Sally Norton: Weight loss—help us to help ourselves

sally_nortonIf I hear one more time that keeping your weight down is all about personal responsibility—”just eat less and exercise more”—I will take a double chocolate, banana, and salted caramel, extra large, two for the price of one muffin and ram it into the mouth from whence this smug platitude came.

Of course weight control is about personal responsibility, but with two thirds of the English population classed as overweight, most of us are clearly unable to do the necessary on our own. So, do we just carry on, failing to manage our weight ourselves, or do we ask for help?

If it is that easy, why are we unable to manage our weight? Let’s look at an average day in the life of someone trying to take responsibility for their weight . . .

Mrs X climbs out of bed, a bit tired as the neighbour’s car alarm went off at 4am. Despite that, she is determined to make today the first day of her new healthier life. After getting the kids up and breakfasted, she just has time to grab a banana for herself and head out on the school run en route to the office. By mid morning, she is understandably starving, but the vending machine in the lobby can only offer her chocolate or crisps and her resolve is holding strong. She keeps the hunger at bay with a cup of black coffee. Although the gym is around the corner, work deadlines mean that a lunchtime break wouldn’t be well thought of, so she dashes to the staff canteen where the salad looks a bit bland and unappetizing and very expensive compared to the “meal deal” of mayonnaise laden sandwiches, crisps, coke, and a chocolate bar . . . . and she only had a banana for breakfast after all. Anyway, it’s easier to eat a sandwich than a salad at her desk.

On the way home (again, no time for the gym as she is collecting the kids) she stops at the garage. She only wanted petrol, but for some reason is offered two family bars of chocolate for £1. After a tiring and stressful day at work, it is impossible to resist. Then a quick trip to the supermarket, where the “buy one get one free” offer on doughnuts as she walks in the door is too cheap to pass on. But she does also stock up on the “healthy” dried fruit that is well labelled as providing one of her five a day (although far less clearly shown is the amount of sugar and calories for every serving).

As a birthday treat for one of her kids, the evening is spent at the cinema. Despite a supersize pizza with as many toppings as you want and a “free refill” fizzy drink, the kids are still keen for popcorn, although the only serving size available seems to be large (containing over 600 calories per portion). By the time she finally reaches home and gets the kids, high on sugar, to bed, Mrs X collapses with a well earned glass of red (well, half a bottle in the end) and the second of those chocolate bars from the garage.

Oh well, tomorrow is another opportunity to be personally responsible for one’s weight.

I defy anyone to constantly maintain willpower when tired and stressed—to battle with those daily temptations, only an example of the many we face on a regular basis. It could be so much easier if employers recognised that encouraging healthy behaviour in eating and activity led to greater productivity from their staff. And why should we have to be faced with those chocolate temptations put in our way, unrequested, when we try to buy a newspaper, petrol, or stand in line at the checkout? Why are supermarkets and other outlets allowed to push ever cheaper and ever larger unhealthy products at us? Why are they not made to focus their marketing on healthy products instead?

A recent study showed that healthy food is three times more expensive, calorie for calorie, than unhealthy food. Of course, healthy food is often much less calorie dense, so for every portion that effect is likely to be lessened. But when you are trying to meet (or exceed) your energy requirements for the day, “unhealthy” often seems to be the cheapest and easiest way to do it. Another study has shown that people taking part in a healthy eating, behavioural change programme are more likely to be successful if there are shops nearby that actually sell healthy food. Not really surprising.

Portion distortion is a massive issue, with the average meal or snack serving now at least 50% larger than 20 years ago. With the increased calorie density of many foods now, that equates to an even bigger increase in calories. The environment is a major factor in our ability to manage our weight. Willpower is stretched to breaking point when we are surrounded by temptation at every turn, and unhealthy choices are so much easier and cheaper to make than healthy ones. This is what we need to change, rather than putting the entire blame on the individual.

Yes, we are ultimately responsible for what we eat and how much we move, but we need help too because we can’t fight this on our own.

Sally Norton is a NHS consultant, specialising in weight loss and upper gastrointestinal surgery, on a crusade to put herself out of work by promoting healthier behaviour.

I have read and understood the BMJ policy on declaration of interests and declare the following interests:

NHS and private practice consultant in weight loss and upper GI surgery.
Financial support to attend conferences as invited speaker or delegate from MID, Allergan, Ethicon, Cook Medical.
Founder and director of offering online weight loss solutions and advice.
Founder and director of Vavista Awards: Free awards to industry for developing healthier products.
Founder and director of Health-eSupport: Free apps to educate patients and doctors about surgery.