Welcome to the latest edition of my weekly wellbeing round-up. The last couple of posts have been on the topics of making a wellbeing plan and the importance of connecting for wellbeing, so I thought that this week we would get back to what’s been going on in the world of wellbeing over the last seven days or so. Topics that caught my eye this week included diet, obesity, life expectancy in the UK, digital health and children’s fitness and wellbeing. Let’s get started…
Obesity and diet
Total diet replacement (TDR) programmes hit the headlines this week. These include low calorie soups, drinks and counselling for patients with obesity. The study was reported in the BMJ and recommendations made that such programmes be considered an option in helping patients to lose weight. It is worth noting that the subjects were following the Cambridge weight plan, and that the study was funded by the providers of the service. However expert reaction was generally positive.
My view on this subject is that such programmes may have a limited place in the short-term when it comes to needing relatively rapid and significant weight loss e.g. before surgery or to improve diabetic control or even to normalise a person’s blood sugar. They are most definitely not sustainable, however, and many users report yo-yo weight gain after stopping. If patients come to me asking whether they should consider this or (more often the case) to let me know that they have started on a programme, I take it as a positive that they are motivated to lose weight to improve their wellbeing. I try to give them advice, when the time comes, about the need to transition to eating a healthy diet which is sustainable as a long-term option and a way of life.
Obesity and Cancer
Staying with obesity, it was also reported this week by Cancer research UK that cancers related to obesity in women are set to overtake those from smoking at some point. This is partly because the number of people who smoke continues to drop, partly because more men smoke than women, and partly due to the rising number of people with obesity. Cancers thought to be linked to being overweight or obese include bowel, gall bladder, kidney, liver, breast, ovarian and thyroid cancer.
My take home message from this is that it’s worth reflecting how far we have come in terms of education about and reduction in smoking, which has taken many years of sustained effort. We are much further behind in this journey with obesity in terms of how we engage with the public generally, how medical professionals engage with their patients specifically (80% of obese people report their GP has never raised the subject of their weight, despite only 1/500 obese people saying that they would be worried about being offended if their GP brought it up), and where we are as a country in terms of our relationship with and regulation of the food industry. Plenty of work still to do and a lot of room for improvement. It shouldn’t just be up to health workers either. If you are worried about a friend or family member, don’t duck it. Think about how you might sensitively raise the issue..maybe by asking some questions about how the person is feeling and whether they have any concerns about their health, rather than starting by scolding or shaming them.
Concerns about declining childhood fitness are raised by this article in the Journal of Science and Medicine in Sport. It looked not just at height and weight but also reported levels of activity and objective measures of fitness including endurance and grip strength. The decline in reported levels of activity appears related to a decline in fitness. The comment is made that just measuring BMI and talking about “healthy weight” can be misleading. Physical activity is key. How might we address this? In St Albans we are encouraging our schools to take part in the Daily Mile, a fantastic initiative that is easy to implement and fun to do . You can sign your school up on the website if you aren’t doing it already. We also need to think more broadly. If you are a parent, do you encourage your children to walk or cycle to school? If you live further away and they travel by bus or car, why not drop them off a walk away from the school gates? It’s vital that we encourage our kids to see being physically active as a desirable and normal part of their home life, particularly with the challenges thrown up by ever-increasing screen time and sedentary lifestyles. My boys are all football fanatics and enjoy a kickabout whether it’s in the garden or in our local park but we also encourage them to cycle to school a couple of times a week and we sometimes get them to walk the dog…although it’s more accurate to say that Prince walks them.
Staying with children’s wellbeing, an interesting study looking at the association between sleep, screen time, physical activity and brain function was published in the Lancet Child and Adolescent Health journal (brief summary, needs subscription)and reported by the BBC (more detailed). The take home message was that children who spend less than 2 hours a day on screen time and slept 9-11 hours at night scored better in tests of mental ability. The scores improved further if the children were physically active. It is an american study that finds association rather than causation, but expert reaction was that it is highly likely to be applicable to children in the UK. No distinction was made between different types of screens, so further work could be done in this area. This at least gives health professionals a ballpark figure to discuss with parents when they ask us how much screen time their children should have. If you have a child with a smartphone that can measure and control screen time, I recommend you turn that feature on. iOS 12 recently came out for the iPhone and the screen time feature is really useful. Here’s a how-to guide. It allows parental control over applications both in terms of time of day they are used and the total amount of time that individual apps are used for. You also get a regular screen time report. Just prepare to be horrified by how much time you spent on your phone, never mind the kids!
Stalling Life Expectancy in the UK
There’s been quite a bit of panic over the news that the gains in life expectancy in the UK have decelerated or stalled. We’re all doomed! We’re going to live shorter, nastier and more brutish lives. It’s the end of the world as we know it!
Let’s keep a sense of perspective here folks. What this means is that our current life expectancy is…the same as it was before. Not really something that’s going to keep me up at night. While it’s right that we should look into what affects life expectancy, particularly if the picture is less good in the UK than in other european countries, we need to think about the underlying assumptions that are being made in some quarters. Do we expect to live longer and longer and eventually forever? When we have “cured” cancer and dementia, we will all have to die of something else. Personally, I would rather focus on quality than quantity, living as much of my life as possible in a good state of health so that I can enjoy it. Death is not a disaster when it comes at the end of a meaningful life, well lived.
CQC – requires improvement?
Finally and somewhat ironically, the first major review of the CQC’s effectiveness has been carried out by the Kings Fund and the Alliance Manchester business school. The impact has been described as small, mixed, or non-existent. It has had little measurable impact on services such as emergency care, maternity care, and GP prescribing. Some suggestions are made as to how it could be improved. My suggestion for improvement is that we scrap it and spend the money on something else.
That’s all for this week’s round-up. I hope you have found it useful. As ever, your comments and feedback are much appreciated. Later this week I’m off with my peer learning group of GP colleagues to Valencia, where I will be sharing what I have learnt from reading the Four Pillar Plan and encouraging my colleagues to put it into practice. We’re going to be learning how to make paella and sangria, which will be very important for our wellbeing whilst we are away. Until next week, take care of yourselves!
Dr Richard Pile