But what is the government doing about the rising obesity levels? Are the current government dietary guidelines working?

In my opinion it is a resounding no.

WARNING: The next section is quite text heavy. Important in context but text heavy.

The latest Health Survey for England, published in 2015[1], makes for some interesting reading. Here are some take home messages.

1. In 2014, 2% of men and 4% of women were morbidly obese (BMI40kg/m or higher).
2. The prevalence of obesity for men and women increased with age, and then decreased in the oldest age groups. Obesity ranged from 9% of men aged 16-24 to a peak of 35% of men aged 55-64, and the equivalent range for women was from 13% aged 16-24 to 35% aged 64-75.
3. For women, but not men, obesity varied with socio-economic indicators, with those in the lowest income households or the most deprived areas most likely to be obese. 31% of women in the lowest income households and 33% of women in the most deprived areas were obese, compared with 20% of women in the highest income households and 22% of women in the least deprived areas.
4. More women than men had a high or very high waist circumference, indicating central obesity (66% of women and 54% of men). The difference was particularly marked for the prevalence of a very high waist circumference (45% of women and 32% of men). The proportion with a high or very high waist circumference generally increased with age.

Being overweight or obese is generally associated to a number of other diseases such as diabetes, and cardiovascular disease. Obesity is also estimated to be the fourth largest risk factor contributing to deaths in England (after hypertension, smoking, and high cholesterol) according to the NHS Atlas of Risk.

Data gathered from the Health Survey for England (HSE) is showing obesity rising from 13% of men and 16% of women in 1993 to 24% of men and women in 2006, since which the rise has slowed. Central obesity, defined as a very high waist circumference, has also risen markedly, from 20% of men and 26% of women in 1993 to 34% and 44% respectively in 2013. HSE results also show that morbid obesity (the most severe category of obesity) has more than doubled since 1993, and reached 2% of men and 4% of women in 2013, with no sign of a reduction in the rate of increase after 2006.

We can conclude that the issue of obesity is a problem in the UK and is continuing to grow year on year. In an aim to address this issue a number of government policies and initiatives are in place, aimed at individuals, the NHS, local authorities, food manufacturers and retailers.

But is this enough; are the current Government Dietary Guidelines adequate to help the growing issue of obesity in the UK?

I think there is more that can be done.

For me the key challenge the government faces when trying to battle the ongoing obesity crisis and other metabolic diseases, is that they need to attempt to lower the energy density of the national diet whilst increasing the nutrient density, and subsequently aiming to increase the physical activity levels of the population.

In my opinion the current dietary recommendations are no longer valid. Basing meals around starchy, calorie dense foods needs to be changed to aim for a greater plant-focused, nutrient dense approach.
They could also potentially look at reducing the recommended calorie intake.
However reducing the recommended calorie intake, could potentially take what is essentially a ‘diet for the masses’, a step too close to the limit of how far you could go before it fails to be beneficial for health.
The latest National Diet and Nutrition Survey data published in 2016[2] actually showed that the mean energy intakes were below the recommended requirement for adults and children over the age of 10. However this doesn’t take into account under-reporting of energy intakes. Which is likely.

As another key factor to fight this ongoing battle is to increase the general level of physical activity of the population, lowering the recommended calorie intake could prove to be too much for many, but may potentially work brilliantly for others. I think it’s fair to say that we would all agree that recommending a calorie intake for 1 person, taking into account their current activity levels, is a lot easier than recommending a calorie intake for a population of over 50 million.

So what would I do?
What would I change on the current recommendations to suit the UK population?

Here are six main points and a little more detail on why I would make these changes.

BASE MEALS AROUND VEGETABLES
The current recommendation states you should eat 5 portions (80g) of a variety of fruit and vegetables a day. However, the latest National Diet and Nutrition Survey data [2] shows that on average the UK population is still not consuming enough fruit and vegetables. Clearly the 5-a-day recommendation is not working.

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By recommending meals be based around vegetables, instead of starchy foods, this should exponentially increase the figure to a more appropriate level. This will also help to increase the fibre, vitamin and mineral intake, which is also reportedly low in some instances. As well as increase feelings of fullness due to the likely increase in fibre consumption.
The current recommendation also makes no suggestion that fruit and vegetables should be consumed as snacks, over items like chocolate and crisps. Therefore I think it is vital that tips on how to increase your fruit and vegetable intake should be present as well.

EAT SOME WHOLEGRAIN FOODS
The current recommendation states that you should eat plenty of starchy foods such as potatoes, rice, bread and pasta. Choose wholegrain varieties or eat potatoes with their skins on for more fibre.
Unfortunately this recommendation is somewhat vague in its message.

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The latest ‘Eatwell Guide’, another moot point that we will come to shortly, does show wholegrain and whole-wheat products as imagery, but in bold writing it then states ‘Potatoes, bread, rice, pasta and other starchy carbohydrates’. This in my opinion indicates for most people white bread, pasta and rice.
Just saying choose wholegrain isn’t enough. There is no explanation in the guidelines over why you should choose wholegrain, no importance placed on the benefits to your health. There are no examples of wholegrain products.
So I would recommend all imagery, and wording is geared around wholegrain not starchy food, and as per my previous point tips on how to consume more wholegrain items should be present.

EAT MORE FISH AND BEANS THAN MEAT AS A SOURCE OF PROTEIN
According to the National Diet and Nutrition Survey data [2] the consumption of oily fish is still lower than the recommended intake of 1 portion (140g) per week. Whereas the consumption of red and processed meat for women has met the recommended average intake, unfortunately for men we still consume higher than the recommended average intake.

Unfortunately I believe that as a nation we are inherently meat eaters, so trying to persuade a population to turn to other sources of protein may prove to be tricky. It requires further education of the importance to vary protein intake, and to include more fish.
In general there has to be a concerted effort to encourage a greater intake of all fish and seafood, not just oily fish. As I have already mentioned in the previous points, tips on how to increase consumption of fish should be provided. Just saying eat more without providing any further information isn’t helping anybody.

EAT SOME FULL FAT DAIRY
The current dietary recommendations are to choose lower fat, sugar and salt options where possible. However, there are recent studies [3,4] that find avoiding full fat dairy is not supported anymore. Some are even showing that increasing consumption of dairy foods has the potential to lower the prevalence of global and abdominal obesity, whilst also being associated with better cardiovascular health [5].

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This doesn’t mean to say all that should be recommended is full fat dairy, rather it should be encouraged that consuming full fat produce isn’t harmful for health, unless you have certain health markers.
The benefit of full fat dairy should be made clear as more and more evidence is coming to light.

LIMIT THE INTAKE OF ALCOHOL AND SUGAR-BASED DRINKS
The consumption of sugar-based drinks appears to still be high across all age groups [2]. We could put this down to a number of reasons ranging from advertisements and promotions to changes in lifestyle. Companies producing the drinks generally target the younger generation.

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With the physical activity levels of the population dropping there is absolutely no reason for the continued increase in consumption of these high sugar drinks. When was the last time you saw an advert promoting the ‘diet’ version, or the ‘zero sugar’ version of the drinks? Never. You rarely, if ever, see them.
The amount of times I see young children and teens drinking cans of Red Bull, Lucozade or the latest energy drink is unbelievable.
We know the obesity levels of the younger generation are on the increase so I would take what seems quite a drastic step. I would recommend the sale of any sugar-based energy drink illegal to anyone under 18. The exact same rules that apply with alcohol.
I don’t think this would stop parents buying the drinks for their kids, but I feel it would be a step in the right direction, and help curtail the excess. An alternative option would be for the government to hike the tax on these products so high, that the companies would need to increase the cost of the product, which would then potentially lead to a drop in sales. Drastic, but in my opinion warranted.
With regards to alcohol, I think further education is required. It should be made clear within the dietary recommendations, and through advertisements how many calories are in alcoholic drinks, and that they do count towards you recommended daily energy intake. If the general population knew how many calories were in there favorite drinks, it may help to limit the consumption during the week.

REPLACE THE EATWELL GUIDE WITH A FOOD PYRAMID
I have no doubt the Department of Health went to great time and expense to come up with this guide. It’s a step forward from the previous plate version. But for me it still has to many flaws and to many conflicting messages as already mentioned.

Eatwell guide 2016 FINAL MAR23

One major flaw is that it gives a false determination of portion and meal sizes. The current plate, if we can still call it that suggests that a 1/3 of your meal should be from starchy carbohydrates, a 1/3 should be from fruit and vegetables and the last 1/3 from protein, dairy and fats. Now, I’ve already spoken in the points above how this is misrepresented and that emphasis should now be made on more plant focused eating and a reduction/elimination of starchy carbohydrates.
So what about the meal sizes?
To me the guide suggests quite large meals, so it may encourage the population looking at it that they can help themselves to large portions. This also depends on the size of your plate. There is no standard size of plate in the UK, so if you have quite a large plate you are more than likely, if you follow this guide, to just fill the plate up. A huge dinner, even if it is balanced out across the current recommended groups would still lead to over consumption of calories.
Also nowhere in the guide does it mention anything about portion sizes. It does mention the recommended calorie intake, but that is it. For the general population this means nothing. The small bit of text, which asks you to check the nutritional label on the food, can be so confusing that it makes that point completely useless.
The current Eatwell Guide in my opinion is a very basic, almost child like reference point, that suggests some out of date research, whilst also lacking some vital information such as portion sizes.

Food-Pyramid-to-help-the-obesity-levels

This is why I would turn to a food pyramid and place a lot of emphasis on the intake of vegetables, with a split of wholegrain foods and sources of protein, dairy and fats. With a very small amount of sugar based drinks and alcohol at the very peak of the pyramid.
How would I tackle the portion sizes?
I quite like the approach of Precision Nutrition with their Hand Measure system. Though I’m not sure this is a perfect fit, but the system may prove to be useful taking into account my experiences of a lot of clients struggling to count calories. A format similar to this could be a way to give the population an easier way to check their portion sizes. Again, as with all the previous points it all comes down to education, and advising a suitable approach. Giving the population the tools to make a better-informed decision.

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Precision Nutrition – Hand measurement system

So that’s six main points I would recommend changing in the Government Dietary Guidelines, but I’m not quite finished yet.

The next few points are not guidelines, more issues, which I feel, should also be addressed to help the nation battle the ongoing obesity crisis.

NUTRITIONAL LABELS
These can be extremely confusing to understand, so I think these need simplifying as much as possible. I do believe that nutrition labeling is rarely looked at, but when it is it can lead to a complete disregard of the information contained due to a lack of understanding.
To help the general population to understand the labeling I would make the following changes;

1. Make it extremely clear how many servings there are within the product. Many times this can be very vague. This should help the population to understand the correct serving size.
2. Highlight the total calories in the serving of the product and remove the term kilojoules (KJ).
3. Re-order the macronutrients, highlighting the main macronutrients, so they sit in order of how much (g) is contained within the product. As with point 1, this should also help the population understand the amount of what is contained within each product.
4. Instead of indicating the nutrient content of 100g. Which is rarely the size of the product. The grams of the whole product should be indicated. Again, I believe this will further help the population to understand how much they are actually consuming.

Below (left) is what my interpretation of the Nutritional Label would look like compared to the current version. I believe mine is a cleaner, easier to read version, removing the information which means nothing to the general population.

Will-a-new-nutrition-label-help-the-with-a-reduction-in-obesity-levels

I would also potentially look at the traffic light system that appears on the front of food packaging as that can often be misleading, and difficult to interpret.

REFORM HEALTHCARE EDUCATION TO INCLUDE LIFESTYLE GUIDANCE
Nearly all-healthcare professionals, including doctors, are not educated on how to help patients lead a healthy life. They are generally unable to offer any advice or support when it comes to lifestyle or nutritional choices. Their job is very much a reactive one. They wait for the public to get ill and then treat. This isn’t inherently a bad thing, but sometimes being able to initiate effective lifestyle guidance and support can have a huge effect on a patient’s future life.
I think upgrading all healthcare professionals knowledge on nutrition and lifestyle as it relates to health is of huge importance in this modern era. Being able to offer better, more helpful advice, in the age of so many metabolic syndromes due to our westernized diet has to be high on the government’s agenda.
A reason I fully support the vision of Move Eat Treat.

So there we have it.

In summary what I’m recommending is based loosely around the traditional Mediterranean diet.
With an emphasis on vegetables, fruits, nuts and seeds, beans, legumes, whole grains, fish and other seafood on a regular basis, selective dairy intake, and with a limited consumption of meat and alcohol. [7]
It’s my belief that if we are going to try to improve a population’s health, a fresh approach needs to be taken, and a bolder more creative Government Dietary Guideline is required to encourage plant food consumption.

‘The desire to promote a simple message to the public must be balanced by ensuring that consideration is given to the complete dietary picture and not just a single nutrient or food type. We must not shy away from explaining complex dietary messages, such as the difference between the types of carbohydrates and their effects; the challenge is to do this using simple language and on a wide enough scale to effect change towards healthier eating habits at a population level’. [6]

 

REFERENCES
1. www.content.digital.nhs.uk/catalogue/PUB19295
2. www.gov.uk/government/uploads/system/uploads/attachment_data/file/551352/NDNS_Y5_6_UK_Main_Text.pdf
3. Drehmer M, Pereira MA, Schmidt MI, Alvim S, Lotufo PA, Luft VC, Duncan BB. Total and Full-Fat, but Not Low-Fat, Dairy Product Intakes are Inversely Associated with Metabolic Syndrome in Adults. J Nutr. 2016 Jan;146(1):81-9.
4. Crichton GE, Alkerwi A. Whole-fat dairy food intake is inversely associated with obesity prevalence: findings from the Observation of Cardiovascular Risk Factors in Luxembourg study . Nutr Res. 2014 Nov;34(11):936-43
5. Crichton GE, Alkerwi A. Dairy food intake is positively associated with cardiovascular health: findings from Observation of Cardiovascular Risk Factors in Luxembourg study. Nutr Res. 2014 Dec;34(12):1036-44.
6. Jane Philpott MA (Oxon), MSc, PhD. Are the Current Government Dietary Guidelines Fit For Purpose?
7. Katz DL, Meller S. Can we say what diet is best for health. Annu. Rev. Public Health 2014. 35:83-103

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