Obesity and Disease – How Concerned Should We Really Be?

This week more headlines have arisen about the risks of diseases associated with being overweight and obese. Although, whilst there are some clear links I wanted to break these headlines down a little further.

Before I do that, I wanted to share some of the highlights from the articles:

-          Type 2 diabetes risk increases by 9 times in obese individuals

-          Morbid obesity increases the risk of high blood pressure by 3 times

-          Associations with obesity and sleep apnoea

-          Morbid obesity was linked to increased risks of dyslipidemia (high cholesterol and additional fats found in the blood)

I’m not here to suggest that these associations have no ground to stand on. Although I am here to explain some of the factors which can also be associated to increased risks and obesity.

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1.       Diet quality is just as (if not more important) than being a healthy weight. Obesity can arise simply from overconsuming (for a prolonged period of time) of healthy foods. In these cases it would be interesting to see whether the risks of these diseases would be reduced if diet quality was taken into account.

2.       You can be overweight and malnourished or overweight and nutrient replete. This point leads on from the point above. Just because an individual is overweight this isn’t to say that they are well nourished. Poor diet quality can lead to mal nourishment if nutrient requirements are not met.

3.       Weight doesn’t define health. It’s easy to see people who are ‘ripped’ on Instagram and think that a six-pack defines health. A very low body weight (particularly on females) can increase the risk of impaired hormone function and amenorrhea (the absence of menstruation).

4.       Obesity is measured based on BMI which doesn’t take muscle mass into account.

So whilst body weight is associated with the risk of diseases, it’s not the bee all and end all. It’s also really important to realise that weight and over/under eating is much more complex than simply eating too much or eating too little. Therefore, one should never feel judged as a result of their body shape or weight.

Is Calorie Information on Menus Useful For Weight Management?

This is a very controversial topic and one which I think needs much more discussion around. Recently there has been more talk around whether calories should be printed on menus in restaurants. Everyone will have their own opinions on this and I invite you to share yours either in the comments of this article or via email.

Before sharing with you my personal opinions on this topic I want to set the scene. There has been research conducted on this topic. One meta-analysis of three randomised controlled trials (this is the highest quality study which can be done) showed that on average calorie information on menus reduced purchased calories by 49kcal per meal. In addition to this some other smaller studies have shown that this initiative can reduce calories purchased by 72kcal per meal. Overall, the researchers concluded that whilst much more research is needed on larger scales to suggest whether this is a good idea, they at present believe that it’s a harmless initiative.

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I totally understand those of you who might be reading this thinking that when you go out to eat you want to enjoy yourself and not focus on the calorie content of your food. Although at the same time we need to be aware that people are eating out more regularly than ever before – so maybe what was once a treat is not longer seen as just that. On average 25% of adults and 20% of children are eating out at least once a week. Note, there will be people who are eating out considerably more than this. When we eat out there’s also more chance that we order starters, mains, sides and desserts (and maybe even a glass of wine or two). As you can imagine going all out every time you eat out can add up. As a population we are currently in a health crisis with the World Health Organization predicting that 34% of England will be obese (not including overweight individuals) by 2025. Therefore, these initiatives have been set out to try and fight these statistics to ensure that these predictions don’t become facts.

Below I’ve listed out the pros and cons of having your calories labelled on menus.

Pros:

-        An attempt to make some change in the UK to help look after the health of the population.

-        Calories are easily interpreted and fairly straight forward to understand.

-        Research shows some small drive to reducing the number of calories purchased.

Cons:

-        Calories are a reductionist approach – not all calories are equal and this strategy ignores micronutrients and calorie utilisation.

-        No education around the meals or individual foods and simply places all of its value on one number.

-        Accuracy is likely to be low. How can restaurants ensure that their measures are correct as smaller restaurants are less likely to be able to utilise trained staff and appropriate energy measurements. Once the calories have been calculated not all chefs measure everything to a tee when serving dishes (especially in independent restaurants).

-        Counting calories can take its toll on some individual’s mental wellbeing who may become possessed by the number of calories they are eating. This could lead to eating disorders and poor relationship with food.

-        We are all unique and have different requirements.

-        Individuals may become reliant on the menus to make decisions around food. Whereas proper education around food may be a more beneficial strategy to managing obesity and the health of the UK population.

-        Places more emphasis on weight than overall health.

As I mentioned at the start I would let you into my opinion on this. I think we have to be realistic that people are eating out more regularly that they have done in the past and we do need to take some responsibility and be aware of what we’re eating. Although at the same time weight gain and obesity is incredibly multifaceted and therefore, I don’t think that this initiative alone is going to help with the UK’s obesity crisis. Not all calories are equal, neither are calories the bee all and end all. It’s important to remember that weight does not define health. One can be overweight and healthy whilst someone else can be ripped and incredibly unhealthy (nutritionally, metabolically, hormonally and mentally).

Overall, I think more research is required and I don’t think calories alone are going to solve the UK’s problem. It is important that people start understanding their food independent of weight.

 

Pineda, E., Sanchez-Romero, L. M., Brown, M., Jaccard, A., Jewell, J., Galea, G., ... & Breda, J. (2018). Forecasting future trends in obesity across Europe: the value of improving surveillance. Obesity facts11(5), 360-371.

Crockett, R. A., King, S. E., Marteau, T. M., Prevost, A. T., Bignardi, G., Roberts, N. W., ... & Jebb, S. A. (2018). Nutritional labelling for healthier food or non‐alcoholic drink purchasing and consumption. Cochrane Database of Systematic Reviews, (2).

Does Red Meat Really Cause Cancer?

This week a study came out suggesting that 25g per day of processed meat and or 50g per day of red meat can contribute to the risk of bowel cancer. It might seem that there’s a new scare mongering headline every week. Whilst we shouldn’t take each headline as hard fact there are often important messages which we can take away from the studies.

Before I give you the take home messages I want to give you a little bit of background information on the study. The study was conducted on nearly 500,000 people this is a really good population number. The dietary intakes were measured by using a food frequency questionnaire and one 24-hour dietary recall. There are some problems with these techniques as they’re based on memory. People are often not really aware of exactly what they’re eating which can make precision challenging. Although there were many confounding factors which were accounted for. Smoking, physical activity, family history, supplements, alcohol consumption, menopause and HRT use were a few of the confounders which were taken into account.

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So the findings suggest that red and processed meat intakes above 50g and 25g per day (respectively) can increase the risk of bowel cancer…. But what can we take away from this?

1.       We shouldn’t categorise both red and processed meat in order to demonise both. As a population we are consuming too much processed meat and should aim to limit it where possible although when it comes to good quality red meat there are some health benefits.

2.       Good quality red meat is rich in nutrients such as iron, zinc and B12. Iron found in animal products is much more bioavailable. This means the iron can be more absorbed and utilised than iron from plant-based sources. B12 is really difficult to get from plant sources and so must be consumed from animal sources. Although if you’re following a vegan diet then you may wish to supplement.

3.       The research also showed the adequate fibre intake was associated with a reduced risk of bowel cancer. The majority of the population are only reaching around 18g of fibre per day when the recommendations for the daily intake is 30g. Focus on increasing your intakes of beans, pulses, fruits, vegetables and wholegrains to help increase your fibre intake.

Whilst there are no conclusive explanations for the association between red and processed meat and cancer intake one explanation may be due to the nitrates/nitrites. Nitrates/ nitrites are chemical compounds used to preserve red and processed meat. They’re the compound which provides the deep red colour. They have a slow transit time which means they lurk in the bowel and it said that this can increase risk. As a result the high fibre intake speeds up transit time which may be one explanation as to why fibre helps to reduce the risk.

Another explanation suggests that the processing techniques e.g. smoking, preservatives and high heating temperatures may impact bowel cancer risk.

Overall try limiting your processed meats, focus on consuming one portion of good quality meat per week and increase your fibre intake to help reduce the risks associated with bowel cancer.