Health checkup: on the obesity epidemic, food labelling and overfed toddlers

Plus: asthma’s fashion victims, the burden on GPs, and vitamin D deficiency

Britain’s £10 billion diabetes epidemic

Nearly 10 per cent of the global population now has diabetes, according to new figures from the World Health Organisation. It’s an epidemic that shows no signs of slowing down — the WHO also reports that the number of adults living with diabetes has risen by almost 300 per cent since 1980 (from 108 million to 422 million). There have been similar dramatic increases in the UK, and diabetes now costs the NHS nearly £10 billion a year, of which 80 per cent is spent managing avoidable complications. On page 36 of this issue Dr Dawn Harper discusses the obesity epidemic and the strain it puts on our bodies and on the NHS.

Take the risk out of the ruck

More than 70 doctors and academics have signed a letter to ministers calling for a ban on tackling in school rugby. They point out that two-thirds of serious injuries and most concussions are caused by tackles and are urging a move to touch rugby, a non-contact version of the sport. One of the signatories to the letter is Professor Allyson Pollock, who wrote a cover article on the dangers of school rugby for a previous issue of Spectator Health. Twelve years of evidence shows that up to the age of 18 or 19 players have a 30 per cent risk of injury over a 15-match season and 90 per cent of these injuries require more than seven days off school. Professor Pollock’s provocative essay is still available to read on the Spectator Health website.

Double burger & fries? That’s a ten-mile run

Shirley Cramer, chief executive of the Royal Society for Public Health, thinks she has a solution to the obesity crisis. In an opinion piece in the British Medical Journal last month she argued that all food should have labels showing the equivalent exercise needed to burn off its calories. She believes this would make people think twice about the food they eat. Current labelling on food is so complicated that nearly half of us admit to being confused by it, and the current system of traffic-light labelling appears to be doing very little to change behaviour.

With more than two thirds of the UK population either overweight or obese, Ms Cramer says: ‘We desperately need innovative schemes to change behaviour at the population level.’ Her article gives an example of the calories in a can of fizzy drink taking a person of average age and weight about 26 minutes to walk off. Ian Marber also tackles the subject of food labelling — in particular on the health claims made by food companies — in his column on page 33.

Plan of a thousand days

There is now good evidence to show that the first 1,000 days of a child’s life are critical in establishing future potential health risks. This makes recent research into the diets of toddlers in the UK particularly worrying. According to a major study published this month in the British Journal of Nutrition, they are not getting enough dietary vitamin D or iron, while being fed too much protein and too many calories overall. Researchers found that the daily calorie intake of toddlers was 7 per cent higher than the recommended public health guidelines. Protein intake was around three times higher than it should be, with nearly all toddlers exceeding Department of Health recommendations. (At 21 months, 63 per cent of children exceed the Scientific Advisory Committee on Nutrition’s recommended daily protein intake of 968 calories, with an overall average intake of 1,035.) Salt intake was almost three times higher than the recommended 0.5g and fibre intake for many children was only 8g—half the recommended amount.

‘The current diets of young children in England are a cause for concern,’ says Hayley Syrad of the Department of Epidemiology and Health at University College London, who is lead author of the study. ‘We know that dietary preferences and habits are established during the first two years of life and that what we eat in early life can have an enduring impact on our health.’

Asthma’s fashion victims

Specialists, campaigners and charities complained for years that asthma was under-diagnosed by GPs. But now two leading lung specialists say the pendulum has swung the other way. Writing in the Archives of Disease in Childhood, Professor Andrew Bush and Dr Louise Fleming of Imperial College and Royal Brompton & Harefield NHS Foundation Trust insist that asthma is now over-diagnosed and inhalers are often dispensed for no clinical reason, to the point that they have ‘almost become a fashion accessory’.

This is bad not just because of the cost and the waste, but also because using them has potential side-effects, including growth suppression and the damping down of immune-cell activity in the airways, which increases the risk of respiratory infections. The National Review of Asthma Deaths shows that child sufferers still die because of failures in basic management, including not using the inhalers that they really need. In their article the two experts argue that asthma diagnosis has been so ‘trivialised’ that the fact it can be fatal is too often overlooked.

The doctor will see you next year

Having more and more trouble getting a GP appointment? It’s unlikely to get easier any time soon. According to a recent study in the Lancet, general practice workloads have increased by 16 per cent over the past seven years, thanks to more and longer consultations. The researchers say these increases are unsustainable and warn that general practice in England could be reaching -saturation point. ‘For many years, doctors and nurses have reported increasing workloads, but for the first time we are able to provide objective data that this is indeed the case,’ says the lead author, Professor Richard Hobbs of Oxford University’s Nuffield Department of Primary Care and Health Sciences.

With research that goes into incredible depths, this is likely to be a very accurate portrayal of what it is currently like on the coalface of general practice with a significantly increased workload despite successive real-terms cuts to GP services.

The study also found that telemedicine — one of the solutions that politicians often cite — might not be the hoped-for panacea. Telephone consulting was introduced to help cope with rising workloads, but each phone call takes 60 per cent of the time of a face-to-face consultation and about a third result in a regular consultation anyway. Based on those figures, the authors now question whether this strategy does help to manage demand. And they also say that relying on telephone consultations may lead to missed opportunities for disease prevention.

Health hazards: four cans of fizz takes nearly four hours to walk off and sunscreen can leave you vitamin-deficient
Health hazards: four cans of fizz takes nearly four hours to walk off and sunscreen can leave you vitamin-deficient

When sunscreen gets a d-minus

Over the past year or so there has been a lot in the news about the health benefits of vitamin D and how many of us are missing out on them because we are deficient. There’s no doubt that this is partly due to the fact that more and more people are following advice to wear sunscreen or cover up when going out in the sun to avoid its more harmful rays.

It’s now quite routine to have vitamin D levels checked by your GP, and new research suggests that people with heart problems might want to consider finding out whether their own levels are adequate. A recent study of patients with chronic heart failure found that supplements of vitamin D improved the heart’s ability to pump blood around the body. These patients are often deficient in vitamin D and lower levels are associated with more severe forms of the disease and worse outcomes.

Professor Peter Weissberg from the British Heart Foundation has called for more research to find out whether these apparent improvements in heart function result in the affected patients living for longer.