I sit on the tube on a rainy Tuesday morning in London with the smug expression of someone who doesn’t usually get a seat. The fact that I have a seat means the goal I set around 3 months ago of leaving the house 10 minutes earlier has finally come to fruition. I’m sitting in the satisfaction of knowing I’m in that magical 5 minute period right before the commute gets suddenly busy and an avalanche of people pour onto the tubes and trains. The moment makes me look up and around instead of straight into my phone or book as I usually do, especially as there is actually space to look up and around rather than the usual close up of someone else’s coat.
Across the carriage there is (what I assume) a mother and daughter sitting next to each other finishing the remnants of a Mcdonalds Breakfast. Whilst the mother finishes some sort of Mcmuffin, her daughter is making her way through a hash brown with the vigour that only children seem to manage when eating, a total concentration of the food as if they haven’t eaten for months. The bag holding the hash brown is becoming increasingly translucent as shes eating it, reflecting the shine of her fingertips which are getting equally as greasy with each bite.
Its interesting to me that my first thought is not to judge, by default, thinking that means I probably am judging to a certain extent, a little like asking someone whose afraid of heights to just ‘not look down’. The truth is that whilst its easy to judge feeding children a McDonalds breakfast as inherently unhealthy for them, its true that I know nothing of this persons personal circumstance, or even the individual circumstance of this moment – this could be a once monthly or yearly treat, or a reward for something well done, I mean, it may not even be her daughter. Technically I haven’t even seen them interact so they might not even be together at all, just two individuals who happened to both get a McDonalds breakfast and sit next to each other on the tube.
But as I think about it further I realise that its very easy to judge McDonalds as stereotypically ‘unhealthy’ but as I look around the tube carriage I can see an assortment of breakfasts being consumed from a range of places – Greggs, Pret, Costa. Some brands are inherently associated with being ‘unhealthy’ whereas a brand like Pret is wholly marketed on being a ‘healthy’ brand with the assumption that their pastries and food are made fresh. But if you compare a ‘Bacon and Egg’ McMuffin from McDonalds with a ‘Ham and Cheese Croissant’ from Pret (both breakfast items from their breakfast menu) – there are differences of course but maybe not as stark as one might think. Mcdonalds comes in at 335 calories and contains ingredients in the meal like Rapeseed Oil, acidity regulators, emulsifying salts and Lecithin. The Pret meal comes in at 312 calories and also contains Margarine (Palm Fat/Sunflower Oil), Sodium Nitrate preservatives and acidity regulators. The McDonalds breakfast comes in at 5.9g of saturated fat and 2.7g of sugar, whilst the Pret meal comes in at 9.8g of saturated fat and 3.2g of sugar. Now all of this is not to say that sugar and saturated fat are completely evil foods, nor that we should try and completely avoid all additives and preservatives in food, or that I’m trying to say McDonalds is healthier than Pret.
The point of this thought process that ended up distracting me from using my phone for my whole train journey (unprecedented in recent times) – is to ask myself the question: do we really know what is healthy and unhealthy anymore? As more and more of us (in the UK and US anyway) fall into the overweight and obese category (currently 74% of the UK population is overweight and obese) it strikes me that it’s become harder and harder to lose weight. And whilst obesity is without a doubt a complex issue that is multifactorial, when thinking about health, we are objectively consuming and purchasing less whole, unprocessed foods and eating more ultra processed foods. (I am not going to go into the definition of UltraProcessed Food in this which in itself is a source of contention recently, but for simplicity we can think of it as something wrapped in plastic with ingredients you wouldn’t find in your mum’s kitchen).
The reality is that the food industry has confused us more than ever. Walk into any supermarket and you will see ‘healthy’ nutritious bars, protein crisps, products with large slogans of added fibre, low fat, no sugar. This combined with ‘Healthy’ high street brands or alternative ‘junk food’ with low calories like low calorie chocolate and low calorie syrups, means we really are more lost than ever. Are these foods healthy? The ingredients say otherwise. That combined with a combination of some social media influencers vilifying these products and others telling us all to ‘calm down and live life’, it’s easy to see how we have got here. Line up 20 people and ask them to walk into their local supermarket and do a ‘healthy’ weekly shop for themselves and they will all come out with a very different looking trolley full of different items. There may be some fruit and vegetables, lean meats and cheese in there but you can guarantee that there will also be grain bars, low calorie ice creams, even ‘healthy bread’ which is arguably the worst culprit once you start looking at the ingredients that go into it.
Whichever way you look at it, the food and beverage industry is a multi billion dollar industry with some companies whose yearly revenues rival (and in some cases comfortably beat) some countries’ GDP. These companies want to promote healthy products as much as possible, but they also need to do one thing before they do everything else which is to make money. And before getting into the semantics of where they can cut cost most (which is usually by industrially processing the manufacturing process of these products) you can simply raise the issue that by selling a product to make money from it, they need us to purchase as much of it as possible. I.e they need us to eat more and more which in itself leads to overconsumption of food which leads to more of us being overweight than ever. For a food manufacturer to actually promote healthy eating habits they would have to…not sell as much of their product. They would almost have to actively market you to not want to eat their products and anyone who suggests selling less of their product in any board meeting in any company probably wouldn’t find themselves sitting there for very long. (The closest anyone has come to this in the food industry was Emmanual Faber, the CEO of Danone – who was eventually removed from his position for poor financial performance in March 2021 after several years of trying to direct Danone’s strategy towards greater sustainability and increased compliance with ESG (environmental, social and governance) criteria).
Like all of us that live in this ‘social media era’ everything is said with a disclaimer. I’m not saying that the food industry is the sole reason for an increase in our collective weight and a decrease in our collective health over the last decade. We also know now that there is a genetic component to obesity but when you see a 26% increase in Obesity rates in the USA in the last 10 years, its safe to say that is not a genetic component alone and whilst the food industry may not be the sole culprit they definitely play a large, if not the largest part. If you think your Pringles are shaped that way for fun, think again, that shape is designed specifically to target as much of the taste buds on the tongue as possible. ‘Once you pop, you can’t stop’ isn’t so much a slogan as a chemically engineered guarantee.
The bottom line for our society on a global scale is that we are getting increasingly overweight leading to a larger burden on our healthcare systems with no likely reprieve on the horizon in the near future. In the US the life expectancy has now declined sharply for the first time in a century since the first World War. The food industry may not be the only culprit but they are wholly complicit. And that isn’t the scary part.
As a Doctor with a specialist interest in Lifestyle Medicine and preventative care, the biggest worry for me is the current proposed solution. Drugs. Now don’t mistake my fear for one of bohemian anti-establishment non conformity. I am well aware of the benefits modern medicine has and I continue to practice to this day. When I tell people that I am a Doctor with an interest in Lifestyle Medicine or preventative medicine, I can occasionally get a look like I told them that I would treat Prostate Cancer with Ginseng Root. The need for pharmaceutical treatment in chronic disease and acute disease treatment is very much necessary and incredibly important. We have made a lot of lives a lot better through prescription medication, without a doubt. I know because I have seen it firsthand. Nor am I against treating the growing Obesity pandemic with medication. It would be a serious conflict of interest if I did, considering I work for a company in which I prescribe them every day.
The issue I have is the insidious thinking now spreading through the weight loss management space. That medication is the ONLY solution to obesity and that its use should be lifelong. That when someone’s BMI hits the 30 mark, they should be immediately started on medication and warned that it’s likely they would be on that or a combination of medications to manage their obesity for the rest of their life. There is a lot of contention at the moment on whether to label Obesity a disease, with some countries already considering it so. Currently the UK has not formally recognised Obesity as a disease. From a Pharmaceutical standpoint, labeling Obesity a disease, means it should be treated in much the same way that Type II Diabetes or Hypercholesterolaemia should be – with medication. Usually lifelong. There is even talk in some circles that because Obesity is a genetic condition, we can pre-empt it and give medication to prevent Obesity, issuing it to people who are not yet obese but just ‘at risk’. It would be fair for you to ask me at this point that as someone who prescribes such medication specifically for weight loss on a daily basis, am I not complicit in this thinking? The difference is the company that I work for offers a predominantly lifestyle based program for people living with obesity, that focuses on nutritional and behavioural changes alongside medication as an adjunct for a short period of time. We use less medication than the medication only alternative and we get people off it much quicker. The idea is that the medication does what medication is supposed to do. Help your body get back to a healthier version of itself that you can maintain on your own. If you get an infection in your lungs, we prescribe you antibiotics. We let those antibiotics fight off that infection, where your own immune system was struggling to manage the task by itself and then when the battle has been won, we stop the antibiotics and let your immune system get back to its normal day to day job. In weight loss terms, by starting people on medication that alters their eating behaviours, coaching someone in nutritional and behavioural changes is much easier than it would be otherwise, especially in a group of people that have traditionally tried multiple methods to lose weight with little to no success. But the idea of prescribing them a medication with very little support and advising them to take it for the rest of their life does scare me.
It leads to a place where I feel that we are being squeezed from all sides. On the one hand we have a food industry that is designed to get you to eat more and will do anything it has to do to facilitate that, including introducing completely industrially manufactured chemicals to make food as soft, palatable and easy to eat as possible. And when we have as a society eaten too much and put too many unknown ingredients into our bodies and the Doctor tells us were at risk of high blood pressure and Type II Diabetes and Cardiovascular Disease, the same Doctor will tell us that the easiest and simplest solution is to inject ourselves for the rest of our lives. And we trust it all because it’s all backed by scientific evidence – evidence that shows that the only things that matter are calories in vs calories out, or that physical activity is all that’s needed to combat obesity, or that the medications work. The same scientific evidence that is largely funded by either the food industry or the pharmaceutical industry.
At the end of it all it leaves you feeling pretty isolated and alone with a sour taste in your mouth (that ironically you will probably treat with a good sugary snack). It’s already too confusing, one day this is right, the next day it’s something else entirely. So the question remains, do we just give in and accept our fate. That we are doomed to fail when it comes to weight loss. For what its worth, the answer I strongly believe is..no. Its on us, and when I say us, I mean healthcare professionals: Doctors, Nurses, Dieticians and Nutritionists. We have a duty to educate ourselves on what goes into our food, what nutrition really means, what’s healthy and what we can do to prevent before we treat. We can start making changes on a micro level, on the small scale. Because expecting large scale, industry level legislative change by Government or those in authority hasn’t worked and isn’t likely to any time soon. We have to start with each individual and hope for a domino effect but before that we have to start with ourselves.