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Happy Christmas everyone!

But sincere apologies for putting a small dampener on the forthcoming celebrations –  most of us will probably put on a bit of weight over yuletide.

The problem of obesity

Obesity is a huge and growing problem in most Western countries and the figures published about its extent are as gross as the problem itself. The weight of the average person in the UK has risen by more than 3lbs (1.5kg) every decade since 1970. It has been estimated that the annual cost to the NHS associated with obesity is more than £47bn. The horrifying statistics go on and on. The UK is the most overweight nation in Western Europe and our levels of obesity are growing faster than in the US.

Obesity and Christmas lunch

I am afraid that Christmas must take a portion of the blame – with some people consuming up to 6,000 kcals on Christmas Day alone. This can be a significant contributor to that inexorable increase in weight which characterises most peoples age-weight trajectory.

Something can be done. A trial, reported in the British Medical Journal last Christmas¹, randomised 272 people to one of two regimes. The treatment group performed daily self-weighing and received information about the ability of exercise to use up excess calories. This is known as Physical Activity Calorie Equivalent (PACE). Some of this advice seemed a bit unkind – for instance that it takes 21 minutes of running to use up one mince pie. (Perhaps Oliver Cromwell’s ban on eating mince pies at Christmas was not so bad after all). The control group was given a healthy living leaflet, without dietary advice. Everyone was weighed before and after the study. After Christmas, people who had been given weight-control advice had lost on average 0.13kg, while the leaflet group gained an average 0.37kg. A 0.5kg difference in weight change. Half a kilo of weight gain does not sound too bad a penalty for enjoying some indulgence and feasting. Worth it? Possibly.

More about PACE

So PACE labelling of foods – either on packaged food or restaurant meals  – might act as an incentive to reduce calorie intake. Unfortunately such labels do not make comfortable reading – walking at between 3.5 and 4 mph burns off about 5 kcals per minute – about 26 minutes of walking is needed to walk off a can of fizzy drink. A digestive biscuit might take climbing 25 floors of stairs and a quarter of a pizza fuels running for 43 minutes. Here are a few more examples:

A study reported in the Journal of Epidemiology and Community Health² looked at the combined effects of PACE labelling in 14 trials and found that 65 fewer kcals per meal were selected when Pace labelling was used, and 80-100 fewer kcals consumed, equating to 200 kcals per day

The Royal Society for Public Health claims that most people do not understand the meaning of calories in terms of energy balance and that PACE labelling should help . This form of labelling would mean that a small bar of milk chocolate would show that 42 minutes of walking or 22 minutes of running would be required to burn it off, rather than simply showing it contains 229 kcals. Maybe you don’t want to know that.

Eating out at Christmas

Another contributor to weight gain over the Christmas period is all the office parties and similar festive get togethers for a meal out. Last year’s Christmas British Medical Journal looked at this too. They found that full service restaurants offered significantly more calorific main meals than fast food outlets. The public health recommendation for eating out is for meals to be within 600 kcals. They found that the average calorie content of restaurant meals was 977 kcal compared to 709 for fast food meals. So book your next Christmas office party at McDonald’s, KFC or Burger King rather than the local posh restaurant?

What to do?

Probably not much except be aware of all this bad news. The New Year with all its opportunities for virtuous and weight losing resolutions is just round the corner. More of this next week!

1. BMJ 2018;363:k4867
2. DOI: 10.1136/jech-2019-213216