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One in five people in some parts of Kent are now obese and in many areas more than half the population is carrying excess weight.
We decided to take a look at the problems behind obesity, and why it's not as simple as telling people to eat less and exercise more.
Watch: Losing your toes - type II diabetes in Thanet
The GP: "Just giving someone a diet sheet simply won't work"
“Another two or three months and I don’t think I’d be here” says Kim Reed.
“I really was so low, and if I hadn’t got Jess and I hadn’t joined the group I certainly wouldn’t be here now. It really has helped that much.”
We are sitting in Kim’s living room and at the sound of her name Jess - a large trail hound - opens one eye and looks up from her basket.
Over the last year Kim, from Faversham, has lost five stone, dropping from a size 22 to size 14 dress size.
She’s been going to Kent Community Health Trust's Specialist Weight Management Service and now she walks Jess for at least an hour a day, often two.
It’s part of a new exercise regime she maintains despite her chronic pain syndrome, which saw her confined to a wheelchair for five years and can still leave her practically unable to move.
“If you stop and think about it it tears you to pieces, so you just learn to live with it. You've got to”
“You would walk 25 yards and you would be in tears. It was just excruciating,” she says.
“The pain comes and goes. The days when I’ve got it bad, I don’t do anything. You just have to let it go.
“But I won’t stop walking Jess. I’ll always do that no matter how bad the pain is. To show it won’t beat me.”
The condition meant she found exercise difficult, and started to put on weight.
But it really started to get out of hand after her husband Trevor developed vascular dementia, and she soon found herself providing 24 hour care.
“He had a lot of illnesses... before then he was diabetic, epileptic, asthmatic; you name it my husband had it.
“He wasn’t good with his diabetes, he wouldn't take anything in moderation and then when he got the dementia he kept forgetting he was ill.
“I tried, I tried to talk to him everyday, but with the dementia it was difficult. He wasn’t lucid all the time. They couldn’t give him any medication because of his heart problems and diabetes.
“If you stop and think about it it tears you to pieces, so you just learn to live with it. You've got to.”
Some nights Kim would get just three hours sleep as she kept an eye on her husband, who suffered from sleep apnoea and relied on a machine to help him breathe.
“It was constant. It was like a new-born baby. You sleep with one ear open, and listen for any noise and as soon as I heard anything I was awake."
“I just switched off to it. My husband needed the care more than I did. He had to come first. He had far more wrong with him than I had”
To cope, she turned to comfort eating, and quickly grew to 16 stone. Before Trevor died, she was was diagnosed with type II diabetes, but even this did not stop the cycle.
“I just switched off to it. My husband needed the care more than I did. He had to come first. He had far more wrong with him than I had.”
It was only afterwards that Kim realised she had to take action. Three months after Trevor’s death, she got Jess from a rescue centre.
Kim said: “I got her because I didn’t want to be alone and because I knew I needed to get out and exercise.
“It’s made a hell of a difference. I walk Jess two hours in the mornings, and on the days I do volunteer work in a hospice shop, I do an hour and sometimes another hour at night.
"I’m walking all the time. All the time.”
Kim's diabetes has gone - she no longer needs to inject insulin. And she has replaced high calorie foods with fruit and vegetables.
But despite her huge success, Kim still worries about going back to her old ways.
"I worry all the time because when I get stressed I know I’ll comfort eat so it’s constantly being aware at the back of my mind.
"I try to avoid it but sometimes you can’t. If I do I try not to have the food around in the first place so I can’t eat it.
"You really don’t understand the stories of why people are big. I mean there are people in this world who can’t be bothered but I’d say that’s a minority.
"A lot of people look at me and they don’t realise what has gone on and what does go on.
"And when you look at other people who have got similar problems you do actually understand, you do feel for them. I was as big as any of them.”
Treating the problem
Kent Community Health Trust's Specialist Weight Management Service (SWMS) is a team of professional dieticians, exercise instructors and a psychotherapist.
The group combines advice about healthy eating and exercise with counselling, aimed at addressing the underlying factors driving people to overeat.
The service is run by Murray Allen.
He said: "Everyone knows you can lose weight through a combination of diet and exercise; making sure you burn more calories than you consume – however if it really was that easy then we wouldn’t have an obesity problem.
"We offer a counselling service where we can unpick the reasons why people eat for comfort or other emotional reasons. This very intense, personal approach works well with the majority of our clients"
One in 4 SWMS clients have a disability, which can make it difficult for them to exercise, but experts are on hand to make sure they can do so safely, slowly increasing their activity levels.
Mr Allen said: "We make sure that people are given a safe and supportive environment in which they can get active and kick start their exercise and activity regime. At the same time we spend time with them looking at what they eat, when and, most importantly, why.
"We offer a counselling service where we can unpick the reasons why people eat for comfort or other emotional reasons. This very intense, personal approach works well with the majority of our clients, many of whom will have tried various diets over the years with no success.”
The results are impressive. Nearly 90% of clients who start SWMS lose weight, and 98% increase the amount of physical activity they are doing.
Physical activity is important.
Defined by the Chief Medical Officer as "an adult who achieves fewer than 30 mins of moderate physical activity per week", physical inactivity has been identified by The World Health Organisation as the fourth leading risk factor for global mortality.
A study in the Lancet, cited in Kent County Council's most recent report on physical inactivity, says it has been identified as the cause of 10.5% of UK coronary heart disease burden, 13% of Type II diabetes, 18% of breast cancers and 19% of colon cancers.
But in some parts of Kent, physical activity is declining.
Exercise more, eat less?
“Telling people to eat less and exercise more doesn’t work for most - it's almost obvious it’s more complicated than that, and there are various different factors involved.”
Dr Rachel Terry is a clinical and academic tutor at Canterbury Christ Church University's Salomons Centre for Applied Psychology.
She says the oft-repeated mantra is an unhelpful - and possibly harmful - response to many suffering with obesity, the causes of which are hugely varied.
“Genes play a part, she says, “how much people eat, how healthy their diet is, how active they are, but also individual psychological factors - whether someone might eat for emotional reasons.
“But also there are societal reasons. How available high fat, high sugar foods are, lifestyle factors in general, how many opportunities there are for activity.”
"If you’re offering people interventions that aren’t going to work on their own then that’s going to backfire and leave people leaving more hopeless and low" - Dr Terry
“And as with drugs and alcohol, some people use food to make themselves feel better, although like drugs and alcohol this doesn’t work in the long term."
Dr Terry says a successful solution to obesity must address the causes, not just the symptoms, but the services people need are often not available.
“If people are presenting to their GP saying they need to lose weight the NICE guidelines would suggest they are offered things other than diet and exercise but I don't think the reality is there at the moment.
“We’re hearing all the time there’s a massive lack of resources in the NHS, so this perhaps isn’t prioritised, but that’s very shortsighted.
"If you’re offering people interventions that aren’t going to work on their own then that’s going to backfire and leave people leaving more hopeless and low, and, if that’s their coping strategy, more likely to turn to overeating.”
Overeating as a coping strategy for stress or bereavement requires careful handling, according to Dr Terry.
“If someone is using food as a way of dealing with stress you need to find another way of helping them cope with stress or you’re leaving them in a very difficult and vulnerable situation.”
And it’s not only patients who may need to change their way of thinking.
"The solution is increased understanding and awareness in general that obesity isn’t just due to people eating too much and being lazy,” said Dr Terry.
“There is still a stigma people towards being overweight.
“People can feel very low, and have low self esteem and if negative views are what they are hearing in culture and society than that is just going to feed into that.
“If people are just eating to make themselves feel better you can get into a real vicious cycle there.”
Watch: Losing your toes - diabetes in Thanet
The GP: "Just giving someone a diet sheet simply won't work"
Obesity can cause a number of serious conditions, which can shorten lifespans and put a huge strain on Kent's NHS services.
Strood GP Dr Julian Spinks sees many overweight and obese patients in Medway, where nearly half the population is carrying excess weight.
He said: "If you're overweight or obese your putting extra strain on the body. You're putting a strain on the heart, the extra fat can cause diabetes and then you've got the strain on the joints which can cause things arthritis."
"It's also putting an enormous strain on the health service because we're having to deal with the problems associated with it, and it has the possibility of shortening lives when for many years we've had increasing lifespans.
Dr Spinks agrees that it is not enough simply to put someone on a diet.
There aren't that many services out there I can refer on to, particularly compared to the number of people who are overweight and obese"- Dr Julian Spinks
There's always mixture between the physical and the psychological with nearly every disease you may think about," he says
"Some people may feel compelled to eat, other people get a distorted view of their body image.
"There is also a normalisation of obesity. People see so many people who are overweight and obese people around them and begin to think it's a normal body shape, when it isn't."
However, although the best option for patients are schemes such as the Specialist Weight Management Service, there are a lack of places county-wide.
Dr Spinks said: "People tend to respond best to a mixture of support, psychology and diet and exercise and so on.
"I have to say as a GP it's not always easy for patients to access those services. There aren't that many services out there I can refer on to, particularly compared to the number of people who are overweight and obese.
"But there are schemes in Medway that will help people tackle the whole problem - just giving someone a diet sheet simply won't work."
Dr Spinks would like to see more of this type of service, but says health authorities are finding it difficult to keep up with demand.
"I don't think there are enough services. The CCGs and local authorities are developing more and more of these groups but of course they are finding it hard to keep up with the number of people who are obese or overweight.
"It's extremely frustrating as a GP. I'm very aware that I need to be helping people to lose weight and not only that, helping people who are not yet overweight but are developing it, by teaching them how to eat and exercise and so on.
"But as general practice gets more and more pressurised we do rely on these external services."
