Diet-related disease and obesity are subjects that recur with increasing frequency in our national conversation, and with good reason.
A recent report revealed that conditions related to lifestyle (such as type 2 diabetes and high cholesterol) cost the NHS a staggering £11 billion per year; and alongside alcohol consumption and tobacco use, poor diet plays a prominent role in these illnesses.
Hyperbolic as the term ‘obesity crisis’ may sound, it isn’t an overstatement. To give you an idea of the sheer magnitude of the issue, obesity rates in 1993 as reported by Public Health England were 16.4% and 13.2% among women and men respectively. By 2014 these figures had risen to 26.8% (women) and 24.3% (men). By 2050, they are expected to rise to 50% (women) and 60% (men).
Of course, the more that can be done to halt and reverse this trend, the better for our health and healthcare services. And understanding the causes of this rise is no doubt key to developing a comprehensive programme to tackle the problem.
As we’ve said several times before, we think that adopting a particular diet or programme of exercise in order to lose weight is something which everyone should speak to their doctor about first. No one approach is suitable for everyone, and as someone familiar with your medical history, your GP is the best person to ask before implementing any significant changes.
The sugar and obesity debate
But as far as the wider debate goes, we’ve witnessed recently that the best dietary methods for reducing obesity and preventing related illness is a subject which splits even the most reputable of health organisations and research bodies.
In May this year, the National Obesity Forum and Public Health England had a very public difference of opinion on the topic, which garnered a significant amount of column inches and controversy. The sugar tax also became a hotly contested area of debate around the same time.
What foods we should be avoiding and what we should be including (and indeed how much of each we should be including) is a discussion subject to ongoing and intensifying debate among dietary experts. As we learn more about about nutrition, different schools of thought are being developed all the time and the debate is becoming an ever more complex one.
In recent years, a number of commentators have pointed towards sugar (as opposed to fat) as being the main instigator when it comes to the obesity epidemic.
We like to hear from all sides of a debate here at Treated.com, and with this in mind, we thought it might be interesting this week to hear from Lou Lebentz, TEDTalks speaker and founder of health and wellness brand Sweet Enough. The Sweet Enough programme aims to educate people on the health risks associated with sugar consumption, and help them to make healthier choices.
Our team got in touch with Lou to get her thoughts on the obesity epidemic, and some of the wider news topics surrounding it. Here’s what she had to say:
Q. Since the 1970s, obesity in the UK has risen from less than five percent to around 25 percent in 2013. What do you feel are the main factors behind this rise?
Lou: ‘Since the 1970s TV commercials and health campaigners have been urging us to cut the fat out and go on low fat diets and look what’s happened; we’ve continuously become more overweight. This diet advice doesn’t seem to be working, so it shouldn’t take a rocket scientist to work out here that somebody must have made a very significant and costly mistake.
Why did they make the mistake? Because there was an epidemic of heart disease in the US in the 20th century. Many of the scientists in those days believed fat, saturated fat particularly, to be the main dietary cause of heart disease.
In 1972, British scientist John Yudkin published a book called Pure White and Deadly and he was the first person to prove that sugar was bad for our health. Unfortunately for us, he was ignored by the majority of the medical profession and rubbished by the food industry and his career was over, he was shunned and disappeared. If we had heeded his warning we may have avoided 1 in 4 adults in the UK now being obese.
In my opinion, this misguided science effectively led to the birth of the low fat diet which aimed at restricting saturated fat in our diets. Interestingly, the obesity epidemic started at almost the exact same time the low-fat guidelines first came out. Because when they took out the fat to make the food palatable they replaced it with sugar. So sugar got added into the food chain and into almost everything that we ate. This hasn’t changed since.’
Q. Obviously we know more about nutrition today than we did 40 years ago, and the average person has more ready access to this information now (through the internet and technological convenience) than they ever have before. Despite this, obesity and overweight prevalence continues to rise. Why in your opinion is this wider access to knowledge and nutritional information at odds with obesity trends, and not translating into healthier practices?
Lou: ‘I think people are confused. They are being given different advice by different people, they don’t know what to think, who to trust or who to believe; I think that’s part of the problem.
Also as a population, we’re more stressed than we were 30-40 years ago and we know that increased levels of cortisol (the hormone released with adrenalin when we are stressed) leads to an inability to lose weight for a lot of people. So to help people lose weight we need to help reduce stress levels as well. We need to start considering a whole-body approach.
People often think they are eating healthily because products are marketed that way, but they don’t realise how much hidden sugars are in everything because its labelled or advertised to make you believe it’s healthy; but actually it is highly processed and sugar laden.’
Q. The UK government unveiled its new obesity strategy a few weeks ago.
To provide a brief summary:
The strategy has proposed that food and drink manufacturers reduce the amount of sugar contained in their products by five percent over the next year.
It has set a total target of a 20 percent reduction. PHE will continue to review this during the next four years.
It also urges primary schools to introduce 30 minutes of activity for children per day, and pledges to make more funding available for school sports.
What are your thoughts on it? What strategies and implementations do you think could make it more effective?
Lou: ‘It’s a plan that aims to appease both sides and meet industry and medical and health professionals in the middle somewhere, but it is not appeasing either side and still basically upsetting both.
The childhood obesity strategy also says:
Public Health England (PHE) will set targets for sugar content per 100g, and calorie caps for certain products and then PHE will report on whether the industry is reducing sugar content through the voluntary scheme or not. They reckon that if insufficient progress is made, the government will consider "whether alternative levers need to be used". I will be interested to see when and if this happens and how they plan to monitor it all.
Also a new voluntary "healthy schools rating scheme" will be taken into account during school inspections aiming to get schools to take some of the responsibility in helping children get healthier.
However, in my opinion what the government plan has failed to tackle is the following;
The 5 percent leading to 20 percent reduction in sugar is a voluntary reduction scheme for reformulation and not compulsory so all food manufacturers and producers do not have to abide by these set targets whatsoever.
Also there were no restrictions made on the marketing and advertising of junk food to children and young people.
There was also no discussion about compulsory labelling and how to make it easier to spot how much sugar it actually carries on the front or back of products.
It’s incredible to think that this is a catastrophic epidemic. In the US 50 percent of the population has metabolic syndrome, the precursor to diabetes. I don’t think we are that far behind in the UK sadly, but we still don’t seem to have got our heads around the fact that poor choice, mass production of processed foods and our overall consumption of sugar is ultimately making us all really sick.’
Q. The proposed sugar tax caused widespread debate earlier this year: those for it argue that it will help to reduce the prevalence of diet-related disease, and that if it worked in Mexico it will work here; while those more critical of it argue that it will only serve to penalise the poor. What are your thoughts?
Lou: ‘I don’t think it will have much of an effect on diet related diseases sadly because sugar, fructose, glucose, and sucrose all of sugars and are also present in food, like cakes, biscuits and juices and not just fizzy drinks! However, the biggest drinkers of pop are teenagers so it might go some way into curbing their appetite for fizzy drinks at 18-24p a litre hopefully.
Does it penalise the poor? Yes sadly, it probably does. However, the government would do much better if it would put some of the money from the sugar tax raised towards subsidising healthy foods, fruits and vegetables for low income families. Rather than spending it all on school sports which although useful, exercise only accounts for a small percentage of weight control whereas diet plays a much more prominent role.
And fresh wholesome foods quite frankly cost a fortune.
Personally, I feel the sugar tax was more beneficial because of the public health message and warning it gave out about sugar. The symbolism of taxing something unhealthy also may have been seen as progress.
So the sugar tax is a small step in the right direction; but it only applies to drinks and not other products that are laden with sugar. There’s also now been a huge increase in the diagnosis of non-alcoholic fatty liver disease (‘NAFLD’) in the population too, so we may have to think again.
NAFLD is caused by all the fructose (fruit sugars and high fructose corn syrup) in drinks the West are consuming, so it’ll take more than taxing drinks and educating people unfortunately, to now start bringing those diseased liver numbers down effectively.’
Q. There was some controversy around guidelines released by the National Obesity Forum a couple of months back, which suggested that eating fat can help to reduce obesity, and that the promotion of low-fat foods may cause 'disastrous health consequences'. PHE criticised them for issuing this advice, and argued that it added to public confusion on the subject. What did you make of the situation?
Lou: ‘Public Health England goes by the Eat Well Plate and its guidelines do not operate from the new paradigm of “fat doesn’t make you fat, sugar makes you fat” so they would have been upset by it. The National Obesity Forum are acting on the latest research which shows that low fat produce has so much sugar in it, that it really should be marketed as high sugar rather than low fat! And fat itself is starting to be shown by many studies as not being the number one enemy and in fact it is a macronutrient that most people can embrace. The advice would have caused a lot of tension between the old school philosophy and the new school of thought.’
Q. Do you think the calories in - calories out approach to weight loss is outdated? Why?
Lou: ‘Dr Zoe Harcombe PHD is the expert on this question and I’d look at her website for more information. Gary Taubes has written some great books on this, as has Robert Lustig. But basically I have gone off the calories in/out model too, particularly from recent research, theirs included.
The effect food has on the body as you consume it is the most important aspect of weight gain, and now it’s being proven as being the effect that has the most impact on overall health, size, weight and shape.
So 100 calories from a fizzy drink will cause a totally different response in the body than 100 calories from broccoli. What the body does with those two different ingestions is completely different biochemically, as is the endocrinological response. That’s what we should be looking at: the hormonal activation around those nutrients and not the calorie amount.
If we believe that insulin is the regulator of fat storage within the body then we need to be doing things that lower that insulin level and not spike it. Sugars and highly refined foods spike the insulin levels so keep the blood sugar high. That’s what stores fat and makes us unable to lose it. So we need to be eating more foods that aren’t high in sugars like broccoli and less fizzy cola and cakes.’
Q. Please tell us a bit about the Sweet Enough philosophy. What are the main principles behind the programme, and how does it help participants to develop healthy eating habits?
Lou: ‘The Sweet Enough 360-degree approach tackles sugar and sugar dependency at a much deeper level than any other programme. It works on a number of levels including: the neurological, teaching people about the brain; and the biological, teaching them about stress and their hormones too. When they have all the information they need I then move them onto the psychological and emotional areas, explaining how people think and feel are vital to success in their ability to shift their relationships with food.
I don’t just simply educate our audience about the impact sugar has on their physical and mental health, I also give them tools and techniques to help them understand what’s going on with their emotions and to recognise the part that sugar plays in day to day life. The Sweet Enough product offerings (eight week online programme and two day seminars) are designed to be hugely informational, but more importantly motivational and inspirational too. We know that people need huge encouragement at the beginning when quitting sugar and junk food but the Sweet Enough team and I are also with people on the journey and giving them a helping hand all the way through the eight week plan.
The programme teaches you about food and nutrition, but it teaches you a whole lot more than that too. It teaches our clients how to stop the fight and quit using food as a fix and start loving themselves fully and their life again. I help them find that “Sweet Enough” spot on the inside so they have no more need for sugary filling from the outside in. As a result they will discover a new, happier, healthier and probably slimmer person as a result.
However, we all believe at Sweet Enough that giving up or reducing sugar is not about going on another diet. It’s not necessarily about losing weight or even obsessing about your body, although fat loss will likely be a side effect of quitting sugar and junk. Fundamentally, Sweet Enough is really about making a sustainable, deeper, more effective change for life. We don’t believe in quick fixes and we want to teach people how to continue eating healthily so they don’t have to keep coming back!
Lastly, and importantly too, I look at our client’s greater goals, the end destination they have in mind which takes into account the deeper elements of their life whilst giving them the fuel and motivation to stay on track. Sometimes having a desired dream destination is the most important part of the process for them and can be hugely powerful as a motivator to keep them on board.
Therefore, Sweet Enough really does look at every angle and all parts of people’s relationship with food, making it truly comprehensive. It’s been based not only on many years of experience as a therapist treating others with addiction and eating disorders but also on many years of my own healing and recovery.
I always wanted to write an effective programme, which was going to be deep enough to help people make long and lasting change and I think I have managed to do that. I guess when it launches in January 2017 others can be the judge of that. I hope it’ll really help some people transform their relationship with food one bite at a time.’
You can read more about Lou Lebentz’s story over at Sweetenough.online.