“Take TV-free days to combat obesity, health experts urge,” The Guardian reports. This is one of a range of new recommendations from National Institute of Health and Care Excellence (NICE) draft guidelines that are designed to help adults and children maintain a healthy weight.
Although the headlines have largely focused on TV (as well as other types of screen time, such as smartphones), the recommendations cover a range of health-related behaviours, such as walking to work and avoiding fizzy drinks.
This draft guidance is mainly aimed at people in organisations who set up, pay for, or put into practice programmes that aim to help people maintain a healthy weight and prevent excess weight gain. The guidance is designed to help them know what sorts of behaviours these programmes should target.
The draft NICE guidelines are now be available for anyone to comment on. NICE will consider the comments and make revisions to the guidance as needed, before publishing its finalised guidance.
Why do we need this guidance?
The guidance aims to help reduce risk of diseases associated with excess weight, especially obesity, including:
- coronary heart disease
- high blood pressure
- type 2 diabetes
- liver disease
- some cancers, such as bowel and breast cancer
Like most of the developed world, the UK is in the grip of an obesity epidemic. The latest statistics suggest that one in four adults are obese, making the UK “The Fat Man of Europe”.
Aside from the impact on health, if current trends continue in the coming decades, then the costs of treating obesity-related complications will become untenable.
Helping people to not become overweight or obese in the first place, and even stopping people who are overweight or obese from getting heavier, should bring significant benefits.
What does the draft guidance recommend?
The draft recommendations urge people in charge of weight management services to:
- support everyone to maintain a healthy weight or prevent excess weight gain
- focus on both physical activity and dietary habits
- encourage physical activity habits that increase energy expenditure
- encourage dietary habits that reduce the risk of excess energy intake
- encourage adults to limit the amount of alcohol they drink
- address misconceptions about behaviours that may influence weight
- encourage self-monitoring (such as regularly weighing yourself or using a pedometer to measure steps)
- provide sources of information and support
Each recommendation then gives more detail about how to go about these things, and some of this detail is reported below.
What do they say about the misconceptions?
The draft guidance says that public health messages should address misconceptions people may have about how to influence weight. They say that this includes, for example, making it clear that:
- healthy eating and being active are as important for people who are currently a healthy weight as for people who are already overweight
- gaining weight as an adult is not inevitable; most people will gain weight as they get older if they are inactive and eat an energy-dense diet (one which includes a high number of calories per gram)
- extreme behaviours (such as avoiding all carbohydrates) are difficult to keep up in the long run and may not be accompanied by improvements in health
- no single behaviour (for example, consuming or not consuming a specific food or drink, or taking part in physical activity) will maintain a healthy weight by itself
- all foods and drinks, even those sometimes seen as "healthy" (such as olive oil, fruit juice or milk), contain energy and can contribute to weight gain if consumed in large amounts
- eating in the evening (for example, after 5pm, compared with earlier in the day) does not make it harder to maintain a healthy weight, unless total energy intake is increased
Does it say I can’t watch TV for more than two hours a day?
Watching less than two hours of TV a day is just a single example the draft guidance gives. It gives the example as one way to encourage habits and routines that will gradually increase the amount and intensity of physical activity people do. It says that any strategy that reduces TV viewing and other leisure screen time may be helpful, such as having TV-free days or aiming to watch TV for no more than two hours a day.
It’s an eye-catching recommendation, and one that has clearly struck a chord with the media. Arguably, it could have been more helpful for the media to focus on the misconceptions that they may intentionally or unintentionally reinforce through reporting of fad diets and focusing on single foods.
In addition, recommendations don’t just focus on TV, they also want to promote:
- regular walking, particularly brisk walking, or cycling as a form of active travel
- activities during leisure time and breaks at work or school
- activity as part of daily routines (such as taking the stairs instead of the lift)
- support and encouragement for children to be active at every opportunity, such as having active school breaks
What does the draft NICE guidance say about food and drink?
NICE’s draft guidance says people should try to:
- reduce the energy density of their diet; energy-dense foods (such as fried foods, confectionery and full-fat cheese) pack a lot of calories into a small quantity of food, and the guidance recommends reducing how often and how much of these is eaten – it also recommends substituting them with less energy-dense foods, such as fruit and vegetables
- follow the principles of a Mediterranean diet – which is mainly based on vegetables, fruits, beans and pulses, whole grains, fish and using olive oil, instead of other fats
- eat breakfast, and to choose healthy breakfast foods, such as unsweetened wholegrain cereals or bread and lower-fat milk
- aim for meals to be enjoyable and without distractions (for example, avoid eating while watching television)
- reduce fast food and takeaways – for example, by limiting them to no more than once a week
- avoid sugar-sweetened drinks
- reduce total fat intake
- increase proportion of high-fibre or wholegrain-rich foods
- limit intake of meat and meat products
How have the news sources covered this guidance?
Most news sources covered this draft guidance relatively briefly and factually, with the focus in the headlines often on the recommendations around TV watching.
While most media sources are broadly supportive, the Mail Online’s headline refers to the draft guidance as “Health watchdog's 42 pages of health tips – for the perfectly healthy!” and says it is “aimed at those who are in good health and not overweight”. This seems to imply that the guidance is a waste of time. It also goes against one of the misconceptions NICE aims to tackle – that healthy eating and physical activity are not important in people who are a healthy weight.
The Mail has failed to grasp the concept that prevention is better than cure.
Also, the guidance aims to make recommendations that can be applied to the population as a whole – which includes individuals who are overweight or obese. It doesn’t cover specific recommendations about treating overweight or obesity (that is, about how to lose weight), as there is other NICE guidance covering this.