One in four UK adults has obesity and one in three is overweight. These factors increase the rate of diabetes and cardiovascular disease. Although many people lose weight after starting various types of dietary intervention, they are often dismayed that weight is usually regained.
A systematic review and meta-analysis of 249 weight management programmes for adults worldwide was conducted. Intense weight management programmes were compared to less intense or no intervention at all. Intensive programmes included diet and exercise but not medications or surgery.
All trials ran for at least a year after the interventions were completed and some as far as four years afterwards. The average follow up period was 28 months.
Those who had little or no support had lost 2.1kg and those who had had intensive support lost 4.9kg. Those who lost the most weight gained it back the most quickly.
The researchers found that five years after the end of a weight management programme, people who had been offered support still weighed less than those who got little or no support. They also had lower blood pressure, cholesterol, and blood sugar levels despite the weight regain.
Photo by Katie Rainbow ud83cudff3ufe0fu200dud83cudf08 on Pexels.com
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.
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.
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.
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.
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.
HRT prescriptions were given to 29% more women between 2022 and 2023 in England.
My comment: This increase could be due to the increased publicity brought about by Davina McCall and Mariela Frostrup through the media.
There were significant geographical differences. Twice as many women in affluent areas were prescribed the medication compared to women in the most deprived areas.
In a recent Pulse educational article I was reading very recently, I was dismayed to see that the author, considered an “expert” in the subject, was very strongly of the opinion that GPs should only prescribe HRT for women who were suffering symptoms of the menopause. It had been my practice for many years to discuss the pros and cons of HRT with regards to the patient in front of me, so that she could decide for herself whether taking it to suppress symptoms on the medium term or taking it long term to reduce osteoporosis, cardiovascular disease, genito-urinary problems, and bowel cancer was something that she wanted to do.
The very helpful site: Menopause Matters, has useful information to guide patients as to the pros and cons of the use of HRT and the types of formulation that are best for individual circumstances.
In Denmark the records of 10,000 people were examined. Since 1996 vibration perception has been done in type one and type two diabetes patients in a specialist diabetes centre.
In middle aged type one patients, distal symmetrical polyneuropathy fell five fold between 1996 and 2018.
In older people with type two diabetes the incidence of polyneuropathy halved.
As polyneuropathy is often the precursor to ulceration and amputation, this is good news indeed.
One in four deaths are due to cancer between the ages of 35 and 69. The most common 23 cancers were investigated by Shelton and colleagues. Even though we have an aging population, cancer deaths over the last 25 or more years have declined.
Data from adults in the UK, aged 35 to 69, who had a diagnosis or death from cancer were analysed retrospectively covering between 1993 and 2018.
The incidence of cancer registrations increased in both both sexes by a substantial amount. 57% increase for men and 48% for women. At the same time cancer mortality declined by 37% for men and 31% for women.
In men, the cancers with the best improved mortality were for stomach, bladder and mesothelioma with some improvement in prostate cancer. In women, the best improvements were for stomach, cervical and non-Hodgkin’s Lymphoma with some improvement for breast cancer. In both genders lung and bowel cancer improved considerably.
In the UK the chances of dying from cancer before the age of 80 declined between 2002 and 2019 from one in six to one in eight for women and from one in five to one in six for men.
The results have been due to a reduction in smoking, less asbestos exposure at work, earlier detection due to screening and health education, improved diagnostic investigations and improved treatments.
France, the Netherlands and Sweden also show declining cancer deaths in the same age group.
Some types of cancer, are however increasing, mainly due to the increased weight of the general population.
Some cancers have become more common. Liver cancer incidence has been rising since 1980. This is due to increased alcohol consumption and body weight. These two factors account for 4.1% of cancers in men and 6.3% in women.
In adults under 50 the incidence and mortality rates for bowel cancer are rising. Various hypotheses for this are increased weight, less physical activity and antibiotic effects on the gut microbiome.
Breast Cancer Now, a research and support charity for breast cancer, sent a very helpful educational leaflet to all UK General Practitioners via Pulse, the GP magazine. Mainly, this is to act as a reminder to them, to investigate and refer women who could be presenting with breast cancer that has spread. Nowadays more than 4 in 5 women who are diagnosed with breast cancer survive long term. Women who present with secondary breast cancer symptoms can sometimes still be cured, but sometimes they can’t. Information about possible secondary cancer symptoms is useful for the GP, but it is even more useful for women who have had breast cancer, so I’m sharing it with you today.
Secondary breast cancer occurs when breast cancer cells spread from the first cancer to other parts of the body. This is via the lymphatic or blood system. General symptoms can be tiredness, nausea, loss of appetite and weight loss. These can be caused by many other conditions such as infections, medications, immunological disorders and other illnesses, but if you have previously had breast cancer it is worth getting a diagnosis sooner rather than later.
Signs that cancer may have spread to the bones include: bone pain that doesn’t respond to simple pain killers and may be worse lying down or at night. Fractures with or without prior trauma. Unexplained back pain, difficulty walking, numbness or lack of bladder or bowel control. Feeling sick or being sick, fatigue, passing a lot of urine, confusion, and being thirsty. These may be due to a high level of calcium in the blood.
Signs that cancer may have spread to the lungs include: feeling out of breath on activity that you usually can do easily, or breathlessness at rest. A cough that doesn’t go away after three weeks. Pain or tightness in the chest that doesn’t go away with rest.
Signs that cancer may have spread to the liver include: pain in the abdomen or the right shoulder. Pain under the ribs on the right side. Nausea, loss of appetite and weight loss. Persistent hiccups, swelling of the abdomen, feeling unwell or tired. Itching of the skin or yellow discolouration of the skin or whites of eyes.
Signs that cancer may have spread to the brain include: persistent headache, nausea and vomiting especially in the mornings. Weakness or numbness down one side of the body. Dizziness, unsteadiness, loss of balance or co-ordination. Fits. Difficulty with speech. Problems with vision. Changes in behaviour, mood or personality. Confusion. Memory problems.
Signs that cancer has spread to the skin include: a change in colour of the skin. A persistent rash. A firm, painless lump or nodules or multiple lumps of different sizes. Swelling of the arm, hand or breast area. Pain. Bleeding. Infection. Smell.
Signs that cancer has spread to the lymph nodes include: a lump or swelling under your arm, breast bone or collar bone. Swelling in your arm or hand. Pain. Dry cough.
Signs that cancer has spread to the abdomen include: abdominal pain, swollen belly, feeling sick all the time, loss of appetite, feeling full quickly when eating, constipation, feeling bloated.
If you have NEW symptoms, that DON’T HAVE AN OBVIOUS CAUSE, or DON’T GO AWAY, you must report these to a doctor. If you first see or speak to a nurse or physician assistant it is worth asking for a doctor appointment.
The charity Breast Cancer Now has a phone line where you can discuss your worries: 0808 800 6000. They have dedicated nurses and can tailor information and support to you, not just at the point that you are worried about symptoms but if you are then diagnosed with secondary breast cancer.
Diabetes Diet 