The Weekly Wellbeing Round-Up is away…Merry Christmas!

In the spirit of practising what I preach and maintaining a good work/life balance as we head into the festive season, I will be taking a break for the next week or two. I would like to thank you for reading and supporting this blog. I hope that you are finding it useful personally and, if you are a health professional , for your patients. I’m looking forward to making it even better in 2019. Any comments you have to make are much appreciated and help me develop it further. Please share the blog with your friends, family, colleagues and patients if you think they might find it helpful. Remember, when it comes to wellbeing, it’s all about keeping it real.

Merry Christmas and a happy new year!

Dr Richard Pile

The Weekly Wellbeing Round-Up #27 – More…or less?

Hello and welcome back to my weekly wellbeing round-up!  This week’s post from the world of wellbeing focusses on what we should be doing more of,  what we could be doing less of,  and where the evidence isn’t quite so clear.  Sufficiently intrigued?  Good…let’s dive in!


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Physical activity. 

I thought I’d start with a nice easy one.   No surprises here.  Sport England have published their first activity survey for children and young people (2017-18).  It reveals that one in three children in England does fewer than 30 minutes of physical activity a day – half the amount recommended by government guidelines (60 minutes a day, 30 in and 30 out of school).  Girls are less likely to be as active as boys, with 13 to 16-year-olds the least active age group.  This correlates with the findings of this study which looked at the dropping levels of physical activity by age, identifying a key age of 11 after which physical activity may drop off more sharply.

This week the Health Survey for England (2017) was published by NHS Digital.   The scale of the challenge we face individually and collectively is sobering.  Five key risk factors for health were identified as physical inactivity, obesity, drinking more than 14 units a week of alcohol, smoking and eating less than five portions of fruit or vegetables a day.  Headline stats include:

  • 68% adults are overweight or obese
  • Children who have obese parents are three times more likely to be obese than children of healthy weight parents.
  • Less than 20% of children eat five portions of fruit and veg a day
  • 19% of adults had three or more out of the five risk factors for health
  • 90% of adults had one or more of the five risk factors for health

So when and how should we address this challenge and who is responsible for doing so?  My answers are as early as possible and everyone.  As humans, we are made to move.   Before we had chairs we walked, we ran, we stood, we squatted and we sat on the floor…something that now seems “unnatural” to many of us.  In my opinion, to sit still should be seen as an unnatural exception to the norm, necessary for a few hours of the day only for certain work and social activities that can’t be easily done standing or on the go.  When parents are worried about their ill child, one of the most common things they will say is that their child is quiet, sitting on the couch and not moving around freely like they normally do.  It’s a sign something is wrong.  When kids go to school, they are expected to sit still in a chair for hours at a time and get told off if they move around.

Clearly I’m being deliberately provocative here, but I’m trying to make the point that to address the considerable challenges we have largely made for ourselves as a society in pursuit of a life of convenience, we need to flip this situation on its head and establish a new norm.   As parents, we should not just be encouraging our children to spend more of their time physically active but modelling it too them as well.  If we tell our kids to turn off the games console and “do something”, as we sit slumped on the couch, we should be  unsurprised if they are unconvinced.

We need to choose to live lives that at times are a bit less convenient.  This could be choosing to walk up and down the stairs more at home or at work, not taking the lift, walking or cycling to the shops/school/work,  getting off a stop or two early from the tube or bus, taking short breaks to walk around and stretch our legs at work, using standing desks or having standing meetings.  I can guarantee it would make the latter considerably shorter and more focussed!  This year I’m going to get a standing desk for work and offer my patients the choice of standing or sitting when we consult.  A number of my colleagues have already done this and found that it works well for them and their patients.

It may be that you feel some of these options are realistic and some not…that’s fine, we are all individuals in unique situations at home and at work and there are always simple opportunities for us to become more active.  Interestingly, one of the common findings from looking at the world’s blue zones (where people have unusually long life expectancy and good health) is that the communities are generally active but in a modest and gentle way – walking for an hour a day, for example.  There aren’t many gym-bunnies or HITT practitioners amongst the centenarians of  Okinawa.



Statins for primary prevention.

I need to make a confession.  When NICE dropped the threshold for recommending prescribing a statin for primary prevention (preventing heart disease or stroke in people who have not yet had one) from a risk score of 20% to 10% in 2014,  I felt profoundly uneasy.  To put this simply, GP’s were effectively being advised to treat every man over 60 and every woman over 70 as being diseased and statin-deficient, requiring a drug to lower their cholesterol.  This felt instinctively wrong to me.

According to the NNT (numbers needed to treat) website, taking statins to prevent these things happening does not make you less likely to die as a result.  217 people need to take statins for one person to avoid a (non-fatal) heart attack and 313 people need to take statins for one person to avoid a (non-fatal) stroke.  For every 21 people who take statins, one will experience muscle pain and damage and for every 204 people who take statins, one will develop diabetes.   As a result of all of this, I do have conversations with my patients about the NICE guidelines, the issue of medicalising the ageing process, and the risks and benefits of statins for primary prevention.  I offer them the drugs.  The majority decline and we usually agree to them making some lifestyle changes and to have the conversation again in a few years’ time.

The findings of this study into the use of statins for primary prevention, published in the BMJ, suggest that the current NICE threshold for offering treatment is too low. For men and women over 70, benefit seems to occur in those with a risk score > 20%, and for people in their forties, benefit seems to occur from a risk score of 14% or more for men and 17% or more for women.  I am greatly encouraged by this.  It’s always nice to have some actual evidence to back up gut-based practice!

Arthroscopies for meniscal (knee) problems

This study looked at exercise therapy vs arthroscopy (inserting a camera inside the knee joint) for degenerative knee problems in middle-aged patients.  The conclusion was that exercise was at least as good a treatment option as surgery.   My question would therefore be – why would anyone opt for an invasive hospital procedure with the associated risks of complications including infection? It does of course does depend appropriate advice and support being given re exercise.  Just like physical activity is available on prescription in the community, it needs to be taken seriously by hospital specialists, motivated primarily by the best outcomes and least risk for their patients.  It’s important that all health professionals in whatever setting, community or hospital, are either knowledgeable about what advice to give or can signpost to someone else who can.


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As promised this week, I’m finishing off with something a little less clear cut.  Regular readers of this blog know that I’m a big fan of sleep and have made some changes to my lifestyle as a result of learning more about it.  If you haven’t read it yet, I recommend for your christmas stocking the excellent Why We Sleep by Matt Walker.   One of the questions that my patients and colleagues often ask me is – how much sleep do we need?  This study looked into sleep duration and associations with death and major cardiovascular events.  Six to eight hours per day was associated with the lowest risk of deaths and major cardiovascular events. Daytime napping was associated with increased risks of major cardiovascular events and deaths in those with more than six hours of nighttime sleep but not in those sleeping less than six hours.  My interpretation of this is if you are sleep deprived a nap is a good thing, whereas excessive daytime sleepiness in people who are already sleeping quite a lot at night may indicate possible underlying health issues causing these symptoms.   This would also potentially explain why increased risk was also associated with sleeping more than nine hours at night.


That’s almost all for this week.  I wanted to finish with some podcast recommendations for you.  I cycled an hour each way to work one day this week and one of the great things about that (other than the benefits to my wellbeing, of course!) was that I got to catch up on my listening and fill my brain up a bit more.  They have both inspired me in the writing of this week’s post.

My first recommendation is TED Radio Hour, the Fountain of Youth.  It’s all about the secrets of ageing and longevity and what we can learn from studying the blue zones.

My second recommendation is episode 39 of Dr Rangan Chatterjee’s Feel Better Live More Podcast, entitled How to Stay Pain Free with the Foot Collective.  It’s all about how we are made to move, and should do so as naturally as possible.  It’s about much than just feet!

I hope you have enjoyed reading this episode of the weekly wellbeing round-up as much as I have putting it together.  It will, of course, return.  Until next week, take care of yourself!

Dr Richard Pile


The Weekly Wellbeing Round-Up, Episode #26

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?

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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

  1. 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.
  2. 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. 
  3. 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. 


Food labelling

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

The Weekly Wellbeing Round-Up #25 – Mental Health

Welcome back to my Weekly Wellbeing Round-Up.  This week I will be focussing on mental health, partly because items about this have been hitting me between the eyes all week and partly because of an amazing experience that I was privileged to be part of this week…but more of that later.  Let’s get into it!

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This week saw the publication by NHS Digital of its report into the Mental Health of Children and Young People in England, 2017.

On the positive side, in the opinion of the Children’s Commissioner, mental health services are showing some slight, slow signs of improvement.  Also , despite the daily reporting by all and sundry that we are in fact Going To Hell In A Handcart, there was only a very slight worsening in the prevalence of significant mental illness amongst children and young people, most of it due to emotional disorders and anxiety.  I’m not sure this could strictly be reported as a positive but a lot of expert commentators have been surprised that it wasn’t significantly more.

On the negative side, it is concerning that more than one in ten young people (12.8%) suffer from a formally diagnosed psychiatric disorder and one in four young women will  be struggling with  a mental disorder of some kind. Children with mental health disorders are also more likely to be heavy users of social media.  In addition, the burden of mental health problems is carried by those who are disadvantaged and vulnerable, particularly in northern England.

Specialist services for children and young people are known as CAMHS (Child and Adolescent Mental Health Services).  These services are seeing a continuing rise in demand.  The children’s commissioner found that one third of referrals into CAMHS were not accepted. Those of us who have tried to access these services either as a health professional or a parent or young person will be entirely unsurprised to hear this.  The average wait nationally is currently two months.  For many people it is a lot longer than that.   There is some good news.  There is to be a new target of 28 days for CAMHS access, which is being piloted at present.

Austerity and Mental Health in the UK


This week also saw a damning report by Professor Philip Alston, the United Nations Special Rapporteur on extreme poverty and human rights.  The twelve page document makes uncomfortable reading.  Professor Aston, in commenting on 20% of the country living in poverty, says “in the fifth richest country in the world, this is not just a disgrace, but a social calamity and an economic disaster, all rolled into one”.  He goes on to highlight the potential further risks of Brexit.  The government response has been to take issue with the definition of poverty, which is defined by a new measure in this report.   Speaking of Brexit, the Journal of Epidemiology & Community Health reports an association between the Brexit vote and rising prescriptions of antidepressants.  Whilst interesting, we should remember that association is not causation and whilst this is topical, it’s also probably both simplistic and even a little opportunistic.

Positive steps to improve mental health

You might be forgiven for feeling a little on the gloomy side after reading this post so far. You might be asking yourself what you can do either for yourself, your friends or (if you are a medical professional), your patients?  

Here are some of my suggestions:

Don’t be afraid to ask the question

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A lot of people who are struggling with mental health issues feel ashamed and unworthy.  They need help but find it difficult to ask for it.  Most of us can sense when someone we know is struggling.  Don’t be afraid to ask them how they are.  You might get an initial, superficial response but it’s worth taking a little bit of extra time to dig a little deeper.  Ask yourself what you would like others to do for you, and what a meaningful relationship really looks like.

We might also worry about asking someone whether they have had thoughts of suicide, in the belief that it might encourage suicidal thoughts that weren’t already there.  There is absolutely no evidence for this.  I have been asking patients this question for almost twenty years.  No one has ever been offended or upset by my asking it and many have been relieved to be able to answer it honestly and open up about how they are really feeling.

Don’t give negative messages about medication

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I spend a lot of time writing and talking about things that are at least as good if not better than drugs for mental health such as physical activity, a good diet, practising mindfulness and having good real life social connections.  However, that doesn’t mean that drugs are unhelpful.  Some people really benefit from them, particularly those who are more severely affected by serious mental health problems.  I know friends and colleagues who have found them very beneficial.  It’s important that we avoid “pill shaming”, as highlighted in this short vlog for BBC news.

Consider social prescribing

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We hear the term “social prescribing” bandied about a lot these days.  The government certainly seems very keen on it, as described in this article in the BMJ (subscription required for full article).  According to NHS England, social prescribing (also known as community referral) “involves helping patients to improve their health, wellbeing and social welfare by connecting them to community services which might be run by the council or a local charity.”   The determinants of health and wellbeing include socioeconomic status,  education, physical environment and social environment – so it’s really important that GP’s and other health professionals have as wide a range of tools available to them to help patients to help themselves.   In Hertfordshire, we have an organisation called Herts Help which contains within a network of locality-based Community Navigators.   Patients can self refer or be referred.  In some of our practices now, we also now have social prescribing groups set up by patient participation groups.  Examples of social prescribing activities include volunteering, arts activities, group learning, gardening, befriending, cookery, healthy eating advice, debt advice and a range of sports.

Ultimately we are social animals and real, physical connections are vital to us, particularly at times when we are struggling with our wellbeing for whatever reason.  This is one of the five ways to mental wellbeing:  connect, be active, take notice, keep learning, give. 

A good news story

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I thought I would finish off  this week with a fantastic example of how a local community service helps people with addictions connect, support each other and recover.   The Living Room is a non-residential service that provides therapy to help people to abstain from their addictions, achieve abstinence and secure long-term recovery.   It does tremendous work and is highly respected in our locality.  This week, an event was held in our church called “Stories From The Living Room”.  It was an evening of spoken word performances delivered by the clients, past and present, of the living room as well as the counsellors who provide the service.  Many of these people have never even written a story or a poem, never mind performed them in public.   It was a truly amazing evening:  a massive eye-opener for those of us who have never experienced serious addiction and its consequences.  For the audience it was a particularly humbling and emotional experience.

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Highly relevant to this issue is this week’s episode of Dr Rangan Chatterjee’s Feel Better Live More podcast.  Episode #37 is a conversation between Rangan and Gabor Maté, a world authority on addiction, on how our childhood shapes every aspect of our health.  I heartily recommend this episode to everyone, whether you have issues with addiction, are trying to support someone who does, or would just like to know more about this issue.  It goes deep and I guarantee it will be well worth your time. 

That’s all from me for this week.  I hope you have found this week’s post interesting and helpful.  Your comments and feedback are much appreciated as ever as they help me to make it as useful and relevant as possible for my readers.  The weekly wellbeing round-up will be return.  Until then, take care of yourself!

Dr Richard Pile

The Weekly Wellbeing Round-Up #24

Hello and welcome to another edition of my weekly wellbeing round-up!  I hope you have had a good weekend and are feeling relaxed and restored.  Life has been a bit full recently.  This weekend I have taken part in my first Parkrun (and getting a 5k PB into the bargain whilst dragging my dog Prince round the course!) and also done a shift for our out of hours urgent care organisation…so it didn’t leave much time for everything else.  In the interests of practising what I preach and balancing work and family time, this week’s post is a shorter one.  I have curated the wellbeing-related news that has caught my eye in the last week, and put it all in one place for you which you can access by clicking on this link.

Some of the topics covered this week (links to individual articles) include:

Diabetes – the cost to the NHS of prescriptions for drugs, and the new diabetes monitor available that could transform the lives of thousands of people with diabetes.

Cancer – why obesity causes it and how NHS bosses plan to overhaul screening for it.

Cardiovascular disease – how CVD risk is affected by marital status and how we might take new approaches to the detection of atrial fibrillation.

Other areas covered include the effect of pollution on children’s lungs, raising awareness of mental health issues faced by young people, and how low carbohydrate diets may contribute to maintaining weight loss.

That’s it for this week.  I hope you have a good week.  The weekly wellbeing round-up will return.  Until then – take care of yourself!

Dr Richard Pile

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