Another 1600 reasons that prove PHE doesn’t understand weight loss

Last week Duncan Selbie, Chief Exec of Public Health England announced us Brits "need to go on a diet". He said “the simple truth is on average we need to eat less. Children and adults routinely eat too many calories and it's why so many are overweight or obese.” 

OK PHE, now that you’ve insulted us all, let me walk you through the inaccuracies and massive generalisations you’ve just made with your 400-600-600 Cal plan and the potential harm this causes.

Yes, in literal terms the word diet simply means the food we habitually eat BUT the most common definition most people associate with the word diet is the way in which a person restricts what they eat in order to lose weight.  But hat we eat is certainly not the only factor that determines our body weight!

I have a problem with PHE using the word diet because eating less does not automatically lead to weight loss and it carries so many negative connotations. You can't dictate a Calorie limit to meals! How does this account for the different nutrient density in foods?  How does this factor in hunger and appetite? 

I also assumed PHE always used a strong evidence base upon which they base their health recommendations and it appears I was wrong.  Are you aware that gold standard evidence concludes trying to lose weight is likely to do more harm than good and cannot be recommended as a safe and effective treatment? And that’s quite aside from how the ‘get thin’ message leads to prejudice and shame, neither of which improves personal or population health.

I too had the benefits of weight loss drilled into me for over 20 years. I was told a higher BMI (body mass index commonly used as a measure of fatness and health) is associated with an increased risk of disease and death.  But if you look (because of course it’s easiest to see what you want to see), I mean really look at the evidence critically, increased fatness does not necessarily lead to disease and dieting does not necessarily improve health.

So what went wrong at PHE? Did you miss the global statistics that show weight reducing diets and restrictive eating plans do not help people lose weight and more importantly maintain weight loss? Have you seen the papers that report ⅓ - ⅔ of people will regain the weight lost within one year and almost all will regain that weight in 5 years?

Did you see the great article published in The BMJ last year that highlighted the common misassumptions around weight loss;

• That weight loss is always consistent with better health outcomes
• That weight reduction is a prerequisite for better health
• That every fat person wants to lose weight
• Focusing solely on weight loss is not harmful

Because their findings are pretty convincing!

PHE I am here to tell you that weight is not the biggest determinant of health, that weight loss is not the be all and end all for fatter people.

I am here to tell you that weight loss is so rarely successful in the long term, that weight loss ultimately leads to weight regain and worse health? Calorie restriction is more likely to result in weight cycling this increases the risk of cardiometabolic disease.

Counting Calories (points or other metrics linked to energy) creates a pre-occupation with and obsessive behaviours around food. You may have experienced this yourself when you restrict something; you become completely obsessed with the object of your restriction and at some point you will ‘give in’. Then come the feelings of guilt, failure and resentment; all of which create a negative relationship with food and ourselves.

Ignoring hunger and attempting to manipulate the body into weight loss will trigger compensatory mechanisms that will aim to restore the status quo. The body will always be one step ahead, putting mechanisms into place to prevent weight loss. This is why it can be so hard for so many. Telling people to diet is setting them up for failure!

During Calorie restriction, the body will shift into ‘starvation mode’ and hoard energy. Metabolism and energy levels drop to compensate for less fuel being delivered. Appetite increases to drive us to eat more (one of our primitive survival instincts). Sensitivity to feeling full becomes dampened. Not exactly conducive to boosting motivation and improving health behaviours!

Had you forgotten to  consider that illness, poverty, social inequalities, mental health and stigma are equally if not more powerful indicators of health than body weight. These factors can significantly alter our metabolism.  We are so much more than Calorie burning machines.  Did you read this paper that 7 years ago recommended shifting away from conventional weight loss strategies? 

You may find it all a bit woo but have you actually looked at the evidence that supports a non-diet approach on health outcomes?  It may seem ‘out there’ but we are all unique human beings. This is a great article that evaluates the evidence for prioritizing well-being over weight loss. After all, we are so much more than a BMI or a number on a scale aren’t we?

So much of our society is obsessed with getting thinner; is PHE joining the flock that says thin = healthy? Are you aware of the emotional battles, degradation and negative self talk that goes on as we strive for 'perfection'. Diets so often lead us to feel deprived and worthless when we can't match unattainable body standards. By dictating a Calorie intake, you are emphasising what the diet industry already says. That we should ‘conform’. Well let me tell you PHE, you are promoting weight bias. You are reinforcing negative societal attitudes, stigma, and prejudice. Not good is it? I really worry about the children and young adults in our society.

This paper highlights the harms of weight bias,  the adverse health consequences associated with it, that shaming individuals for their body weight does not motivate positive behaviour change and take note - that public health interventions, if not carefully thought out, can perpetuate weight bias.

A question I have is where did the 400-600-600 come from? We know that men and women significantly underestimate Calorie consumption but please note PHE that 37% of Brits don’t know how many calories they consume on a typical day. Therefore what use is it to prescribe 400, 600 and 600?

Some of the challenge the public face is the complexity of labelling and marketing. Another is that not all foods, especially when eating out provide the nutritional information the public need to make an informed choice. Not that everyone can understand and interpret nutritional information in the first place.

From my experience, the biggest challenges people face around eating is knowing the difference between physical and non-physical hunger, knowing what hunger even feels like, knowing how to respond to hunger or simply knowing what the body really needs because we live life a a million miles an hour. Life’s pressures, the need to be constantly available, ever increasing demands, multi tasking, rushing…...can’t stop!

I bet if you ask 100 people, most will say they just make do when it comes to food; that the next item on the to do list is more important, that they are too tired or don’t have enough time to eat what they ‘should’. Our society is sleep deprived, exhausted, unmotivated, broke. These are the fundamental problems we need to deal with, not what people weigh and saying we should have a 600 Calorie meal for lunch and dinner. But fear not, there’s always Let’s Eat to fall back on as we remain fixed on the sofa, because that will really help won’t it.

What about the nutritional quality of the 400 or 600 Calorie meal? The starch, sugar, fibre, fat and protein content that will determine the level of satisfaction after eating? Similarly I have the same concerns about the 100 Calorie snack campaign; I could give my son popcorn as that's low in Cals but he’ll be back in 20 minutes saying he’s hungry again because there's nothing much in it. Not all Calories are the same and eating is not a one size fits all!

The public are confused enough about food and nutrition as it is. We have young and vulnerable children growing up in this country with eating disorders and mental health problems continuing to rise.  Tightening the screws and using a misinformed blanket approach is not the way forward.

What's the alternative? My preference would be to take a weight inclusive approach; one that acknowledges everybody is capable of achieving health and well-being independent of weight. This means adopting a non-weight centered approach to health and one that invites intuitive eating skills is far more positive and helpful.

Rather than focusing on and tracking the energy and fats in foods, I recommend and practice in helping people become more attuned to the body's natural hunger signals. Research shows intuitive eating is much more effective in achieving and maintaining a healthy weight (for each individual) and creating a more positive relationship with food and reducing the risk of disordered eating.