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How to solve the obesity crisis

Jul 12, 2025Jul 3, 2025 kaitiscotlandLeave a comment

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Adapted from BMJ 27 Jan 2024

Dissecting Health by Scarlett McNally

The body positive movement correctly states that weight based discrimination can contribute to poor health and even more weight gain. Even so, obesity causes considerable health and economic damage.

The Tony Blair Institute calculated that obesity costs the UK £98 billion a year including £19.2 billion from related illnesses.

People who have obesity have seven times the likelihood of type two diabetes and the complications such as infection, amputation and kidney failure. Obesity can cause heart disease, cancer and chronic pain.

A person under the age of 50 who is obese, is more than ten times more likely to have complex multi-morbidity than someone of healthy weight. Hip and knee joint replacements are needed earlier, need longer operating times, a 50% greater risk of infections and a higher chance of needing postoperative intensive care.

Several treatments can successfully reverse obesity and type two diabetes including bariatric surgery, low carbohydrate diets, intermittent fasting, ultra-low calorie diets, and now regular injections to suppress the appetite.

Prevention of obesity is different. Obesity is caused by the type and availability of food and a lack of physical activity. Exercise alone doesn’t reverse obesity, but it can help prevent it.

Obesity is a product of our environments. People in the most deprived areas have the fewest food and exercise options and are twice as likely to have obesity (36.8%) as those in the least deprived areas (19.2%).

We need to go back to basics: affordable fruit and vegetables, unprocessed foods, less snacking, smaller portions, and less alcohol.

Many organisations have suggested such interventions such as play parks, limits on junk food advertising, and more PE in schools. We need safe cycle lanes, green spaces, and 20 mph limits in built up areas. Despite swimming being a great all round exercise, many affordable swimming pools have closed.

The obesity epidemic matters more about health than just appearance. Poor health results in unaffordable health needs and reduced tax income from the economically inactive working age group.

We cannot afford the inevitable human and financial costs of inaction.

Surgery is the best option for long term benefit from Dupuytren’s contracture

Jul 6, 2025Jul 2, 2025 kaitiscotlandLeave a comment

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Adapted from BMJ 24 Feb 2024

A randomised controlled trial by Mikko Raisanen in Finland compared treatments for Dupuytren’s contracture.

This condition is common in those of Viking ancestry. Famous afflicted people include Ronald Reagan, Margaret Thatcher and Frank Sinatra.

Thickening and tightening of the tendons in the palms of the hands occurs. Progression is usually slow, but as the pinky finger and others become unable to extend, it can cause real difficulty in dressing and holding objects.

Three treatments were compared: surgery, needle fasciotomy and collagenase injections.

At the three month point, all seemed equally successful with 70% improved considerably, but after two years, surgery was 78% effective compared to 50% and 65% respectively.

Diabetics are prone to this condition too, as tendon glycation worsens the problem.

Testosterone replacement therapy appears to be safe for men with hypogonadism

Jun 30, 2025Apr 14, 2025 kaitiscotlandLeave a comment

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Adapted from BMJ 3 Feb 2024

No excess prostate cancer has been found in hypogonadal men who were treated with replacement testosterone over 20 months follow up.

A randomised trial of 5,000 men found no difference in genital problems between the treated group and the untreated group.

The incidences of prostate cancer, acute urinary retention, prostatic surgery, and drug treatment for urinary symptoms were all low and no different between the groups.

My comment: This should be reassuring for those men who need to take testosterone for sexual health reasons and also to correct their hormonal status, as testosterone deficiency can be one cause of type two diabetes in older men.

It is still worth treating CIN 2 to prevent cervical cancer

Jun 24, 2025Apr 12, 2025 kaitiscotlandLeave a comment

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Adapted from BMJ 2 Dec 2023

Should women have grade 2 cervical intraepithelial cancer treated with large loop excision or should they just be kept under surveillance?

A Danish study sought to find out. Women who had CIN 2 diagnosed between the ages of 18-40 were followed up from 1998 to 2020. The study involved 27.5 thousand women.

The cumulative risk for cervical cancer was only 2.65% but women who had had the loop excision biopsy were four times less likely to get cervical cancer.

How likely are you to have further fits if you have a first epileptic seizure?

Jun 18, 2025Apr 9, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 13 January 2024

What are the chances of having a second epileptic seizure?

After a first unprovoked seizure:

one in four adults and children will have another fit within the first six months

one in three will have a fit in the first year

two in five will have a fit in the first two years

Children have a slightly higher chance of further fits than adults.

More than 633 thousand people in the UK have epilepsy. A diagnosis is made if you have had two unprovoked seizures at least one day apart.

One in 25 people will have an unprovoked seizure in their lifetime. People want to know how much at risk they are of another. This is important for driving, some jobs, bathing, swimming, and travelling.

Studies have put the risk between 24 to 65%. This review looked at 58 studies covering the experience of 12,160 people and covered both adults and children.

If you have a fit in the UK, you will be banned from driving completely in the first six months and for a year if they have a further fit.

Researchers want to continue the work to find out what factors may precipitate further fits in the ten years after the first one.

Pelvic floor yoga improves incontinence

Jun 12, 2025Apr 7, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 7 September 2024

Although pelvic floor yoga has been advised after childbirth and pelvic surgery for decades, it has never had a firm evidence base.

In California, a randomised trial was conducted with 240 women aged between 45 and 90. All reported urge, stress or mixed incontinence.

One group were given 12 weeks of twice weekly group instruction of pelvic floor Hatha yoga and the other group was given the same time and frequency of general muscle stretching and strengthening exercises. The women all had to keep three day diaries of their voiding habits.

At the start the mean frequency of unwanted voiding occurred 3.4 times a day. This fell to 1.1 episodes with pelvic yoga and 1.5 with general physical conditioning.

There were similar improvements whether the woman had stress or urge incontinence.

My comment: I’ve been doing a wide variety of exercise almost daily for the last 35 years, including pelvic floor exercises. Although pelvic floor exercises are taught to almost every pregnant woman, as a GP, nearly all women I met who had incontinence said they had rarely practised the exercises or had given them up after a few months. Due to my exposure to incontinent women I have been really good at keeping my pelvic floor strong. Whatever your age, but particularly if you have been pregnant or have hit the menopausal years, it seems a good idea to make pelvic floor exercises a daily habit.

Always take an iron supplement with orange juice

Jun 6, 2025Apr 6, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 23 September 2023

Women have long been advised to take iron supplements with orange juice to increase iron absorption. This is mainly done through the years of menstruation and particularly in pregnancy and the post partum months.

A study was done using radioactively labelled iron to establish how effective or not this advice was.

Women with low iron levels were divided into three groups. Iron with orange juice, with coffee, and with a breakfast that included both orange juice and coffee.

Taking iron with just orange juice increased the iron absorption by four times the amount by taking it with coffee or a breakfast with both coffee and orange juice.

You can increase the absorption by 20mg per dose by doing this.

Another use for iron supplementation is in older people who get leg cramps. Sometimes iron deficiency is the cause, and they will benefit from this advice as well.

Bright light works for non-seasonal depression too

May 31, 2025Apr 4, 2025 kaitiscotlandLeave a comment

Adapted from BMJ 8-15 March 2025

We know that bright light therapy is effective for seasonal depression. A systematic review has also found that it works for non seasonal depression too.

In eleven trials, remission and response rates almost doubled in groups receiving bright light therapy.

Speed of response was also accelerated.

My comment: we all need more sunshine in our lives!

Cold water immersion therapy is said to improve various health measures by some practitioners. A systematic review found that reliable evidence of benefit was thin on the ground.

Most trials were vulnerable to bias and few results were replicated consistently.

One change that was consistent however, was that sickness absence fell by a quarter in participants who took cold showers.

My comment: I tried this years ago and I didn’t get any benefit. I have a friend who swims in the sea every week in Ayrshire. She enjoys it, but it doesn’t seem to have changed her health one way or another. I know a very fit farmer who has been having cold baths and showers daily for over 20 years.

Relugolix is a new drug for endometriosis

May 25, 2025Apr 3, 2025 kaitiscotlandLeave a comment

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Adapted from BMJ 22-29 March 2025

Nice has approved a new daily pill for the treatment of endometriosis. It contains relugolix, estradiol, and norethisterone.

Patients must be of reproductive age and have had medical or surgical treatment but are still symptomatic.

The new pill works on a block and replace method. Relugolix blocks the woman’s own hormones that affect endometriosis and supplies a steady dose of oestrogen and progestogen to replace them.

Users take it at home and it does not need regular clinic visits.

Exercise is the most effective thing you can do to live longer

May 19, 2025Apr 2, 2025 kaitiscotlandLeave a comment

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Adapted from Outside online magazine for runners by Alex Hutchinson Dec 11 2024

By understanding what factors predict longevity, you can take control of your life before it is too late. Biostatisticians in the USA examined data from the National Health and Nutrition Survey (NHANES) to compare the predictive value of 15 potential longevity markers. The winner was the amount of physical activity you perform in a typical day as measured by a wrist tracker.

It can be difficult to get a true picture of how much physical activity people actually get from self reporting or old style pedometers. This study used wrist accelerometers worn day and night between 2011 and 2014. 3,600 subjects between the ages of 50 and 80 were tracked.

The factors that were examined were: Age, gender, body mass index, race or ethnicity, educational level, alcohol consumption, smoking, diabetes, heart disease, congestive cardiac failure, stroke, cancer, mobility problems and self reported overall health.

In order of importance, the best predictors of living longer were: Physical activity, age, mobility problems, self-assessed health, diabetes and smoking. In a nutshell, how much and how vigorously you move are more important predictors of longevity than how old you are.

In 2016, the American Heart Association, realised that VO2 Max was a very important measure of cardiorespiratory fitness. They noted that a low VO2 Max tended to be stronger predictor of mortality than smoking, cholesterol levels and high blood pressure. VO2 Max is determined to the tune of 50% by your genes, whereas how much you move is up to you. (There are indeed “sporty” families!)

So get up, get out, and get moving, as much as you can.

In a separate study published in Cognitive Science, Dementia, an article written by Eric Dolan on 27 March 20025 states that verbal fluency was the most important factor regarding freedom from dementia.