We must not shy away from talking about obesity if we are to address it.

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I was recently asked to write an article for the Church Times on the subject of obesity and the church’s role in addressing it. Writing for a magazine or newspaper presents its challenges: you are usually asked to focus on specific issues and given a word limit. I was happy to do it as I felt it was a really important topic. I laboured over it for a week or so before submitting it to the editor. I felt that I had done my best and hoped that it would be well-received and helpful to as many people as possible, encouraging the church community to be more proactive and not separate the physical from the spiritual when it came to people’s wellbeing.

I became aware that my article had gone live when a friend texted my wife and asked if we
were aware of the response to it. I wasn’t quite prepared for what followed. The main issue
appeared to be the choice of image to go with the article, which I have included below for reference:

I hadn’t been consulted about the change to my proposed title, or the image itself which some people found upsetting. There was a flurry of activity on social media (although interestingly no one corresponded with me directly as the author) and a letter was sent to the Church Times protesting about the way this issue had been approached. Opinion was clearly divided, with others defending the article and the points I was trying to make in it. The criticisms made by some demonstrated that they hadn’t read the entire article or reflected the fact that I had not been able to address every nuance of the issue within the confines of the the restricted brief that I had been given. I don’t blame people for making this point, as they may either not be aware of these practicalities or genuinely have a different opinion and personal experience. Either way, it highlighted the depth of feeling on this issue.

My first reaction was that I was sorry that anyone had been upset. My intention in writing the article was (as some readers pointed out) to challenge the church community to consider what their role and duty of care may be in this area. It was certainly not my intention to fat shame. I acknowledged the burden, both physical and mental, of obesity and emphasised the importance of addressing the wider societal determinants that contribute towards it.

What struck me was that many of those commenting negatively on the article stressed the
importance of those who do struggle with their weight practising self acceptance as well as being accepted and loved both by their community and God. As a starting point this is
absolutely right, and I emphasise this in my book, Fit For Purpose. For the majority however, it should not also be the end point but rather the launching off point for taking the next steps to making whatever changes in our lives we are capable of, with as much help and support from others as we can get.

It’s important not to conflate acceptance with fatalism. It might sound appealing to accept
ourselves whatever size our body, but I doubt many of us would accept the possible
consequences (hypertension, diabetes, stroke, heart disease and cancer to name but a few)
quite as philosophically. Denying the extent of a problem doesn’t mean that it isn’t one, and that it won’t create more. I don’t see anyone arguing against taking action to address the wider societal causes of obesity by tackling inequality or addressing the challenges posed by cheap, accessible ultra-processed food and the increasingly sedentary lives that we live. I don’t see anyone defending the health related consequences of obesity as being in any way desirable or something that we should put up with. I’m sure this goes for everyone who signed the letter to the Church Times.

There is, however, a jarring disconnect here. We are society. Society is made up of
individuals. Wanting better for our population means wanting better for the individuals
within it. If no individual progress is made, no progress is made at all. We could shy away from this difficult topic. We could try to cancel or misrepresent those who raise it as an issue. We could just avert our gaze and plough all our time and effort into the next generation, focussing on pregnant mothers and young children to address the problem at root cause. We could take our money out of treating disease, which is both expensive and tinkering at the margins at best, and put it all into prevention. We could
truly level up the inequalities within our society’s future. We could write off the generations already struggling with obesity, regarding their fate as sealed. No more nagging or awareness raising. No more expensive drugs, no more hospital treatments. No more doctors’ appointments. Their lives would be shorter and unpleasant but within a few decades, the health of subsequent generations could be transformed.

Maybe a few would consider this a price worth paying in the long term. Most, I
suspect, would be outraged at this dystopian proposal and insist that we need to address the challenges we face, collectively and individually, when it comes to obesity. So there comes a point, no matter how unfair life is and no matter how complex and multi-factorial a person’s health problems may be, they have to consider what they are going to do about it. They could just accept their fate, and I wouldn’t blame them for it. However, most people will want better for themselves.

There are lots of conversations to be had about how we do this better, whether for ourselves or for others. There are many issues to consider when it comes to living a meaningful and satisfying life and enjoying wellbeing. Our weight is just one aspect of our lives and we should not obsess over it to the exclusion of other areas, but it is an important aspect nonetheless. Obesity is a complex issue and requires an individual, tailored approach whether for yourself or others. One size truly does not fit all. Fat shaming is not the way to go. Some people will prefer to deal with the intensely personal issues relevant to them in private. Others will need support whether from their friends, family, church community or health professional. Self acceptance is important because for change to be possible we need to love and be kind to ourselves. Being able to talk honestly about it and feel listened to, accepted and supported is the start of the journey, not the end.

Dr Richard Pile

Wellbeing for Real Life: what is resilience and how do we build it?

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I was recently asked to write a module on resilience for clients of a healthy lifestyle service provider. We had previously put together modules on anxiety, depression and stress management. The feedback that we were getting from some team members delivering the modules was that they found the subjects rather complex and difficult to discuss and there was a risk of ending up focussing on the negative. We therefore decided to simplify the modules, fuse them together where appropriate, and to take a more positive tone discussing fitness rather than illness. As I put the module together I was reminded that teaching something is a great way of learning something , and so thought I would share what I have learnt in the hope that it is useful to you.

Let’s start with some questions people commonly ask. What is resilience? Do I have it? How do I know? Can I measure it? If I don’t have it, can I get it, or improve it? How can I help my kids to have it?

Defining resilience

A very basic definition of resilience is the ability of a substance or object to spring back into shape after trauma. To make it more human, we could describe it as the ability to cope with setbacks, or the ability to overcome difficult experiences and to be shaped positively by them. It might be described very simplistically as physical or mental strength or fitness.

Resilient people are not just born, they can be made

As my wife pointed out to me during the writing of this post, anyone who has had a few children can tell you that we are all in different places on the scale of natural resilience. It’s undeniable. However, where we end up is not inevitable. Nurture has at least as important a role as nature. I used to be a bit daunted by the people in the weights section at the gym, heavily muscled and confident specimens stalking around the equipment as if they owned the place, occasionally grabbing hold of some colossal bits of metal and wrestling them into submission before grunting and moving on to the next unsuspecting piece of apparatus. This was until I realised that they hadn’t become like this spontaneously but had developed themselves over time, with regular practice and commitment and maybe some pain. I’ve heard physios encouraging people to keep doing their exercises, advising them that they should be aiming to stretch their muscles and cause them to ache because that’s the only way they will ever strengthen them. When you exercise, you need to get your heart rate up for it to do you some good, which isn’t always comfortable.

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So it’s good news for all of us, particularly if we are feeling life’s challenges. The route to resilience is adversity – getting through it, and learning from it. Machine parts are tested before they leave the factory, to ensure they are strong enough. In the same way that a person who never makes a mistake never learns anything, you can’t be resilient if you have never suffered any setbacks. I’m not suggesting you go seeking adversity, or deliberately make decisions that are likely to have a bad outcome, but its ok and indeed necessary to endure traumas to build resilience. In the same way however that an athlete would prepare to compete, there are of course things that we can do to prepare ourselves for life’s challenges.

My top tips for developing resilience, based on my own life and what I have learnt from others, include:

  1. Self nurture. Sleeping well, being physically active and eating a healthy varied diet will mean that we are physically and mentally in as good a place as possible to take on whatever comes our way each day. Relaxation is an important part of this too, setting aside some regular time that is just for you. That could include reading, listening to music or meditating.
  2. Good connections. With friends, family and other people that you have a shared interest with. Prioritise the positive relationships with people that encourage and support you, and who you can do the same for. Put dates in the diary to make sure it happens, or it won’t. If you have kids, make sure that they have positive, nurturing relationships in their life. These could be with friends, teachers, relatives, health care practitioners and of course…parents! It can be vital to be able to ask others for help when we feel we don’t have the strength for ourselves.
  3. Positive action. Take a positive attitude towards your abilities and encourage yourself, especially in difficult situations. Be assertive and open in your relationships, whether personal or professional. Set goals in the short, medium and long term and make a plan for how you are going to achieve them, breaking it down day by day and moment by moment if need be.
  4. Develop new skills and hobbies. You could learn a new language or take up an instrument. This is good for your brain, encourages further social networking and helps with practising delayed gratification. This is particularly important for children who have been born into this era of instant gratification and rarely having to wait for anything for any significant length of time.
  5. Learn from challenges. Whether it’s a mistake that you made, or something beyond your control that happened, take time to reflect on how it made you feel and what you can learn from it or do differently next time. If you have kids, it’s important to let them make decisions and live with the consequences. Obviously you have to pick and choose depending on the stakes for their immediate health and wellbeing. Resist being a helicopter parent. It’s understandable but rubbish preparation for life and not in your child’s long term interests. If you wrap them up in cotton wool, they will just break later in life when you may not be around to support and encourage them. Better to let them make mistakes at a younger age and be stronger and wiser for it.
  6. Practice gratitude. This is such a simple and yet profound thing to do. I would be willing to bet that if you are reading this blog you have at least one thing in your life to feel grateful for, no matter how bad today or this week or month has been. You can start with the very basic stuff (like being born!), narrow it down a bit (like living in a democratic society in here in the UK where you are allowed to express and practice your beliefs) and then focus on the more personal and specific things you are thankful for like the place where you live, your friends and family…maybe even your job!

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I hope you have found some of these tips helpful. Remember – we should not and cannot avoid adversity in life. It’s the route to resilience and can make us stronger.

Wellbeing for real life: it’s all about connections

Three Manchester United legends together

Those of you that follow football may be aware that last night was a pretty big night in the Champions League, especially if like me you are a follower of Manchester United. I was raised in Manchester and have supported United all my life. Growing up, I was spoilt by having Sir Alex Ferguson, the greatest manager in premiership history, manage my team. It was an era of legends with players like Eric Cantona and at one stage arguably the best club midfield in the world with the likes of Giggs, Scholes, Keane, Butt and Beckham. Fergie, the team and the fans expected and demanded success. The promised land was reached in 1999 when United won the holy grail of the treble: the premier league, the FA cup and the champions league. No english premiership team had ever done it before and almost twenty years later it has yet to be repeated. The winning goal was scored by Ole Gunnar Solskjaer in injury time. I remember being on my knees, screaming at the television just before he scored it. There were many more trophies over the years to come, but for me that was the high watermark.

Sir Alex retired in 2013. Since then, it’s been pretty uninspiring. A few more trophies, lacklustre football and a series of uninspiring managers, the last of which was sacked in December 2018 when the team were at an all time low. One of the accusations made by the fans was that these managers didn’t understand the history and traditions of the club. On December 19th, Ole Gunnar Solskjaer was appointed as interim manager, largely out of desperation. I don’t think anyone seriously expected what happened next. Three months later, United have played 15, won 12, drawn 2 and lost 1. They are undefeated in the premier league, and still in the hunt for the FA cup and the Champions league. Last night they made european football history by coming back from 2-0 down in the previous match, scoring 3 goals to defeat their opponents and qualify for the quarter finals.

What’s the secret? How has a team of dispirited individuals, performing as so much less than the sum of their very expensive parts, been transformed? Does Ole have a magic wand? The answer, partly at least, is connections. He is legend of the club, whose name was still sung by the fans even before he returned as manager, and he is a connection to the glorious past. He is connected to arguably the club’s greatest manager as he once played under him and considers him his mentor. He is connected to the team by his understanding of and passion for the game, and his ability to inspire and motivate them. As a result, the players are once again connected to each other. Last night there were ten players unavailable through injury, including their world class midfielder Paul Pogba, and yet because they were connected they actually played together as greater than the sum of their parts, some of whom were teenagers out of the academy. He’s connected to the fans who sing “Ole’s at the wheel” endlessly, home or away.

Connections are vital for all of us. This week I have been listening to two of Dr Rangan Chatterjee’s best ever episodes of the Feel Better Live More podcast. It’s a two part conversation with Johann Hari, about understanding the real causes of depression. I cannot recommend these two episodes enough. Johann shares so many insights and important messages. I was struck by some in particular that I will list without commenting:

We have evolved to live in a tribe but nowadays often try to live without it.

Home is where someone notices when you are not there.

People are happier thinking collectively than individually.

Social media is fine as a way station to real life, offline encounters but if it’s the last stop on the line, then there’s a problem.

Speaking of social media, my friends and I use a WhatsApp group to organise our man-cave evenings. Last night they brought some beers and crisps, as per man-cave rules. We played some really terrible pool. We talked about our week, our work and our personal lives. Some did more talking, others more listening. The only thing I used my phone for once we were all together was a mancunian music playlist as we watched champions league history unfold in front of our eyes. Regardless of our tribal football affiliations, or lack thereof, we all enjoyed the evening. I’d like to think that at the end of evening I was the happiest person in the room, for obvious reasons. However, my friend Darren was a close second. He’s a West Ham season ticket holder who had decided to pop down the bookies beforehand and place a bet on United winning. To be honest, he had more faith than I did. He got fantastic odds. Next time we connect, the drinks are on him.

Wellbeing For Real Life: How to do a work place workout that doesn’t feel like work

One of the commonest new year’s resolutions that I hear my friends or my patients make is to be more physically active. “I will re-join the gym/start exercise classes/get 10,000 steps a day”, I hear them declare through slightly gritted teeth, looking slightly miserable, with a facial expression that suggests they are very likely to be declaring the same thing for their 2020 new year’s resolution.

One of the commonest reasons for people’s resolutions not coming to fruition is that they feel that they just don’t have the time. Time and again, people tell me that at the end of the day when they get home from work they just don’t have the time, inclination or energy to exercise. It’s another onerous task, another chore, another thing to tick off the to-do list.

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Today is your lucky day. I am the bearer of good news! You can cancel the gym subscription, throw away the unflattering lycra and uninstall all those exercise apps (you know, the ones that you don’t ever use) from your phone. Forget all this talk about no pain and no gain. Physical activity should be a simple, pleasurable, achievable and integral part of your life. For most of us this means working it in around our work. Evidence suggests that simply being less sedentary at work gives you at least the same health benefits as being sedentary and then doing a gym workout at the end of the day. So today I give you – the Work Place Workout! It’s a list of tips to enable you to spend your day being physically active , getting the benefits of a workout without having to actually do one.

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  1. Start the day before. Give yourself a good night’s sleep, aiming for 7-8 hours. It feels much better to start the day by waking naturally than being jarred from sleep by an alarm and the glare of your mobile phone screen.
  2. Give yourself enough time. Getting up a little earlier can work wonders for your working day. Having enough time to avoid rushing, to savour your coffee, enjoy breakfast or meditate for five minutes before you go to work will put you in a great frame of mind, focussed and full of energy for the day ahead.
  3. Work out on the way to work. If you are a commuter, think about how you can use this to your advantage. Could you walk or cycle to work instead of using the car or public transport? If you are on the bus, the train or the tube, why not get off a stop early and walk the rest of the way? When you walk, walk briskly so that you can feel your heart rate increase and you feel slightly out of breath. If you can’t manage that for the whole walk to work, start with 5 or 10 minutes at this intensity and build on that over time.
  4. Walk before work. As a result of getting up a little earlier, I can get to work, turn on my computer and then take a walk into town and back before I start surgery. It’s a good time to enjoy uninterrupted peace and quiet. This can also be a good time for getting your creative juices flowing and coming up with good ideas. If there are any green spaces near your workplace, I recommend you include them as part of your route if you are able. We all feel better for spending time in nature. Doing this, I can hit 3000 steps or more before I’ve made my first phone call of the day.
  5. Live a work life of inconvenience. My job is pretty sedentary and I could just sit at my desk all day. So I will go up and down a flight or two of stairs (or a circuit of the surgery car park) in between seeing patients. It’s a standing joke in our practice. Our pharmacists see me coming up the corridor and ask how many steps I’m on for the day. If I have a prescription that needs delivering to the pharmacy or a letter for reception, I take it myself as and when I can instead of waiting for someone to collect it. Over the course of a day, it probably takes about 10-15 minutes of my time to do this. However, it does leave me feeling more alert, energetic and focussed so I think this is a good investment of my time for me and my colleagues. Think about how you can do the same in your work environment. This might be as simple as getting up from your desk to go and talk to a colleague instead of sending them an email. This is likely to lead to improved work relationships so you get a double benefit from this.
  6. Use your breaks to be physically active. I can guarantee you will feel better for getting up and moving around in your break, rather than spending it sitting at your desk where you are already spending the rest of the day. I try to go for a walk at lunchtime. We have talked in my practice about having a walking group at lunchtimes. We might not be able to do this every day, but some will work better than others. Apart from reducing the risks of inactivity (now thought to be about the same as the risks of smoking), it can also help you clear your mind and remind yourself that there is more to the world than your desk and screen-sized bit of it!
  7. Fit in a micro-bursts of physical activity. This does depend upon your physical environment to a degree, but there will be some things that everyone can do. You can use your office or workspace as a gym. When I’m triaging on the telephone as the duty doctor, I will often be using a hands free headset. This means that whilst talking to patients I can do short bursts of exercises such as lunges, squats, tricep dips or even press-ups, using my examination couch, desk or chair. You might feel a bit self conscious in an open plan office but there are probably other spaces that you could find. You can even do a short burst of star jumps or burpees which will really energise you without reducing you to a sweaty, dishevelled mess. If you work from home, you could always just do 5 minutes of moderate intensity exercise a couple of times during the day.
  8. Stay out of your chair as much as you can. Looking back over the sweep of history, the invention of the chair has probably been one of the greatest public health disasters. Clearly there are times of when we have no choice but to be sitting down and at our desk. Try taking brief breaks when you can, use a standing desk and have phone conversations or meetings standing or walking when this is appropriate. Interestingly, there is evidence to support standing/walking meetings as not only being better for your physical wellbeing but also shorter and more productive. They definitely reduce the risk of death… by Powerpoint.
  9. Get into good habits. If you can work out a plan for your working day that involves some of these approaches and manage it for at least a few weeks, it is very likely to become a habit…one that you will want to stick to as you start to feel the benefits of being more active and ultimately more effective at work.

That’s it for my workplace-based workout tips. How many of these do you already do? How many could you adopt? If you make this a part of your working life, you need never darken the doors of a gym ever again. Just think about all the money you can save on membership fees and what you might like to spend it on instead…maybe a nice standing desk?!

That’s it from me for this week. As ever, please do feel free to contribute with your comments and feedback which are most welcome. Until next time, take care of yourself!

Dr Richard Pile

Wellbeing for Real Life – all change for the new year!

alcohol alcoholic beverage celebrate
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Having had a few weeks to take stock over the festive season, I have decided to make some changes to blog for the new year.   I have lots of plans for 2019 which promises to be an exciting year, for the blog and in other related areas too.   In order to fit it all in and practice what I preach when it comes to wellbeing for real life, I will be making a few adjustments.

The world of wellbeing is a fascinating one but seismic shifts in evidence and practice don’t tend to occur every week and I am keen to keep content fresh and relevant rather than reporting on the same issues if not much has changed.  As a result  I will be posting a little less frequently on news updates and more on specific topics (including topics suggested by you, the followers of this blog) and trying to keep the posts shorter, easier to digest and even more practical and user friendly.

As ever, your feedback is vital in helping me develop the blog so that it is as useful as possible, whether you be a professional practising in the world of lifestyle medicine and wellbeing, or a person interested in this for yourself or for others.   Please send your questions and suggestions for topics in and I will do my best to accommodate.   If I have enough questions on particular topics then I will put together a Frequently Asked Questions section as a permanent resource for all blog readers.

On January 16th, I will be presenting with my colleague at a New Year, New You event on healthy weight and wellbeing at Spire Hospital in Harpenden, Hertfordshire.  If you live locally and would like to attend, more information is available here.  We will be covering a number of areas of wellbeing including diet, movement, sleep and relaxation (including the chance to take part in a taster session of meditation and and mindfulness).

Good news! The further you’ve got to go, the easier it is to get started.

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I will finish today’s post with one of the key messages that I will be giving at the event.  It’s one about change.  Lots of us use the opportunity of the start of a new year to reflect on the last one, think about our wellbeing and what we would like to change or improve over the coming year.  Some of us succeed, some don’t.    It can be pretty daunting when considering making a big change to your life such as stopping smoking,  losing weight, drinking less,  doing more physical activity or learning to relax.   You may feel you have a mountain to climb.  You may look enviously at your friends and work colleagues with apparently perfect body mass indexes, turning up to work on their bikes with a yoga mat on the back, eating their healthy salads at lunchtime and talking about their plans for a dry January.

What I want to share with you is that if you feel you have a long way to go and big changes that you would like to make…it’s really, really easy to get started!  No one  climbs Mount Everest in a day.  People start at low altitude and gradually acclimatise.   The greatest benefits to health and wellbeing are seen in those who move slightly from being at high risk of these problems…to slightly lower risk.  To base camp, not the summit. If you are more or less completely inactive and break into a sweat at the thought of breaking into a sweat, just 10 minutes a day of walking could reduce your risk of heart disease or stroke by 30 or 40%.  If you are permanently stressed out and anxious, just starting with 5 minutes a day of relaxation (such as reading, listening to music, being out in nature or using a mindfulness app) will make a big difference to how you feel.   If you are chronically sleep deprived, cutting out caffeine after midday avoiding alcohol and not using your phone for an hour or two before bedtime could really improve the quality and quantity of your sleep, which will mean you wake up each day transformed with more energy and better mood.  Thinking small can make a big difference.  Why not talk about the changes you would like to make with your friends, family or doctor?

That’s it for this week.  Until next time, take care of yourself!

Dr Richard Pile



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