This is a CRACKER of an episode!

Join me as I chat to Dr Ed Pooley, GP.....

Ed works as an NHS GP with an interest in the interface between psychology and health. Prior to medical school he was a researcher in molecular biology, neuropathology and behavioural genetics.

When not working in primary care, Ed works as a communications consultant training doctors and healthcare teams to communicate more effectively with each other and with their patients (if you work in the medical profession you can buy Ed's book here) - and all that experience certainly made for an interesting conversation!

We talk about the complexities of fat loss, body image and the influence of social media, bariatric surgery and the options for overweight people on the NHS, and even Slimming F*cking World gets a mention!

If you believe that the answer to obesity is 'eat less, move more' then you might wanna open your ears (and your mind), to listen to this.

If you loved this episode, please leave us a review.

If you'd like a question answered here on the podcast, just send it in to hayley@food.ninja and I'll do my best!

And finally, if you'd like to hang out with a bunch of like-minded people, all focused on finding their version of healthy, you can join my FREE Facebook group here.

Enjoy the show!

​ Hayley Food Ninja: Hello and welcome

Podcast with me, Hayley Food Ninja.

And today I am very excited to have a guest that I think we've been trying

to do this for a while, haven't we?

Because I've always thought, Oh, you'd be good to put a podcast because I know that

you watched some of my Facebook Lives and you always had a lot of good comments.

I was like, I'd like to talk to Dr.

Ed

Yeah, I think I just used to spring up and mildly troll you a bit.

Yeah.

And go, That's a great idea.

Or have you thought about this?

So yeah, it's, I've been looking forward to this for a long time.

Yeah.

Amazing.

So yes, my guest today is Dr.

Ed Pooley, Ed, do you wanna tell us a little bit about what you do, because

you are not just a doctor, you do a few other things as well, don't you?

Do you wanna tell us a little bit about that?

I currently work as a GP in Nottingham.

Before being a GP, I did lots of things before, so I was a

molecular biologist for a bit.

Then I was a geneticist, a neuropathologist, which

is what my PhD's in.

And then now that I've moved into general practice, I also work as a

communication skills trainer for doctors.

So I teach doctors how to communicate better with each

other and more effectively with their patients, particularly.

Challenging topics like obesity, exercise, health promotion, and things like that.

Wow, that is like fascinating.

I can't wait to talk to you about all this stuff because obviously I

have a lot of kind of stories, good and bad from my clients about their

experience with that kind of thing and people's language around it and stuff.

So that is super interesting.

And you've also written a book, haven't you?

Am I right in thinking, yes.

The first book I wrote was on time management.

It was about systems in general practice mainly in general practice, but how to

consult more effectively and the second book's out this year, which is on,

consultation styles and how to communicate more effectively with patients.

Oh, that'll be interesting for me to read.

Cause I'm always reading.

I like to read a lot of the books about, like motivational interviewing

and stuff like that because a lot of the type of clients that I

generally get tend to be chronic dieters, you might be a bit resistant

to change and that kind of stuff.

So I'm always interested in new ways to try and communicate with people and.

I guess be a little bit persuasive in terms of trying to get people to

change their behaviours and stuff.

It is, It's really interesting actually, that if you look

at the things that keep people stuck where they are, it's this sort of balance

of fear between wanting an outcome but being a bit fearful of the change.

Sometimes we get stuck in these psychological ruts of it.

It's better the devil, yeah.

And we become a bit change resistant and then the environment around

us becomes a bit change resistant.

Sometimes we get pushback from family members or friends who know us a

particular way and don't want us to change, or don't want us to to alter

that dynamic that may already exist.

Yeah I actually always make a joke of this cause I do

a little bit of role play around stuff like that because I've had so many

situations where people are in a group of friends, for example, if they're

the fat friend, The other friends don't want them to change because

who's gonna be the fat friend then?

You know it's gonna be one of them.

And it's really interesting, that dynamic, isn't it, where people have, they put

a label on you or you fulfill a certain role in a group, whether that be a

family or a community or whatever, and people have feel really uncomfortable

when you want to change that.

Hugely, when we get used to internalizing the language that people use

to describe us as well, we in some ways we do adopt that role and it becomes part of.

It's almost like a coat that's given to us that we put on and

we're not allowed to take it off.

And if we do, then we can feel a bit vulnerable, even if we don't

really like how the coat feels.

Yeah.

Because we worry about being seen as something different

or something that's changed.

So yeah there's all of that.

That dynamic that goes on is fascinating.

Both in terms of weight, in terms of health, your psychology,

mental health particularly.

It's absolutely fascinating.

Yeah, I think it's probably the most favourite part of

what I do, because I realized really quickly when I started working with

people that I didn't actually have that many conversations about what to eat.

People know that, don't they?

They know what to eat, but there's so many things that prevent them from adopting

those behaviors family circumstances, stress, all of that kind of stuff.

So it's, I feel.

That stuff is harder to sort out for sure with clients, but is so much

more impactful because it lasts so much longer than telling someone,

Hey, just eat a bit more protein.

Yeah, and I think what I really like about your

approach particularly is that you incorporate that aspect of things

because I think just in the same way that I could give someone a tablet.

To take, to lower their blood pressure if they don't understand why they're

taking it or what the benefits versus the risk or, sometimes the way that they

might feel initially on that or that once that, that change starts to happen.

There's that sort of behavioral inertia that we have.

Yeah.

And it's really hard to shift initially, and we are really resistant to it.

And then once that shift starts to happen, we get that positive feedback and

then it makes it so much easier to do.

Yeah.

Particularly when it's something that we associate with unpleasantness

or something that is challenging or going to alter the way that we live.

Because a lot of people, Particularly it comes to food.

They will structure their lives around food.

And we see this particularly with mental health issues, when people become

depressed, they'll either stop eating or they'll eat more, or they'll withdraw

a bit and everything becomes about.

Waking and going to bed.

And then they get a little bit better and a little bit further on that journey,

they'll start structuring around I've gotta get up cause I've gotta eat

breakfast and I've gotta eat lunch.

It's something to almost look forward to.

Yeah.

And it's a really hard line to tread in making food something that

you do that is part of your normal existence and also reframing it as

something that doesn't have to define

your existence.

Yeah.

And I think lots of people who work in nutrition often take this

kind of food is fuel extreme and it becomes really difficult to then.

Convince people that actually food is more than fuel.

It's about social interaction.

It's about sharing.

It's about connecting with people.

It's about shared enjoyment.

It's it's a bit like going to the theater and you are the one who's overdone it.

So you are in the corner with a blindfold and earphones on.

It takes away that, that humanness of it.

And if we don't, if we don't acknowledge that, how do we change anything?

Yeah.

I think that is so important because, food is emotional whether we like it or not.

We all emotionally eat, don't we?

Whether that's.

Because we are sad or because we are happy or because we're celebrating

food has got this really strong correlation with our emotions.

And I always say to people, it's not bad to eat emotionally as long

as you get the desired effect from it, maybe I feel a little bit sad,

so I might eat a bit of rice, put in with a blob jam in the middle.

Cause my nan used to give me that and it makes me feel happy.

But then if.

10 bowls of it and three packets of crisps and then I feel like shit and I

feel ashamed and guilty and embarrassed.

That's when the emotional eating isn't really working.

Cause it's not making you feel better.

It's making you feel worse.

I think there is something about addressing that inner

child that comes out, if we think.

From a kind of childhood perspective, you are in the family home.

You are being given food.

If you're being fed as an infant, you don't have much control over that.

You are fed.

That is your source of connection.

That's how you interact with people primarily.

And there is something about understanding that inner child

and that inner child's need.

Something, Food does that very much.

And then we add all of these unfortunate social layers on top where we then

associate, you can do a certain amount of something and that's great if you

do too little, that's also a worry.

I see lots of parents who will bring children in because they're not eating

enough, and then you, there's an optimum that somebody has set and then there's

too much, and then that's where it starts to tip into this shame cycle.

Yeah, and we know that shaming people for what they eat doesn't work because

if you shame people, they will just feel bad about themselves or they

will become even more change resistant because they then develop a mindset of

you don't understand what it's like.

And yeah, then there's almost more entrenchment and more difficulty

surrounding the need to change.

. Hayley Food Ninja: Yeah.

Yeah.

It's, it is I could just talk to you for three hours about this one thing, . cause

it, I find it just so fascinating and I spend a lot of time thinking and talking

about this because I know that it's the one thing that seems to make a difference.

It doesn't, it's not somebody's macros or whatever.

It's just trying to figure out what is that thing that, like you.

It's hard to motivate people with health behaviors because

the payoff is not immediate.

It's like really slow.

So it's the really hard sell to go, Hey, just do this one thing.

They're like, Do it every day for 12 weeks.

It's really boring, and eventually you'll see some benefit.

People are like, What?

? Dr Ed Pooley: Yeah.

You can't really market it as this one weird trick that has

doctors furious or whatever.

, the latest internet click bait is going to.

Because people see through it, people, you get people's hopes up and then

it doesn't deliver, and then they get into this spiral of, just shame

and feeling that it's their problem.

They're the ones who didn't work hard enough or didn't try hard enough.

And yeah it's it's a very horrible industry, I think in

some places when it's done badly.

It absolutely is.

There's so many tactics and things that I see where you just think,

...My first thought when I work with someone is I mustn't leave

them worse than when I found them.

Obviously I have more optimistic hopes than that.

For sure I should never leave someone worse off than I found them.

And you see just people who are chronically stressed and everything

and they've just got a macro coach screaming at them going, Why

didn't you hit your protein today?

And my last guest, Kristin last.

Week, who is actually part of the fitness industry.

She's a CrossFit box owner, and she's talking about a very well

known nutrition program that actually gave her an eating disorder.

And this is someone with a lot of awareness and stuff.

So I just think yes, the industry is in a terrible mess and I think

if people would, just adopt that one thing of let's not leave this

person worse off than I found them.

That would improve things straightaway, let alone trying to

actually improve their situation.

I agree.

I wish that more people took the approach that you do.

Yeah I see the consequences of it when it isn't done appropriately.

Yeah.

And then when it, when something that is, starts off as normal but maybe not

optimal, then becomes damaged in some way or the, that, that psychological

connection is disrupted, then it becomes illness and then that's the bit I see.

And it, you just, it's so much harder to try to help someone from

an illness perspective than trying to maintain them when they've got those

physical and mental resources to do something differently

earlier in that journey.

Yeah.

They were they've actually got, a bit of resilience and capacity and stuff

and I imagine by the time they get to you, that's just completely gone.

It is, and it put, by the time they get to me, there's

often a desire to look for either medical fixes or some sort of

wonder drug that's gonna help.

And there is some research in the area and there are some interesting medications

that help, but fundamentally, there, there is a need to understand the psychological

process and to deal with that.

In a helpful way.

I think one of the things we've spoken about before is things like

bariatric surgery, for example.

Where you are essentially limiting the body's ability to absorb food.

So you are in effect, it is a calorie reduction.

With some hormonal changes that happen as a consequence of surgery

and also reduced intake, but it's a fixed thing that happens to the body.

You can't half do surgery.

It's just done.

So it's like a fixed thing that is done.

And so therefore the evidence for it working is fairly high because unlike

a diet, you could advise people to go on a calorie control diet, but data

looks less good than say, surgery.

There's lots of issues with the analysis in that.

Yeah.

But we know that if you take two groups of people, one who you do intensive

psychological interventions with and then bariatric surgery and one

that you just do bariatric surgery with the one, the group with the

psychological interventions do better.

And that's quite a big thing cuz the NHS particularly does the psychological

interventions because it wants to try.

Not put someone through surgery.

So if the psychological stuff is enough, that's where that patient's

journey kind of ends for now.

But a lot of people obviously are saving up for surgery and they're having it done

privately where they don't get as much of the psychological support, for example.

So it's a big thing.

It's a big issue that needs to be Brought out into the daylight and discussed

in ways that can move how we do things forward and how we can do them better.

Yeah, like you said, we've spoken about it before.

Cuz I, I find this fascinating because I've now had is it five, either five

or six clients who have had bariatric surgery before they became my client.

And I can think of one example in particular of someone who was 40

stone, they had bariatric surgery and actual the bypass, not just a sleeve.

And they lost 20 stone and then they put it all back on again.

And to me that is obviously it's terrible, but it's also fascinating because this

isn't person who's had a sleeve, which from my understanding, it's probably quite

easy to actually start over eating again.

But to have part of your stomach removed, , but then put on 20 stone

again because there wasn't any counseling or psychological or emotional support.

That's like serious shit, right?

That's not to mention, obviously people have these bypasses that it, that's.

Lifelong that has lifelong implications, doesn't it?

For your health and your digestive system

And stuff.

It does, and it fundamentally affects how you eat forever.

It changes how you absorb various vitamins.

You have to take vitamin pills and supplements and things like that

to, to compensate for that surgery.

And there are some people for whom surgery is probably the best option.

Yeah.

Because the risk and benefit profile in terms of, their risk of developing

diabetes and the consequences of that the effects on the musculoskeletal system.

The cardiovascular system, it's the best option.

And for a lot of people it works brilliantly, but there are some

people who it doesn't work for and we don't talk about that group because

it's almost like they've, it's a bit like medicine has gone well.

We did our best effort and.

Here we are again.

Yeah.

And you think what?

Let's study that group of people and find out what happened what made the difference

or what didn't quite go to plan?

Because if you don't, you can't make the process and the things

that we provide better and that's ultimately what we want to do.

That would be my take on it.

Yeah so you said that there is quite good kind of psychological

support now if you go down the NHS route, which obviously based on the

experience with the clients that I've had, I know that it wasn't there for them.

So that's interesting.

Is that like a recent development?

So it's becoming more part of a process, so

it's more of a pathway really.

Yeah.

And it does vary depending on where you are in the uk, on the nhs.

And it probably varies as well in different healthcare

systems in different countries.

They're constantly changing it and the thing that they change

most is the entry criteria.

You've gotta be over a certain BMI to get in.

You've got to have one or more comorbidities.

Because more and more people are pushing for it because they see

the, they see people on television, you've had gastric surgery and

that they go that's what I want.

And it is.

It does have a consequence.

And for most people they do.

They do see that dramatic amount of weight loss.

It's just whether that could be achieved through other methods.

That I think is the bit we don't do as well.

Yeah,

definitely.

I think that, people have always wanted a quick fix with weight loss, haven't they?

That's why you get, drop a dress size in a week and six week shreds until

you can see your abs and all that crap.

. So there has always been that, but I noticed.

That is even worse now and I imagine this will happen to me today because

we've been talking about it, but when I've been speaking about bariatric

surgery before, I then get targeted by Facebook of ads of asking me if I want

bariatric surgery in Turkey for two and a half thousand pounds and I can do it

on a payment plan and I can be fixed and I can have a lovely holiday after.

And then you just fly off and that's your life, whereas there's no talk about.

You're gonna have this surgery and it's gonna affect your hormonal profile and how

your digestive system and how you absorb your food and all of that kind of stuff.

So I feel maybe cuz of the celebrity culture it's almost just normal

to consider surgery, isn't it?

It's just Oh yeah, I'll just go and have some surgery.

. Dr Ed Pooley: It is, I mean

Is social media generated?

We used to talk about the impact of print media on eating disorder particularly.

That was always the thing when I was at medical school.

It's if they put pictures of models who look a particular way,

that's gonna have an influence on.

People who go on to develop eating disorders, and you just think now

everyone lives in this reality where there is their authentic self,

which is the bit behind the camera.

And then there's this projected sort of perfect version of themselves

that gets all the validation.

And so you, the further apart that authenticity is from that

projected ideal, the more difficult it is to combat because you're.

people on social media are rich, young, successful, attractive.

There's a certain look, there's a certain way of behaving, and we see

that desire for anything that will move you from where you are now to that.

That sort of ideal.

Yeah.

We see it in terms of body shape.

We see it in terms of, for particularly men, the rise of body dysmorphic

disorder is just going up and up.

Wow.

We see it in terms of, even surgery on people's genitals

to, to look more perfect.

Yeah.

And you just think where did it go wrong?

That everything, every way that we judge people is about

how they look about how they.

How much money they have about how they project themselves.

Because and I know that what tends to happen with people who

struggle with their weight is that the weight becomes the fixation.

Everything about their worth, about their confidence becomes about the weight, and

which is why if you don't tackle that, if you don't split that apart when they lose

the weight and they don't feel any better.

Because they're like, Oh, I'm three stone lighter, but I'm not more confident.

Yeah.

They don't know why that's happened, because everything

has centered around this ideal.

Yeah.

It's a really challenging thing to, to overcome.

I don't think we have a, I don't think we have enough information and.

Trials of different techniques to find an optimal way forward

because different people are gonna respond to different things.

For some people, it's gonna be weight loss surgery.

For some people, it's gonna be having a coach who will talk them through things.

For other people, it'll be psychotherapy input.

For other people, it'll just be moving out of the situation they're

in and starting a new somewhere else.

As potentially a different.

A different persona that they can adopt.

When people go from say, school to university or university to

the workplace, there's almost that option to adopt a new persona.

Yeah.

And we often see things like weight loss and changes in

behavior happen at that point.

Yeah.

Yeah, that's really interesting because that's

something that I work with my clients on, is talking about this alter ego.

At the beginning when I say to them, what would you like to be like?

What would, how would you like to feel?

What would you like to be able to do?

And.

, just imagine, create this sort of alter ego.

And at the beginning it's always about, I'd like to look a certain way.

And then as you've progress them through and they go on that journey of.

Actually, I'm starting to feel a bit better.

Maybe how I look isn't quite as important cause now I've got a bit more energy

or I've found a sport that I like.

And then the alter ego sort of changes from a very, I'd like to be a sized

10 to, I'd like to be able to play football three times a week or and

it's really interesting because.

I always tell them to use this alter ego, because I always say to people,

if you don't do that, if you don't for one a better phrase, squash the

fat person that lives in your head.

When you become, or get to a healthy weight, whatever that means for you.

If you are still thinking in that way, those behaviors will pull you back

and you know exactly what you've said.

You, you won't really have changed in any meaningful way.

. Dr Ed Pooley: Absolutely.

It's that little bit of doubt in your head that is tied up with the experiences

that the overweight version of you has.

The looks from people, the not being picked for the school teams, the someone

looking at you, hoping you don't sit next to them on bus, for example.

All of these tiny little things that, that add up that just chip away at

a person's self worth their sense of identity is really challenging.

And particularly as a gp, one of the, one of the things that.

People will often say not a thin guy.

So in some ways it helps is that people come into surgeries and particularly

if they have an issue with weight, you could almost see a reluctance to come

in because they're almost expecting the doctors to say, Have you lost any weight?

Or, and sometimes doctors do that.

A lot of times it's the expectation that the doctor's gonna do

that, that gets the conversation dynamic off on the wrong start.

And sometimes doctors just aren't very good at bringing it up.

One of the things I am particularly keen on teaching doctors

to do is to ask permission.

That's verbal permission for, Is it okay if we talk.

How your weight might be impacting on this.

And if they say no, I'll say That's fine.

I, you didn't come in here for a lecture.

Yeah.

Let's look at everything that could be contributing and then we

can work out the best way forward.

But if you don't do that, and if you just see the person with the

arthritic knees or the back pain, and you're like you need to lose weight.

It's not gonna help.

It's not gonna make the person magically go, Oh yes.

You're right.

I never knew that.

Yeah.

But if you've asked permission or if they've said know my weight's

not helping actually, that, that can be a really powerful conversation

about starting things, moving.

Yeah.

And approaching things in a more holistic way.

I think the frustration I have is not really having an easy way

forward for many people who are struggling with their weight.

Yeah.

We have NHS dieticians who are brilliant, but the majority of their time is

spent focusing on disease management.

So diabetes, children with very specialized diets helping people through

chemotherapy and optimal nutrition.

We don't really have a readily accessible.

Way forward to help people with weight other than sometimes medication,

which to be honest, has either fairly awful side effects or Yeah.

may not work because people just eat what they're gonna eat anyway.

And it's, it doesn't, for a lot of it, it doesn't help.

Yeah.

And then we fall into the, these sort of quick fix things.

So I think when people in the NHS are thinking how do we sort out the

weight, the obesity epidemic, and then someone will go, Oh, let's try

Slimming World, or Weight Watchers, or something like that because

they work and you're like, Oh, just

This is something I wanted to ask you about because.

Obviously, anyone who follows me on the internet knows my

thoughts about Slimming World.

And people always say to me like, Why are you so hard on them?

Why do you know?

I had a bit of a rant about Slimming World and it went viral on TikTok,

it's like a hundred thousand views and there's a lot of hate on the post

from people who do Slimming World.

But I always say it's only.

Much like you said that, you only get people when they've, they're desperate

and they've tried everything else.

I generally get the people who've been at Slimming World for 20 years and

can't understand why they don't know anything about food and energy balance.

Why they believe that they are a bad person for what they eat and

what they put in their mouths.

Why they call some food sins, And that whole connotation of I'm a terrible

person or starving themselves before weigh day and then getting weighed and

then going home and eating chips and cake and chocolate on the way home.

And that is why I'm so hard on them because it creates and promotes

such a terrible relationship with food that I have to spend a lot

of time unpicking with my clients.

. So my question was gonna be to you.

, do you have any idea why?

Why doctors or health authorities think it's okay to signpost

people to Slimming World?

Because I know that's really common and I know, I dunno if

you have it in your area, but.

Here we have the Live scheme where people basically go see their doctor

for smoking cessation as well, isn't it?

And obesity, that kind of thing.

And Slimming World is a place where they get signposts, they

get referred to live well.

And then the Live person says, Oh, I'll just hook you up with

a slimmer well consultant.

And I just wondered, obviously you are not responsible for that policy,

but what's the thinking behind that and what's happened basically

? Dr Ed Pooley: think there's a

There, there are people, and there'll be people who watch this.

Video in this episode, Who Sliming World and Weight Watchers has worked for.

That's great.

Yeah.

But I suppose I'm coming at it from a perspective of the people that

it hasn't helped and the things that I can see that make no sense.

So I agree with you.

This whole concept of the circle of shame, that puts most people back.

If they've had weight problems for a long time, that's just like taking

an overweight child and shaming them.

Yeah.

And so overweight children will do lots of things to, to

overcome that sense of shame.

They'll starve themselves, then they'll reward themselves for feeling okay.

. But what you tend to see over time is if it worked, you wouldn't see the same

bunch of people again and again and again.

So there is clearly a bunch of people that it doesn't work for and

they have a lifelong membership.

They

do , which kind of implies that it doesn't work

because they're not selling.

They frame it in terms of healthy eating, and I guess for some people

it is a healthier form of eating, but I don't like the thinking behind it.

For example, if eat a whole banana, that is somehow better

than eating puree banana.

That doesn't it, the only thing that changes is the ability of your

gut to use the fiber within the.

Yeah, but nothing else.

You're still getting the same number of calories.

But in Slimming world, they'll tell you that it makes

the sugar more readily available.

. Dr Ed Pooley: So that would assume

and enters the same way that it leaves, which is yeah, pretty evident.

Not the case . So yeah, I, it's a very odd thing in, in terms of health policy.

When you look at health policy, a lot of it is determined on is there

something I can buy in that fixes a need?

Is it costed?

Is it available to a large group of people?

And is there some evidence that it reduces people's weight?

And I think Sliming World and Weight Watchers, Would succeed

on all of those metrics.

It's a prepackaged product that somebody who is deciding health policy

can easily suggest as an option.

And like I say, for some people it will work, but there are a lot of people for

whom it really won't work, and then we'll never see those again and we've lost

an opportunity to do something useful.

And that's the thing that annoys me because actually people

have very distorted views.

Diet on weight control.

Even the biggest one I see is probably people who come in and they'll say I

can't exercise because of X, Y, and Z.

That's, that with exercise is not the best way of, altering your physical

shape in terms of energy balance.

It's not an efficient way of doing that.

There are more efficient ways but we never look at people in a holistic way.

It's Give them a healthy eating program and send them on the way.

It feels like tokenism to me.

. Yeah.

And I think that's why I don't like it, but I can see why it's done.

Because the NHS is for all its good Bits is a rationed healthcare system, and

you have to make a decision on how do you adequately fund a system to do the

bits that we know help a lot of people.

and it focuses on those people.

It's not a national wellness service and there are some parts of me

that the was, but that would need a huge amount of funding, yeah.

That would need people to really take on board and run very tailored

programs about energy balance, about optimal nutrition, about exercise,

about the psychology of eating.

We struggle to do that with things like how to live a normal

life after a heart attack.

Yeah.

Trying to do it for something as complex as the psychosocial impact of a dietary

change is one step further more difficult.

Yeah.

And I think that's why it's done.

I saw a handout the other day for people with diabetes advocating a

12 week meal replacement program.

It was all about dietary shakes, and I thought, have we not moved on from that?

Because what's really interesting is I've worked with about 15 patients, not

a huge number, but people who've been very interested in wanting to tackle

their diabetes, and we've talked about diet, we've talked about exercise, we've

talked about the psychology of it, and.

About 12 of those 15 have now resolved their diabetes because they've had

that kind of one on one type care.

And that, that was back in about eight years ago when we had a

little bit more time and space to do things and there weren't the

pressures on the healthcare system.

We can see that there are other options.

One size doesn't fit all.

Yeah.

Some people who need medication, some people who need surgery, some people who.

Psychological input.

Some people who just need to know what to do and some people who need

their entire family situation to change because actually there are

those maintaining and those factors that will keep a behavior going.

Yeah.

And that's a really difficult thing.

You must have clients that have family members who also

struggle with their weight.

Yeah there's a bit of me that thinks, I wonder what would happen if we could

get someone to live with them for three months and just sort out all of

the cooking and all of the meal prep and all of those sorts of things.

I wonder what the impact of that would be.

Yeah.

But obviously that would be prohibitively expensive for

healthcare systems to provide.

Yeah,

no, absolutely.

I see it all the time with clients.

It will either be, their home environment, it will be their relationships, it

will be, the ways that they choose to respond to different stressors.

It's always something other.

What am I supposed to eat?

Obviously there will be some people who don't have that level of knowledge

in terms of what to eat and stuff, and I always wonder it in terms of

kind of very basic nutrition advice.

Why do you think that a lot of doctors are just either, not able to do that, or

for instance we know that there's shed loads of evidence to, to point to the

fact that everyone should eat a lot more protein than the recommended daily amount.

Even for things like, preventing age related sarcopenia so that

people remain stronger and you.

When they get older and then they'll get less falls and broken

bones and all that kind of stuff.

When something so simple could have such a massive impact.

Why do you think that?

People are often either not allowed to give that advice or

are not able to for any reason.

And then they obviously just decide, oh, we'll point them to Slimming

World instead, who will tell them to eat unlimited Muller corners.

I think that a lot of the times it's, sometimes

it's a knowledge gap, but I think that's probably in the minority.

I think there are lots of doctors who are, who know what to do and what to

advise, and it's not really a case of.

Not being able to advise it because we are, as long as it's sensible

and we're not telling them to eat something that's, or do something that

is, is ridiculous, but where there's a clearly defined, pushed outcome.

, then I think that's often what we'll do, yeah.

If we're, if we have a 10 minute appointment and nine of those minutes

is talk is focused on adjusting diabetic medication or dealing with someone's

mental distress because of the impact of mental health and chronic illness,

you just don't have the time to do it.

And so there's an easy option and it's let's go down that route.

And it, you tick the box and I think.

It is a frustration for lots of doctors that we don't have the time

or the resource or the capacity to do a lot of the jobs that we want to do

in the way we would like to do them.

Yeah, and that's, there's, you could get me on my soapbox for hours about how the

NHS is structured and how it's funded.

. But it's it's very difficult.

We deal with lots and lots of illness of which nutrition

is one part of some of that.

Yeah.

And of that, of which one part is about energy balance rather than optimal

nutrition for chemotherapy say or trying to reverse the effects of malnutrition.

Yeah.

So it becomes very small part of what we do.

, but we know that over time it becomes important.

So I think if I was designing a health service, I would put a lot of money

into preventative care, into educational resources for children, for families.

I would make.

I would make healthy food cheaper.

I wouldn't necessarily increase the cost of foods that are labeled as bad

cuz I don't think labeling foods as good or bad as particularly helpful.

But I think you could do lots of things that would encourage people

to adopt more healthy lifestyles without really realizing it.

So there's lots of work, for example, in architecture on how you make people.

Move around buildings in a way that causes them to expend more energy.

Yeah.

Or there is a a move, for example, to talk about providing meals for workers so

that they don't have to think about the stresses of meal prep or things like that.

And anything that we can do that makes behavioral change.

Almost something you have to do or have to go with, and then you

enjoy and it takes some stress out of your life is much easier.

Yeah.

Even things like funding free public transport, making people walk to

bus stops and get on and off buses and walk to their places of work.

Will get them a calorie expenditure they wouldn't have had by walking to their.

car.

Yeah.

And I think it needs those sorts of novel ideas to be embedded really.

Yeah.

In society.

Like you said of making the healthy choice, like the easy,

easiest choice to make, essentially.

Yeah.

Yeah.

And do you still, Cause I know that I've heard this as well

from various different people.

If you go down the route of almost prescribing, Diet or,

I know that some doctors like prescribe exercise, don't they?

Do you ever get the, a bit of a sort of reaction of outrage?

People have come to you to almost fix their problem with a pill or whatever

and you're Oh, if you did some diet and exercise that, does that get met with

a sort of, not a very good reaction?

It can get met with pushback.

I think that if you, obviously my most of my career now is about how to communicate

more effectively with patients.

So I tend not to get that degree of pushback.

, but there are ways of doing it that are more effective.

And we can do that for all sorts of illness where people don't need a tablet.

They actually need to do something or to do something differently

from what they're doing.

Yeah.

And it's about how you engage people in that process.

And there are some doctors who are very skilled at it.

There were some doctors who are less skilled at it, but they all want the

same thing, which is that person to be.

Healthier than they are now.

Yeah, and when we think about things like exercise prescription,

again, usually for most exercise prescription things it's something that

doesn't need to come from a doctor.

It doesn't need to come from a doctor to be validated.

It's why can't people just ring up a local gym and say, I'd like to get some exercise

please, because I've got this condition.

Here's the medication.

Can I just do it?

But one of the things that happens, particularly for gps, which is a

real frustration, is that everything almost has to be risk managed.

It's a bit like when you join a gym, have you got high blood pressure?

Go and see your gp.

It's why?

The exercise is going to bring down that pressure.

They're not going to be running a marathon on day one.

Yeah.

And stop if it starts to hurt a bit too much.

It doesn't need a GP to sign off and take the risk of that.

But unfortunately we get into this a bit of a spiral of someone taking the risk

for people's health rather than them taking the risk for their own health.

And we do live in a bit of an Amazon Prime mentality where everything has

to be done today or the next day.

And if it's not available, it's somehow not great.

And I think it trains us out.

being able to tolerate discomfort for longer periods of time.

Yeah.

And I think my worry is that will make things worse and worse because

the body doesn't fix itself in hours.

It fixes itself over days, weeks, months.

Yeah.

And it takes that time for behaviors and habits to embed

yeah, absolutely.

Unless it's the most amazing habit ever, it's not you wouldn't need 25

days or whatever the latest buzzword number is for a habit to stick.

If you were going to pick up 50 quid from the end of the street

each morning, you just go and do it.

There's no, it's not causing you any distress to do that.

Yeah.

So I do wonder about all of these societal things that,

that feed into how peoplebehave.

No pun intended

yeah.

And actually on that because this is something obviously that is quite recent

I was wondering how your conversations.

That you're having with patients have changed if they have, in terms of the

health every size movement, because I know that there are a lot of people, and I'm

imagine I'm gonna get shot down in flames for this that clearly have health risks.

They're overweight to the point where they're, they are definitely at a

propensity to, or a bigger likelihood to get different metabolic diseases.

But because they subscribe to the health at every size movement you cannot

have that conversation with people.

Do you think that's gonna have a knock on effect on the conversations

that GPS have with people?

And do you think we are going to end up with a lot of people who are

in denial about some of the health problems that obesity can cause?

I think it's really challenging cuz I think

a lot of that movement came as a consequence of feeling marginalized.

Of feeling, shamed of feeling.

Yeah.

That, any difference from a perfect, normal accepted figure was a bad thing.

And it isn't.

But we know that risk exists on a continuum.

It's not, if you are outside of 20 to 25 with your bmi, you are

suddenly at hugely increased risk.

It's a spectrum.

and you can be healthy and larger, that's okay.

You can be healthier and muscular, for example, and have a very high bmi.

But there is a continuum of risk.

And I think if we acknowledge it in terms of a continuum of risk and engaging with

people when they want to engage about their health if, for example, someone

is of a larger size and for example, their blood pressure is creeping up.

I would be medically remiss not to make a connection there, because actually

I know that reducing weight on the musculoskeletal system would improve

a person's blood pressure potentially.

And I could be accused of not doing the job that I'm supposed to do.

Yeah.

And I think that one of the problems of Movements where there is a, there's

almost like a direct challenges that it, it stifles debate a little bit.

Yeah.

I'm not arguing that we should have conversations with people where

we're being insulting or that we are infringe on people's rights,

but we need to have conversations that I think are being pushed away

almost as unintended consequence.

And actually if everyone was just a bit kinder to each other and.

. We're trying to understand the person's perspective and looking at exercise

and diet and what we eat and how we eat in the context of actually

valuing that person, I think the conversation becomes much easier.

Yeah.

. Hayley Food Ninja: Yeah, it, it is a

Because on the one hand, I think it has been positive in terms of people

who are bigger, who thought that maybe they didn't wanna try exercise and

stuff because they felt self-conscious.

Now that.

There are more people doing that and maybe it's encouraged people,

who are bigger to say do you know what other people are doing it?

I'm gonna go and do some exercise.

And so in that case, they are getting healthier.

But like you say, if you are on a continuum where you might be doing a

bit of exercise but still, your bmi or you are in the kind of morbidly

obese or, super morbidly obese, you can't ignore the fact that still

might have some health implications.

Yeah.

Yeah.

So another fascinating subject, . Cool.

So finally my last question that I like to ask everybody is what does healthy

mean to you in terms of, maybe from a professional and a personal point of view?

What's your definition of health and what do you believe, how do you

create your own version of healthy.

I think, I mean from a medical perspective with there's back

and forth philosophical arguments about whether it's the absence of ill

health, whether it's about function.

I think to me, the things that mean that you have the best health you

can have boil down to seven factors.

And it boils down to nutrition.

Notice I'm not saying diet because nutrition obviously

is more nuanced than that.

Yes.

Movement and being able to move as you would want to rest.

That is time to yourself and sleep.

good quality, sleep connection.

Are there significant others in your life who are meaningful and bring you joy?

Are there less toxic people in your life?

Security that is freedom from threat and having enough money or

resources to do what you want to do.

Mindset, which is how you think about the world and how you

think about yourself and purpose.

If you have all of those things and you're able to do all of those things well,

that, that's what I would aim for in terms of health or optimal functioning.

So that, that would be it.

That's my way of skirting around all of the complex stuff

about, absence of disease.

Yeah.

And That would be my take on it.

Yeah.

I feel really happy now because that is essentially what

I shoe shoehorned that into a ninja acronym I couldn't say it properly then.

So I had to n was like neuro.

In terms of like brain health and stuff like that.

I was for intelligent Ninja in terms of upskilling yourself in

terms of the knowledge to look after yourself and learn about things.

Then I had n, which was network, which was all about.

Relationships and connection and stuff.

Jay was joyful, which was emotional health and having a handle on your

own emotions, and A was active, which is your movement bit.

So I feel like I should say that I am now medically approved

to deliver health to people.

I feel like I should knight you with a stick of broccoli or something.

Yeah.

That would be really good!

Good . Awesome.

Thank you so much for doing this.

I feel like we could just basically do an episode a week cause we have so

much stuff that I could talk about.

It's I just find it all fascinating.

Particularly, the work that you're doing around the communication and you.

Doctors talking to patients and all of that kind of language stuff, which

I find really interesting and all of the psychology of change, which

I think is the most interesting bit of changing people's health.

Awesome.

Thank you so much and maybe we'll get you back on in a few months

to talk about something else.

Perfect.

Look forward to it

awesome.

Thank you so much everybody for listening.

And I'll be back next week with another episode.