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NICE guidelines and a confession

Updated: May 30, 2023

I stood on the scales today for the first time in a long time and it was bad news. I officially weigh almost two stone more than I did on the last day of my Covid illness in October 2021. It feels like a terrible time to be starting a health business, when my own health is – relatively speaking at least – not in a good place at all.

I have a habit of giving myself a very hard time. I set ridiculously high standards for myself and then berate myself when I fail to meet them. I am a classic, highly perfectionist, Type A personality: hard working, driven, ambitious, and prone to a rather unhelpful ‘go go go collapse’ mentality.

I have been having some coaching to help me to set up this business, and perhaps one of the most valuable things my coach reflected back to me was the question (and I paraphrase): ‘do you really think that you being perfect is what the people you are trying to help need?’

Well touché. I had been questioning whether I could really set up a low fat, high raw, plant-based education, coaching and consultancy business when I was not myself a stick-thin, 100% raw model of beach-body glowing health. When the reality of my life is that I am mostly over-tired, over-stressed, and trying to pick up whatever food I can find on the run.

This week I am busy writing a proposal for a quality improvement project at my hospital to find out how good we are at meeting the needs of overweight and obese children. I will be auditing the practice of the paediatric team against the NICE Clinical Guideline 189: Obesity: identification, assessment and management.

The document is 56 pages long, and on page 25 under the heading ‘Dietary approaches’ we see this rather diminutive little statement:

1.7.2 Do not use unduly restrictive and nutritionally unbalanced diets, because they are ineffective in the long term and can be harmful. [2006, amended 2014]

Where shall I begin? Well of course, what constitutes ‘unduly restrictive’ and ‘nutritionally unbalanced’ is not here defined. In principle I agree with this statement. The ‘only celery-juice’ diet is definitely not suitable for children in the long-term.

It is remarkably easy to produce a very long and detailed document about obesity without actually defining what a healthy diet is. By the time we have discussed anthropometry and psychology and exercise we have relatively little space left to deal with the highly controversial issue of food. All we need to do is insert some small comment about balance and warn against fad diets and the job is done. We all know what we are talking about, don’t we?

When I had Covid I was ill for two weeks and barely ate anything at all during that time. I lost half a stone and then my appetite came back with a vengeance. It occurred to me only recently that my weight has been remarkably stable for most of my adult life with two notable exceptions: when I was pregnant with twins and after I had Covid. On both those occasions I piled on a lot of weight in a very short period of time and the common factor both times was breathlessness. My post-Covid cough lasted the best part of a year and like all healthcare workers I worked through both lockdowns. Let’s just say it was a struggle and leave it there. I fell off the raw wagon very badly.

So I’m back on the wagon now but it’s going to take some time for that weight to come off. In my opinion the calorically adequate, appropriately supplemented, low fat, high raw, plant-based diet is nutritionally balanced and not unduly restrictive, but I know that not everyone will agree with me. There are good, solid reasons why it works for weight loss and leads to the resolution of all kinds of other illnesses too. So I’m not starting this business to show off my perfect beach body: I'm starting it because I can help you to understand what those reasons are.

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