How to tackle obesity head-on

By Melanie Leyshon

25% of adults in the UK are already obese and two-thirds are overweight. Worrying statistics, which, according to Professor David Haslam, National Obesity Forum chair and Healthy Food Guide expert, means we could be facing a ‘doomsday scenario’. At the start of National Obesity Awareness Week (13–19 Jan), David wants to see campaigns for obesity becoming as hard-hitting as those against smoking.

‘There’s a lot more we can be doing by way of earlier intervention and to encourage members of the public to take sensible steps to help themselves,’ says David. ‘But this goes hand in hand with government leadership and ensuring responsible food and drink manufacturing and retailing. We need more proactive engagement by healthcare professionals on weight management, more support and better signposting to services for people who are already obese, and more importance placed on what we drink and how it affects our health.’

To tackle obesity successfully, health experts believe all the elements of the condition must be addressed. One successful scheme has been trialled in Rotherham, South Yorkshire.

The town’s weight management programme brought together health authorities and commercial enterprises such as WeightWatchers, with a focus on healthy eating and exercise. Its community approach encouraged overweight people to request a referral to the Rotherham Institute of Obesity from either their GP, nurse, pharmacist or dietitian, or to refer themselves.

Of the patients who completed the six-month weight-loss programme, 93% lost weight and 66% met or did better than their targets. Overall weight-loss results were up to 29% of the original starting weight.

‘It worked because once assessed, patients could see a weight management professional, dietitian, exercise physiologist or talking therapist, or whatever they needed,’ says David. There were three stages to the scheme: stage one identified people at primary care level; stage two was community based, where nutrition and lifestyle and exercise advice was given by trained staff; and stage three looked at specialist interventions, such as bariatric surgery. For children, this included residential weight management camps.

David believes the Rotherham approach is utterly cost effective and should be used across the country. ‘People are sitting in the wrong clinics. They’re in the cardiology clinic and the diabetes clinic or liver clinic, when really they should have started in the obesity clinic so that the problem could really be dealt with.’

‘If you rolled out the Rotherham programme everywhere, it would cost far less than the amount obesity is going to cost us in 25 years’ time, according to Government predictions,’ he says. The programme costs under £1m and if it were rolled out nationally, it would cost around £250m - a small fraction of the bill we will be faced with in 2050 if the obesity crisis continues at its current pace.’

For advice on tackling obesity, check out the National Obesity Awareness Week website www.noaw2014.org.uk/recipes - Healthy Food Guide has a week’s worth of recipes available for you to try.

For more everyday recipes - all 500 kcal or less - get a copy of Healthy Food Guide’s Make it Special 100 Speedy Suppers Recipe Collection (£3.99), out now at branches of Tesco, Sainsbury’s and WH Smith, or download the iPAD edition from iTunes. 

Easy ways to cut down on sugar

The Action on Sugar campaign was launched yesterday to tackle concerns that we’re all consuming too much sugar. 

While the debate rages on what can be done about the national obesity problem, here are Healthy Food Guide’s practical tips on how to reduce your own sugar intake – plus we reveal which foods are higher in sugar than you may have thought.

7 ways to replace the white stuff:

1.     Get baking – if you like the occasional cake or biscuit, make your own so you can control the ingredients (you can normally halve the sugar content without affecting the quality). Look out for healthier sweet recipes in the pages of HFG.

2.     Try sugar substitutes – natural products like stevia are sweeter than sugar, with fewer calories.

3.     Use spices for flavour without the sugar – try cinnamon, mixed spice and ginger in stewed fruits, porridge and puddings.

4.     Watch the drinks – alcohol, fizzy drinks and juices are an easy way to overload on sugar without noticing. Try sparkling water with lemon slices and fresh mint sprigs, chilled herbal teas or diluted juice.

5.     Look out for hidden sugar in unlikely foods (see below) – look for ingredients ending in ‘ose’ on the ingredients label and check out the value for sugars: less than 5g per 100g is considered low in sugar while more than 15g per 100g is considered high (although this value refers to all sugars, not just added ones).

6.     Choose lower-sugar versions of cereals, baked beans, soups, canned tomatoes and ketchup.

7.     Eat fewer processed carbohydrates such as white bread, croissants, muffins, biscuits, cakes, chocolate and sweets. These convert rapidly to glucose in the blood, so high levels may contribute to energy highs and lows and cravings. Switch to wholegrains instead.

Do you know where sugar is lurking?

Food doesn’t have to taste sweet to contain sugar. Check out some of the more unlikely products you’ll find it in if you look closely…

* 30g cornflakes = ½tsp

* 1tbsp salad cream = ½tsp

* 1tbsp balsamic vinegar = ½tsp

* 1 slice bread = ½tsp

* 1tbsp tomato ketchup = 1tsp

* Half a large tin mushroom soup = 1tsp

* 2tbsp coleslaw = 1tsp

* A third of a jar of salsa = 1tsp

* 30g branflakes = 1½tsp

* 125g ready made Bolognese sauce = 2tsp

* 400g lasagna ready meal = 3tsp

* 400g chicken tikka masala ready meal = 3½tsp

Sugar in our diets: what's the risk?

By Paul McArdle, British Dietetic Association dietitian and diabetes specialist

The newly launched Action on Sugar Campaign is pushing for a reduction of 20-30% in the amount of sugars in our diet – sugar hidden in products we buy and the sugar we add to our food and drink. Can our sweet addiction really put us at risk of obesity and type 2 diabetes?

It's true most of us are consuming too much sugar, and much of the sugar we consume is already in pre-packaged or convenience foods.

Although sugar has fewer than half the calories of fat, it's very easy to consume large quantities of it, especially in the form of drinks, which doesn't leave you feeling very full or satisfied. Often foods with added sugar provide very few nutritional benefits and, therefore, 'empty calories'.

The British Dietetic Association (BDA) supports the call by the campaign group Action on Sugar for the food industry to reduce the sugar added to foods. If successful, the reduction in sugar may contribute to cutting the number of calories people are eating.

This is the main problem: the sugar we eat is part of a diet which is already too high in calories – indeed it may be contributing to this, and therefore to the increasing numbers of people who are overweight and obese. Small amounts of sugar, as part of a balanced diet and in people who are successfully managing their weight, is not necessarily a problem. Moreover, there are no research studies that have proved eating sugar causes type 2 diabetes. However, there are studies that look at links between dietary patterns and the risk of developing type 2 diabetes.

One such link is sugar-sweetened beverages. A very large study of men found an association between drinking sugar-sweetened beverages and developing type 2 diabetes. Over a 20-year period, it showed a 24% increased risk for those with the highest intakes of these drinks. This doesn't demonstrate they are the cause of the diabetes in the study population, as different types of research studies would be needed to determine that. Watch this space.

A breakthrough for type 2 diabetes?

By Tracy Kelly

Can we put type 2 diabetes into long-term remission? It’s a question that’s asked often and to date we don’t have the answer – but that could all change within a few years. 

That’s because Diabetes UK has recently awarded a £2.4 million research grant to look into whether losing weight – and keeping it off – through a low-calorie liquid diet is a feasible long-term treatment for putting type 2 diabetes into remission.  

As part of the Diabetes Remission Clinical Trial (DiRECT) study, researchers will recruit 280 overweight people with type 2 diabetes and put them on two separate diets. This new trial follows a 2011 study that found that 11 overweight people with type 2 diabetes saw their insulin production return to normal and their type 2 diabetes put into remission after eight weeks on a low-calorie liquid diet. 

Following the huge media interest in this study, many people with type 2 diabetes were interested in this approach. But as exciting as these findings were, the study did not focus on the effects of the diet in the long term and there is still much about low-calorie diets that we are yet to understand.

As part of the new trial, one group of 140 people will spend between eight and 20 weeks on a low-calorie diet of 800 calories a day – mainly nutritionally complete diet soups or shakes, plus ample fluids. Then, as normal food is reintroduced, they will learn how to change their lifestyles permanently. 

The results of this group will be compared with an equal number in the second group, who will follow what is currently accepted as the best advice for weight loss and weight maintenance. 

Both groups will be monitored for two years to study the long-term effects of their diets on weight. MRI scans will look at what’s happening inside their bodies during the diet.

The aim is to see whether the stress and effort of following a restrictive diet for several months is beneficial in the long run. After all, 800 calories is not a lot – people following such a diet are likely to feel hungry quite a lot of the time. Also, will they be able to stick to it for long enough for it to be successful? Even more fundamentally, this kind of diet is not an easy option or a ‘quick fix’ and people will still have to follow a healthy lifestyle afterwards to stop their type 2 diabetes coming back. It’s a fact that weight regain after liquid diets is common.

Type 2 diabetes will always be a serious condition, but perhaps it won’t always be seen as a condition that people have to manage for the rest of their lives – and that inevitably gets worse. If this study shows that low-calorie liquid diets can be used safely, on a bigger scale and as part of routine care, it could completely change what we know about type 2 diabetes and how it is treated by the NHS. It could also provide an accessible way to help people with this condition live longer, with a better quality of life and a reduced risk of serious health complications.  

For more information about the trial visit www.diabetes.org.uk/DiRECT