What does it mean to be well?

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This weekend I had the privilege of running a wellbeing workshop at the annual Onelife conference. Onelife exists to equip and connect young people and students to become leaders in every sphere of society. when I was asked to put something together something for the conference I was initially a little daunted. I’m used to presenting to largely middle aged patients with, or at risk of, long term health conditions. My Chemical Romance had it right when they sang about how scary teenagers are, and I was required to face a whole room of them, to provide them with something useful, hopefully emerging with my dignity intact.

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At the beginning of the day I stood up in the main conference and pitched my session to the delegates, as they had a choice of three. As I sat in the seminar room afterwards, I wasn’t sure how many would actually turn up. I thought that the other sessions sounded a bit more exciting than mine. I steeled myself for the sort of numbers that would result in a session best described as “intimate” or “cosy”. Eventually they began to trickle in. I got chatting with a few people and when I looked up to start the session, the room was full, with people finding space on the floor after they ran out of chairs.

My nightmare scenario had been that I would end up lecturing a room full of bored and baffled adolescents all wondering who had dug up the crusty middle aged guy rabbiting on sleep and about the evils of social media. Instead, I encountered a room of people who were really switched on, passionate about leading and serving, and interested in not just their wellbeing but also that of others.

We talked about how we define wellbeing individually and collectively, what made each of us feel well and what we might like to improve. We discussed being well in Body, Mind & Soul…and how it is artificial to divide the physical, mental and spiritual if we truly wish to be well and fit for whatever purpose we have in life. We focussed on some key areas including sleep, physical activity and the use of technology & social media. I was impressed by how many were already taking positive steps to promote their wellbeing. Discussions were animated and plenty of questions were asked. After doing briefly dipping into behavioural psychology and the principles of behavioural change, I asked the group to draw up wellbeing plans together so that they could encourage and hold each other accountable.

Reflecting on the day afterwards, I never really needed to be concerned. My audience was largely self selecting. They were a group of young people who had chosen to be there, interested in exploring their faith and sharing a desire to grow as individuals and to lead and serve others. It was enjoyable and rewarding to be part of this. Feedback about the wellbeing workshop was very positive. Hopefully it will serve as starting point for some of the delegates and help them to look after themselves and others as they grow into the leaders that I believe many of them will be.

The challenge that this throws up for me, and indeed for all of us involved in providing care and encouraging self-care, is how to reach those who may have even greater needs, less awareness of them and fewer opportunities to be supported in addressing these issues. The inverse care law states that those most in need of assistance with their health may also be the least likely to seek this assistance. Speaking for myself, it inspires me to try a bit harder in my consulting room. Of all the things that we can invest in as a society, how many are more important than helping someone still in the early stages of their life journey to think about what it means to truly be well?

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

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