British Heart Foundation. Heart matters – nutrition. 2023. https//

Cancer Research UK. How does obesity cause cancer?. 2023. https//

House of Commons. Research briefing: Obesity statistics. 2023. https//

McNally S. Obesity is a community issue, not just an individual one. BMJ. 2023; 380 https//

National Institute for Health and Care Excellence. Alcohol: problem drinking. 2023. https//

National Institute for Health and Care Excellence. Obesity prevention. 2015a. https//

National Institute for Health and Care Excellence. Preventing excessive weight gain. 2015b. https//

NHS England. Delivering better oral health: an evidence-based toolkit for prevention. Chapter 12. 2021. https//

Organisation for Economic Co-operation and Development. Health at a Glance 2021: Alcohol consumption among adults. 2021. https//∼text=Measured%20through%20sales%20data%2C%20overall,in%202009%20(Figure%204.3

Public Health England. From plate to guide: what, why and how for the eatwell model. 2016. https//

Sodhi M, Rezaeianzadeh R, Kezouh A, Etminan M Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss. JAMA. 2023;

Willett W, Rockström J, Loken B Food in the Anthropocene: the EAT-Lancet Commission on healthy diets from sustainable food systems. Lancet. 2019; 393:(10170)447-492

World Health Organization. WHO European regional obesity report. 2022. https//

Eat, drink and be merry…

02 December 2023
Volume 28 · Issue 12
 Alison While
Alison While

With the festive season approaching, the usual ‘eat, drink and be merry’ mantra may need more consideration; this is in light of the emerging evidence that ‘overindulgence’ appears to be associated with negative health outcomes and, in particular, cancer and cardiovascular disease risk. Cancer Research UK (2023) have assembled evidence that being overweight or obese is the second biggest cause of death by cancer in the UK and causes more than 1 in 20 cases of cancer. Cancer Research UK (2023) has asserted that cancer risk is related to the extent of obesity and the duration of obesity, with a healthy weight reducing the risk of 13 different cancers.

The National Institute for Health and Care Excellence (NICE) guidelines (NICE, 2015a; 2015b) have provided recommendations to avoid excess weight gain and overconsumption through maintaining an energy balanced diet, combined with recommended levels of physical activity. This guidance is echoed by the British Heart Foundation (2023) webpages which also highlight the danger of ‘extreme’ diets in the quest for weight loss. However, if weight maintenance was easy, the increasing prevalence of obesity would not be a current public health challenge. According to the 2021 Health Survey for England (House of Commons, 2023) 63.8% of adults aged 18 years and over were estimated to be overweight or obese (up from the previous year at 63.3%) with variations across the genders, geographical areas, levels of deprivation, ethnicity, presence of disability and level of education. According to the World Health Organization (WHO) (2022), being overweight or obese has reached epidemic levels in the WHO European Region, with the UK lying 4th for its prevalence of overweight and obesity in adulthood and 3rd for its prevalence of obese adults.

Losing weight can be challenging and has stimulated the demand for semaglutide and other glucagon-like peptide (GLP-1) agonists (Wegovy, Ozempic, Rybelsus, Saxenda) which can only be used for a maximum of 2 years. However, like all medications, semaglutide and other GLP-1 agonists may be associated with serious adverse events (side-effects). Sodhi et al (2023) examined health insurance claim records for a random sample of 16 million US patients who had been prescribed either semaglutide (n=613) or liraglutide (n=4144), two of the main GLP-1 agonists, and the active comparator bupropion-naltrexone (n=654), a weight loss agent unrelated to GLP-1 agonists between 2006 and 2020. The sample included patients with a recent history of obesity, and excluded those with diabetes or who had been prescribed another anti-diabetic medication. Compared to bupropion-naltrexone, GLP-1 agonists were associated with a 9.09 times increased risk of pancreatitis, 4.22 times higher risk of bowel obstruction and 3.67 times increased risk of gastroparesis. They also found a higher incidence of biliary disease, but it was not statistically significant.

‘According to the 2021 Health Survey for England (House of Commons, 2023) 63.8% of adults aged 18 years and over were estimated to be overweight or obese (up from the previous year at 63.3%) with variations across the genders, geographical areas, levels of deprivation, ethnicity, presence of disability and level of education.’

McNally (2023) is critical of the English Government's attempts to tackle obesity and has observed how, despite 14 obesity strategies including 689 policies over 30 years, the prevalence of obesity has increased from 15% in 1993 to 28% of UK adults in 2019. She asserts that four physiological facts are not widely applied in attempts to reduce over-consumption:

  • Complex carbohydrates (bread, pasta, rice, and potatoes) are rapidly converted to glucose and preferentially stored as fat. The insulin released to control high glucose levels stimulate hunger and more consumption. In contrast proteins, fats and fibre cause a lower insulin spike so that people feel fuller for longer. A low carbohydrate diet therefore has advantages
  • There is a binary switch in the suite of hormones, so we are either using or storing fat with any food intake, reducing fat loss for a period of time. This is the rationale underlying intermittent fasting regimes
  • Eating slowly enables satiety to take effect and reduces the urge for a second helping
  • Physical activity (exercise) stimulates lipolysis which reduces fat levels.


McNally is particularly critical of Public Health England's (2016) Eatwell Model, with its promotion of 38–50% of daily calories from carbohydrates, when it is the intake of carbohydrates which are driving levels of obesity. However, while the Eatwell Model recommends just over a third of the diet should be in the form of carbohydrates, it also recommends that people choose higher fibre or wholegrain varieties of carbohydrates. The Eatwell Model continues to underpin current NHS dietary advice (NHS England, 2023).

‘Alcohol-related deaths are also increasing…there were 13.9 deaths per 100000 population in 2021, with an increase evident across both genders and in areas of most and least deprivation to varying degrees (Nuffield Trust, 2023).’

McNally (2023) noted that the EAT-Lancet (Willett et al, 2019) report recommended less processed food, less carbohydrate and more unsaturated fat. She has argued that more protein, fat, or fibre is needed in diets which is challenging during a cost of living crisis, giving rise to the view that obesity is not an individual issue but a community and environmental issue. Watson (2023) echoes McNally's call for actions to address the UK's obesogenic environment through government policies, regulations and determined efforts to make healthy eating and taking exercise easy and accessible to all.

Alcohol-related deaths are also increasing. Having remained stable between 2006–2019, there were 13.9 deaths per 100000 population in 2021, with an increase evident across both genders and in areas of most and least deprivation to varying degrees (Nuffield Trust, 2023). Most heavy drinking in 2021 was reported in the 55–64 year age group, with 15% exceeding 8/6 units on any day in the last week while only 1.8% of those aged 75 years and over reported heavy drinking (NHS England, 2021). Men were more likely than women to drink at increasing risk levels (23% versus 13%), with 5% of men reporting drinking over 50 units a week and 2% of women reporting drinking over 35 units a week (higher risk levels).

The Organisation for Economic Co-operation and Development (OECD) (2021) noted how a minority of populations consume disproportionate levels of alcohol and in almost all OECD countries, well-educated individuals (i.e. those with a university education) were likely to be weekly drinkers. This was particularly true of women compared to men. This association between frequency of drinking alcohol and education level reflects the affordability of alcohol for those with higher incomes. However, alcohol-related harm is more frequent among those in lower socioeconomic groups in all OECD countries. The OECD has argued that the COVID-19 pandemic increased the alcohol consumption of some people as they sought to manage stress and domestic challenges, including domestic abuse when normal social activities and access to places for alcohol consumption were banned or limited. These drinking behaviours may have persisted beyond the pandemic. Alcohol-related hospital activity has increased recently, although there was a dip during the COVID-19 pandemic. It is estimated to cost the NHS £3.5 billion per annum and £21 billion per annum for society as a whole (Nuffield Trust, 2023).

Like excess personal weight, high levels of alcohol consumption are associated with increased risk of cardiovascular disease including strokes, liver cirrhosis and certain cancers (breast, bowel, throat and mouth) (OECD, 2021). Further, alcohol consumption is associated with road traffic accidents and other injuries, violence, homicides and psychiatric illness including suicides, especially among young adults (OECD, 2021). The UK Chief Medical Officers (NHS England, 2021) all recommended that adults should not drink more than 14 units of alcohol per week regularly and alcohol consumption is best spread evenly over 3 days. They noted that there is no safe lower limit. A NICE (2023) Clinical Knowledge Summary (CKS) summarises how those with an alcohol dependence can be assessed and supported in primary care.

While not wishing to be a kill-joy, perhaps the festive period can be enjoyed as much as ever without excessive consumption of food and alcohol. The evidence is clear that such excess consumption is not good for health. Further, when it comes to loosing weight, it is not easy and as people age is does not become any easier to loose weight. So let's eat and drink in moderation and enjoy the festivities and enter 2024 without regrets about overeating and over-drinking over the festive period.