Slim down to save the NHS

Treating obesity-related diabetes will leave the health service bankrupt unless we all shape up soon

This piece is an extract from the latest issue of Spectator Health, out this Thursday.

I am an NHS GP and I have genuine concerns that if we don’t wake up to our obesity epidemic we could bankrupt one of Britain’s greatest institutions — our National Health Service. I was asked to speak about this at the UK’s biggest TEDx event, and addressed an audience of 1,800 people at a packed Colston Hall in Bristol with 2.7 million more following online. What I had to say clearly hit a nerve and I thought I would share it with you…

I think of the NHS as ‘Mum’. For most of us she has been around all our lives. She may not be perfect. In fact, sometimes we may feel she lets us down. But make no mistake, she has our best interests at heart and one thing is for sure — we will really miss her if we lose her.

The problem is that we in the western world live in an obesogenic society (one that tends to cause obesity). For most of us, food is readily available and our lives are increasingly sedentary compared to the generations before us — 80 per cent of British adults don’t achieve the recommended levels of 30 minutes of exercise five times a week. In a nutshell, it is just too easy to put on weight, and maintaining a healthy weight is not easy. I also appreciate that it is tougher for some than others to avoid those extra pounds, but that doesn’t mean we shouldn’t try.

Health midline banner May 2016

In fact I understand this better than you might think, because genetically I am an obese person. Patients often tell me I’m lucky because I am obviously ‘naturally slim’. There aren’t many people that can prove they are not, but I am one of them. Through my work on Channel 4’s Embarrassing Bodies I have been tested for no end of things, but some of the most interesting have been tests for a whole host of fat genes and, yes, I pretty much have a full house. I have also had my gut flora analysed. We all have about 2kg of ‘good’ bacteria in our guts that help us digest food. They come from two main families and we have different proportions of each. One is significantly better at absorbing energy from our food and much work is being done looking at the possibility of altering gut flora to help with weight loss. And, yes, you guessed it, I have 98 per cent of the family that is more efficient at extracting energy. So, genetically and biologically, I am programmed to be overweight. I know I have to really watch what I eat and exercise a lot. If I let my hair down for a while over Christmas or on holiday I know my waistline will tell the story, and I’m sure many of you feel the same way.

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A pound of fat equates to 3,500 calories. So, if you consume an extra 500 calories day for a week you will gain a pound of fat (the average British man needs 2,500 calories a day and the average woman 2,000). Do that every week and you will put on more than 3.5 stone in a year. If I did that my body mass index (BMI) would go from 20 to 29, making me not just overweight but bordering on clinically obese in just 12 months, so it is easy to see why we are getting fatter as a nation. There are so many health problems associated with being overweight, and they are expensive for the NHS. Take diabetes: 3.2 million people in the UK have it and 90 per cent of those have type 2 diabetes, which is often linked to carrying excess weight. And that’s just the ones we know about. There are estimated to be another 630,000 people who already have type 2 but are yet to be diagnosed. On top of that there are an estimated 11.5 million people today who are at risk.

If the number of people with type 2 continues to increase at the present rate (we are currently making 400 new diagnoses every day), then by 2025 there will be five million people with diabetes in this country.

That probably scares me a lot more than it does you because I know just how much the NHS is spending on this condition. We spend £1 million per hour every hour. You don’t need a financial or business brain to work out that if the NHS is struggling to fund itself today (which it is), then we could be seeing the end of our NHS within our lifetimes if we don’t all act now.

With two thirds of British adults overweight, it is easy to be complacent and lulled into a false sense of security. I remember when I was at school there was one poor child in each class who was the ‘fatty’. Always last to be picked for sports teams and probably utterly miserable. Today more and more children are overweight. Now I’m absolutely not a fan of putting children on diets. To a degree I am not a fan of going on diets at all. Simply because going on a diet means by definition you will at some point go off it and, believe me, I have seen so many people achieve truly admirable weight loss only to put it all back on and usually some more. Why? Because they haven’t addressed the real issue — their day-to-day lives.

Health midline banner May 2016

And there’s another issue with false sense of security. When I first joined general practice, making a diagnosis of type 2 diabetes was relatively uncommon and when I did it was usually met with fear. Today everyone knows someone with type 2 and they probably look quite healthy. There is almost a perception that type 2 is a ‘touch of diabetes’ or ‘the mild form’. I’m afraid that simply isn’t true. Don’t be fooled by an apparently healthy exterior. By the time someone is diagnosed with type 2 diabetes, half of them will already have diabetic complications. And I am talking really serious complications — heart disease, eye disease (diabetes is the leading cause of preventable sight loss in working-age people in the UK), kidney disease and peripheral vascular disease. (The NHS performs more than 100 amputations a week as a result of vascular disease in people with diabetes.)

So that’s the bad news. The good news is that it doesn’t have to be this way. We can turn the tide. We really can, and each and every one of us can play our part. I’d like to ask each of you reading this to do something for me today. Can I ask you to measure your waist? And I mean waist! Your waist is halfway between the bottom of your rib cage and the top of your hip bone. No cheating! I have seen far too many people walking around in 34in waist trousers fitting snugly below a 44in tummy.

If you are a woman with a waist greater than 32in (80cm) or a man with a waist greater than 37in (94cm) you are at risk of type 2 diabetes. If you are a woman with a waist circumference greater than 35in (88cm) or a man with a waist greater than 40in (102cm) then your risk is very high. You could be one of the 630,000 people who don’t know they have type 2 diabetes. You are certainly one of the 11.5 million at risk.

If that’s you, please make an appointment to see your practice nurse. Take a sample of urine with you and get yourself checked. If you are lucky enough to be in the clear, that’s great but don’t be fooled. For your sake and for the sake of our beloved NHS, take this as a warning shot across your bow and get yourself on a healthy living plan.

I promise you, I’m not being ‘fattist’ here. I’m being a realist. I love our NHS ‘Mum’ and I am very proud to be part of her. I have worked in countries without such a wonderful service and I would hate to see the UK go the same way. Slimming down the Great British waistline really could save our NHS so that she is still here for our children and our children’s children.


  • willshome

    Great to see someone sticking up for the NHS. And no argument with the need to fight diabetes. But we need to tackle the creators of this crisis, not its victims.

    Just as we spend too long having a go at smokers rather than really standing up to tobacco companies, so we castigate the fat rather than those who lie to them for profit. We need to tackle to profiteers of ill-health, and not just with some far-off sugar tax.

    Number 1 – why are calories not compulsory on alcohol labelling? Number 2 – why is added sugar content not prominently displayed on the front of every food package? Number 3 – why are companies allowed to mislead over nutrition with terms such as “healthy snack” “one of your five a day” (plus sugar and fat) and by printing in large numbers the calories for a “portion” when they know the pack will probably be eaten in one go?

    Advertising standards need to be stricter and strictly enforced, especially when aimed at children. It is too easy to make an argument that poor people eat badly so they don’t deserve an NHS. It is those who get rich by selling the poor (and the rest of us) too much food and too much of the wrong kind of food that need to be disciplined.

    People might belly-ache about the “nanny state” but it’s this simple: people should not be lied to when their health (and our taxes) are at stake.