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BRITISH BROADCASTING CORPORATION
RADIO SCIENCE UNIT
CHECK UP Programme no. 3 - Obesity
RADIO 4
THURSDAY 26TH JUNE 2008 1500-1530
PRESENTER: BARBARA MYERS
CONTRIBUTORS: ANN ROBINSON
PRODUCER:
NOT CHECKED AS BROADCAST
MYERS
Hello. Can you believe how easy it is to pile on the pounds - a little bit here, a lot more there - the skirt that fits is now ooh size 16 or is that an 18? Trousers suddenly feel quite tight, even with a 40 inch waist band. Being polite we talk of middle age spread, aren't we supposed to be a stone or two heavier than we were when we were younger or are we kidding ourselves and putting our health at risk with our ready meals, our super size portions and that couch potato lifestyle?
The hard facts are that one in two adults and one in six children is now officially overweight or obese. And carrying excess weight seriously increases our risk of heart disease, stroke and diabetes.
Now anybody classified as morbidly obese might be eligible for drug treatment - a new class of obesity drugs has been approved for use just this week. Or you might have heard of surgery - there's been a lot of comment about celebrities who've had gastric banding to help them lose weight. Or maybe you know that we should all just eat rather less and exercise more but we're struggling to keep it going. Well if you need encouragement, advice or information you've come to the right place, talk to our expert in the studio today she's Dr Ann Robinson. And the first caller is on the line, it's Marion. Marion says she's 61 and has lost a lot of weight. So, so far so good then Marion, what's the problem?
MARION
Well I can't shift the extra inches around my waist.
MYERS
Ah, so what does the tape measure say?
MARION
The tape measure says 35 and the range which is supposed to be healthy is under 32.
MYERS
Right, so reasonable then to want to shift the extra three inches, even though you have lost a lot of weight. What is your actual weight then at the moment?
MARION
I'm 10 stone 4, so I've got a healthy BMI, because I'm five foot four.
MYERS
Right, well that last comment has brought a smile to Ann Robinson's face because BMI is quite important as well as the waist measurement, isn't it Ann?
ROBINSON
Yeah, hi Marion and congratulations on losing weight, it's not easy at all, if it were easy then half of us wouldn't be overweight. So congratulations. And getting your BMI into the healthy weight range, which you have, is great and is actually the most important thing. The waist size measurement is one factor and is factored in with the BMI. Once your BMI is in the normal weight range you basically don't need to worry too much. You're obviously an apple sort of shape, as opposed to more pear shaped. If you were overweight and you were also apple shaped that would be slightly more risky than being overweight and pear shaped. But now that you're normal weight I don't think you need to worry too much.
MYERS
There's some talk though, isn't there Ann, about using the tape measure and the waist size as being the key to establishing whether you are carrying too much weight but you're saying, very clearly there, that that's only in conjunction with the BMI and of course you can get your BMI checked, not that easy to work out but there are ready reckoners. And that's a relationship between what - height and weight?
ROBINSON
Height and weight, that's right, you take your height in metres squared, you put over your weight in kilograms and you can do it online or ask your GP to do it for you - absolutely A BMI of 18.5-25 is normal, 25-30 is overweight and if it's over 30 you're seriously overweight.
MYERS
So Marion, just before we let you go, is there a key to having lost the weight that you've managed to lose, what have you done?
MARION
I think it's just a case of finally getting my head in the right place and deciding that I really wanted to be slimmer more than I wanted the chocolate cake.
MYERS
So it's willpower and it's been sort of virtue as its own reward, is that what you're trying to say?
MARION
No I think I had lots of attempts and gave up and it took me a very long time to get the weight off but gradually it gets easier because you start to see the benefits and then you start to really feel I want to do this and so it becomes a bit easier to resist all those interesting foods.
MYERS
Well that's rather inspiring, I hope people can take - take not of that and it sounds as though from what Ann has said anyway you're extra couple of inches may be - are not at all a problem. So thanks for that Marion. Nick has e-mailed us, he's in west Devon, and he's got a question for Ann. He's asking: Is fat a problem in itself or is it a merely a problem when associated with couch potato lifestyle? He says he's 47 and borderline obese with middle age spread. Am I wrong, he asks, to wear my paunch with pride? He reckons it's a good layer of natural organic insulation and he says - actually I lead a fit and active lifestyle which includes cycling 17 miles across Dartmoor. So is middle age spread just a vanity thing he asks like greying or receding hair? So has Nick got his head in the right place about weight?
ROBINSON
Well Nick's obviously doing good things by cycling across Dartmoor, that's great, and he's obviously got a cheerful disposition, which is also great. But I think he is kidding himself and euphemisms like middle age spread or I'm putting it on a bit and patting your tummy with pride are disguising the fact that there is no doubt that being very overweight is not good for you. It costs the NHS about a billion pounds a year, so it's not with that it's cost to society but for an individual you do start to put up your risk significantly of diabetes, high blood pressure and high cholesterol. And the problem is that all those things then feed in to a greatly increased risk of heart attacks and strokes, so that is what you're trying to prevent. When you're in the in between range of just being a bit overweight the problem is that unless you really watch it you tend to drift into obesity, that is the natural trend - to get heavier, not lighter. So one can't be too blas茅 about being overweight, although being overweight - a little bit overweight - per se is unlikely to actually significantly risk your health, it's more the fact that if you start off a bit overweight you're likely to slide into obesity unless you do something.
MYERS
Of course it's alright if you can be active and at least Nick is looking after that side of things, if he's cycling but there are a lot of people who can't be as active as they would like to be and therefore the sort of energy balance gets a little bit out of kilter. I don't know - let's talk to Margaret Blinkow who's on the line now from Pembrokeshire and I think is in fact bed bound, Margaret, is that the case, and therefore struggling with weight, tell us what the problem is then.
BLINKOW
Well I put on weight - I'm in bed for approximately 95% of each day ...
MYERS
Due to illness?
BLINKOW
Yes I've got severe ME. About five years ago I put on a lot of weight, I'd never had a weight problem in my life before, and I was 67-68 then. And I just have not been - obviously I can't exercise - and I've been - I've seen my GP about it and she said well just cut down on the amount of meals that you have. I keep to - well more or less keep to - I do have the occasional blow out - but a low fat, low carbohydrate diet.
MYERS
And are you prepared to say what you weigh - are you well overweight?
BLINKOW
I'm thirteen and a half stone, sometimes I go a pound or two above that, but that's way over - that's at least three stone over.
MYERS
Okay, so Margaret - I mean I guess Ann would confirm that that sort of weight is a high BMI and therefore you would be at added risk of other health problems. But clearly it's obvious that it's not so easy if you are inactive as you are and we've had one or two other calls again, whatever the problem may be, but it's this business of wanting to perhaps do more but not being able to and therefore putting on weight. Well let's see what Ann might have to say.
ROBINSON
Well I think I can sympathise, it must be very difficult because you're obviously battling ME and all the problems that come with being bed bound essentially and you can also see the weight piling on, despite the fact that you're probably not eating anymore than you used to eat, perhaps even a bit less. So it's a tricky equation and it's not an easy one for you. Of course your incentive to try and keep your weight down is huge because as hopefully you get back to more normal activity, as hopefully the ME gets better, you obviously don't want to find that you're then heavy so that your joints start to hurt and you know those things then start to incapacitate you. So you've obviously got a big incentive to try and keep your weight down. And I mean your GP's right in the sense that if your options for activity are limited really the only part of the equation that you can easily remedy is to eat less, it's obviously going to be a question of substituting lower energy foods, so keeping a bit pot of blueberries by your bed that you can eat one at a time, perhaps eating fruit whenever you can and a stew or casserole made of vegetables in the evening which can fill you up without all the added calories, so it takes a little bit of planning I suppose. And if you do need to snack just to relieve the boredom then definitely things like blueberries or radishes or carrots are the way to go. You can also do a certain amount of exercise, even when you're bed bound, if you have a friend or anybody who knows how to do yoga or breathing exercises, you can do a little bit ....
BLINKOW
I did - well I do do the breathing exercises and I do deep breathe relaxation and some meditation as well. I - I'm interested in the blueberries, not having been near the shops for years I don't even know what's in them. Where would I get blueberries from?
ROBINSON
Well they're pretty much nowadays available in the shops throughout the year actually and the price seems to have come down and - I just particularly like them because they're quite small, you can eat one at a time and they've got negligible numbers of calories in and they're good for you as well.
MYERS
Margaret, send out for blueberries immediately. But just to take that point on a little bit Ann, I mean this idea of choosing alternatives, I mean it's not about not eating, it's not about cutting all calories because those are kind of fad diets aren't they, but where you can find something that is pleasing to eat but eating smaller amounts, eating more slowly - all these things are going to help aren't they?
ROBINSON
Yeah I mean it all helps but the bottom line is that to lose a pound a week or half a kilo a week you have to shave 500 calories a day off what you're eating, whatever you're eating that maintains your weight, which is normally around 2,000 calories but is obviously a little bit less if you're inactive and bed bound, you then have to shave a further 500 calories a day consistently off that amount to lose a pound a week. It's not easy because that deficit of 500 calories is going to leave you feeling hungry occasionally, no matter what you substitute for what essentially if you're eating only 1500 calories a day everything you put in your mouth has got calories in it, 1500 calories is not very much.
MYERS
And what I take from that is of course it's a lot easier if you don't put on the weight in the first place and of course this is the problem for us as a nation - we seem to be piling on the pounds and then struggling to get them off. Maybe we need to be thinking, and certainly on behalf of our children when they're growing and so on, not putting on the extra pounds to start with because it is a struggle for everyone isn't it?
ROBINSON
Yeah I mean that's obviously the ideal. We've steadily been putting on weight as a society since 1900, it's not a new phenomenon, it might have escalated recently and the phenomenon of children becoming overweight is relatively new because our children used to be so much more active. Actually they used to eat more than they do now, on average kids growing up in the 1940s in England, 1950s, ate more calories than the kids now but they did an awful lot more as well, much more running around in the street.
MYERS
Let's go back to the calls, Jennifer is in Perthshire, Jennifer, you've got a question or a comment for us please?
JENNIFER
Hi there, just a bit of both really. I wanted to say that I've tried lots of different diets, including slimming clubs and restricting different food groups, such as carbohydrates, but I'm currently at the minute I'm having the most success I've ever had by doing the good old fashioned calorie counting. I restrict my calorie intake to 1400 calories a day and try to burn 200-300 calories a day in exercise and I keep a log of everything I eat and all the exercise I do. And if I stick to this rigidly I lose an average of about a pound and a half a week, so it's absolutely guaranteed to work.
MYERS
Oh that's very encouraging to hear and although we've been saying that perhaps fad diets don't work actually calorie counting is working for you. And Ann would you say it is a reasonable thing for people to try and be a little bit more aware of the number of calories they're both eating and expending or are we all going to turn neurotic if we try and do that?
ROBINSON
Well I mean I think that - congratulations, because I mean you have really summed up the answer, I mean that is the answer - it's 14-1500 calories a day and to be - to be burning up about 200 calories in energy means that you're jogging two miles a day or fast walking four miles a day, I mean absolutely the way you've described it is the blueprint for steady and successful weight loss, so thank you.
MYERS
Jennifer, thank you very much, well done, that's excellent. Let's move to Susan who is struggling because she reckons to have no willpower with a result - what Susan that you're bigger than you need to be?
SUSAN
Yes I'm lots bigger than I need to be. I also have ME and I'm in bed 95% of the time. My husband, he tends to cook most meals and I say I don't want as much as that but I always eat it, I've got no willpower. I know I shouldn't, I'm a diabetic, so I do have chocolate occasionally, I've got no willpower where that's concerned, but luckily I'm sensible and it doesn't affect it too much. But I just - it doesn't matter how hard I try and how hard - I'm so determined sometimes not to do what I do and yet I still do it. It's ridiculous.
MYERS
Well I don't know if we've got willpower available on prescription but is there anything else again that you might suggest because we just have heard from another caller in a very similar position, I guess what you said then would apply? But are there other things perhaps as a doctor Ann that you might be able to offer under those circumstances?
ROBINSON
Yes, well as we said before you're in a tricky situation, it's difficult and I don't think you should beat yourself up too much about it, I think anyone in your position would probably want to eat and make life nice for themselves as possible, so the weight will go on. I think two things. Firstly, I think it's really important not to look at the whole mountain but to take a day at a time, so don't worry about how much you should be losing or an ideal weight, just each day is a new day and start out each day, perhaps even measuring out what you're going to eat in the day or planning what you're going to eat in the day and just try and stick to it for one day. And if you are in a position where your ME is such that you can do a little bit more activity that day so much the better but if not at least concentrate on what you're eating. Take one day at a time, if you get to the end of that day and you've managed to do what you set out to do you'll feel better the next morning and then you can do another day. So do it a day at a time and don't worry about losing the whole amount of weight because you might get demoralised. But the other thing to say is that you'll probably be - if you are very overweight and diabetic and you've got ME - you might well be eligible for one of the drug treatments and maybe you should speak to your GP about that because they can give people a bit of a boost, especially people who are finding it particularly difficult to get started for understandable reasons.
MYERS
Perhaps I can bring in John, at this point, because I think he's got a question about some of the drugs that are available, I think that's right is it John? Is it something you think might be helpful in your case?
JOHN
Yeah what it is is my family have a history of adult obesity from my father's side, so me and my siblings have all put on weight since our 20s. Since - for the last 10 years or so I've been struggling against it, trying things like Atkins etc., but my sister has had a gastric by-pass and my identical twin brother has been taking - I think it's called Rimibard?
MYERS
Rimonabant?
JOHN
Yes that's right. He's been doing that through a private nutritionist. Now I've actually been to a private nutritionist and I'm on a low wheat diet and I take walks three times a day and I've now got to the point where I'm wondering which is the best method for me to perhaps have stomach surgery or to try this medication.
MYERS
Well that's an interesting dilemma and it sounds as though one or other might be helpful if you've really been struggling and failing to make a lot of progress. So Ann if you were to see John what would you be offering, would you say he's eligible for medication or better yet for surgery?
ROBINSON
John, do you have any idea what your BMI is?
JOHN
No I don't.
ROBINSON
Do you know about how much you weigh?
JOHN
I would say I'm morbidly obese. [Indistinct words] ... my weight is, but I could tell you that I'm about five foot eleven and my waist is about 46-48 inches.
ROBINSON
Right okay. So obviously it's very good that you're getting into a lifestyle where you're at least watching what you eat, although I'm not sure about specifically low wheat diets but any diet that restricts the amount you eat is good. And your building exercise into your routine which is also very good for the long haul. We generally don't recommend surgery as the first line after the lifestyle changes but try the drugs first, if that's what people want. And very occasionally people get referred straight for surgery but that's if their obesity is such that it's potentially life threatening or usually because they've tried the drugs and lifestyle and it hasn't worked for them. So I would always try the drugs first. You're talking about a choice of three drugs essentially and to put it very briefly really you have orlistat, which means you don't absorb a third of the fat that you eat, the problem is it tends to come straight out and can lead to oily spotting from your back passage and wind and a very strong urge to go to the toilet when you eat fat filled foods but that's one option, it's quite a safe drug. The next drug around is sibutramine, which works a little bit like an anti-depressant actually, and it stops the craving for the food, the only problem with that is that you have to watch your blood pressure because it can go shooting up, so you do have to have that checked and sometimes because it works a bit like an anti-depressant it can make you slightly agitated and disturb your sleep a bit at night. But on the whole it's a reasonably safe drug. And the third drug is the one that your sister's been given, or is it your twin, rimonabant. That's only just been licensed actually so if you're getting that privately that's probably ...
JOHN
Yes privately and lost considerable weight.
ROBINSON
Yeah, I mean it does work as well, it doesn't work hugely better than sibutramine. Personally - I mean I don't want to say this really if your twin's on it - but I'm not sure I would take it. It's not approved in the United States because it can increase the risk of depression and if you have any history of depression yourself I would avoid that particular one.
MYERS
Okay, hope that's been helpful. Let's go to Tony who I think is also a little bit concerned about surgery, as an option. Not on your own account I think on behalf of your sister, is that the case Tony?
TONY
Yes. She's 25 and 19 stones. [Indistinct words] having the surgery where they remove part of her stomach. And I'm quite concerned that over the period of time that she's going to be moving such a large amount of weight - 9 or 10 stone over the year or so - and the people who I've seen - the people who've also had this surgery they look very malnutrin ...
MYERS
Malnourished.
TONY
Malnourished - that's the word sorry yeah - they look very gaunt as well [indistinct words] ... got no life left in them...
MYERS
Tony forgive me but we've got not a very good mobile line there but I think we got the questions really there about concerns around having surgery. So of course it looks like a quick fix doesn't it - an instant thing - you know your stomach gets stapled or banded and you lose a lot of weight, what's not to like. But it's not, like a lot of things, it's not that easy is it Ann?
ROBINSON
No, I mean surgery is surgery and when you're very overweight, which by definition you are if you're having this procedure, surgery carries more risks. There are two operations actually, one is where they just put a band round the - near the top part of the stomach and that creates a very small upper stomach, so you feel full up very quickly, then it gradually goes into the lower bit of the stomach. And the other one is the more radical one of the by-pass which is less commonly done. And the band is relatively safe, as surgery goes, and it can be very effective - people have an average weight loss of 28 kilo, most don't look gaunt, they look better, to be honest, they feel better. And although it carries some risk the feeling is that in the people who are suitable for it the benefits do outweigh the risks. And you have one or two nights in hospital, two weeks recovery and you lose about half of your excess weight usually. So it's not without complications. One in 200 people can die from this operation, although that risk is coming down as it gets more commonly practised. And more commonly one in eight get some kind of complication.
MYERS
Perhaps just to end Ann you could give us one or two steers - things that we can do relatively easily and could make a real difference, in other words we do nothing else today what might we do to try and manage our weight a bit better?
ROBINSON
Well I think Barbara you've summed it up - if possible try to make sure that we and our kids don't get too fat, that in itself is a struggle enough in our society. If we do feel we need to lose weight - eat less, do more. And if you can only do one of those things then just eat less. And we're talking really around 1500 calories a day, you're going to be a little bit hungry for a very long time to achieve that but the weight will come off in a steady and sustainable way.
MYERS
Eat less, eat slowly, enjoy what you do eat. Thank you very much indeed Dr Ann Robinson for your words of wisdom, as always.
If you missed anything on the phone-in today you can listen again to the whole programme, you can go to our 大象传媒 website, follow the prompts to Check Up. You can download this programme as a podcast. And if you'd like to speak to someone about more sources of information then you can call 0800 044 044.
Join me again, if you will, at the same time next Thursday at three with your questions about headaches.
ENDS
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