Intended for healthcare professionals

Rapid response to:

Practice ABC of obesity

Obesity—can we turn the tide?

BMJ 2006; 333 doi: (Published 14 December 2006) Cite this as: BMJ 2006;333:1261

Rapid Response:

More vital points to add

The article is very welcome reading, covering as it does, the need
for regulation of commercial provision of foods, assessment of diet
products; training of medical professionals; transport planning; and
education in schools. But important though these we must address several
other issues too.

Sports facilities are too expensive for the majority of people most
affected by obesity, who are poor. Gyms are completely out of reach and
swimming takes a hefty £10 or more out of a modest housekeeping week.
We should look at prescribing exercise: an accounting exchange between the
health service and the sports centres would be no more expensive than a
prescription for a standard diet drug.

Sports centres should be far more accessible to the general public who are
treated as an afterthought to commercial classes and schools.
For example, pools currently often open for only short sessions of an hour
(making a late start cancel the benefit of a session); sessions are at
irregular times impossible to coordinate with work commitments; pools
actually close early at weekends - and completely on public holidays when
people are most able to use them.
The governmet ministry concerned claims they have no influence in this
area, and no one can have any input t local authorities' choices here.
This is not the case.

We need training of medical practitioners urgently of course but we also
need a public awareness campaign. Public awareness is cheap and highly
cost effective. People now know not to offer a drink to an alcoholic.
They must be taught not to offer food to the obese - any food, except
plain fruit. Hosting a dinner must mean checking for obese acceptable
foods as well as vegetarian.

Obese people are typically affectionate, sociable personalities
particularly vulnerable to pressure to please.
Too often the obese are urged to "have one, just this once" or even "have
one just to please me I got it specially." Other ignorant comments are
"treat yourself, go on why not?" "Just one slice can't hurt." The outcome
is obvious as determined self control cannot hold 100% through all waking
hours and especially against onslaughts like these.
There is also a destructive male culture that condemns dieting women as
silly and unattractive. This needs challenging, especially as the same men
who announce their highly influential opinions, do not want fat

The entrenched and prejudiced view that the obese are greedy,
uncontrolled, and inefficient is known to cause job and other kinds of
discrimination we would never tolerate for anorexia for example.

Chocolates should become much less the favoured special gift. Perhaps
fruit distributors could be encouraged to distribute gay or elegant

All together a great deal could be done by ordinary people helping to
create a social context that helps the obese in their struggle.

But a widely available leaflet in surgeries, libraries etc outlining
how "eat less and exercise" is inadequate would do wonders. This is also a
cheap and effective option.

Most people simply don't know enough about which foods to avoid! Nor
do they know WHY breakfast is vital; nor that eating later in the day
especially after 7pm lays down much more fat. Nor that "eating less"
triggers famine syndrome and holds on to fat. Nor that sticking to the
same regime lets the body adjust and renders all the effort useless, so
up/down days or weeks are better. Nor that high throughput of water is
vital. Nor that everyone goes into plateau after 3 months or so, so "diet
holidays" are actually beneficial.

While restricting advertising on TV is essential, keeping junk food ads
after 9pm is actually counter productive. This is the peak period of
vulnerability for obese strugglers when the physical system is tired and
reacting to a day without fats and sugars it craves. Late night shops and
garages make supply easy once the craving is stimulated.
Instead we should separate out children's programme linked adverts in the
afternoon from adult linked ads which are actually safer in the daytime or
early evening.

Competing interests:
None declared

Competing interests: No competing interests

19 December 2006
Shan Jayran
First College UK GL15 6LX