'People are assaulted by food at every turn, and we’re biologically programmed to eat in case there might be a famine round the corner,' explains Professor Susan Jebb as the West struggles with plenty.
Professor Susan Jebb studies behavioural medicine at Oxford, and her work is becoming more important by the year as the West battles obesity, diabetes and a multitude of other weight-related illnesses. She focuses on why we eat too much, why fad diets are counterproductive, and how to get the public losing weight efficiently. Here, she talks through strategies to tackle our collective weight problem.
Which effective strategies have you come across?
'There are major operations like bariatric surgery. This forces you to change your life and clearly people lose a huge amount of weight, but that is only suitable for a very small number of people. I’m interested in more modest weight loss, done in a way that is appropriate for millions of people to bring huge public health gains.
'One recent trial shows that if your doctor refers you to one of the commercial weight-loss groups, like WeightWatchers or Slimming World, people lose (on average) twice as much weight than people who are treated by the practice nurse – and its cheaper for the NHS too. But this won't suit everybody, so we need a range of effective interventions so that the doctor will be able to have a conversation about which of these options might suit individual patients best, effectively tailoring the treatment they offer.'
What's your standpoint on the amount of conflicting information on fad diets or celebrity diets?
'It’s certainly a huge problem. There is greater diversity of advice than there was, and news of the latest diet fad travels quicker than ever before. It is incredibly unhelpful. The frustrating thing is that the general advice – eat less saturated fat, eat less salt, eat less sugar, eat more fruit and veg – has remained pretty constant. If you look at the authoritative, expert opinion from the World Health Organization or the UK Scientific Advisory Committee on Nutrition, it’s been amazingly consistent. Those bodies produce worthy (but relatively dull) reports while individuals publicise far more exciting, anecdotal stories promising to transform your life. It’s not surprising the latter appeal to people – but when it fails, they lose confidence in their ability to manage their weight successfully.
'One of the things that we've started to do is to talk about food rather than nutrients. Nutritionists think in terms of nutrients: fat and sugar, protein, iron and calcium. But when you're talking to people about what they're buying at the supermarket, they think of it in terms of foods, they don’t go and buy 30% fat, 6g of salt. They go with a shopping list which has food on it. I think as nutritionists we’ve got to start talking to people in terms of foods, not nutrients. We need to get back to an emphasis on the core foods in the diet – ingredients – and re-establish the principle that foods like processed meats, biscuits, cakes, confectionery, sugary drinks and alcohol should be occasional, not every day, items. That will help cut calories, saturated fat, sugar and salt – all in one go.'
What do you think about health apps and free calorie and exercise trackers?
'There is research that suggests the use of these apps is associated with modest weight loss. They’re a useful part of the mix, especially for people trying to self-manage their weight. It’s important to remember that we’re not looking for "the one thing", we’re looking for a range of strategies which are suitable for different people or things that each person can pick and mix and put together into a plan that works for them.'
'This has led to a new stream of research focused on self-management that one of my DPhil students is working on. The truth is that, in trials, we often get a very particular kind of person, not necessarily the average person, and we very often – for obesity trials – get people who have tried and failed many many times to lose weight.
'Within the NHS we’re not very good at helping people manage weight; most people don’t even think about going to their doctor. Instead, a lot of people are trying to manage their weight themselves, without professional support. So the question is, what do they do? We don’t really know. Recently, together with my colleague Paul Aveyard, I’ve done a big piece of work to identify a whole range of behavioural strategies that people might use to manage their weight and we’ve now developed an online questionnaire: OxFAB (the Oxford Food and Activities Behaviours).
We’re looking to recruit as many people as possible who are trying to tell us what they do. And what we’d most like is for them to continue to tell us what they're doing intermittently over the next few months or ideally a whole year. We’ll ask them each time they log in to tell us their weight, and then there will be 10 multiple choice questions.
'We hope to build up a picture of what the nation is doing to lose weight, and – ultimately – what works. What’s really crucial to this, and why we really want the public to join us in this, is that we want to understand what goes wrong. So over time we can build up a picture of what’s going on and the strategies associated with success.'