Susan brought her 7 year old son to see me. She was becoming despondent. His eczema was uncontrollable, despite using all the lotions and potions available to her. He itched terribly, his sleep was disturbed and he sometimes scratched till his skin bled. Additionally he suffered from recurrent head colds, ear infections, and asthma attacks. My colleagues had tried every treatment available. So I had a thought. Might he be allergic to dairy products, milk, butter, cheese and cream? Would a diet free from all of them help? We agreed it was worth a try. Susan set out to put her son on a dairy free diet for one month to see how he reacted. The result was dramatic. Within a few weeks the eczema which had plagued him constantly for years was almost entirely gone. Mum brought him back to see me one month later. Not only had his skin improved but Susan, faced with a child who was unhappy with his new dietary regime had offered to follow the same dairy free diet to support him. “I can’t believe how I feel” she said. “I’m not as tired as I always was, my tummy pain and bloating have gone and I feel so much more energetic”. Susan thought she might have been suffering the effects of a dairy allergy for years without knowing it. It can often be hereditary.

Now, there is scientific support for this. Recent developments in immunology allow doctors to test for antibodies which can show if an individual is indeed allergic. Many of us carry a gene which makes us vulnerable. But not everyone who reacts to dairy products is allergic. Some have a “hypersensitivity” to dairy, resulting in the same symptoms, albeit perhaps to a lesser degree. An allergy to dairy though quite common in Asian people, is increasingly being recognized in Europeans too. But before you start putting two and two together to make five, and deciding you might be allergic to dairy too, consider this. Dairy products are a valuable source of calcium. Calcium, which helps the development of healthy strong bones, and prevents the development of osteoporosis, thinning of the bones, in later life. And if you cut out dairy you have to make sure you’re getting calcium from alternative foods. Natural foods containing good sources of calcium apart from dairy products include canned fish, beans, almonds, oranges, broccoli, spinach and kale, tofu and white bread which is fortified with calcium. Commonly available milk substitutes include soya, oat and rice based “milk” products.

A diet free from all dairy is hard to accomplish and takes a bit of work, especially at the beginning. But if it makes you feel well it will be worth it. Susan came back again a few months later. Yes she was still “dairy-free”. Yes she was still feeling well. But one thing had changed. She’d lost more than a stone in weight. Avoiding full-fat milk, butters, cheese and cream meant she had dramatically reduced her daily calorie intake. As she said, not being able to enjoy some of her favourite foods had some added benefits.

So, given that we are all trying to control our calorie intake and we can’t just eat as anything we might like, do we have to make a choice between fruit or fibre? Between a risk of stroke or bowel cancer? Fortunately of course the answer is no. We can reduce our risk of both. As I’ve said so many times on this blog, a healthy lifestyle is one that is balanced. And a balanced diet, rich in dietary fibre foods like oats and wholegrain rice, and with healthy amounts of fruit is easily achievable.

Government advice is that we should eat at least 5 portions of fruit and veg a day. Of course I agree, but why stop at 5? If you are able to, enjoy even more. Breakfast is said to be the most important meal of the day. A warming bowl of porridge with some added fruit makes a great start to anyone’s day. Fruit can be a healthy snack between meals, and wholegrain rice or pasta can help achieve a feeling of fullness as part of a light lunch or evening meal. And the net effect of such a healthy, micronutrient laden, fibre-rich diet will almost certainly be improved weight management. Which incidentally can also directly decrease you risk of stroke, bowel cancer and many other health problems.

So, do your best to keep the doctor away. Today, tomorrow and every day.

Even defining overweight in your pet dog is difficult. The vets define it as when the amount of body fat starts to make it hard to feel the dog’s ribs, affects its ability to walk, or its breathing. So, the next time you cuddle your dog or cat you might want to make sure its ribs are still easy to feel. But how can a dog, or any pet become overweight. Thinking of dogs in particular, in their natural world they would roam the forest for hours on end just trying to find something to eat, if they were lucky. Then, when they did spot something, intense physical activity through hunting and chasing would follow. After some time spent eating their prey they would rest and sleep, only for the whole process to recur the following day. Now think of a modern pet dog. He lies around most of the day, maybe a half hour walk if he’s lucky in the evening, and dinner is served literally on a plate, often several times a day. Instead of a 6 hour trek to hunt, it’s a six foot plod to the feeding bowl, food guzzled in a few seconds, then it’s back to sleeping for the rest of the day. Till the next meal, at least.

This very sedentary lifestyle, and energy dense diet, rounded off with frequent treats from loving owners means the vast majority of domestic pets are overweight. And the reason why it occurs is because owners, with the best of intentions, “humanise” them, and attribute human behaviours and needs to them. But, just like in humans, an overweight pet is more prone to heart disease, diabetes, mobility problems and a shorter life expectancy.

Now, if you have an overweight pet, the only way to deal with it is by reducing their food intake and increasing their energy expenditure. It might be hard, but it is necessary. Just one more thing to bear in mind. My vet colleagues also told me that overweight pets are more often than not brought in to the clinic by…….overweight owners. Time to feel for your own ribs? Walking the dog every day might have even more benefit than you anticipated. And they’ll love you all the more for it.

We calculate obesity, and overweight, using the “body mass index (BMI)”. You can find out what your BMI is from lots of places, including on the home page of www.jennycraig.co.uk We traditionally consider a BMI of 25+ as being overweight, and a BMI 30+ as obese. Now, when you use this definition, there are indeed only 3% of South Koreans who are obese. But what I quickly learned from speaking with the Korean doctors, and which has since been recognised internationally, was that Koreans, and many other Asian peoples, develop health problems associated with overweight at a much lower level of body fat. They are in effect genetically programmed to be much lighter than Caucasian (European) people. Instead of health risk starting at a BMI of 25, as we use here in the UK, in Asian countries, the same level of disease risk cuts in at a BMI of around 23. Instead of the risks of obesity starting at a BMI of 30, in Asia it starts at a BMI of 27.5. Calculate the number of South Koreans with a BMI of 27.5+ and suddenly we were looking at a population where some 15% were, from a health perspective, to be considered obese. And that’s why the Korean doctors were so worried.

My first trip to Korea was followed sometime later by a second, to run training courses for Korean doctors on weight management. I enjoyed my time there immensely. Such a friendly, dignified, cultured, and fascinating nation. In some ways we are so different, and in others so alike. But since that time, as a general rule I encourage people to consider the following. If you’re Caucasian, and your BMI is 25 or over, you might want to think about losing weight. Your health risk is already unacceptably raised. If you’re of Asian, Chinese, or Indian descent, the same increased risk of disease starts with a BMI of 23, and although some tables might tell you your weight is normal, take it from me, my Korean doctor colleagues, and the WHO, it probably isn’t. Once you’ve decided that weight loss is important to you however, at this point the same rules apply to everyone.

On my first visit to Seoul, one of my new colleagues took me straight out for lunch. I was amazed at what was laid out in front of me. The table was set in traditional Korean style with 17 different, delicious dishes. Fortunately each was just a tiny portion. Sometimes quality is far more important than quantity.

The first time I experienced this was when I was much younger. Until my early 30’s I never had to think about my weight. A combination of youthful zeal and a busy social life left little time for weight gain. But a sports injury at 31 years of age which led to my leg being incased in plaster of paris for 9 weeks changed everything. From nowhere, so it seemed, I gained one and half stones. My energy balance equation had shifted, and with it so had my scales………..

I experience the same seismic shift every year. Several times a year if I’m honest. After summer, and over Christmas especially. You see, for me and perhaps most of us, my battle to control my weight is not a one-shot deal. It’s an attitude of mind, a lifestyle, maybe an obsession, albeit a healthy one at that. Because as soon as I take my eye off the ball, as soon as I forget to think, at least some of the time about how I’m living, it all starts to slip. Southwards, that is.

So, here I am again. Activity levels up, food intake down. Bit by bit my weight is dropping again. By around a pound a week. And that’s fast enough for me. I know I can do it. I always do. But my frustration is that I don’t seem to learn from my experience. Will Rogers, the populist humourist and satirist from the 1920’s once said that “good judgment comes from experience, and a lot of that comes from bad judgment”. I’m certainly experienced. If only I could teach this old dog some new tricks and develop some better, more pro-active judgment.

I know how to lose weight. I’ve helped countless other to do it too. And when it comes down to it the same rules apply to us all. But from my repeated bad personal judgment comes an experience, a belief, that weight loss is achievable for anyone. If you’re prepared and willing to turn bad judgment into good.

26% of men in this country ore obese, and up to two thirds carry excess weight. This in turn puts them at risk of heart disease, type 2 diabetes, and some forms of cancer. It can also lead to impotence, arthritis in the lower back, hips and knees, and can lead to sleep apnoea and breathing problems, not to mention low self esteem and depression. Cancer of the throat and mouth is more common in single men, in their 60’s, who have a poor diet, drink too much alcohol and are overweight. Prostate cancer is more common in obese men, but additionally, when it occurs, it’s seen to be much more aggressive in obese men too. Gout is very common too if you are overweight and a heavy drinker. And, needless to say, all of these conditions can be prevented, managed, or improved by better diet, exercise, and weight loss.

The screen test was a fascinating experience. Part of the plan is for the programme to engage men out and about in the towns and cities and to ask them, in full public view, about their health concerns. Now, I have often said that men are very private when it comes to their health. However, put a TV camera in front of them and it alls seems to change. I was amazed as we walked through the streets of London how many men were not just willing, but keen to talk to me, a stranger, albeit a medically qualified one, about their lifestyle, their relationships, their symptoms, and their worries. In fact, it was a humbling experience. It would be great to have the opportunity to be involved in this production. There is so much we can do to help men, of all ages, regain control of their lives and health. If only they knew how to. Fingers crossed.

Scientists in Amsterdam have recently made a gene-map of one of the oldest women to have lived. The lady, who has remained anonymous, died at the age of 115. Though she was born prematurely, and wasn’t expected to survive, she lived a long and healthy life, moving into a nursing home at the age of 105. What astonished scientists after her death was that she seemed extraordinarily young, had no signs of Alzheimer’s, and even before she died when she had a mental agility test they found she had the mind-set of a women in her 60’s. They are now busy trying to work out what aspects of her genetic inheritance made her so resistant to the effects of ageing. Now obviously that won’t be of much direct help to you and me, but who knows what new medications might arise from a better understanding of the very complex, and as yet, mysterious, ageing process.

Obesity, having a body mass index over 30, according government figures, reduces life expectancy by around 9 years. Most people would also agree that carrying excess weight also makes us look older. Reducing our weight back to normal can of course go a long way to regaining those “lost” 9 years. We may not be able to change our parents, but at least we can change our lifestyle. But it’s all about balance isn’t it? A few months ago, I had given a talk to a group of older people at a local community centre, and I had spoken, among other things, of the dangers of alcohol. When we opened up to questions from the audience the first question was from a very sprightly 97 year old lady. She wanted to know whether, for the sake of her health, she should stop her daily routine, which she’d adopted some 30 years ago, of having a tot of whisky before bed each evening. I couldn’t help but smile. What would you have told her? I think she must have chosen her parents well.

Ten percent body weight loss, around 14 pounds or a stone of weight for many people, can have a dramatic effect on diabetes. Research has shown that in newly diagnosed type 2 diabetics 10% weight loss would reduce blood sugar levels to normal in around half of them. In my Practice we see this all the time. After only a few weeks of weight management fasting glucose can return to normal, reducing the need for new diabetes medication or even stronger doses of that already prescribed. But not only does diabetes control improve, the sense of self-satisfaction and empowerment that patients can achieve is dramatic too. John is a 52 yr old who developed type 2 diabetes a few months ago. I saw him again recently. After 2 stones of weight loss his sugar level is now normal, and he’s looking and feeling great. He asked a very specific question. “Has my diet beat my diabetes?” My answer? “Yes, completely, for now at least”. Diabetes does develop over many years and in time John might require added help. But he has delayed the need for medications, and the unpleasant complications of diabetes, if not for good, for many years at least I’m sure.

The principles of weight loss in people with diabetes are no different to those without. Moving about more and eating less are still key. But people with diabetes do find it more difficult. More difficult because of the “insulin resistance” they have, but more difficult too because many of the medicines we use to treat diabetes actually cause weight gain. Ironic really, that weight gain causes diabetes and the treatment we use sometimes makes the weight gain worse! Insulin, gliclazide, and the “glitazones” are the most common culprits. But so too can other related medicines we use, such as statins for cholesterol, and beta blockers for blood pressure. You see it’s not just high blood sugar that causes problems for people with diabetes, its high blood pressure and raised cholesterol too. And guess what, both of those problems can also be helped with 10% of body weight loss.

I left the seminar happy that I’d had the chance to spread the word. Yes, even doctors need to be reminded that type 2 diabetes is in large part a “lifestyle disease” and one of the best ways of tackling it is through improving our lifestyle, losing weight, and becoming more active. Going by the questions they asked after my talk they’d already started to think about helping their patients lose weight. I hope so. It’s a win-win situation. So, if you have diabetes and want to lose weight, you need to know that it’s possible, it’s safe, and it’s very powerful. It’s never too late to start. I’d suggest you talk with your doctor or practice nurse straightaway though. That way they can work with you, and make sure your medication is adjusted appropriately as you progress. Once your diabetes starts to improve, make sure your doctor knows about it. Nothing beats a good case history to reinforce the message!

As a nation we don’t have the best of diets. As few as one fifth of us manage to eat our recommended five portions of fruit and veg a day. We exercise too little. As a result 26% of men and women in this country are clinical obese, and as many as two thirds of us are overweight. But obesity is not just a medical problem. It’s a social problem. The biggest preventable risk to you becoming obese is not the cost of a burger or a bag of chips. It’s where you live. It’s the job you do. It’s the choices you have. A fat tax would be unfair on those who most need the help it is supposed to create.

So the news that the Danish government has proposed that any food product which has more than 2.3% saturated fat should be taxed in order to tackle their obesity problem got me going again. I was invited on to BBC Radio 4’s Eddie Mayer show to contest it. I made it clear that I think this “fat-tax” is unfair, unmanageable, and won’t work. I was invited to have a second go in the Daily Mirror the following day. Fat, saturated or not, is fat. Saturated fat is less healthy that unsaturated fat, but it’s no less calorific. Equally of concern is the amount of salt and sugar in the food that we buy. But a fat tax won’t do anything to reduce that.

What I’ve learned over the years is that behaviour doesn’t change through criticism. It changes through understanding, and opportunity. A fat-tax might well reduce consumption of unhealthy foods in the short term. But there is no proof that it will have any impact on obesity levels whatsoever. Wouldn’t it be better to look at reducing taxation on healthy foods, to create an incentive, to make it easier for everyone to afford them? At the moment you don’t pay VAT on a piece of fruit. But you do if it’s been processed. So fruit juice and smoothies already have a kind of fat-tax and are regarded by many people as prohibitively expensive.

We have to make it easier for those at risk to live healthier lives. And that means addressing the fundamental underlying social and economic causes. Not punishing those who have already fallen through the net. Yes, it’s about personal responsibility. But it’s a shared responsibility too. Ok, I’m stepping off my soap box now…………..

This news might come as a shock to today’s modern men, those hands-on dads who are justly proud of their role in looking after the little ones but who don’t want to lose their masculinity in the process. But in fact it should reassure more than alarm. Because the very fact that less testosterone makes a man perhaps more able to care for children would suggest that we have in fact evolved over millennia to do exactly that – care for our children. In other words, it’s natural. As one commentator put it, the changes in testosterone level might make a man “more sensitive to the cues given by small children, and less to those of a woman he meets in a restaurant”.

Now, what’s that got to do with a blog about weighty issues? Here’s something to think about. For me the most amazing thing about this story is not that testosterone levels decrease, but about how they decrease. Because the research suggests that rather than testosterone changing dad’s behaviour, it is dad changing his behaviour that lowers his testosterone! In other words his lifestyle is changing his physiology.

Appetite is controlled in large part by hormones, ghrelin, leptin, and others. So much attention has been given to searching for new drugs to aid weight loss by interfering with those hormones. So, what if we could modify their blood levels ourselves by changing our lifestyle first? What if we could regain control of our food intake first by actively modifying our behaviour, and then, as a secondary effect, by controlling our own hormone levels? I’m intrigued by the very thought. I’ll research further and let you know what I find out.

We continued our chat by going back to basics. How regular was his eating pattern? Answer, chaotic. Did he eat a low fat diet? Answer, sometimes. Did he watch his portion sizes? Answer, nope. Did he regularly exercise? Answer, yes, once a week. Five-a-side football with his mates. But what really struck me was just how little his lifestyle had changed in the three years. He’d used the tablets as his main route to weight loss. And that’s the most disappointing thing about it. No lessons had been learned, no habits changed.

It took a while to persuade my new patient that medication alone would never lead to long term weight loss. In fact in most clinical studies drug treatment can only help with a few pounds of weight loss over and above that achieved by good old-fashioned diet and exercise. And given that no-one would want to be on medication for any longer than necessary, they have to be used short term, and if nothing else changes, any weight lost will be short term too.

Now, prescription medication is a valid aid to weight loss, in some circumstances, and I continue to use it selectively in a few of my patients. But in my experience, the people who lose most weight, and keep it off, are always those who make significant changes to their lifestyle, at the beginning, in the middle, and after their weight loss programme. Good health takes effort. It has to be worked at. There’s no quick fix. But like most things that have to be earned, it can be very rewarding indeed. I think we parted on good terms. I’ll know if he returns as agreed next month for a further chat. Then again, he might prefer to see someone less challenging!

A normal pregnancy might cause weight gain of between 28 and 35 pounds, around two and a half stones. Only a small part of that is the baby itself (7 pounds). The rest is amniotic fluid, increased maternal blood volume, and some of it is increased body fat, an energy store for mum for when she’s breast feeding. I would never advise weight loss during pregnancy. It’s too risky. It makes it difficult to ensure adequate micronutrients, minerals and vitamins, essential for healthy baby development. So although weight loss before pregnancy can often be advisable, during pregnancy it’s time to take a pause. The emphasis then has to be on a healthy balanced diet, plenty of moderately vigorous exercise, and an aim towards slightly less weight gain than normal, to around 20 pounds over the course of a pregnancy. And all to be done under the guidance of your doctor or midwife. That will help ensure a healthy start for the baby, and a safer pregnancy and delivery for mum.

After childbirth it’s appropriate for women who have a need to lose weight to start a weight loss programme 6 weeks after delivery. The same applies to women who breast feed. Breast feeding can bring great joy and wellbeing to many new mums and needs to be supported. The one difference it makes therefore is that we would usually aim for an extra 400-500 calories of intake each day to support that. Life with a new baby is full of challenges and for many new mums looking after their own health can often slip down their list of priorities. But the start of family life shouldn’t mean that mum stops caring for her own well-being. In fact, I could argue it’s never been more important. As you plan your new baby’s next nutritious meal, and as you plan their next activity, and do whatever you can to keep them healthy, please remember you deserve the same care too.

So, to the point. Well, the very sight of the weighed down branches, laden with ripe fruit, got me thinking. How good is a peach? An ideal if exotic alternative snack for those between meal hunger pangs, it’s only 40 calories. But even better, it’s fat-free of course, it has no cholesterol, and in addition to being rich in fibre, it contains large amounts of niacin and potassium and is rich in vitamins A and C. In fact the only thing you could say against a peach, is that it is quite high in sugar, containing around 3% of an average individuals daily requirement. But taking it all in context, peaches can form part of a healthy, nutritious, and varied diet. As long as they form part of a balanced diet you can enjoy them with impunity. Your conscience can be clear. No need to be “peached” for eating a peach.

Summer and early Autumn is a great time to start eating a healthy diet. An abundance of fruits are available, locally grown and on sale, if not in your own garden. And any suggestions as to what I can do with a whole tree’s worth of ripe peaches would be welcome…………

Finding the right motivation is important. I’ve written before in this blog about the importance of exercise in keeping weight under control, but also in fending off other health problems like heart disease, type 2 diabetes, and some forms of cancer. However I make no apology for bringing it to your attention again. It’s that important. But, a report from Macmillan Cancer Support says this week, exercise is important not only in preventing some forms of cancer, it’s also important in improving outcome levels. Their research shows that women with a diagnosis of breast cancer can reduce their risk of disease recurrence by 40%. Men with prostate cancer can reduce their risk of dying by 30%. And bowel cancer patients can reduce their risk of dying by up to 50%.

How much exercise? Same as for everybody else to maintain good health, around two and a half hours a week. They also showed that those undergoing treatment for cancer actually felt better and had more energy, not less, if they exercised regularly during treatment. Exercise can reduce the risk of cancer recurrence, but is also important in preventing weight gain and other problems: just because you are unfortunate enough to have been diagnosed with one problem doesn’t mean you have to allow yourself to succumb to another. Your health is still important to protect, for now, and for the future.

Prevention is always better than cure. But even after diagnosis, the importance of regular, moderately vigorous exercise can’t be understated. I’m fortunate. I don’t have any health problems, and I’m doing my best to make sure I don’t develop any soon. But making exercise a part of my daily “routine”, even if it does mean an early start several times a week, is a lot easier when I know why I’m doing it. Health today? Sure. And health tomorrow. Here’s hoping.

I enjoy quite active sports. Summer is for water sports. But the rigours of sailing even my little dingy are physically demanding. A sudden pain in my left shoulder a few months ago should have been enough of a warning shot over my bow. But, being a stubborn (some would say stupid) male I choose to ignore it. Too busy, too “hard” as my kids would say, to admit that I needed some professional help. I could still sail. I could still water-ski. I just couldn’t do either of them very well. No change there then. But the difference now was that in addition to not being very good, it was hurting me! When it started to disturb my sleep I knew my goose was cooked. I had no choice. I had to make the call.

Karen is a very experienced sports massage therapist. She immediately knew exactly what was causing my discomfort, and I’m now on a regular programme of soft tissue massage and home-based exercises. Already after two treatments the improvement is palpable. I still sail, and I still water-ski, and still badly, but they don’t hurt as much, and my sleep is no longer disturbed.

All this serves to remind me just how fragile we are, how one torn muscle can impact on so many activities. When we embark on a new weight loss lifestyle, changing our diet is key. But so too is becoming more active. A salutary reminder to us all then that we need to care for our bodies, treat them with respect, and when needed, get the attention and help we need. If you are just starting out on an exercise programme, maybe you haven’t done any exercise for some time. It might be worth talking it through with your doctor or practice nurse. As Karen my therapist said to me today, “you might think you’re hard doc, but you’re only human, and humans break sometimes. Next time come and see me at the beginning, not when it’s already becoming too late”. Wise words. I’m suitably told off!

Obesity is a product of our genetic inheritance and our environment. Put simply, while our genes might “load the gun”, our environment “pulls the trigger”. By environment I mean the way we live our lives, the place we live our lives, and the influence of all those around us. The evidence is very clear. Someone who lives in the rough part of town, who has little or no income, and who is faced with little choice, and therefore little control over their lives, is far more likely to have a weight problem. Changing the environment might be akin to changing society, but if the so-called “Big Society” is to have any chance at all it needs Government to take the lead. An individual can’t make their neighbourhood streets safer on their own. They can’t create work opportunities in the town. And they can’t suddenly find they are a font of knowledge about how to live a healthier lifestyle.

So, in my opinion, the first responsibility must fall to government. That said, while we’re all waiting, and we’ll wait a long time, the only resource we really have is ourselves. And we owe it to ourselves to take the lead in our own small part of this big world we live in. Health starts at home. Small steps can, in time, build up to large changes. If we could all make a simple resolution, to think at the start of every day, “what could I do today that would be good for me and good for my family?” And, more to the point, if we acted upon that thought, can you imagine what a huge change would begin to arise in our own lives, our families, and our communities?

Breast cancer is, to a small degree, an inheritable condition. But like many other cancers it can also be heavily influenced by lifestyle, and some new research has shed light on what women can do to significantly reduce their risk. Many breast tumours are what doctors call “oestrogen sensitive”, meaning that their growth is in part stimulated by the naturally occurring female hormone, oestrogen. Having too much oestrogen can increase the risk of developing breast cancer by up to three times. Smoking seems to increase the amount of circulating oestrogen. So too does drinking alcohol to excess. But researchers at the University of Oxford, whose work is published this month in the British Journal of Cancer have shown for the first time that being overweight has a stronger influence than any other lifestyle factor. Fat cells have many properties, some helpful, some not. They also secrete oestrogen, and it seems women with a high level of body fat secrete more than they need, and so increase their risk of developing breast cancer. I’ve known for a while that a high saturated fat diet increased a women’s risk. So too, and more directly it seems, does being overweight.

Unlike our genetic inheritance however, being overweight is something we can change. There are so many good reasons why we would want to return to a healthy body weight. To look and feel good today. And to secure a safe, and healthier, future.

When I was a medical student I was taught that gall-stones were more likely in people who were, as the “5 F’s” state, “fair, forty, female, fertile, and……fat.”. I often recall the wise words of one of my professors who, at the beginning of a lecture, warned us that “half of what I am about to teach you will one day turn out to be untrue. The only problem is I don’t know which half it is”! And so when I reflect back on the “5 F’s” I have seen no evidence that fair people are more likely to have gall-stones. And though the risk increases with age I’ve had patients who’ve developed gall-stones in their 20’s. Certainly they are more common in women. And even more common the more pregnancies they have had. So it stands true that there are at least 3 F’s. So what about the fifth, fat? Fact or fiction? (those F’s don’t count!).

It’s seems to be fact. The more overweight you are, the greater the risk of gall-stones. A body mass index of 30 (roughly 2 stones overweight) increases the risk by 4 times. A BMI of 40 (maybe 5 stones overweight) increases the risk by 7 times. The reasons for this are not entirely clear. It’s not just weight that has a bearing, it’s also the way fat is distributed. Central fat, or a bulging waistline, seems to carry a greater risk overall. It’s probably because being overweight raises levels of cholesterol in the blood. Most gall-stones are formed from crystallised cholesterol in the gall-bladder. The irony is that even though being overweight increases the risk, losing weight might actually increase your risk yet again. But evidence shows that it’s rapid weight loss, or after weight loss surgery that the risk increases. There’s some evidence in fact that a more gradual weight loss, of around 2 pounds a week on average, will actually decrease your risk. Like most things medical, prevention is better than cure, and the best way of decreasing your risk of gall-stones is to work towards a return to normal body weight through steady, gradual weight loss.

Rachel has now decided that she wants to live a healthier lifestyle and lose a bit of weight. I’m sure she’ll be successful. She might not be at risk of gall-stones any more, but she’s now acutely aware of the other health risks being overweight can pose. And dieting could never be as tough as going through childbirth. Right?

A new report by the Trust for America’s Health makes gloomy reading. The number of obese US adults rose in 16 different states last year, with a dozen states now having obesity levels above 30%. Mississippi is the fattest state at 34.4%, and Colorado is the least, but still with obesity rates of 19.8% – the only state with a level below 20%. Not one state has achieved a decrease. “Today, the state with the lowest adult obesity rate would have the highest rate in 1995” said the Trust’s chief executive, Jeff Levi. “Over the last two decades people in the US have been eating less nutritious food and more of it and at the same time activity levels have fallen.” And to reverse this trend Jeff Levi added “Will-power won’t do it alone. We’re going to have to make healthier choices easier”.

Here in the UK we’ve also seen a steady increase in obesity rates with general agreement that around 25% or 1 in 4 adults are now obese. And of course the effects of that are many and include a rapid growth in rates of type 2 diabetes, heart disease, mobility problems and some cancers. The past decade has seen significant steps taken at a national level to work towards reducing levels of overweight and obesity. And we must make sure they continue. But, as I repeatedly tell my patients, we can’t wait for the government to do this for us. We have to take action for ourselves. Time to stand up then, take stock, and resolve to make those choices easier for ourselves. Will-power alone will not solve the problem. We need to enlist the right kind of support. But making a decision to change some of our lifestyle habits and start making those “healthier choices” is the only way to start.

Everywhere you go now it’s customary to see people carrying a bottle of water with them. It might seem appropriate at the gym, or when out on a long walk, but more and more people just like to have some water with them. So, how much “water” do we really need? Everyone will have heard or read the exhortation for us all to drink “6 pints a day”. In fact it’s quite misleading. As a guide women need 2 litres of water a day (just over 4 pints), and men around 2.5 litres (5 pints). Larger people need a bit more, and more active people might need more again, but it’s a guide. And of course in warmer weather we all need more fluid intake. And it doesn’t just have to be water. Tea, coffee, and fruit juices all count. And even the water content of fruit and vegetables counts – yet another reason for eating more fruit and veg!

Fruit and veg are largely made up of water! A banana is 74% water, grapes 81%. Pineapple is 87% water, and strawberries are a massive 92%. Vegetables are just the same. Carrots are 87% water, broccoli 91%. Peas are 79% water, and tomatoes 94%. That’s another reason why they are so helpful when trying to lose weight. Rich in fibre, low in calories, and stuffed full of water they can help to quell an over-active appetite. So, to stay healthy, and enable you to become more physically active, make sure your water intake is sufficient. It’s hard to drink too much, but bear in mind there are lots of sources of water and they all count. As a rule of thumb if you start to feel thirsty, you’re probably already becoming dehydrated. When you are in doubt if what you feel is hunger or thirst, opt first for thirst and see if after a long drink you start to feel better and the “urge” fades. You might find you don’t need to eat so much. Unless it was some more vegetables of course…………….