We can’t base public health policy on one MP’s experience
Dr Ellie Cannon
The deputy leader of the Labour party has declared he is on a mission to make everyone feel as good as he does, after losing over six stone and reversing his type 2 diabetes.
In a story familiar to many GP consulting rooms, Tom Watson lived on a diet of fast food and curry throughout his political life, seeing his weight gradually climb to 22 stone and the consequential diagnosis of type 2 diabetes.
Undeniably what happened next is absolutely admirable and something I can only hope will happen for many of my patients in a similar situation: he did something about it. Initially paralysed by fear and shame and guilt, after months living with the diagnosis he put himself on a diet and exercise regime with dramatic results. His weight loss was accompanied by a reversal of his diagnosis, as well as better sleep and mood as well as all the other benefits of slashing the health risks that come with his former BMI.
I admire Tom Watson; I really do. Not many politicians would speak up about the guilt and shame of obesity, or share such a personal health story and diagnosis. I think that is hugely inspiring to his colleagues and the electorate. And now predictably, as we have come to expect in today’s world where ‘lived experience’ is king, he has zealously declared he wants to help other people do the same: if Labour comes to power his low carb, zero sugar, zero processed-food will form the basis for his obesity strategy to save the health of the nation and the cost to the NHS of type 2 diabetes.
Personal experience should not govern public health strategy - especially when it ignores the totality of the evidence
The Labour MP has fallen into the trap of believing ‘it worked for me, so it will work for everyone else’. If only life was so simple, we wouldn’t have an obesity crisis in the first place.
Losing weight is not easy. Equally, encouraging patients to lose weight is not easy. Dieting is hard work and takes time and support and also money. Low-carb diets are not cheap, if you’re used to bread and potatoes. I don’t want to be a naysayer – I congratulate Tom, I really do. But his personal experience should not govern his party’s public health strategy, especially when it appears to ignore the totality of the evidence.
The low-carb lobby were no doubt cheering as Mr Watson decried hidden sugars, starchy carbs and ultra-processed food; supporters came out to disparage Public Health England (PHE) dietary advice for ignoring the success of low-carb diets in type 2 diabetes. But please let’s stay sensible and evidence-based in this.
Any diet where you exclude a whole food group will make you lose weight if you create a calorie deficit. Whether you cut carbs, fat, a particular treat, or alcohol – if you create a calorie deficit you will lose weight and you will improve your HbA1c levels. If the diet suits you, it will work. The most common success I have seen in practice is where patients have chosen to ditch treats – usually biscuits. So low-carb is not uniquely successful in this arena – and in fact, the bad-cop approach to dieting has a major flaw: it does not look at all health outcomes. Low-carb diets, for example, include far too little fibre, an essential component for long-term health.
Despite Tom Watson’s experience, PHE can’t adopt his low-carb diet plan because they can’t negate the evidence that doesn’t suit them – large reviews still show carbohydrates should be a part of our diets for holistic health outcomes. Yes our portions need to reduce, as does our sugar intake, but the unilateral carb-attack approach is still backed by book sales not data.
If losing weight and reversing diabetes is a goal of our patients and Labour’s health policy, the key message should be the one from Roy Taylor, the professor of medicine and metabolism who has spent 40 years studying the disease. Diabetes is a disease of too much fat inside the liver and pancreas: shifting that will reverse the diabetes. Taylor’s work revealed Watson-like results on patients who adopt a very low calorie diet of 800 calories – their type 2 diabetes reverses at which point they are maintained on a balanced Eat Well plate diet – indeed including carbs and all.
PHE are now reviewing all their guidelines on diets for type 2 diabetes in collaboration with Diabetes UK, the Scientific Advisory Committee on Nutrition and NHS England, exploring the totality of evidence for what actually works and what dietary advice all political parties should be extolling.
Until we have that whole picture, GPs should avoid being swept up in the low-carb moment and support their patients in following the current dietary advice.
Dr Ellie Cannon is a portfolio NHS GP in London and broadcast media doctor