Good morning and welcome back to the weekly wellbeing round up. I though this week I would start with…
Last week I posted from our family holiday in Verona. My three younger boys are a band, Princes to Kings (shameless promotion: click here for their instagram, website, facebook page, and YouTube channel). During my sunday morning run round this beautiful city, I was also scouting out locations for their latest video. Yesterday I was updating Facebook with pictures of me and my son’s camping weekend. We had a lovely break in Verona and were able to share some of the highlights of this special trip with our family and friends. It was important for the boys to be able to share some bits and pieces with their followers as well, which added extra enjoyment to the weekend. Zac and I loved our weekend away. My posting pictures of what we were up to enabled me to reassure my wife that we safe, having a good time, and had survived our 70 kilometre bike ride to London and back. I don’t feel that doing this detracted from either of our trips. The internet and social media can enhance our lives and the lives of our friends and colleagues, and enable us to do and share things that were unimaginable even ten years ago. It’s a tool. It isn’t intrinsically good or bad, it depends how we use it. Just like medicine, exercise and even water, it has a correct dose. Too much is bad for you, physically and mentally.
This article published in WebMd points out one of the pitfalls of too much screen time, namely weight gain. Teenagers who exceeded two hours of recreational screen time were twice as likely to be overweight or obese. This will not really come as a surprise to anyone reading this, as this risk is posed by any “activity” which is essentially sedentary. The American Heart Association recommends limiting screen time to two hours a day. If you are struggling to persuade your children of this, you could consider encouraging them to play games which involve physical movement as most of the latest generation consoles from microsoft, playstation and nintendo all have hardware that enables these sort of games to be played. When my kids were younger, we loved playing games with the xbox’s kinect. I can still remember laughing so hard it reduced me to tears when my then seven year old beat a series of my adult friends senseless in a (virtual) boxing match in an online gaming session. We would also do a deal with our kids, such as them agreeing that they could have some screen time after walking the dog or playing football outside. There is of course always the option of the Off Switch. If negotiations fail, I recommend throwing the kids out of the lounge or playroom, and just remember that when they say “I’m boooooooooorrrrrrred!” you can tell them that boredom is an important part of childhood and good for their developing brains and creativity! Of course this doesn’t address the issue of mobile devices. I will dedicate a future blog post to this as it’s a topic worth looking at in more detail.
Staying with the social media theme, the term “snapchat dysmorphia” has been coined by plastic surgeons who are seeing increasing numbers of people come to them requesting surgical procedures to make them look more like their snapchat photos. The issue is described in this report of an article in JAMA. I personally have not yet had a patient come to see me to discuss this (and they certainly wouldn’t get past our clinical commissioning group’s low priority policy if they did!) but joking aside, the article makes the point that a facial feature such as a nose that looks good in a manipulated selfie taken from a phone held just a short distance away, would look very small and weird in real life …something we can reassure ourselves and each other about!
So what might the antidote be to some of these digitally induced woes and mental health problems? You will win no prizes at all for guessing that it’s….
Physical Activity for improving mental health
Physical activity is good for depression, according to this summary in theBMJ. I think this is a very encouraging study. There are a few key points worth noting:
Firstly this was an observational study (as opposed to say a a randomised control trial) of 1.2 million adults in the US. So we can say that people who are physically active have fewer days where there mental health is “not good” compared to those who are not active. There is a consistent association but we can’t confidently claim causation in this study. However, other variables (known as confounding factors) were taken into account in assessing the likely effects of physical activities, which is important.
The effect was noticeably greater in those with a known history of depression. So those most in need of this intervention are also the most likely to benefit from it, which is great.
In terms of dose, the greatest effects were seen in those who were physically active for roughly about the number of minutes per week that we recommend here in the UK, which is handy as we can just remember our current guidance which is 150 mins of heart raising exercise a week (e.g. 30 mins a day, 5 days a week). However, more than 3 hours a day was associated with worse mental health. I wonder whether this is due to risk of injuries and their consequences, or perhaps excessive exercise being a symptom of more serious underlying mental health issues?
All types of activity (including housework, gardening and running around after children) were beneficial to a degree. Team sports, cycling, and aerobic and gym exercise were the most beneficial.
The benefits of physical activity with regard to mental health were greater than the effect of education level, financial security or body mass index.
Weight loss and eating breakfast
Speaking of body mass index, this study done by the University of Alabama showed that people who were overweight were no more likely to lose weight if they skipped breakfast. I have often been struck by how many of my patients who are overweight (and not losing any weight despite their apparent efforts) tell me in either a proud or slightly mystified way that they don’t eat breakfast. I believe that breakfast is an important meal as it gives you nutrients and energy for the day. A high protein lower carb breakfast (such as eggs or porridge, for example) is much healthier than sugary cereal and toast and will keep you feeling full for longer. Many people who skip breakfast end up snacking on less healthy food during the day due to feeling hungry. It is well known that when we then try to recall what we have eaten during the day, we are prone to underestimating (or forgetting entirely) the snacks that we may have had in between meals.
Passive smoking in teenagers
Finally, I found this article in Paediatrics,reported in Journal Watch, quite thought provoking. Teenagers without asthma living with a smoker were more likely to report respiratory symptoms and, as a consequence, to miss school or attend the emergency department or seek urgent care. The suggestion is made therefore that such settings are ideal for offering health promotion to the teenagers and their smoking family members. When I do an out of hours shift and consult with a teenager with a flare of their asthma, I haven’t necessarily thought to ask about their family smoking history or talk to their parents about this at the time, having felt this is up to their usual GP in normal hours. However, people are more likely to change their behaviour if an intervention is timely…and surely sitting in A&E with a breathless child is the perfect time to raise the subject? I will try to do this more in future.
That’s it for the wellbeing round up this week. See you next week and in the meantime, take care of yourself!
Dr Richard Pile