Welcome back to the Weekly Round Up. Have you enjoyed the start of the World Cup? Or are you already counting the days until it’s over? In our house, we fall firmly into the former category. My kids have already chosen world cup fantasy football teams and we are planning our family last sixteen sweepstake and what the prize might be for the lucky winner. So let’s kick off (bad pun fully intentional) with some…
Physical activity
Resting heart rate (RHR) has long been considered a proxy measure for physical fitness. I first encountered this as a junior doctor when I met an olympic rower with a resting heart rate of 35 beats per minute. Does this mean, therefore, that a higher resting heart rate is a bad thing and a possible predictor of increased risk of death? The answer may be yes, according to the Melbourne Collaborative Cohort Study which found that a rise in resting heart rate over a decade was associated with increased risk of death from cardiovascular disease, cancer or other causes. Of course this may be an association rather than a cause. So what can we take from this practically in primary care? Consider a RHR of greater than 70 in men and 80 in women to indicate a higher risk of mortality and target those individuals not with drugs to slow their heart rate down, but with more intensive lifestyle counselling. It could be an added dimension to an NHS health check.
Weight
It can be a little awkward broaching the subject of wellbeing with an overweight patient…especially if they are a child. Here is a useful video on childhood obesity that has been made by Public Health England to inform and support health professionals in this area. Take home message – we need to start with women who are pregnant or planning to become pregnant to have these conversations. Additional materials can be found here.
Food
Patients and health professionals alike may be aware of the ongoing debate about food related issues such as carbs vs fats and what helps most with weight loss. In an attempt to provide balance, and to act as an anecdote to the unedifying behaviour sometimes seen on social media in this area, the BMJ will be publishing a series of articles covering this and other contentious areas, looking at both sides of the argument. This week’s article is on Food based dietary patterns and chronic disease prevention. You will need to have a BMJ subscription to view the full text. The key messages are
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Food based prevention of chronic disease risk should prioritise fruits, vegetables, whole grains and fish and lower consumption of red and processed meats and sugar sweetened drinks
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Higher consumption of nuts, legumes, vegetable oils, fermented dairy products, and coffee are further likely to confer benefit
Personally I recommend that you use olive oil in salads and dressings, and use other oils such as ghee or coconut oil if you are going to fry food, as they oxidise at higher temperatures than olive oil and other vegetable oils. Make of this what you will, but may I recommend you avoid behaving badly on twitter, wherever you stand?
Digital Wellbeing
The Children’s Commissioner has recommended that social media must be made less addictive for children. The example of “streaks” in Snapchat has been highlighted. The protestations of social media companies that their products are not designed to be addictive sound very similar to those of Big Tobacco. No immediate, tangible results here. My recommendation to my patients in the meantime is that no child should have a mobile phone before secondary school age or access to social media until they are older e.g. 14+. Parents who roll their eyes and say that they don’t understand technology and can’t figure out how their home wifi works or how to restrict applications on their kids’ phones should be asked whether they would take as relaxed an approach to allowing their kids to have access to pornography, cigarettes or under age drinking. I will be dedicating a whole blog topic to this. I think social media addiction is the new inactivity, which was the new obesity, which was the new smoking etc etc etc.
On a related note, Techcrunch reports that Apple has unveiled digital wellness features for children and adults alike. These include an upgraded version of Do Not Disturb, options to reduce and restrict the intrusiveness of notifications, a regular report of how much time you have spent on your phone and which apps you use the most, and parental controls to limit screen and game time. Well worth a read. Other companies such as Google are making similar moves. In my opinion, starting with making us aware of just how much time we are spending on our screens is the first step towards us challenging ourselves and managing it better and more mindfully.
Technology is not all bad, of course. So to end on a positive note, here are five free apps for mental health and wellbeing. I particularly recommend Headspace (available on iOS and Android). I started using it a few years ago when life was quite challenging because of my son’s severe uncontrolled epilepsy and all the knock on effects this had for him and for the rest of us. It’s designed by a former buddhist monk (although it doesn’t require you to embrace any particular philosophy or belief system) and has different modules for different aspects of your life. A subscription is roughly the price of a cup of coffee per month. As a result of getting into the habit of using the principles regularly, I have found it hugely beneficial (disclaimer – I’m not getting paid or given a discounted membership to promote this!).
That’s all for this week. Thanks for tuning in. See you next week!
