The Weekly Wellbeing Round-Up #18: a weekend of wellbeing in Valencia.

When I was a medical student our favourite lecturer was Dr Andy Sparrow. Not because of his subject (which was anatomy) but because at random points throughout his slides he would show us pictures of his holidays – a bit of light relief in the midst of gruesome detail.

I am currently at around 30,000 feet as I write this blog post , returning from a weekend in Valencia with my friends. We are all part of a GP learning set and this was the group’s 19th annual trip. It’s been a great weekend in a fantastic city that I will definitely return to.

During our time away we each prepare a topic to discuss. We do these throughout the weekend, combining continuing professional development with eating, moving, (some) sleeping and plenty of relaxing. My topic this year was Lifestyle Medicine and Wellbeing. I shared my journey thus far and how learning about the importance of this has transformed how I feel about my job and purpose. We discussed models of wellbeing including the four pillars that I have already mentioned.  I had recommended to the group that we try to all read Dr Rangan Chatterjee’s Four Pillar Plan before the trip. We also added another pillar: connection. So for this week’s blog I hope you will indulge me as I share some of our experience how it relates to wellbeing for real life. With a few holiday snaps thrown in.

Eat

One of the pleasures of the trip is finding nice places to eat good food. We like to go on local recommendation, backed up by Trip Advisor. The highlight for me this year was a day spent on a farm learning how to make proper valencian paella and sangria. It was of course terribly gruelling but we did end up with a certificate which I will show to my appraiser next year. Learning about the origin of the dish and what the correct ingredients are (apparently if there’s sea food or chorizo in it then it’s not paella, just rice with things in it) was interesting but the best part was how paella is served up and eaten. First of all everyone makes a point of thanking the cook (whether it tastes good or not!) and then everyone sits round the table with a spoon (not a fork) and eats from their segment of the paella dish. If you want a bit in someone else’s segment you negotiate for it. You can put bits you don’t want in the centre for anyone to take. And you never, ever turn the dish round to take something you want, not unless you enjoy getting stabbed in the hand with a fork by one of your neighbours.

Connect

What struck me is how important this is for a key pillar of wellbeing: connection. The food is cooked from local, seasonal ingredients. The meal is communal. Everyone shows their gratitude. Food is shared together over what will doubtless be good conversation, helped perhaps by a little sangria. It was a wonderful experience that our hosts were very happy to share with us, and send us away as paella ambassadors! Interestingly, the valencians consider paella to be a dish that you only eat at lunch, and as it can be quite heavy then they enjoy their siesta afterwards and tend to have a light evening meal around 10pm, often with tapas dishes. In Valencia, anyone eating paella for dinner is definitely a tourist.

Sleep

In the interests of full disclosure, sleep was a bit of a mixed bag. There is time-stamped photographic evidence on our WhatsApp group of some deep and meaningful discussions taking place in a bar in the early hours of friday morning. However, we were quite sensible for the other nights. What is always striking when going to Spain is the siesta. In his book Why We Sleep, Matt Walker explains how we naturally have a biphasic sleep pattern as humans (i.e. we do best if we sleep twice a day) and so to have a siesta is consistent with this. In the UK we have forced a monophasic sleep pattern on ourselves with a masochistic long working day…which results in less productivity, not more. When Greeks stopped their siesta at the height of the financial crisis, cardiovascular deaths increased significantly as a result. We also get a surge in these events when the clocks go forward and we lose an hour’s sleep every year. The EU will stop the twice yearly changing of the clocks in 2019. It will be interesting to see if population health benefits can be demonstrated. After Brexit (the only topic we banned for the whole weekend) the UK could be the control arm of this large-scale population experiment!

Move

Walking from cafe to bar to restaurant was, as you can imagine, absolutely exhausting. Somehow we managed. We did take in the sights as well, hitting 10,000 steps most days. There are beautiful museums, markets and churches in Valencia

Having to walk up and down four flights of stairs due to a broken lift was very helpful in this respect. We must write a note of thanks to the hotel. On our last morning I went for a run with my friend through the park that runs along a dry river bed in Valencia. It’s a lovely setting and despite being early it was practically rush hour with the locals in running clubs, walking dogs and riding their bikes…Valencia’s equivalent of Park Run. Running with someone who is a better runner than me really helped me go further and faster than I would normally. I made a point of thanking them for this through only slightly gritted teeth. Incidentally, did you know that Park Run is a global thing? Apparently some people do the Park Run Alphabet challenge finding cities all round the world where it takes place. It takes place in both Mile End and Milan. I suspect the starting letter and hosting Park Run are the only thing they have in common. There’s also a UK version.

Relax

We are not usually short on relaxation during one of our trips. The key idea that underpins very trip is the idea of “me time”…that as human beings we all need and deserve some me time. Our group is very fortunate in being able to do this for a whole weekend once a year. What was interesting is that sitting round the dinner table and talking about which pillars we find easier and which we need to work on, the commonest area for improvement was in relaxing. One of our group described their child had complaining to them that they couldn’t sit in their lap if there was a lap top already there.

It’s great to have an opportunity like this once a year, but probably more important, if you had to choose, to have five minutes every day. We talked about what we found relaxing: reading, listening to music, walking the dog, eating a meal as a family or watching our favourite TV show with them. We discussed practising mindfulness, being present and limiting screen time and I showed some of our group how to use Do Not Disturb and night-shift functions on their phones, before we finally turned in for the night.

By the time this post is published I will be at my desk in the surgery on a cold, busy monday morning. I will feel a bit sad that our trip is over for another year. However, I have got more CPD points for my appraisal, a new background photo on my desktop, more fond memories to add to the nineteen year collection, and a date already in the diary for next year.

Thank you for allowing me to share this with you. I hope that making it personal has been useful. Like James Bond, the weekly Wellbeing round-up will return. Until next week, take care of yourselves!

Dr Richard Pile

The Weekly Wellbeing Round-Up #17

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

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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.

Child health

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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.

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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?

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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

The Weekly Wellbeing Round-Up #16: connecting for wellbeing.

Over the last few months on this blog I have talked a lot about eating, moving, sleeping and relaxing.   As I have learnt from others and developed my own model of looking at and improving wellbeing, I have realised that for me one of the most important areas that determines our wellbeing is that of connection.  Humans are, for the most part, social animals.   At the end of the day, regardless of what we’ve eaten or drunk, how physically active we’ve been, how much sleep we’ve had and whether we’ve done five minutes of mindfulness or not, as humans I believe that we all need connection with others on one level or another for us to truly have a sense of wellbeing.   It doesn’t matter whether you are an introvert or an extrovert, whether you like to do your socialising in the pub or via letter or skype, connection is important for our mental wellbeing.

The effect of loneliness on our wellbeing

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Much has been made of the five ways to mental wellbeing.  One of the five ways is connecting to others.  If we look at the converse, as a society we are being made increasingly aware of the impact of loneliness upon us individually and collectively.  We now have a minister for Loneliness.  This isn’t because they were the MP picked last for the cabinet football team, but because it’s a significant issue in today’s society.   The Campaign to End Loneliness quotes some alarming statistics.   Loneliness and social isolation are harmful to our health, estimated as being as bad as smoking 15 cigarettes a day.  People who are lonely and isolated are more likely to visit their GP, use medication, fall, attend A&E (regardless of long-term conditions) and end up in a nursing home.  Just this week, an article was published in BMJ’s Heart journal which concluded that social isolation seems to remain as an independent risk factor for dying after a heart attack or stroke.   Loneliness and social isolation have also been associated with an increased risk of hypertension, heart disease, dementia and depression with the overall increased risk of premature death being as high as 25%.

Are we more lonely than before?

Of course, loneliness affects all of us at some time in our lives.  Significant events such as changing schools, moving away from home, going to university, starting a new job or suffering a bereavement may be the trigger.  It affects people at all stages of life, young or old.  It is part of life, often temporary and can push us to reach out and make new positive connections.  It’s important to think about that word – connections.  We shouldn’t fall into the trap of assuming that if you are “connected” then you aren’t lonely.  Many adolescents (the group most affected by this) report feeling lonely even though they are connected,  like never before,  through social media.   We need our connections to be meaningful and that’s where the problem lies.  It doesn’t matter how many followers you have on Instagram or how many likes you got on Facebook with your last post.  If we’re not careful, our relationships become increasingly superficial.  We end up with a lot of friends, but they are either virtual or might as well be for the good it does us.   I’m not being down on social media as it has its place, but what really counts is the quality of our connections.  Historically these connections have been more face to face with extended families, in local communities and in other common interest groups including faith-based.  However, family units these days are more fragmented than they were.  People often move away from home when they start higher education or enter employment.  Fewer people identify themselves these days as having a religious belief or being part of a formal religious organisation which, whatever views you hold about religion, results in more people not knowing where to look for help in times of significant life events and crisis.  Just one or two good quality connections can be all we need to make a big difference to our lives.

Tips for building and strengthening connections. 

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Family time

  • try to build a fixed, protected time for this into your week.  Prioritise it and organise the rest of your diary around it.  If you don’t plan it, it probably isn’t going to happen.  It might be for the whole family, or just one or two others.
  • Turn off the TV and sit round the dinner table or play a game with your kids.  Or just talk.  I took advantage of some of my family being away today to have lunch and a coffee with my son.  I didn’t have to drill him for information about what’s going on and how he feels at the moment (he actually volunteered some!) because it was a relaxed, natural setting.  Also this week our son Luke invited us round for dinner.  Luke is twenty-one and has severe epilepsy and a moderate learning disability.  He lives in Essex his own flat in a house that he shares with other people with additional needs and is looked after twenty-four hours a day by a wonderful organisation called Zero Three Care.  His carers encourage him to have as much independence as possible and this includes cooking healthy meals for himself.  He served up a delicious chicken chow mein yesterday and was very proud of himself.   We played Operation afterwards, which I lost convincingly.   I made sure his brothers did the washing up!

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Friends

  • Try to catch up with a friend you haven’t spoken to for a while.  It might just be a phone or video call if they live some distance away.    One of my best friends from school still lives up north, whereas I have betrayed my northern roots and become an adopted southerner.  We conspire to meet when he’s in London for work and catch up on the phone every month or two.
  • Visit someone you know needs extra support at the moment.   If they are feeling low or depressed, they may prove elusive.  Don’t give up on them…harass them (in a nice way) until they give in.
  • Arrange a meal or night out with friends.  This is my favourite.  Eating and drinking together is a very bonding social experience.  My wife informs me that I am already an expert in this area.  I tell her that I need to keep up my  social skills, that there’s always room for improvement and that’s why we’re all meeting up at a beer festival this weekend.  And the pub the week after.

Work

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  • Speak to someone new at work.  Invite them to join the next social event
  • Have a meal with a colleague.  The other week one of my GP partners and I met up for breakfast together before we started surgery.  We don’t often get all that long to talk unless it’s about work.  It was a great start to the day.

Volunteer

  • This is also part of one of the five ways to wellbeing, giving.
  • You could volunteer at a local school, hospital or other community or shared interest group.  A number of my patients who have suffered from stress related and mental health problems have found this very beneficial for themselves, as well as benefitting others of course.

In summary…

When it comes to wellbeing, other people matter.

That’s all for this week.  I hope you have found this blog post helpful.  Please do leave a comment – your feedback is much appreciated and helpful.  Until next week – take care of yourself!

Dr Richard Pile

 

The Weekly Wellbeing Round-Up #15: making a plan to improve your wellbeing.

When I first became a GP, I decided that many of my patients who needed to make lifestyle changes also had undiagnosed conditions that resulted in problems with their understanding,  memory and planning processes.  There must be something wrong with them, so my reasoning went, because they left my consulting room chastened by me about their lifestyle choices,  concerned about their impending doom, and clearly intent on turning their lives around….but when I saw them again they hadn’t done anything.   In fact, some of them were even more unhealthy than before.   Some cases stood out, like the man who was still popping out for fag breaks in between ward rounds on the coronary care unit after he’d had his heart attack.  Or the elderly lady with furred up arteries in her legs who looked me straight in the eye and told me that she was more scared by the thought of life without cigarettes than she was by the below knee amputation that she was heading relentlessly towards.   Surely the only explanation was stupidity or a death wish?  Or so I thought.

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Years have gone by and I have learnt a lot about people, which is an inevitable and highly desirable side effect of working in primary care.  I have spent time talking these things through with patients.  I have read round the subject of behavioural psychology (I highly recommend Nudge, Inside the Nudge Unit, and Think Small for a good grounding in this area), met with people from the Nudge Unit (or Behavioural Insights team, to give them their proper name)  and spent time discussing these issues with psychologists and other colleagues.   At Thrive Tribe, we are working with the Centre for Behavioural Change to ensure that all our practitioners are appropriately skilled in this area to help their clients, offering a service that is more than just education about giving up smoking or losing weight.

For the purpose of today’s blog post, I am going to share with you a small but important part of what I have learnt over the years.  It’s not very clever or surprising.   Neither is it difficult.  Everyone can do it.  It’s about having a plan.

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Why do we need a plan?

Humans are not rational creatures.  We assume that because we have been well in the past we will be so in the future.  We cleverly avoid joining the dots with all that we know about what is likely to happen as we get older.  We know that there are theoretical risks of things happening, like heart attacks and cancer and road accidents, but we assume that somehow we as individuals are exempt from this risk,  unlike everybody else in the world around us.   I’m sure you can see the potential flaws in this reasoning.  When things unravel, they can unravel quickly.  Even when things are not yet seriously unravelling health-wise, people are often still aware of their wellbeing issues.  When people fail to make changes that are needed, it isn’t because they don’t know what to do.  It’s beause they either don’t know how to do it, or they do know how to but have no plan in place to make it happen.   I know that I would like to catch up with my brother for breakfast over the next few weeks.  I also know based on the endless games of message-tag we play that via text, facebook messenger, what’s app and email unless we actually make a plan, it will  never happen.   It’s better to have a plan.  It could be written on paper, or stored electronically – just as long as you can refer to it and review it whenever you need.

Do wellbeing plans work?

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Plans are not foolproof.  Otherwise we wouldn’t refer to the best-laid ones or talk what the road to hell is paved with.  They do, however, increase our chances of making and sustaining the changes that we want to.   There are various reasons for this.

Accepting the need to make changes

Firstly, making a plan to change means that we have generally (perhaps grudgingly!) accepted that there is a change that needs to be made.  Maybe you’ve been along to see your GP, practice nurse or health care assistant and a few issues have been raised that you concede might be worth a look at – that weight you’ve been meaning to lose for years, your need to quit smoking or reduce your drinking because of the effect it’s having on your health,  or perhaps your worries about getting a bit fitter as you move into middle age.

Being specific about the changes

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Vague plans are not much good.  “I will lose weight/eat fewer biscuits/do more exercise” might work for a small minority, but for more people it will never translate into anything.  Why? Because they have leapt straight to the desired outcome and are too vague.  We need to be clear about what we are going differently that will result in those outcomes.   Each step in the process needs to be considered, broken down into even smaller steps if required, to see how realistic it is and what needs to be done in what order.  A plan makes it easier to achieve than a one-off mental note to self or vague intention.

A plan makes us accountable for the changes

If we have a plan, it means that we are accountable.  Not just to ourselves, which helps a bit, but potentially to others, which significantly increases our chances of success. Letting other people know what you are doing and even asking one or more of them to be a referee and hold you accountable means you are more likely to follow through.

A plan helps us to measure success as well as failure

If we have been specific in terms of what we want to achieve, how we will achieve it and how we will measure our success, then this will help us by encouraging us when we achieve what we have planned (which increases the chances of making further changes and sustaining what we have already done) as well as maybe challenging us with the areas where it hasn’t quite worked out yet.   The plan can always be changed when we learn as we go.   Putting rewards into the plan for when we achieve each stage of success can be quite motivating as well.

My top tips for making your wellbeing plan

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  1. Make it for yourself and only if you really mean it.  Not to make your GP happy.  If you’re not ready to make changes, let them down gently as early as possible and perhaps keep an open mind for the next time you have a wellbeing conversation.
  2. Make it simple.  The more complicated it gets, the more likely you are not to achieve bits of it, which can be disheartening.  Better to have simple success and build on it.
  3. Make it specific.  Losing weight might be the overall desired outcome, but break it down into smaller chunks e.g. cycling or walking to work, cutting out snacks, shopping for and preparing more of your own meals, not eating after a certain time of day.
  4. Make it achievable.  If you are inactive at present and break into a sweat at the thought of breaking into a sweat,  don’t aim for 150 mins of exercise a week from the outset.  Start with 5-10 mins a day every other day.  If you want to learn about mindfulness, start with 5 minutes a day on your smartphone app or just spend the time reading a book or listening to music.  I know a lot of people who say “I tried that” by which they mean they gave it a go a couple of times and gave up because it was too difficult or not immediately rewarding.  Changes are more likely to be made if they are easy, accessible, social and timely.
  5. Make it rational.  Think about what changes you can implement that are compatible with every day life and easy to sustain.  It needn’t involve hours of your time every day or expensive kit, diet plans or gym memberships.  It could be walking more briskly to the shops or whilst out with your dog, taking the stairs at work or working in the garden.
  6. Make it measurable.  It might be weight lost, minutes of activity completed, amount of sleep you have obtained or personal goals achieved (e.g. taking part in a social activity with your friends or playing football with your children or grandchildren)
  7. Make yourself accountable.  Tell people what you are doing e.g. work colleagues, friends and family, social media groups.  Consider asking someone to be a referee who will check in with you regularly.  Some people might ask their spouse.  Some might prefer a friend or colleague depending on how much they enjoy being nagged!
  8.  Make it a work in progress.  Your objectives are likely to change over time.  You will succeed in some areas and maybe not others.  That might simply mean not giving up and then trying again, or it might mean learning from what has worked well and not so well, and coming up with a better plan for the future.

Wellbeing planning in the real world.

I thought I would finished with some real life examples.

  1. Last year, all the GP practices in my area took part in a local Cardiac Prehab scheme which I had designed with some of my colleagues for our CCG.  Part of the service included identifying patients at higher risk of having a heart attack, stroke or developing diabetes and inviting them to an educational event at their GP practice.  The evening included a presentation on wellbeing and finished with each patient signing up to their own personal wellbeing plan.   These plans were collected and scanned into each patient’s records.  When they were reviewed a few months later, the doctor or nurse they saw reviewed their plans with them and discussed what had worked well or not so well.  The majority of the patients I reviewed had achieved at least one of their intended outcomes and were really pleased to see how well they had done, which encouraged them further.  This year the scheme has been rolled out across our entire clinical commissioning group, with a patient population of over 600,000 people.
  2. Those of you that are kind/enlightened/fortunate enough (delete as applicable) to read my blog posts regularly will know that I talk a lot about Rangan Chatterjee’s Four Pillar Plan.  Inspired by this, I have started to develop a welbeing plan template for EMIS (our computer system) which is based on this.  I have shared it with my practice colleagues and am now using it to enter data into the patient’s record and give them a printed copy after our consultation, so they have something to remind them of what we have agreed and to document their progress. Rangan Chatterjee and Ayan Panja did an excellent presentation on Prescribing Lifestyle Medicine at last week’s Emis National User Group conference at which they showcased an early version of their own lifestyle medicine template which is currently in development and  which will no doubt be snazzier than mine when it’s finished!

And finally, my own personal wellbeing plan

It is only right, of course, that I practice what I preach.  For years I have meant to lose a bit of weight.  For years I have surveyed my profile in the mirror in the morning, disappointed in myself for not having achieved anything and disappointed in the Six-Pack Fairy for not having visited overnight as I had hoped.  So in the end, I made a plan.  This included eating a lower carb diet (specifically changes to what I make for breakfast, making salads for lunch and cutting back on biscuits), exercising more regularly (getting up early to walk before work, doing HIIT workouts when I didn’t have time to ride or run), and doing press-ups as strengthening exercises each morning).   I am also much better at getting enough sleep, although there is always room for improvement.  I told my wife about this as I knew full well she would remind me if/when I lost track.   The results?  I have lost just over half a stone without feeling that I am depriving myself.   I feel fitter and have more energy.  I still don’t have a six pack and have decided that I was probably born without one, so maybe I will leave that out of the next version of the plan.

That’s all for this week from me.  Weekly Wellbeing Round Up #10 will be out next week.

Please do make a comment on the blog if you have enjoyed it, if you feel it could be improved, or to suggest future topics for me to work on.  I want to make it as useful as possible for all of you.  Please feel free to share the blog with your friends/colleagues/pateints/family members and sign up to it to receive updates automatically if you haven’t already.

Until next week, take care of yourself!

Dr Richard Pile

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The Weekly Wellbeing Round-Up #14

Welcome back to the Weekly Wellbeing Round Up.  We’ve taken a couple of weeks off to focus on the low down on low carb diets, and digital wellbeing.  I’m pleased to say that this week normal service is resumed.   Topics for today include calorie counts in menus,veganism, probiotics, the cost of eating health food, heart age and heart disease.  Let’s tuck in….

Counting the cost of counting calories

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The department of health and social care is to launch a consultation on its plans to require calorie counts on menus as part of its childhood obesity strategy.  The BBC reported this week that concerns had been raised by the treasury about the cost to small businesses, and the risk of distressing people with eating disorders. recommended this week that.   Whilst I have sympathy for both potentially affected groups, I think we should ask ourselves what our priorities should be for the health of our nation and particularly our nation’s children.  I seriously doubt that my local greasy spoon cafe will go out of business because they have to work out the calories in their full english breakfast.

Is being vegan good for your health?

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The BBC reported this week on the experience of Dr Giles Yeo going vegan for a month, in an episode of Trust Me I’m A Doctor.  During his trial, Giles lost weight, reduced his body fat and his cholesterol.  He required dietary advice to avoid becoming deficient in certain nutrients such as iron, vitamins B &D, omega 3 fatty acids, calcium, iodine and protein.  Some of this can be sourced from plants, but some probably requires supplementation.

This meta-analysis found that people on a vegetarian (including vegan) diet had an overall descreased risk of dying from heart disease and cancer but that there was no overall decrease in cardiovascular deaths or all cause mortality compared to non-vegetarians.

Take home message?  You might be slightly less likely to die of heart disease and cancer but overall vegetarians don’t live longer.  It is sensible to consider going meat free for some of your meals each week…maybe replacing them with oily fish.  Whilst my quality of life might be improved in some respects, I could no longer have a sausage, egg & bacon bap with my buddy Al on a sunday morning after our bike ride.  That would be a No then.

Children in food poverty

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On a more serious note, the Food Foundation issued a report stating that “a healthy diet is beyond the reach of 3.7 million children in the UK“.  It’s a shocking statistic.  There isn’t an easy answer to this one.  It’s easy to glibly state that an apple costs less than a mars bar (which is generally true, in fairness), but it is a fact that crap food is cheap, and good food either costs more or (and I think this is part of the problem) takes more time and knowledge to prepare.

The answer for me has to be pragmatic.  Whilst influencing national policy and financial instruments is beyond the ability of most of us, we can take simple steps to improve the situation even if we can’t achieve perfection.  There are plenty of books and websites out there about cooking on a budget.  Some examples include:

BBC Good Food Seven Days of Cheap Healthy Meals

Jamie Oliver’s cheap and cheerful recipes

Jack Monroe’s Cooking On A Bootstrap

Some providers of lifestyle services including cooking lessons, not just lectures about healthy eating.   If you really want to be challenged and inspired in this area, I heartily recommend Dr Rangan Chatterjee’s interview with Jamie Oliver in Episode 16  of his Feel Better Live More podcast.   Jamie’s passion for this subject shines through.  I particularly like his ideas about using his recipes like a jukebox for types of meal and associated costs, to come out with some realistic options for families struggling in this area.   If you are a health professional talking to a family about this, just remember that even if they eat one or two healthier family meals per week, and their kids have maybe one or two healthier lunches at school, that is making a difference and it’s a start.

Probiotics…the sage continues.

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Finally  for our food section this week, the BBC reported on this study in the journal Cell which reported on the use of probiotics and whether they have a meaningful impact on our gut flora.  It’s a very long paper and to summarise very simply…they don’t have much effect if taken in a one-size fits all approach.  If you think about it logically, introducing a tiny amount of unsuspecting friendly bacteria into a person’s entire gut flora or “microbiome” is going to have very little impact in terms of relative numbers.

Take home message?  Our understanding of the gut microbiome is still at a very basic stage and there is very little available to us so far in terms of evidence that has immediate practical applications.  In the future we will look back and realise how little we knew.  Probiotics might work better if it is possible to take a personalised, individual approach to treatment.  For now, if a patient asks me whether they should take some “friendly bacteria”, I advise them that they won’t do any harm but in the average person they won’t do much good either.

Physical Activity

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The World Health Organisation has recently produced a report on global levels of activity.  It was a self reported study based in 168 countries with 1.9 million participants from 2001 to 2016.   The BMJ reported on the findings this week.  Sufficient activity was defined as 150 mins of moderate intensity activity per week.  36% of UK adults were insufficiently active, with Kuwait winning the wooden spoon at a whopping 67%.  Women were generally less active than men.   Inactivity was a worse problem in high income activities.  Over the study period, levels of physical activity did not rise.  The solutions are large scale and up to governments when it comes to decisions about transport and infrastructure etc.  Personally, I think 36% of UK adults being insufficiently active is a massive under-estimate and a reflection of a lot of people kidding themselves when they filled int the report.  My take home message is that health professionals should bear this in mind and drill down a bit more into a person’s history when asking about how active they are.  Physical activity is a miracle cure, a wonder drug.   If you haven’t seen it, I recommend you take five minutes to view Twenty Three and a Half Hours on YouTube.  It ends with an excellent challenge that puts all our excuses about physical activity into perspective.

My dog Prince has offered to be share, with anyone who wants to know, how he feels about exercise.  All you need to do is to come round to our house, look him in the eyes and ask him if he would like a walk.   You may wish to consider wearing body armour with an anti-slobber coating for this exercise.  Don’t say I didn’t warn you.  Here is the presentation he has put together.

Heart health and disease

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In a collaboration between Public Health England have released a Heart Age online tool that allows you to calculate what your heart age is compared to your actual age.  When it comes to risk, people often struggle to get their heads around risk scores as percentages over a number of years and scoring tools are increasingly calculating the age of the relevant organs in your body (heart, brain, lungs) as it is felt that this is a more powerful motivator for people to make changes.   You can take the test online.   If your heart appears to be significantly older (according to Public Health England!) then you actually are, it may be worth booking a phone call with your GP to talk things through.  If you haven’t already done so and are between the ages of 40 and 74, I recommend you take up the offer of a free NHS health check.

Lifestyle Medicine

As a new user of EMIS (a GP computer system), I attended the national user group conference in Birmingham this year.   It was a great event and both I and the rest of my surgery team learnt a lot and came away with loads of ideas for how we can provide better and more efficient care for our patients.  One of the highlights of the conference was the Lifestyle Medicine presentation by Dr Rangan Chatterjee and Dr Ayan Panja. Excellent, inspiring stuff.  The real time roleplay between Rangan and Ayan of a GP consulting with a stressed, sleep deprived patient was particularly good and could have taken place in any GP surgery in the land.  I was able to catch up with both of them afterwards and we talked about the difference that this approach can make to our lives as patients and healthcare professionals.  I have already seen a positive impact on the lives of some of my patients.   I am definitely going to sign up for their highly rated, RCGP-approved Prescribing Lifestyle Medicine course in January 2019.  If you can’t wait that long, I recommend you get a copy of Rangan’s Four Pillar Plan in the meantime.  I recommend it to all my patients who need to make changes in their life, as it has helped me to make changes in my mine.

That’s it for this week.  I hope you have enjoyed the blog.  Your comments and feedback would be really helpful.  If there are particular topics you would like me to cover, please let me know and I will do my best to keep it real.    Until next week, take care of yourself!

Dr Richard Pile

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