Dr Ellie Cannon: ‘Why we need to stop sugar-coating obesity’

With two-thirds of adults in the UK now overweight, our health is at crisis point, says GP Dr Ellie Cannon. She reveals the complex reasons behind it – and why willpower is not the solution

We are a nation gripped by what seems now to be a never-ending obesity crisis. Public health measures arrive to great fanfare, fad diets pop up with each new year, exercise regimes appear and disappear and yet the average person in the UK is getting larger and larger. An estimated 64 per cent of adults in the UK are now overweight, alongside a third of children.

Dr Ellie Cannon

Fat is not an aesthetic issue. But it is a health problem. And a big one. The majority of people who are classified as obese will unfortunately suffer health consequences as a result. We have seen very clearly throughout the pandemic that being over a certain weight has meant a higher risk of Covid severe disease, hospitalisation and death. For decades now the global medical establishment has warned about the role of obesity in type 2 diabetes and the ensuing tidal wave of cases.

But this is merely the tip of the iceberg of what doctors like me see in our clinics. Experts face criticism for pointing out that obesity is a risk factor for certain diseases, even though there is strong evidence to prove this. An obese person is more likely to suffer with arthritis of the joints, chronic pain, snoring and insomnia, depression and isolation, back pain and several types of cancer including womb and bowel. It has been proven to impact on fertility, worsen asthma, acid reflux and heart disease.

Photograph: Van Santen & Bolleurs

I recently referred a patient for a mobility scooter as their arthritis was so bad in the knees – not uncommon for elderly patients. This person was 49. It is frightening to think that, according to NHS figures, obesity can reduce life expectancy on average between three and ten years, contributing to at least one in every 13 deaths in Europe.

These are grim figures indeed, which doctors try to highlight. Yet we are really not getting anywhere with helping people and society improve the situation. My heart sinks when I read of a new diet plan or the latest reactionary public health measure – we are going to weigh all children! – because none of it seems to work. Empty promises from diet plans poorly thought-out edicts from government… everyone seems to appreciate the risks, yet we are getting fatter. We have got something very wrong. Our European neighbours bask in the sunshine, enjoy their Mediterranean diet full of olive oil and wine and don’t get fat, yet here we are in the UK continually struggling to fight the flab.

As a GP, I see that obesity measures aim to tackle individuals rather than the obesogenic environment we live in. We put the onus on the overweight person: it’s a lifestyle issue, a choice, their problem, laziness or denial. And yet, clearly, UK society in 2021 is a perfect storm for fuelling obesity. I’m afraid to say that it has become the default; the factory setting for a UK adult unless you have the power and the money to reset. Maintaining a normal weight is now a lifestyle choice, a conscientious decision to opt in to.

Photograph: Van Santen & Bolleurs

Life right now is not conducive to movement: the weather, working from home, the price of gyms, the wealth of online activities all conspire to keep us still. We just don’t burn calories like people used to walking to work or washing up, or like people do in hotter climates and more active cultures. We don’t even go to pick up our own takeaways or groceries any more, but rather have them delivered while we stay put. Children are drawn from an early age to online life rather than a kickabout in the street and PE lessons are too short and infrequent. All of this creates an environment where you really have to make an effort to deliberately move to burn excess calories.

And what about those excess calories? Our lives are unwittingly full of them: portion sizes are larger than ever, while meal and snack concepts encourage us to eat or consume during all occasions: while travelling, before and after sport, after school, in the car… Airports and train stations are rammed with food outlets. There are no longer three meals a day but ideas for eating around the clock. Entire supermarket aisles are dedicated to the after-school snack. Cars and children’s buggies come with cup holders and snack trays. Retailers sell food containers and carry bottles so that we can eat and drink all the time while walking, running or working. And even if these snacks are made ‘healthy’, it is all constant calorie consumption. Families walk into my consulting room eating snacks or carrying a drink. As a child in the 1980s and 90s it was considered bad manners for me to eat anywhere other than at a table. Now we wouldn’t walk down the road without the ubiquitous cup of coffee. We have been conned into eating and drinking all the time.

So we move less and we eat more – the perfect formula for gaining weight. It’s not exactly rocket science. Willpower has to be very strong to counter this environment, yet all solutions we are sold seem to rely on it. The innovative app. The latest fasting diet.

The new exercise – go on, you can do it! Except you’re up against a world encouraging you to consume more and more. So, in all honesty, it is unlikely that you can do it.

Photograph: Van Santen & Bolleurs

Why have we made the answer so difficult? Perhaps because we always blame the individual and ignore the mass societal influence. Not only is obesity anything but an

individual lifestyle choice, successive public health policies fail to recognise it is also an issue of poverty. Highly processed calorie-laden food is cheap and always on offer. It’s easy to prepare or heat up. There is no point health ministers telling us to eat our five a day when buy-one-get-one-free is invariably on snack foods rather than fresh veg. Opting into healthy food sounds straightforward – I hear commentators and ministers eulogise all the time about healthy eating and moving more. This is all easy when you can afford it and know how: far harder when life is already a struggle. It’s so simple to get off the bus one stop earlier and walk – but not if you’re rushing to your second job.

Years ago I was a parent helper on my child’s class school trip to hear a children’s author at the library. It was a small primary school with just one class per year, all coming from the local middle-class area. When we got to the library the class sat on the floor next to the kids from another London school and I sat behind them all with the teachers. I have no idea what the author spoke about because I was so struck by the difference in these kids of the same age – the size differences were stark. I can honestly say, aged nine or ten, not one of that affluent class was even overweight while some kids from the other school were spilling out of their uniforms – already overweight or obese.

How can this be about willpower or laziness or bad choices aged nine? Or bad parenting?This is the difference between a class whose parents can afford sports, good food and the luxury of time to make healthy choices versus parents who simply can’t.

We now live in a society where it is incredibly easy to gain weight but very difficult to talk about it. But talk about it we must because we are not winning. And we are letting down the very people we need to help for fear of offending anyone.

It is a minefield for those seeking to help or discuss it. In 2018, Cancer Research faced a backlash for their public health campaign associating cancer with weight. How did they get it so wrong? Weight has been scientifically proven to increase risk for certain cancers. But the campaign appeared to target individuals and blame personal decisions. It also oversimplified obesity, disengaging the very people it wanted to connect with.

Until we all face up to the complex causes of obesity in the UK and address it honestly as a national problem, rather than an individual choice, we will keep getting it wrong. Willpower is not the answer.


Dr Ellie explains how your GP can help

When individuals come to their GP asking for help with their weight, we offer very specific clinically based assistance with no fad diets or false promises in sight. The help we can offer not only depends on somebody’s BMI or waist circumference but also on their health problems – if that person already suffers with type 2 diabetes or heart disease they are likely to be offered more significant help.

  • People can be offered referrals to exercise groups, gyms, courses and slimming clubs, depending on what is available locally and what is funded. These are known as weight management services, but there is huge postcode variation.
  • The health body NICE recommends that GPs do not advise patients to use restrictive or nutritionally unbalanced diets as they are ineffective in the long term and harmful. Either a 600-calorie-a-day deficit or a low-fat diet is advised.
  • Doctors recommend very simple exercise goals, with walking and cycling, but for at least 30 minutes every day on programmes such as Couch to 5k. For some people this may need to be at least 60 minutes a day and working towards a goal of 10,000 steps a day.
  • A medication called orlistat can be prescribed by GPs if people have tried diet and exercise and have a BMI over 30. This purges the fat from what has been eaten and helps to maintain a low-calorie diet. Other medications such as liraglutide can be available but only from hospital-based obesity services.
  • Individuals with a BMI over 40 (or 35 if there are health issues) can be referred for surgical weight loss management as long as they have already tried other things. People undergo a series of tests and counselling in the hospital first as part of the assessment for the operation. They also have to commit to long-term follow-up.