Obesity - The Bing Crosby Approach.

"Accentuate the positive, eliminate the negative!" That is the 'spin' of politicians and doctors,  who wish those endowed with excessive subcutaneous fat to be nudged into a healthier paradigm for life. Yet most of their 'crooning' is patently wrong. It is said that more and more of us are getting fatter, and as a consequence, putting ourselves at higher risks for heart disease, diabetes, liver and kidney failure, together with a myriad of co-morbidity's associated with the 'obesity explosion'.

Fellow blogger the masked crusader has a rather darkly humorous solution, but his description of the obese as 'pie eating lardbuckets' is somewhat harsh to say the least, because it is the advice that many of his colleagues provide to 'fatties' that is fueling the crisis. It is also obvious that his cunning plan to recycle the result of liposuction is fatally flawed. The energy needs to enable such a 'rendering' would far outstrip that provided by the resultant product. So, put down that pie and pay attention!

Obesity is defined by having a Body Mass Index of 30kg/m2, which can be ascertained by dividing your weight in kilo's by your height squared. For someone 6ft tall (1.8mt) and 11 stone (70 kgs) that would be a BMI of 21.60kg/m2. There are, as one can imagine, quite a few people with lots of muscle who would then be called 'overwieght' (BMI of 25 - 29.90) and even obese, so the formula does not fit all. In fact, whilst subcutaneous fat is an indicator of obesity, it is visceral fat (the fat around internal organs) that is a better predictor of disease.

The recent survey on health and obesity from the NHS shows some quite interesting data, especially on diet (although it will take some time to read all 112 pages), which does show that advice to eat '5-a-day' is working with the 5 to 15 year old's as consumption has doubled. All people are also eating less trans-fats, saturated fats and sugar than 10 years ago, and calorific intake has tended to decrease since 2006. Yet we are still getting fatter, have more diabetes and heart disease (despite the fatalities from it decreasing). We are as a whole also taking more exercise, with a 7% increase (absolute) between 1997 and 2008, with men exercising much more than women. Surely, it is sensible to assume then that this advice, issued to the public and taken up, should have made some inroads into the obesity epidemic, even if only small, but it hasn't, if anything things are getting worse! Could it be that the advice is wrong? Err... well yes!

Looking at the advice we have; eat less fat, eat '5-a-day', take exercise, don't smoke, drink only a little of alcohol, don't eat sweets or sugary drinks, and of course consume carbohydrates in vast quantities, up to two thirds of your food intake (when you take fruit and vegetables into account). Now that we have been doing that for about thirty years, at ever increasing frequency, we are then told that; we are all lying about what we eat and we are eating far too much, remembering of course that average calorific intake has diminished since 2006, which together with lack of exercise (or not enough of it) is the reason for the spread of obesity and disease. So by 'accentuating the positives' of low fat, exercise, and non-smoking, and 'eliminating the negatives' of saturated fat, meat, alcohol, lack of exercise etc. etc. we have achieved, well nothing!

Now we are told, that if we are above a certain BMI, we smoke, or drink above a certain limit, that we will be proscribed from various treatments on the NHS, because it's all our own fault and we are a bunch of lying, drunken, "pie eating lardbuckets", who do not deserve the largess of the NHS to help us fix the problems that ensue from our aberrant behaviour. What a crock of s**t! What about the other cohorts in society, who run in marathon's or just run in the the vain hope of 'super fitness' and end up in dedicated 'sport injury clinics' in the NHS? Or those who diet to the point of death, because society's model of beauty is a size 6, or indeed children diagnosed with ADHD, because their parents take the advice of the DH and feed them sugar laden grain products for breakfast, because it's 'healthy grains', pasta (wholewheat of course) and bread with almost every meal (brown of course). Surely all of these are equally responsible for their plight as is anyone who is said to be a chronic 'over eater'. This is Eugenics for 'fat people' and in my view is bordering on racism for adiposity.

You get fat not because you eat too much, or don't exercise but because you eat the wrong things, usually based on the advice of the Dept. of Health, or Heart UK, or Diabetes UK or one of the other self serving organisations we allow to govern our lifestyle choices, simply because they are heeded as being 'expert', when in truth they preach misguided and unscientific dogma. Despite the fact that they have been doing so since the late 1970's with no tangible proof of success, or indeed any evidence to support their ludicrous claims that they 'know best'. Often their advice is based upon Food Industry claims completely unsupported by any evidence because they want to sell you something. Or indeed some pseudo science from the USA that has long been disproved as fantasy.

There is no evidence that fat, makes you fat. None at all. Never. There is no evidence that eating saturated fat causes heart disease. In fact there is considerable evidence that the converse is true, with low carbohydrate, high fat and protein diets being the best solution for weight loss and health. There are many proofs of this but the most meaningful is the biochemistry involved in food intake. Carbohydrates are the food group that requires an insulin reaction to enable them to be metabolised, and conversion to glucose, no matter what their glycemic index is, will be extremely rapid, and more importantly virtually completely, to provide energy needs. The problem is that glucose, if not used up immediately is stored as fat and it is very difficult to utilise all of the glucose from a high carbohydrate meal immediately no matter how much exercise is taken. Fats and proteins are somewhat different in that they are not metabolised rapidly but quite slowly and not with the same ruthless efficiency as carbohydrates. Protein intake is needed for cellular generation from the amino-acids formed from their product in the body, so little is stored as fat. Fat is metabolised very slowly and with very low efficiency with nearly half of intake being 'wasted' and passed as ketones in urine. And of course, the 'calories in calories out' paradigm peddled as the 'gold standard' for diet is fatally flawed because of this.

The use of a 'low carb' diet has proved to be the most effective for weight loss for over a hundred years and it's modern equivalent 'The Atkins Diet', the 'Paleo Diet' or indeed any of the more up to date versions of diets reliant on fats and proteins in varying mixes to achieve a reductions in body fat are in the ascendant, yet the DH and Doctors generally seem hell bent on ignoring evidence of its efficacy. I find it difficult to see why.

It seems perverse to refuse treatment to any sector of society however guilty they may be of their predicament at the same time as providing it to others who are intrinsically as guilty, but worse have deliberately pursued a reckless course of exercise, or driven too fast, when drunk, or taken drugs. Fat people have usually tried hard on low calorie diets, or worse taken some of the awful, and generally useless drugs for obesity and consistently failed. If healthcare continues down the road of diets that set up the obese to fail, they are just as complicit as those they refuse to treat, indeed more so. Taken to extreme, why not have an undertaker posted permanently at A&E to wait whilst undeserving patients expire?

I seem to remember that a certain Steve Field, once head 'honcho' at the RGCP (now replaced by the excellent Claire Gerada) was a bit of a 'lard bucket' at the same time as he was selling us the idea of a 'healthy diet', didn't seem to work for him either! (Sorry, couldn't resist).