Hello and welcome back to the weekly wellbeing round up. After my report from my “wellbeing clinic” last week, normal service is resumed. The main focus of the round up this week will be on obesity, as the government published Chapter Two of “Childhood Obesity – a plan for action”.
Nearly a quarter of children in England are obese or overweight by the time they start primary school aged five, and this rises to one third by the time they leave aged eleven.
Children growing up in low income households are more than twice as likely to be obese than those in higher income households.
The ambition is to halve childhood obesity, and reduce the gap between richest and poorest, by 2030.
Obesity costs the NHS £6 billion a year, and wider society £27 billion a year
The planned 5% reduction, within this last year, of sugar in foods commonly eaten by children has not been achieved (the target is 20% by 2020). The target for calories in foods consumed by children is a 20% reduction by 2024.
Consultations are proposed in 2018 on –
- banning the sale of energy drinks to children
- mandatory calorie labelling for all foods in restaurants and cafes
- 9pm watershed for adverts for foods high in fat, sugar and salt
- a ban on unhealthy foods being offered on price promotions or at the checkout or entrance to stores
Local authorities will be encouraged to use their powers to promote healthier environments, and to share best practice across the country as part of a trailblazer program.
Schools will be advised and helped to reduce sugar content of food served to children and every school will be encouraged to adopt the Daily Mile, or a similar program. As prevention lead for our clinical commissioning group, I have already met with primary school headteachers, who are beginning to embrace the program.
My view? Fine words. A good start. Hard to object to, like motherhood and apple pie. The question is whether the government has the will to legislate against Big Food. We are now facing the same kind of challenges with these companies as we did in the 1950’s and 1960’s with Big Tobacco. A report by Public Health England highlights the scale of the challenge, pointing out the not entirely surprising news that England’s fastest areas are fast food hotspots. For me, this is not just a fight about health and wellbeing, it’s about social justice. Here in Hertfordshire, our CCG and local authority need to be working together to make meaningful changes..something that we aspire to and need to work harder on.
Practical steps you can take today
We can’t afford to wait around forever for government legislation to change, so what can be done about this in our communities by health care professionals and patients? This week I have been listening to Episode 22 of Feel Better, Live More podcast. It’s a conversation between Dr Rangan Chatterjee and Professor Satchin Panda entitled “Why when you eat matters”. It’s all about time restricted feeding, also known as intermittent fasting. The idea is that if you eat all your food for the day within a specific time period, your body digests your food better and you can enjoy a number of benefits including weight loss. There has been good animal data about effects on weight loss and reversing diabetes, and there is now some emerging human data to back it up. Here is one example of some study data supporting this approach. In an ideal world, people would modify their diets to eat more healthily and this can be done in conjunction with time restricted feeding. However, if I have a patient consulting with me that I know is going to struggle to change their diet, at least I can recommend they try this approach as a start. Once they start to feel better as they lose weight and have more energy, they may well then wish to make further, even better changes. Dr Chatterjee recommends a 12 hour window in his excellent 4 Pillar Plan book, and I think that this is achievable for most of us, at least some of the time.
On the subject of diets, I am often asked by patients whether they might benefit from supplementation and if so, with what sort of things? I have always been something of a sceptic in this area. I found this article from Dr Hazel Wallace, the Food Medic, a very helpful summary for me and I will share it with my patients. In summary – if you are in good health and do not have any nutritional deficiencies and eat a well balanced diet, you do not generally need any supplementation of your diet. Dr Wallace does recommend, in line with public health england guidance, that you consider vitamin D supplementation in autumn and winter. She also highlights other groups who may benefit from some supplementation including pregnant women and children under five.
Finally , I thought I would finish with this encouraging study which appears to demonstrate the benefit of weight loss in patients with atrial fibrillation. Patients who lost 10% or more of their body weight significantly reduced or reversed the progression of AF. When you consider the disease burden associated with AF including four to five times the risk of stroke (and the strokes themselves being more likely to kill or disable a person), and the difficulties that some people have in tolerating drugs for rate and rhythm control, and the risks associated with anticoagulation (taking blood thinning agents), this must surely be something that every significantly overweight person with atrial fibrillation should consider seriously.
That’s it for this episode of the weekly wellbeing round up. Stay tuned for next week’s episode and in the meantime, take care of yourself!
Dr Richard Pile