Obesity Wars: Fitness Vs Fatness

Interviewer: Lucy Vernall (Interviewer, Ideas Lab)
Guest: Professor Janice Thompson, Dr Gareth Wallace, Dr Carolyn Gregg, Shaleen Meelu, Mark Roscoe
Recorded: 02/10/2014
Broadcast: 24/10/2014

Intro VO: Welcome to the Ideas Lab Predictor Podcast from the University of Birmingham. In each edition we hear from an expert in a different field, who gives us insider information on key trends, upcoming events, and what they think the near future holds.

Lucy: Welcome to a very special edition of our Ideas Lab Podcast. Today I’m joined by Professor Janice Thompson who’s Professor of Public Health, Nutrition and Exercise at the University of Birmingham. Welcome, Janice. 

Janice: Thank you.

Lucy: And also a host of invited special guests. Before we introduce them, Janice, tell us more about the Obesity Wars event and how it all got started.

Janice: The event, Obesity Wars: Fitness versus Fatness, is a public engagement event that we’ve gotten funded through the Physiological Society. They have public engagement grants and this year they’re focusing on obesity as their theme. So we’re very excited to be delivering this event 30th October at Thinktank.  

Lucy: And so prior to that we have this special podcast to unpick the issues a little bit more.   And this came off the back of a BBC2 programme that you were involved with, Janice – Trust Me, I’m a Doctor – we did an item about BMI and fitness which was tremendously popular wasn’t it? 

Janice: Well I think so from what the statistics show! It looks like it was, which is great. 

Lucy: And people were desperate to know more, so thanks to the Physiological Society for helping us do that. So today we’re joined by some colleagues from the School of Sport, Exercise and Rehabilitation Sciences. We have Dr Gareth Wallace, Lecturer in Sport and Health Nutrition. Hi Gareth.

Gareth: Hello.

Lucy: And Dr Carolyn Gregg who is Senior Lecturer in Nutrition and Ageing. 

Carolyn: Hello.

Lucy: And we’ve also got some guests from the outside! From the real world beyond the university. So welcome to Shaleen Meelu who’s a registered Nutritionist and co-founder of the Harborne Food School. Shaleen.

Shaleen: Hi.

Lucy: And finally Mark Roscoe who’s Commissioning Lead for Lifestyles at Birmingham Public Health. 

Mark: Hello.

Lucy: So we did a bit of preparation for today and we spoke to Professor Steven Blair who’s a colleague of yours, Janice, based at the University of South Carolina’s Department of Exercise Science. You said he’s the global expert!

Janice: He is. We would call him Mr Fit and Fat and I don’t think he’d mind that at all. .

Lucy: You mean, expert in fitness and fatness. 

Janice: Well, and as he says, he’s fit and fat as well, so there you go!

Lucy: So he couldn’t join us live today but we’ve spoken to him and what we’re going to do is play in some of the comments that he made and talk a bit more about them. So the first one is we asked him what’s more important, fitness or fatness?

Steven Blair (recording): Fitness is far more important for your health than your fatness. We’ve published many papers on this topic and people are surprised to hear that if you are obese but also have good aerobic fitness, which you would get by meeting the physical activity recommendations, so that a fit person who is obese over the next decade has one half the risk of dying compared with a normal weight person who is sedentary and unfit.  

Lucy: So I just think that’s incredible. Does everyone, did everyone around this table know that? Was it only me that hadn’t heard that before? Everyone’s nodding. Yeah. So how come that is news to, I think, most people?

Janice: Well I think – I’ll just start with this, I’m hoping my colleagues will jump in. 

Lucy: Go for it, Janice!

Janice: I think a lot of it is that we are societies, both here in the UK and in the US where Steven Blair works, and Australia as well, we’re societies that really focus on the physical image and fat and of course for years we didn’t have the research base. We didn’t know that obesity, you know, we didn’t know it was risky. We don’t want to minimise it, it definitely is associated with a lot of health risks. We don’t want to minimise it but it’s really probably only been in the last twenty years that we’ve been able to get funding and do the research to be able to study and look at the role that being fit might play in people across different weight levels. 

Lucy: So you’re saying it’s a research time lag. Just that, you know, it’s not getting out to the general public. 

Janice: I think that’s part of it but I also think there’s an over-emphasis that we have in society on how we look and we like to demonise things and we also like to punish ourselves. So I think the message that we should not eat very much and lose a bunch of weight, it's more popular with people sadly than saying maybe accept a bit more weight possibly but then be more active, and a lot of people don’t want to exercise. I think that’s another issue. So I’m not sure, my colleagues probably have a lot to say about that. 

Carolyn: Well, we know that participation rates in physical activity in the UK, and not just the UK, are very low despite the public health messages about the importance of exercise and being active. And also being inactive isn’t very good for you either. It’s an independent risk factor for a host of diseases and conditions. 

Lucy: So Mark, this is the, you’re at the sharp edge of this aren’t you?

Mark: Yes, we are. Obviously I work within Birmingham Public Health and we fund a wide range of programmes ranging from specific physical activity programmes to specific weight management programmes. I mean obviously a lot of our kind of commissioning and service redesign is based around what is the NICE clinical guidance and it’s very clear, to be perfectly honest. The guidance is very much emphasising the importance of weight management but also incorporating physical activity. We’re not getting away from obviously there is increased risk of sedentary behaviour and there’s also increased risk if someone is overweight or obese, but I look at it from more of a long term and sustainable point of view and I think they both need to be combined together really to have a real impact in terms of helping people lead a healthier lifestyle and reduce their risk of long term conditions.

Gareth: Yeah, I would say going back to the question is it a big revelation? It’s not a revelation to, I guess, GPs, scientists, academics, that being fit is potentially more beneficial for your health than reducing body weight but I think if you look at some of the drivers in society that Janice referred to then yes, aesthetics is very important to people and then you look at some of the commercial products that are available for meeting those sorts of needs and a lot of it’s driven by industry who can sell things like diet products and slimming aides, which actually they can make money from so they’ll put lots of money behind that.  And the public obviously are very interested in being able to look better. Exercise and physical activity is a harder sell because there isn’t really an industry driving the promotion of physical activity, at least with the weight that some of the big corporate organisations have within the nutrition industry. So I think to some extent we’ve known about this but actually the public are less likely to have known about it because of where the marketing’s coming from and that’s certainly not – the money hasn’t gone behind the physical activity the way that the nutrition industry has fuelled the diet theme. 

Lucy: So Shaleen, from the food point of view, what do you think to that?

Shaleen: I think that – and also my background’s public health as well – so from a public health point of view, the reason I would say that more people are aware of basic healthy eating and weight related messages is because public health nutrition advice has been around longer and Mark would agree that for example there haven’t been as many physical activity teams working within the public sector as there have been nutrition. So this is only recent and it’s only a recent study which said that not taking part in physical activity is as dangerous as smoking, isn’t it really? So these new big studies have come in and they’re having an impact on what we’re doing at the public health level. I do agree that we are hugely under the influence of people’s projected ideas of what beauty is about. That’s definitely a fact but I think that the studies, I agree with the academics in the room that the studies have definitely been shown that fitness is not just about body weight. So even though NICE have recently come out with guidance around waist circumference for example, we’ve been talking about other measures for a long time and this is where the big gap is between what academics have always known and maybe the medical profession through health checks know, but the public don’t know and I think that maybe that’s our responsibility now to show that fitness is more than just body weight.  But it’s not just fatness versus fitness, there are lots of other factors – I believe, personally. I don’t know!

Mark: It comes back to some of that personal perception as well doesn’t it?  If you look at the commercial slimming companies, they’re looking at calorie restriction and that gets a very quick short term gain. There’s a lot of issues from a research point of view in terms of the long term actual sustainable weight loss if they come off that calorie restricted programme, but from the public’s perspective, they’re very much looking at what is a quick fix. If you’re looking at it from a physical activity point of view I think there’s some research out there which suggests that someone needs to do between 120 or 250 minutes of physical activity on a weekly basis.  The realisation to get someone who’s sedentary to suddenly start to do that level of physical activity is really difficult, bearing in mind the wider issues around health in terms of employment, money to be able to go and take part in physical activity, the education and knowing where to do it, community safety – there’s a lot more detrimental effects really which create a problem. 

Shaleen: But I would love to know how he himself decided that he was super-fit. How has he classified himself as fit, not fat, would be an interesting thing. 

Janice: Well I think the research that Steven Blair was referring to would be the VO2 max test, so it’s a maximal oxygen uptake test which you do on a treadmill. That’s what they’ve done in the evidence. Much of the evidence he’s siting would be a laboratory type of test where you get on a treadmill and either walk or run to a point where you feel like you can’t anymore and then there’s a number that you look at. So you collect people – people breathe into a machine and you’re able to collect that information and we have standards based on how we might define someone as being fit or less fit, and so that evidence that he’s saying there – now granted that’s a test we don’t do in the general public – so I think back to what you were saying, Shaleen, around public health, that’s another gap we have.  How do people know if they’re fit enough and how would a general person who doesn’t come into an exercise physiology lab like we have here, know whether they’re fit or not? That’s a really good question that I don’t think we can answer yet for the general public. 

Lucy: So we did ask Steven to clarify a little bit more about that point so maybe we can hear that clip. 

Steven Blair (recording): We have typically defined fitness into three categories – low, moderate and high fitness. So it’s getting out of the low fit category that is associated with the major health benefits. So what is the low fit category? Well it differs for men and women and it differs by age group, but in one respect it doesn’t differ. The person who gets 150 minutes a week of moderate intensity physical activity, or gets 75 minutes of vigorous activity, will get out of that low fit group and be at least moderately fit.  And again as I said earlier, getting out of low fit into moderate fitness cuts your risk of dying or developing many different non-communicable diseases almost in half over the next several years. So you don’t have to be a marathon runner to get a lot of benefits from being active and being fit. 

Lucy: So that’s a reasonably simple way of looking at it I think, getting out of that low fit category by doing the minimum amount that is recommended. 

Janice: Right, but I think it’s interesting, a lot of the research I do, people come back to us and they know the guideline, they know that number, but when they actually try to apply it in their daily life, they really struggle with, you know, is this enough? I work with a lot of people who they would count a fairly low level of housework, which makes them tired and keeps them very busy so I don’t want to minimise it, but it’s actually not enough to get them into that more moderate fit category. So even if they did 150 minutes of that a week, I think that’s again where maybe educationally and in terms of messaging we could do a better job of trying to help people within their own contexts figure out how that might apply to their life because we can’t just do it in one way because not everyone’s going to garden or not everyone’s going to walk at the same pace and things of that nature. 

Carolyn: And I don’t think everybody does know what the numbers are actually. I think they know that they should be doing something but they don’t know how many minutes. We know, but I would question whether the majority of the general public know. 

Shaleen: I would agree with that because I’ve been delivering training around the country, so brief advice training, so what the key brief advice message is, and what’s surprising is that even health professionals aren’t aware of daily/weekly recommendations and so there’s definitely a gap in understanding. So even for the five a day message, what exactly is a portion? So when we do thirty minutes of exercise, not very many people know that according to the guidance that we can break it up. So yeah, that’s definitely out there. I think Mark, you’d agree with that?

Mark: Yeah, definitely I’d completely agree with that and even more so with the issue around moderate intensity because people just don’t understand what moderately intensive physical activity is. And some people might even be walking but walking at such a low rate that it wouldn’t even be classified as moderate intensity and gain the health benefits that we’re trying to achieve. 

Janice: And they’re doing the right duration so in their mind, they don’t need to hear that they should do more. What they need to hear is that they need to do what they’re doing, but up the intensity a bit and that’s not the message we give people. We just keep telling people to do more of this sort of amorphous thing that they’re not really sure about. 

Lucy: Yeah. I think I’m right in saying that less than half of us do that minimum. Less than half adults in England do that minimum. 

Carolyn: On average, yes.  And of course the older you get then that percentage comes right down. 

Janice: And women do a lot less than men and there’s also an interesting difference in gender in terms of men actually would prefer – when it comes to weight loss – men would prefer to do something that involves physical activity or exercise, whereas women tend to prefer to do the dieting and so it’s kind of a, there's not a lot of research in this area, there’s more growing that we need to know and understand the gender differences on how people might want to take a programme and then apply it to their lives. But definitely a lot of the results of the data we have is from the diet industry or from weight loss studies is predominantly female based and that’s very different to how men are maybe going to want to approach things if they want to become more fit and less fat. 

Lucy: So what’s the best way to motivate people? Do you think if people knew this amazing statistic about the effect on their health, that you have half the risk of dying over the next decade if you’re overweight but fit compared with a slim sedentary person, do you think that would be a motivator?

Shaleen: I think it would be quite a good idea not to focus on death actually. I mean that’s not the only benefit of physical activity. But premature death, yes, clearly is an issue and we want to address it and we want to address health inequalities as well but there are so many benefits around physical activity – how we feel – and I’ve now moved to a gym where interestingly the average age is over 50 and people, maybe due to early retirement, have started physical activity and what amazes me is that we’re doing the same classes and I can see that people of all ages are benefiting from the same class and sometimes it’s just nice to be reminded that our bodies are capable of moving and of being active, whether we’ve done it in the past or not. I think that this is probably where the fat versus fit debate comes in. You do not need to be thin, to move.   And so if we can remind everyone that then it’s like the start of the motivation process, encouraging people and moving away from – well, you don’t need to look athletic to go to a gym, put it that way. And it’s really amazing to experience other aspects of exercise and physical activity. That’s my personal thought. 

Lucy: Gareth's really nodding.

Gareth: Yeah, I would agree.  I mean I normally look at things from the physiological perspective and unfortunately that’s not usually the best way to motivate people to be active because some of the benefits come later on in life and a lot of people are thinking well, I’m OK now so it doesn’t matter.  But one of the things that I’ve certainly noticed and I think particularly in the ageing population, is actually some of the social benefits of being more physically active and going to walking groups or organised exercise classes.  Actually the social interactions that that brings is of tremendous benefit and obviously they’re getting physical benefits but then there’s also the psychological benefit as well.  I think talking about physical activity in the context of it being an enjoyable activity is perhaps one way to get certain populations to engage more.  I think one of the issues is that each demographic if you like probably has a different driver and so an older person may be more interested in social benefits and a younger person may be interested in something completely different and I think we have to understand what those drivers are, to be able to motivate in the correct way.

Lucy: The Health Survey for England 2012 shows that the more overweight somebody is, the less likely they are to do that minimum amount of activity. So should we be focusing on people who are overweight? Should we be focusing on people who are older? Should we be focusing on people that are sedentary, no matter what – we have to make a decision about where we spend public money, or Mark does! So yeah, where should we be looking?

Mark: I mean for me there’s a critical issue here in the sense of let’s take the example of someone going into general practice, so going into the GP for support the role must already engage in some of the services. My perspective from a public health point of view, I’m really interested in those targeted, isolated, communities who won’t go near any primary or secondary care and won’t engage. But actually, there might be wider benefits that they obviously need to address, like for example social housing, benefits. You take the example of Birmingham, 40% of Birmingham’s population is in the 10% more deprived nationally. So that means we’ve got over 400,000 people in the city who are really low in terms of their income, what comes into the household. What’s the first thing that’s going to go is the leisure and social activity. If we can start to address, in terms of giving people access to appropriate physical activity from a social point of view, it gets them more engaged in the community, it improves their confidence and self-esteem and then they’re more likely to engage in healthcare or general practice and sustaining a more healthy lifestyle themselves, as opposed to them only coming in when there might be a heart attack for example.

Janice: In your last two questions, Lucy, actually I think the point to make is really important is that knowledge does not change behaviour. So we’ve known that for, you know, ever since pretty much we’ve been doing behavioural change research. But it’s critical as a starting point so you at least have to have the knowledge but you can’t expect someone to just have the information and then that will motivate them to make a change. Gareth’s already pointed out, you know, and I think Mark’s expanded on that of triggers, different triggers for people and my point is kind of building on Mark’s, in terms of choosing, we don’t have the luxury of choosing anymore. I know we have limited resource but that’s why we have to be more creative because if we pick and choose only one demographic and we focus on them, everything else falls apart and it still costs and we still have the NHS, thank goodness, we’ve still got that here, it’s still going to cost somewhere down the line. So instead of us thinking within that same box to saying we’ve got to choose and it’s going to either be children in prevention or it’s going to be obesity only, blah blah blah, if we do those things it’s so short-sighted, we know it takes a lot of creativity and I think that’s why we’re really wanting to work more both in terms of academia and working with other sectors, to say how creative can we be, even with industry, you know, can the food industry play a positive role and help us fund some of these things because we’re not going to have the money that we get from Government or from academic sources and I think we have to start thinking out of the box and that’s reaching the most at risk that are really tough to reach. So we won’t do it with traditional means but their lives should be just – they should have as much opportunity to be healthy as anybody else and you don’t have to go to a gym for instance to be fit or to move and to get active.  

Mark: This is where physical activity can play a really important role because if you take the role of childhood obesity, we know there’s a national epidemic around childhood obesity. If you look at Birmingham’s figures, over a quarter of the population of Year 6 children are actually obese.   If we look at the children’s weight management services nationally, we’re still getting very low numbers coming to our services and the long term outcomes of those is actually we’ve still got a rise  in obesity happening, whereas if we can use physical activity from a social point of view and move away from what is school based PE which is more associated with competition and look at the social aspect and the wider gain you can get from physical activity, build that into our weight management services more and use that as a key driver, I think we can instil more healthy and active lifestyles from a younger population which makes it easier to sustain rather than trying to approach, let’s say for example, a secondary school female who has been disengaged with PE from a younger age and will not go anywhere near it. 

Shaleen: I think the issue of why that secondary school female has been disengaged needs to be addressed. But that’s maybe for another podcast!  But I totally agree with what Janice said that in the world of nutrition, public health nutrition at the moment, food poverty is such a big issue and we need to direct our resources to addressing poverty in the way that you just explained, but for the whole of the population, sedentary behaviour and physical inactivity, poor eating, is not just prevalent in one group, it’s clearly more of a complicated issue in that one group, but it’s a huge issue for the entire population. If we’re expecting 1 in 3 adults to have diabetes then physical activity is going to play even more of a role as it’s better than taking medication to do physical activity apparently. So for me I think it’s really important that – Janice is right, that we need to start thinking more creatively about how we engage different groups and what the motivation is, assessing that and having a better understanding of behaviour change and so on.  I also think that it’s really important for journalists and those of us that have a responsibility to communicate to the public to stop separating the issues. So it’s not just about fitness or fatness or physical activity or nutrition, we’ve got to start thinking about things holistically which we’re trying to do in the NHS but it’s not very easy, right?

Mark: No, I completely agree. And picking up on the point around the media side of things, if we’re now suggesting that you can be fit and fat, that’s fine. Because we don’t understand the perception of what fit is and there still are some ambiguities around that research, then from a public point of view the messages that they’re getting are not very clear. So they would more likely go down the route of actually it’s OK to gain weight but we still know the significant risk factors from a long term condition’s point of view, which we do need to address.

Gareth: Yeah, I would agree. It’s dangerous to go too strong on the message that being fit is OK if you’re fat because I think there are still substantial benefits, health benefits, to be gained from actually having a healthy body weight and being fit. You know, from my experience and understanding, you know, cardiovascular fitness is extremely important across all age ranges and body fat ranges. If you’re fat and have a high level of cardiovascular fitness then that’s certainly better than being fat and having a low level of cardiovascular fitness. But I don’t think it replaces the substantial benefits of being fit and being of a normal body weight and that’s just around cardiovascular fitness and if you look at metabolic health and things like risk factors for Type II diabetes, actually an obese person in terms of reducing the risks for Type II diabetes, currently still the best way to do that is actually weight loss. Whether that’s achieved through exercise or diet or a combination of the two, weight loss is critical for reducing risk for Type II diabetes and so I think we do need to be careful. So it is about balance and how the messages go out. 

Lucy: I’d just like to play in here our third and final comment from Professor Steven Blair which I think picks up on what you’ve just said, Gareth, about that balance of messages and how important the two things are. 

Steven Blair (recording): So being fit does nearly, almost essentially, eliminate the negative health effects of someone who is overweight or obese, at least up to a point. I don’t think there are any fit individuals who weigh 200, 300 kilograms but certainly compared to Class 2 obesity, BMI up to 39.9, fitness seems to largely eliminate the health hazards associated with obesity.

Lucy: If I can just come back to you, Gareth, on that one then. So Steven Blair says well, it kind of does seem to eliminate most of the health hazards up to BMI 39.9.

Gareth: Yeah, I mean I think I agree and disagree with some of the points that Professor Blair makes and there are some aspects of health that will be improved by being physically fit and obese, but there is some recent evidence that suggests that not all aspects of health will be protected by just being physically fit. And so I think that we need to do more research to really understand this relationship between physical fitness and obesity and before we make firm conclusions, the current best approach therefore still is that we should be trying to reduce body weight into the healthy BMI range. 

Janice: Or I would even argue maybe into the overweight range, particularly if you’re in that obesity because it’s pretty tough to get into a healthy weight range for a lot of people if they’ve been obese, particularly for a long time. Interestingly there’s more recent evidence coming out on overweight and these are kind of large population based evidence from the US in particular that’s shown that the lowest risk for premature mortality and from all causes is in the overweight range and that caused a lot of hoo-hah media blitzing, particularly in the US and a lot of top experts in the nutrition area particularly were livid, they were angry and these are just basically epidemiologists running the numbers. They’re not emotionally tied to it and the point was made that there may be lots of different reasons why people have an overweight BMI and might still be more fit, they might have really good lifestyle practices, very healthy ones and it seems to be as you get into that obese range of the BMI above 30 where like Gareth said, we still need to do a lot more research and even though I know with Professor Blair’s comments, I would agree that it’s probably not completely benign and we don’t obliterate all of the risk by being fit when we’re obese. But it’s that overweight category that I think we also need to explore and I would really love to see more people move into the overweight category from obesity, even if they can never achieve the healthy BMI range. I think that’s more achievable for people and probably would still have quite a substantial public health benefit.

Carolyn: And BMI itself is perhaps not a particularly good measure of body composition, it’s not really telling you what’s inside, you know, how much muscle you have, how much fat you have. And certainly when you get older we know that your muscles get smaller, so if you’re overweight and you’re trying to get up out of a chair or something like that, then clearly it’s going to be more difficult for you than if you’re a normal weight. So there are issues about how you measure things and how you interpret those measurements and yourself and Gareth have been involved in trying to explain that to the public in the recent past.

Janice: Which we’ll be doing again also in this event coming in October. So we’re going to do more around what does BMI mean and is it any good and should we be using it?

Shaleen: And that’s interesting in relation to we’re in a super-diverse city and so me being of Indian background, I’m supposed to be at a higher risk for diabetes and heart disease and we’ve been told that our cut-offs for body weight and waist circumference are lower than the general population. So it will be interesting to understand these studies in the context of a diverse population as well and whether having a tummy for me is a bigger risk than it is for others as well. 

Lucy: In terms of public understanding though and the messages that need to go out, do we need to focus more on fitness and less on fatness? Someone’s made the point that fatness is visible, you can look at someone and see how fat they are. You can’t look at them and see how fit they are. But as the public do we get the message about the importance of fitness and if we’re trying to crack this issue, if we introduce people to exercise is that not more likely to put them on a kind of virtuous circle than it is as Mark pointed out earlier on, you know, go on a calorie restricted diet, lose a few pounds, a couple of months later put them back on again and where have they got? Are we investing too much on the food side and five a day and all that and not enough on fitness?

Mark: For me this is where we go back to the clinical guidance around what we should be doing from a public health perspective. It is about both weight reduction and being more physically active and that’s where we’re going to get the long term sustainable benefits from reducing that risk. So if you look at the guidance we should be aiming for between 5 and 10% weight loss in what would be a weight management programme within a commissioned public health service and with both elements I think it’s really difficult to be able to achieve that. And also the added issue around – you’ll back me up around this I’m sure – around the nutritional benefits and the vitamins and minerals that you’d be getting out of eating the right kind of balanced diet, as opposed to eating whatever you want but being physically active. There's a lot of added value around that. 

Shaleen: What I would say is that, just in response to your question, is that there’s not a lot of funding behind either nutrition or physical activity. There happens to be perhaps more public interest in food and we somehow need to get the public interested in physical activity in the same way but yeah, there’s an issue for both – the right food messages and the right – so even though we were talking about the nutrition industry, it’s not a regulated industry. There’s no way that a public health nutritionist would recommend that an average member of the population would go on a very low calorie diet or take supplements, yet there’s a huge industry out there which is supported by celebrities endorsing XYZ. And physical activity doesn’t have that much interest I would say. Would you say that? I don’t know. 

Carolyn: Yeah, I mean as Janice says we’ve got to start being more creative and thinking out the box because people are not taking as much activity as they ought to be and they haven’t, you know, since people started recording these things, you know, we have to do something different otherwise we’re wasting our money.

Shaleen: But recently with this, is it the 5:2 diet and 3 minute exercise for example, that’s just got – I don’t know much about it but I would love to know if there’s anything behind it and I’m sure the basis of this is in some sports ex research isn’t it? So that’s the opportunity. If suddenly you’ve got the media’s attention and the public’s attention, then I think that’s when experts like yourselves can step in and say ‘actually, this is what you need to start thinking about’. 

Carolyn: I mean we do need more research in areas such as high intensity exercise and the potential benefits and also the interventions to reduce inactivity rather than increasing activity. There’s a subtle difference between the two. The research is still really in its infancy in some of these areas and with respect to other influences such as gender and race, yeah, we don’t know very much at all. So research is very important.

Gareth: I mean I think your question was around should we be focusing on getting people more active or concentrating on the fatness side of things. I mean I think it's not an either or, it’s not as simple as that unfortunately. At the end of the day obesity is the world’s leading non-communicable disease and therefore it’s obesity we need to tackle. I think we need to do that holistically and probably on more of an individual basis and different people will need different treatments or options for that. Some people may respond well to physical activity and eventually lose weight; others will gain weight when they do more exercise. Some people respond well to diet, other people will not be able to respond well to that. So I think we need to be thinking about how can we combine interventions or choose the appropriate intervention for that specific group of individuals. I know that’s very complicated but when it comes down to it it’s an individual disease if you like.  

Shaleen: Is it classified, obesity? Has it been classified as a disease?

Janice: In the US it is now classified as a disease and that was predominantly done politically so that through private health insurers you can then claim various things to get reimbursement from insurance companies. So in the US they’ve done that but it wasn't necessarily because of physiological reasons or medical, it was really more around the healthcare industry there and what they have to do to get financial reimbursements for treating, because unless you’ve got a disease that you can tick the box and say ‘it’s a disease’, you can’t get reimbursement for various things from private insurers. So it’s a very different situation in a country like the UK where we have a national healthcare system and so, I don’t know, Mark, maybe you have more insights into that but what’s the current political climate here around whether we’re going to define obesity as a disease or as more of a kind of just a condition or a situation that happens, defined by weight and height. 

Mark: At the minute I’m not sure whether there is any push towards defining it as a disease. I think it’s more associated with a lifestyle risk factor which will have an impact on a condition like Type II diabetes, strokes, CHD and so on and so on, as opposed to that specific disease. 

Lucy: So Janice, you and I are going to be at Thinktank on the 30th October, meeting the public and talking to them. So I wanted to ask all of our guests – so Shaleen, Mark, Carolyn and Gareth – if you could give us one message to communicate on that day from your expertise and experience, what would that be?

Gareth: Well my message would be that, you know, it’s very important to be active at any level of fatness and that really should be the public’s primary objective, being active at whatever level of fatness you are and you will reap much more health benefits than if you were inactive at that level of body fat.

Lucy: Yeah, we can take that one can’t we, Janice?

Janice: In fact Gareth’s going to be there as well. 

Lucy: Gareth’s coming as well. There you are then! 

Janice: I’ll have a little sign above his head that says that, how’s that?

Lucy: Shaleen?

Shaleen: I mean I would totally and utterly agree with that, but I also think that it’s an amazing experience to develop an ability to be physically active at all levels and you benefit in so many different ways. But from a fatness point of view, I don’t particularly like using the word ‘fat’ and it’s just got too many negative connotations and for most people it will put you off in the right direction in your head. So in terms of food I would just talk about getting the best, making sure that you get a balanced diet and good nutrition rather than focusing too much on whether you look fat or thin. 

Lucy: Mark?

Mark: I’m supportive of both of those points really. I think it’s really important to have a healthy balanced diet and not necessarily focusing on calorie restriction but eating the right kind of diet with the support of physical activity to help someone lose weight, I think that’s going to have a more longer term sustainable outcome rather than just looking specifically at calorie restriction and not both combined.

Lucy: Can I push you a little bit further rather than just agreeing with what people have said?! Is there anything else?

Mark: I suppose one of my other concerns, and it goes back to the point that was getting raised before, is this issue around high intensity physical activity. I think we need to be very very careful about saying that someone can do 75 minutes of high intensity physical activity rather than 150 minutes of moderate intensity. As we know with the active people survey data, we don’t have enough people doing moderate intensity physical activity and then there's also the other concerns around people’s nervousness about getting more physically active. They’re concerned about feeling their heart beating a lot harder, the out of breathness, which is really difficult to get someone to that moderate stage. So if we’re now saying actually, you can do high intensity activity, I’m very nervous around that having a real impact. I think we need to focus on the smaller steps. 

Lucy: So to boil it down to a simple positive message that would be try and do 150 minutes a week of moderate intensity activity. 

Mark: But building up to that. So gradual build to 150 minutes of physical activity. We wouldn’t suddenly expect someone who’s sedentary just to suddenly be able to do 150 minutes a week. We’d probably turn them off and they would never come near physical activity again if we said somebody had to do that.  So if we can support them to build that up gradually I think that’s really critical.

Lucy: I wonder if when we’re there, Janice, whether we’ll ask people about whether they do know what the guidelines are. That would be interesting.

Carolyn: That's one of the, yeah.  

Lucy: Ah!

Carolyn: I'll be there as well!

Janice: We had a planning meeting the other day and it’s really going to – and I’m very excited about it, it’s fantastic, it’s creative and we’re going to have multiple stations if you will and there will be lots of information shared both about BMI and how we measure fatness and also a lot about physical activity, what the guidelines are and so I think some real fun interactive things people can do to engage with the information. 

Carolyn: Yeah.

Lucy: So Carolyn, I’m not letting you off the hook!

Carolyn: No, you don’t have to let me off the hook. I would say, I mean I know we’ve talked a lot about guidelines, but my message would be sit around less. Less sitting about. If you’re watching TV, get up during the adverts and go and do something. Keep your remote beside the television rather than beside yourself, just little things like that, simple messages. Sit around less, eat sensibly. 

Lucy: Fantastic. Well thank you ever so much everybody and if you’d like to come along to the event at Thinktank it’s free, it’s at Millennium Point on the 30th October. It’s called Obesity Wars: Fatness versus Fitness, and it is funded by the Physiological Society. So hopefully see you there. Thank you very much to all of our guests and thank you, Janice. 

Outro VO: This podcast and others in the series are available on the Ideas Lab website: www.ideaslabuk.com. There's also information on the free support Ideas Lab has to offer to TV and radio producers, new media producers and journalists. The interviewer and producer for the Ideas Lab Predictor Podcast was Lucy Vernall.