourself a weekly treat.


  • Have a goal (shift 3 kg, lift 100 kg, run 5 km a day).
  • Have realistic aims (you are not Mo Farah …).
  • Remember, setbacks are an opportunity to improve.
  • Work with a friend.
  • Join a weight loss group.
  • Research ways to improve.


  • Aim for 6-8 hours of sleep a night.
  • Think long-term improvement .
  • Reduce caffeine intake.
  • Avoid ‘energy’ pills.
  • Don’t take money out at lunch - remove temptation entirely!!

Please discuss any change in exercise and diet with your GP. In some cases there may be health reasons where extra care is needed. Any opinions above are the author's alone. Guidance is based the best available evidence at the time of writing. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice. There are no conflicts of interest.

Ben is a young NHS doctor in the Southwest. His interests include neurology, health communication, and medical ethics. He is also an avid advocate of compassionate care and quality improvement, running a project in the Southwest around medical humanities. Please follow and support: Dr Janaway on Facebook Dr Janaway on Twitter


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