The UK government is considering a policy where Brits could be paid to exercise to help them lose weight.
Given that 63% of adults in England and one in three children starting secondary school are considered to be overweight or obese, health officials are considering all options to get people to lose weight, including paying them by the kilo lost.
The focus is on getting people to exercise as it’s been thought for a long time that weight loss is all about calories in calories out, not what your body does with calories that matters.
But hey, exercise is good for well-being so it has to be good, right?
What we know though is that obesity rates are rising dramatically.
Here is the trend in one statistic from the NHS Digital website for Statistics on Obesity, Physical Activity and Diet 2020 on the number of hospital admission in England for symptoms related to obesity
Admissions in 2019 were close to an order of magnitude greater than they were just a decade earlier. That’s a 10% per annum growth year on year. Very nice for a stock portfolio but not when it’s 10 more hospital beds for every bed needed by a patient with obesity-related symptoms a decade earlier.
It is amazing to think that the bean counters have done the math and realized that the health system is under such pressure that it could be cheaper to pay people to get a little bit healthier to preserve capacity in the hospitals and health centres.
Desire to lose weight
Monetary incentives are an interesting approach.
Already ‘how to lose weight’ and ‘how to lose weight fast’ are in the top 30 most googled questions globally, suggesting that people understand they need to shed a few kilos.
And maybe there is an ‘inbuilt’ incentive to lose weight.
In a study by the Rudd Center for Food Policy and Obesity at Yale, almost half of the people responding to an online survey about obesity said they would give up a year of their life rather than be fat.
Fat people feel judged by others.
Part of that judgement might be because we have been told that if we eat less and move more we’ll lose weight. That makes fat people just lazy and gluttonous, right?
But what if it’s not that simple?…
Let’s start with this suggestion that weight control is about energy balance – calories in versus calories out. This is the idea that if your daily activities expend more energy than your food intake provides, you’ll lose weight.
This idea is rooted in the first law of thermodynamics. In closed systems energy cannot be created nor destroyed only changed in form.
This makes perfect sense in terms of your kitchen stove.
Electrical energy is converted to heat to boil a kettle. The energy in equals the energy out less some losses from inefficiencies.
Human bodies are way more complex.
Food energy in different forms triggers different hormonal processes. This means that not all forms of food energy are used in the same way. There are several different pathways the energy can take.
Most important here is the fat-storage hormone, insulin.
Foods high in carbohydrates will elicit a stronger insulin response in your body than fats or protein. More insulin means a higher likelihood that the energy from your food will be stored as fat.
More insulin also means less stored fat will be used for energy.
In other words, to control weight gain we need to control our insulin.
And to control insulin we need to eat fewer carbs.
Adapted from Figure 2. in: Foster-Schubert, Karen E., Joost Overduin, Catherine E. Prudom, Jianhua Liu, Holly S. Callahan, Bruce D. Gaylinn, Michael O. Thorner, and David E. Cummings. “Acyl and Total Ghrelin Are Suppressed Strongly by Ingested Proteins, Weakly by Lipids, and Biphasically by Carbohydrates.” The Journal of Clinical Endocrinology & Metabolism 93, no. 5 (May 1, 2008): 1971–79. https://doi.org/10.1210/jc.2007-2289.
In a general sense, energy balance is important. But for human bodies the source of that energy is also important.
We’ve been told that a low-fat diet is the best way to lose those extra kilos. The dietary guidelines reflect this idea.
Age-adjusted prevalence of obesity by sex in the United States, 1960–2014. Figure 1. in: Dey, Moul, and Purna C. Kashyap. “A Diet for Healthy Weight: Why Reaching a Consensus Seems Difficult.” Nutrients 12, no. 10 (October 2020): 2997. https://doi.org/10.3390/nu12102997.
That’s going well….
Here are the results of 31 randomised controlled trials, all with statistically significant results, conducted between 2003 and 2018 from a presentation by Dr Paul Mason.
The low carb diets resulted in more weight loss than the low-fat diets every time the results were statistically significant.
How human bodies use energy
A few words about how our bodies use energy might also be useful.
For a moderately active person, most of the energy your body uses is when you’re on the couch.
Basal Metabolic Rate is responsible for up to 75% of total energy output from respiration, circulation, your brain, regulating temperature and digestion.
So, from your 2,000 calorie a day diet you could be burning 1,500 just sitting and thinking.
Your brain is using 20% of your daily calories, 400 of your 2,000
Digesting protein can use five times more energy than digesting fats, while simple carbohydrates will slip effortlessly into the bloodstream, spiking insulin.
Eating more protein will burn more energy and protein is also known to be more satiating – meaning you’ll eat less.
Doughnut calories are not the same as avocado calories.
A 70 kilo man will burn about 375 calories every half an hour of jogging, less than a day of thinking.
A small fries from you know where contains 400 calories.
Should you be paid to lose weight through exercise? Well maybe, but it is going to be hard if it’s just exercise that generates the weight loss.
Exercise is very good for you but losing weight is mostly about diet, and a low carbohydrate diet is the best bet.
Paying people to lose weight through exercise might be missing the mark as are the current dietary guidelines.