Issue:

The sugar tax has arrived in the UK at last, albeit only in Jamie Oliver’s restaurants and a few others, but “the longest journey starts with the smallest step.” My mother used to say, “there’s only 20 calories in a teaspoon of sugar,” whilst she ladled at least two into my milky coffee, and my dentist used to sit at the local pub table munching sugar cubes as if they were dry-roasted peanuts. How things change!

The causes of childhood obesity are complex, and effective intervention requires a systemic approach. Obesity is established early in life, yet many healthcare and early-years professionals lack confidence to raise sensitive lifestyle issues in their work with young families. HENRY (Health, Exercise, Nutrition for the Really Young) has developed a range of unique and effective interventions focused on the start of life that include family support, practitioner training and building community resilience. HENRY’s research-based approach to tackling child obesity over the past 8 years suggests that it is possible to enable positive change. A distinctive element is its focus on parenting, emotional wellbeing and whole-family lifestyle as a foundation for enabling young children to develop healthy food preferences and eating and activity habits right from the start. Results are promising, with families making significant improvements to their lifestyle that are maintained at follow-up, including healthier eating across the whole family, increased activity levels and increased parenting efficacy.

Obesity in pregnancy is a major health issue which affects both mother and child, and about which there remains a lack of knowledge, education and support. However, pregnant women are generally highly motivated to do the best for their children, and clinicians have a number of opportunities to improve outcomes by providing education and counselling before conception, during pregnancy and after the birth. This article outlines the risks associated with obesity in pregnancy and provides advice on improving the care pathway for this important group of patients.

While reduction in energy intake is key to weight loss, it is challenging in practice to achieve a sufficient calorie deficit to achieve clinically significant weight loss. With indicators that a greater weight loss within the first year is a good predictor of long-term weight loss maintenance, the use of dietary methods to give a substantial early energy deficit could be beneficial. Low-energy (800–1200 kcal/day) formula diets (LEDs) and very-low-energy (<800 kcal/day) formula diets (VLEDs) have recently gained popularity in clinical practice as a tool to enable patients to achieve this substantial calorie deficit and, therefore, lose a significant amount of weight, with consequent improvements in obesity-related comorbidities. This review examines the current evidence for the use of LEDs and VLEDs for weight loss and improvements in obesity-related comorbidities, while helping to inform clinicians on their potential use in clinical practice.

While the majority of research into the effects of obesity on reproductive health focusses on women, the latest evidence shows that a large number of complications can also occur in obese men. This article summarises the effects of obesity on male reproductive health across a man’s entire lifespan, from the in utero environment, through puberty and adulthood, to the putative epigenetic effects on the offspring. Treatment options are also discussed, although this remains a somewhat overlooked area of research.

This column aspires to be one that focuses on a piece of news that may surprise readers (see “Cameron for Obesity Czar” in the previous issue of this Journal, page 46), so I’m trying my hand now to coax out a little more detail on an idea likely to crop up in the Prime Minister’s Framework to tackle the epidemic.

Why do we not use very-low-calorie diets (VLCDs) more? I appreciate that I may be biased, as I am Medical Director to a commercial provider; however, the evidence for their use is clear.VLCDs, also referred to as VLEDs (very-low-energy diets) and sometimes LELDs (low-energy liquid diets), are based on a diet of less than 800 kcal/day, provided by a range of shakes, soups, low-calorie meals or meal replacement bars, that are formulated to be nutritionally complete when adhered to.