Upstream Medicine

Upstream Medicine

I was recently invited to a think-tank of forward-thinking exercise professionals (before you think it, I was surprised to get an invite too!) and one of the topics on discussion was ‘upstream medicine’.

The term upstream medicine refers to the use of diet, exercise and a general healthy existence as a means to avoid preventable lifestyle diseases such as Obesity, Type 2 Diabetes, Coronary heart disease, Hypertension etc – rather than deal with problems in future, take steps to prevent them becoming a problem in the first place.

Obesity and its co-morbidities are the biggest problem the NHS faces today, and the trend is increasing at an alarming rate – our year on year increase in people suffering from obesity is outstripping that of America – in other words, we are out-eating the Americans.

Upstream medicine makes perfect sense; if we all stick to a healthy lifestyle, we don’t have to do anything special. By simply keeping ourselves in shape and not living to dietary excess we can prevent a whole host of serious health problems later on in life. This reduces pressure on the NHS, but more importantly it vastly reduces the chances of early onset of disease and in severe cases, an early death.

I have wrestled with this concept in my mind when watching TV programmes about obesity in the past – by exercising and eating better these people can avoid medical conditions that cause extreme discomfort and can reduce their lifespan, but the thought of living a healthier life is sometimes deemed a harder option than living with the inevitable health problems.

 

Without descending into a rant, this shows our society in a pretty awful light, when we would rather rely on expensive and potentially painful medical procedures than proactively avoid a very preventable set of problems. Passing responsibility onto someone else is unfortunately an all-too-common occurrence.

We have all heard various statistics about obesity…

• 25% of UK Adults are classed as Obese (not just overweight – obese)
• Obesity costs the NHS £4.2 billion each year – forecast to more than double by 2050.
• The cost to the UK economy is £16 billion – set rise to £50 billion by 2050.
• Gastric operations related to Obesity have rise by 40% over the past year.
• 78% of UK adults do not reach the minimum exercise guidelines established by the government for healthy living.

These mean little or nothing to most of us – they are just numbers, figures and facts that are quickly forgotten. I personally am now relatively immune to programmes with morbidly obese people and their struggles – they were shocking 5 years ago, but once you have seen one show documenting the problems the morbidly obese face with their day-to-day living, you have seen them all. There is only so many ways you can put a new spin on a topic, and programme makers have battered the format to death.

The focus now shouldn’t be on the public ridicule and humiliation of these people, but more the effect that obesity sufferers are having on our health service, our economy and our attitudes to our wellbeing.

As I mentioned earlier, the facts and figures surrounding obesity fade into obscurity when shadowed by the ‘entertainment’ of watching a person who is unable to even wash themselves effectively eat their way through 20,000 calories per day. The entertainment however is likely to be very short lived – in the UK we have an aging population – there are now more people over 60 than under 16.

Medical science has progressed to a point where we are living longer, able to cope with disease and deformity for an artificial length of time. Obviously this is great news – but by keeping us alive for longer, medicine has stretched our health service to bursting point. An aging population has a number of health concerns that need paying for.

So what has this got to do with obesity and associated diseases? Well obesity is an entirety preventable disease. Worse still, it has numerous co-morbidities that also cost both time and money to treat. This is a massive and unnecessary drain on an already overstretched service, and it is a growing problem.

The message doesn’t seem to be clear though. As a society, don’t need to have these problems. Obesity isn’t something you can catch – it isn’t contagious! It is easy to treat, it requires no medical staff and in truth, very little expertise. But then we all know that…

So how do we eradicate the problem? Government estimates suggest that it will take an entire generation to reverse the problem we have with obesity in this country. At the risk of sounding brash, that is total b******s. If those of us who are able to, started exercising more and eating less the weight would fall off in weeks, not years.

As far as I can see, saying the problem will take a generation to fix actually allows us to believe it will take that long. It wouldn’t take a generation for all of the people who are currently overweight to return to a healthy weight, far from it. To me it is an example of the government putting the problem on the backburner. It’s the political version of ignoring a problem and hoping it will go away.

Financially speaking, the government apparently are spending around £75 million pounds per year on campaigns such as ‘Change 4 Life’ and ‘Move for Health’. To you and me that sounds like a lot, but to a government with budgets that run into the billions it really is a drop in the ocean.

As far as I am concerned though, they shouldn’t have to spend anything on ‘fighting’ obesity – we should be doing the work for ourselves by taking responsibility for our own choices, and not expecting the NHS to bail us out when we overdo the burgers and can’t walk as a result.

So how do we combat the problem? One of the biggest scares is the ‘ticking time bomb’ of obesity – the generation of children who are fed an awful diet and are suffering from Type 2 Diabetes as early as 13 years old. The children who are heavier than their parents before they even hit their teens; The children who are unable to fit into normal size chairs in school; The teenagers who are having liposuction and gastric band operations; The teenagers who Jamie Oliver tried to help with his school dinners campaign. They are the people who will be draining the NHS next, whilst we are paying for an ever-aging population.

With less and less people in work, pension pots are decreasing in size and the care bills are increasing. We are sailing closer and closer to the wind and our population is getting older and older. Estimates state that currently 1 person claims a pension for every 17 people in work. By 2050 it could be 1 person on a pension for every 2 workers, such is the decline in public health and our ageing population. In order for us to avoid financial meltdown, something has to be done.

The obesity problem won’t go away overnight – it won’t go away in a decade even. The sad fact of life is that it really could disappear within a few years if as a nation we took more responsibility for the state of our health.

So how do we get a nation to take better care of their health and practice upstream medicine? Well if I knew that I would be a billionaire…..