Welcome back to my weekly wellbeing round-up. As usual, I have been scouring the news from the wellbeing world over the last seven days and found the most interesting, relevant and useful stuff to present it on a plate for your delectation. This week’s topics include food labelling, diets to reverse diabetes, the benefits of eating together, population health and which interventions provide the best return on investment in reducing cardiovascular disease. Let’s dive in!
Prevention at scale
A different vision for population health
This article from the King’s Fund highlights the shift that is taking place in the burden of disease from mortality (death) to morbidity (illness) with people living for many years with chronic conditions, in pain and in poor physical and mental health. Much of this is preventable. The challenge for us as users, health professionals and commissioners, is to shift our mindset of viewing the NHS as a treatment service for sickness, to one which offers a more comprehensive approach to keeping us well. This needs to apply to general practice, with clinicians and patients practising lifestyle medicine together, as well as to our commissioning decisions about what services we are going to spend money on.
So what should we be spending our money on to prevent disease?
Public Health England have released this helpful tool to help us understand which health interventions give the best return on investment when it comes to the prevention of cardiovascular disease (heart disease, stroke and diabetes) in larger populations. Just in case you don’t have time to read the whole thing or spend hours playing with spreadsheets, my summary is as follows:
The best short term outcomes are obtained by detecting and managing people with a QRISK (cardiovascular disease risk) score of > 10% and using statins to lower cholesterol (£216 million saving by year 2).
The best long term outcomes are obtained through each of the following: increasing the detection of people with diabetes, optimising blood pressure control and having an annual review.
Most lifestyle interventions are not cost-saving within the 20 year time horizon of the model…however, this does not rule them out of being cost saving beyond this horizon. The one exception to this is the excellent National Diabetes Prevention Program, which is shortly to have online versions rolled out for those who find it difficult to attend sessions due to work or family commitments.
My take home messages from this are
- We should continue to carry out risk assessments in primary care (and secondary care?). NHS Health Checks are a great way of doing this and don’t need a doctor to do them.
- It’s much better to detect pre-diabetes or early diabetes and intervene as soon as possible with lifestyle changes to avoid a lifetime of complications and increasingly expensive drug treatments. The National Diabetes Prevention Program is a shining example of how this can really work.
- If people argue against spending money on other lifestyle interventions, they should be asked whether they would also not spend money on medication for diabetes, since the evidence on return on investment over 20 years is no better!
Very low calorie diets to reverse diabetes
As well as enhancing the NDPP offering, Simon Stevens has announced that very low calorie diets will be piloted at scale by the NHS for the first time from next year, after the success of the DiRECT and DROPLET trials in demonstrating weight loss and reversal of type 2 Diabetes. In my view, whilst this is a potentially useful tool for carefully selected patients, we need to remember that an 800 calorie a day diet is not a long term sustainable option. Follow up of these patients and assisting them in transitioning back into a healthy, natural diet will be key.
This week, Kelloggs has agreed to use the traffic light labelling for food introduced by the government’s voluntary scheme in 2013. This indicates how much salt, sugar and fat foods contain. This can only be a good thing as hopefully it will increase pressure on other food companies to do the same. The scheme is already used by most supermarkets and some other companies such as Nestle and Weetabix. It will begin to come into effect from Jan 2019.
Whilst this is welcome news, remember that the vast majority of cereals are, to quote Dr Mark Hyman (author of Food: WTF Should I Eat?) “breakfast candy” – highly processed and full of sugar. As a rule of thumb, any messaging on the packet about how good it is for you and how many of your five a day it contains is at best deceptive and at worst an outright lie. For breakfast I usually choose from eggs (I eat them most days, usually poached), oily fish, avocado, vegetables (I love mushrooms and peppers)… and bacon if I want to treat myself.
Big Food and its influence over what we eat.
On a related note, this article in the BMJ about food industry influence is worth a few minutes of your time. It includes details of paper that will soon be published, examining 4000 peer-reviewed nutrition studies. Researchers found that only 14% properly disclosed financial ties. 60% reported results favourable to the study sponsor, while only 3% reported unfavourable results. Take home message? We should assume that we face at least as big a challenge with industry influence on research, standards and guideline development from Big Food as we do from Big Pharma.
Some good food news about family dinners
To finish this week on a positive note, I was encouraged after reading this article in the New England Journal of Medicine which suggests that adolescents and young adults who eat dinner with their families more often have healthier diets – regardless of how well their families function in general. We already know that sharing meals together is good for our overall wellbeing, particularly our mental health. It helps us be live mindfully, not just viewing food as fuel to be gobbled down as quickly as possible whilst staring at the screen of our mobile phone and thinking about what’s up next. It now also appears to result in healthier diets, even if there are a few squabbles over the dinner table! I have a busy weekend ahead with extended hours on Saturday and an out of hours urgent care shift on Sunday, but as a family we will do our best to at least have some of our meals together. If you don’t have family around you this weekend, why not invite friends or neighbours to share a meal with you?
That’s it for this week. Never fear…the weekly wellbeing round-up will return. If you have enjoyed reading this blog, please share it with your friends, family and colleagues. As every , your feedback is very much appreciated. Last week’s blog focussing on mental health was the most viewed since I started the round-up!
Until next time, take care of yourself.
Dr Richard Pile