13th June 2019
During Diabetes Awareness Week 2019, a blog by health visitor, Josie McHugh, on her attendance in February this year at a meeting of the APPG for diabetes at the House of Commons. The meeting was entitled ‘The Science of Reversing Type 2 Diabetes with low carbohydrates’.
As a health visitor I have a keen interest in infant and childhood nutrition. My interest in this area began early in my midwifery career, where I studied the strong link between nutrition in pregnancy and the significant influence of this on health in adulthood.
One in three children is now overweight or obese by the time they leave primary school. One in two adults is obese or overweight, and obesity costs the NHS five billion pounds per year, which is predicted to increase to 10 billion by 2050. The impact of obesity, however, goes far beyond what we see on the scales or the deficit in NHS funds.
The impact of obesity on children highlighted by the Prime Minister in Childhood obesity: a plan for action (2018):
‘Children who are obese or overweight are increasingly developing type two diabetes and liver problems during childhood. They are more likely to experience bullying, low-esteem and a lower quality of life and they are highly likely to become overweight adults at risk of cancer, heart and liver disease..’ (1)
The sugar tax and the children’s online junk food ban demonstrate a renewed focus. However, these changes may not be enough to change the direction of travel that a growing number of children are heading towards in poor health in adulthood. One of the four principles of health visiting is the influence on policies affecting health. As leaders of the Healthy Child Programme, we have an opportunity to appraise policies and recommend changes to improve health (2).
I was delighted to attend an All Party Parliamentary Group (APPG) meeting for diabetes entitled ‘reversing type two diabetes with low carbohydrates’. The meeting included broader themes such as the importance of staying up to date with the best clinical evidence, viewing the totality of evidence, the root cause of obesity and the strong links between chronic disease and nutrition.
MP Tom Watson opened the meeting with a short speech concerning how he has managed to overcome his type two diabetes and lose over six stone with a low carbohydrate diet. Mr Watson highlighted that not only has he experienced many physical benefits but also the associated mental improvements since losing the weight and putting the disease into remission. Mr Watson also talked about how he feels conflict as he works in politics and yet this diet, that worked so effectively in improving his health, is not reflected in health policy. Dr Aseem Malhotra was then introduced, the author of the Pioppi diet, and someone who helped Mr Watson make significant improvements in his health.
Dr Malhotra is a Consultant Cardiologist interested in type 2 diabetes as this is one of the most significant risk factors of cardiovascular disease. Dr Malhotra, who is also a professor of evidence-based medicine, discussed the need for the best available clinical evidence in order to improve patient outcomes, and asserted that evidence-based knowledge has been hijacked by commercial influence. Dr Malhotra opened his presentation by highlighting that, within five years of a medical student graduating, half of what they learnt in medical school will be wrong or out of date, and other factors that contribute to lack of knowledge are commercial conflicts of interest, defensive medicine and biased reporting in the media.
Most would agree that the root cause of type two diabetes on a population level is the food environment. It has become difficult to avoid sugary, processed carbohydrates wherever we go, including hospitals! Either the nutritional advice is wrong or nutritional education is ineffective when the food environment is working against this. Although counselling and education are important, policy changes that target the affordability, acceptability and availability of sugar and ultra-processed carbohydrates is far more effective. Dr Malhotra discussed policy change such as the sugar levy and the smoking ban in relation to hierarchy of effectiveness as these methods are not dependent on a sustained individual response. This struck me as a health visitor, as we witness the sustainability of change is often the greatest challenge that families face when wishing to improve health.
Type two diabetes was once thought of as a chronic irreversible condition. Dr Malhotra discussed the low carb programme, revealed studies showing significant remission of type two diabetes (up to 60% of patients) on this diet and referenced a systematic review which compared the effectiveness of low carbohydrate with low fat diet interventions on metabolic control in people with type 2 diabetes.
I found it fascinating to learn that globally poor diet is a significantly bigger contributor to chronic diseases compared to smoking, alcohol or physical inactivity combined – hence the need for renewed focus on new scientific evidence relating to nutrition.
As practitioners in the public health field, the statistics around obesity and associated chronic illnesses can be discouraging and the future looks concerning. These facts do, however, provide us with an opportunity to look to new evidence in moving forward with policy change. Current nutritional policy and approaches to tackling obesity and chronic disease are not working effectively enough. I believe this is partly due to out of date evidence coupled with the food environment which is saturated with commercial influence. What we see, with regards to infant and childhood nutrition, is a perfect reflection of this. ‘Weaning’ foods on supermarket shelves and advertising aimed at children and parents are often in contrast to the evidence base, and ultimately is having negative health implications for children, now and for their future. This is why we must adhere to our founding principles and seek to influence policy.
- Department of Health and Social Care, (2018) Childhood Obesity: a plan for action, chapter 2. HM Government
- NMC (2004) Standards of proficiency for specialist community public health nurses