As Your Doctor, I Won’t Indiscriminately Give Weight Loss Advice Anymore

https://www.healthline.com/health/wont-prescribe-weight-loss
Written by Dr. Joshua Wolrich, MBBS, MRCS on May 10, 2019
Weight loss goals aren’t risk-free.

Fact Checked by Jennifer Chesak, April 11 2019

How we see the world shapes who we choose to be — and sharing compelling experiences can frame the way we treat each other, for the better. This is a powerful perspective.

As a doctor, I have a professional duty of candor. This means it’s my responsibility to be open and honest with you when something goes wrong with your care.

It’s with this duty in mind that I want to swallow my pride and admit something.

I’ve judged patients based on their size. I’ve deemed overweight patients less worthy of compassion because I considered them to be responsible for their ill health. I’ve treated symptoms such as pain with scepticism despite having no good reason to do so.

I’d love to justify all of this by just saying I didn’t realize what I was doing, yet that wouldn’t be true. What I now know to be blatant weight stigma I thought was just being “cruel to be kind."

 I was wrong. I’m sorry.

Prescribing weight loss isn’t without risk

Let me explain where I stand before we continue. Weight can have a negative effect on a person’s health. I’m not here to pretend that’s not the case.

But the more I learn about the complex relationship between weight and health, along with the inherently problematic nature of weight loss itself, the more I find myself steering clear of it in favor of encouraging other health-promoting behaviors such as exercise.

My job as a doctor is to try and improve the health of my patients. But if I indiscriminately prescribe weight loss without an understanding of the nuance and potential harm my advice can have, I’m not doing my job properly.

Let’s think about this in a different way: High blood pressure can increase the risk of having a stroke, heart attack, or both. We often prescribe medication to try and reduce these risks.

If a drug came along that promised to reduce blood pressure but ended up doing the opposite in more than half of those who took it, doctors wouldn’t even consider continuing to prescribe it.

So how does this relate to weight loss? Well, not only does dieting rarely work, but it’s not a neutral intervention: It’s a risk factor Trusted Source of eating disorders in both adults and children 

Despite the exact rates being difficult to clarify, it’s commonly accepted that eating disorders carry the highest mortality rate of any mental illness. Sounds like a pretty solid risk to be aware of to me.

The idea that the health benefits of successful weight loss far outweigh the risks has a fair bit of unpacking that needs to be done.

Scientific literature suggests that more than half of people who lose weight through dieting regain it within five years, with at least a third of them ending up at a higher weight than they started at. It’s likely that outside a study, this number is higher.

Why? Because people who take part in weight loss studies are inherently better supported than those attempting to lose weight on their own. Having someone check in with you on a regular basis makes a massive difference, especially when that person is a registered dietitian or nutritionist.

WILL LOSING WEIGHT ALWAYS IMPROVE HEALTH?Our supposed “gold standard” BMI measure is terrible, especially for weight-related health. That “healthy” range between 18.5 and 24.9? Utter nonsense. The BMI scale is only useful at the extremes, and since when are we in the habit of using the extremes to make blanket rules?

When we try and work out at what size someone’s health will actually improve through weight loss, the answer is a lot less obvious than what you might first think.

Trying to explain why the rate of sustainable weight loss is so poor is something that researchers have written numerous papers on, but it always comes back to the multifactorial nature of obesity itself: energy intake, low physical activity, poor sleep hygiene, genetics, poverty, food deserts, etc.

When only one of these factors is addressed, should we really expect the rest to just stop having an effect?

Health is multifactorial. Weight loss can improve health, but it won’t always. Remember that

It’s OK to hold both in tension.

Blanket weight loss prescription contributes to weight stigma

As doctors, our entire practice is about balancing risk. Prescribing medication? Benefit versus risk. Performing an operation? Benefit versus risk. Advising weight loss is no different, yet we often don’t see it as such.

Instead of leading the change from a weight-normative to a weight-inclusive approach to health, we’re trailing far behind. Doctors, nurses, psychologists, and medical students have all been shown to harbor negative attitudes toward their fat patients, including believing them to be lazy, undisciplined, and unattractive, to name but a few.

It’s concerning how early on this starts too. A survey of more than 4,500 medical students showed that the majority exhibited implicit (74 percent) and explicit (67 percent) weight bias.

This is incredibly concerning and needs to change. When a person is discriminated against or stereotyped due to their weight, it has numerous negative health effects, both mental and physical.

From depression and eating disorders to increased blood pressure, and chronic inflammation, weight stigma is certainly no joke.

Weight stigma has inherent potential to negatively influence the quality and content of the care that patients receive.

First do no harm

What about the argument that this is all canceled out by the fact that weight stigma “encourages individuals to lose weight”? Well, the literature would disagree with that.

People who experience weight stigma are more likely to avoid physical activity, increase their food intake, and actually gain weight. All in all, seems counterintuitive to me.

For the more scientifically astute among you, almost all of these associations were independent of BMI. This leads to the question: “What if weight stigma had more of a negative impact on health than overweightness itself?”

I don’t have the answer to that, but I’m going to keep asking it.

If we as healthcare professionals are going to discuss weight loss with our patients, we need to get much better at it, and fast. Otherwise we may be doing them more harm.

Dr. Joshua Wolrich, BSc (Hons), MBBS, MRCS, is a full-time NHS surgeon in the United Kingdom with a passion for helping people improve their relationship with food. One of the few men in the industry addressing weight stigma and diet culture, you can find him on Instagram regularly combating spurious nutrition information and fad diets while reminding us that there’s so much more to health than our weight. Keep an eye out for his upcoming podcast, “Cut Through Nutrition,” for an in-depth look at the appropriate use of nutrition in medicine.

Trusted Source

Do you live on the wrong side of your time zone? People in the west of each region sleep less, make less and are sicker, study reveals

https://www.dailymail.co.uk/health/article-6941273/People-west-time-zone-sleep-make-sicker-study-reveals.html?ito=social-twitter_mailonline
By NATALIE RAHHAL DEPUTY HEALTH EDITOR FOR DAILYMAIL.COM
PUBLISHED: 23:17 BST, 19 April 2019 | UPDATED: 23:18 BST, 19 April 2019

• Not getting enough sleep has been linked to poorer health and productivity 
• Even subtle changes in light hours - like day light savings time - are linked to higher rate of heart attacks 
• A new study from the University of Pittsburgh and Universita della Svizzera found that people go to bed later and get less sleep in the west of each time zone
• This was linked to lower wages and higher rates of obesity and disease  

How much sleep you get a night may depend on where in your time zone you live, a new study suggests. 

And that, in turn, may help to shape your overall health. 

People that live on the wrong side of a time zone see more sun later into the evening, go to bed later, get less sleep, and may wind up with more health (and financial) problems.

Researchers at the University of Pittsburgh and the Universita della Svizzera in Italyfound that people who live on the edge of a time zone where the sun sets latest are at the greatest risks for breast cancer, obesity, heart attack and diabetes. 

People who live on the West side of each time zone go to bed later (dark blue), get less sleep, make less money, and suffer more diseases on average, as a map from the new study shows 

Public health and sleep experts have been sounding the alarm that the US - and many countries the world over - are in a sleeplessness epidemic. 

And being underslept is a known risk factor for health problems. 

Even small changes like daylight savings time are associated with higher rates of heart attacks. 

Similarly, we know that women rates of breast cancer are higher among women who do shift work. 

Irregular work hours disrupt the circadian rhythms that dictate our biological clocks which contribute to the fluctuations of our hormones. 

But the new study, published in the Journal of Health Economics, suggests that more minute differences in our days and schedules can shape our sleep schedules and health outcomes.  

Moving westward, the sun sets later and later into the day, and even sets later within the time zone. 

So within a single time zone, the sun sets a over an hour earlier on the east side than on the west side.  

Sleep experts say that the constant presence of artificial lighting has made it far more difficult for the average person to sleep than it once was. 

Even with all of that additional light pollution, the sun's presence in the sky still has powerful pull on us toward wakefulness or sleep. 

The sun sets at a later time on the west side of each time zone (darker blues), as a map from the new study shows 

Light triggers a chemical that travels to the brain and tells us what time it is and what it is supposed to be doing - which, in the presence of light, is being awake. 

As long as the brain's component of the biological clock, called the hypothalamus, thinks it's daytime, it will in turn instruct the endocrine to hold the melatonin, the hormone that helps trigger sleep. 

So the longer the sun is up to kick of that chain of events, the longer our we'll stay up. 

Even if modern life didn't require us to be up early for work, school and our various other daytime responsibilities, once the sun comes up, the whole waking system gets kicked off again. 

The new study showed just how precise that clockwork is - and how significant its effects could be.  

The researchers compared data on average daily sunset times across each of the four time zones in the US to the average bedtime of people living in each county. 

Average bedtimes per county only varied by about 20 minutes, ranging from 11.09pm on the early side to 11.30pm. 

But even that variation adds up fast. If you fall at the late end of of the bedtime spectrum, but get up at the same time (on average) as everyone else, you lose out on 113 hours of sleep in a year. 

This variation aligned almost uncannily with shift in sunset times from east to west.   

And a further assessment just confirmed what sleep scientists have long said about the negative effects of less sleep on health and economy. 

In counties with late sunsets and bedtimes, more residents got an average of six hours of sleep or less, and more likely to get a full, luxurious eight. 

In those high-light low-sleep zones, obesity was 21 percent more common and people were 11 percent more likely to be overweight.  

Those combined risk factors added up to higher rates of poor health outcomes too.

Heart attacks, diabetes and breast cancer were all more common on the western ends of time zones, too. 

These underslept zones even hurt more financially, with wages falling about three percent short of the east sides of time zones. 

As a side note - or perhaps a consolation for the sleepless west-siders - the study authors found that there might be environmental and biological underpinnings to the notion of 'work hard, play hard.' 

'Individuals may derive more utility from enjoying leisure time with more natural light in the evening,' they wrote. 

Whether that quality of life distinction is worth the lost wages, weight gains and disease was not discussed in the paper. 

Instead, the authors encouraged people who live on the wrong side of their timezone to try to offset their zip codes with pro-sleep social schedules. 

How You Can Lower Your High Blood Pressure — Naturally

https://health.clevelandclinic.org/can-lower-high-blood-pressure-naturally/?utm_campaign=cc%20tweets&utm_medium=social&utm_source=twitter&utm_content=121818%20blood&cvosrc=social%20network.twitter.cc%20tweets&cvo_creative=121818%20blood
Contributor: Leslie Cho, MD

Expert tips on how to take matters into your own hands



About 30 percent of U.S. adults have high blood pressure – roughly 76 million Americans. It’s one of the most common diseases, but there’s still a lack of understanding about the disease.

It’s important to diagnose and treat high blood pressure, which is also known as hypertension. It increases the risk of heart attack, stroke, heart failure, kidney failure and death.

Diagnosis
First and foremost, the optimal blood pressure is less than 120/80 mmHg. The top number is the systolic blood pressure, and the bottom number is the diastolic blood pressure. Pre-hypertension is systolic blood pressure 120 to 139 mmHg or diastolic blood pressure 80 to 89 mmHg.

Hypertension is diagnosed when your blood pressure is greater than 140/90 on two or more office visits after an initial screening.

However, in the European guidelines, diagnosis of hypertension is made using either ambulatory blood pressure monitoring or home blood pressure monitoring.

This approach is especially helpful for patients who have what’s called “white coat” hypertension. Some patients get very nervous, excited or agitated in the doctor’s office, and their blood pressure tends to be high. However, at home, their blood pressure may be completely normal. These patients are good candidates for home monitoring.

Risk factors
The risk factors for hypertension are age, obesity, a diet high in salt, alcohol, a sedentary lifestyle, personality traits, race and family history.

There are other important causes, too, such as over-the-counter nonsteroidal anti-inflammatories (like those sold under the brand names Naprosyn, Alleve and Advil), decongestants, weight-loss medications, birth control pills and chronic pain that can increase blood pressure. Another common cause is untreated or undiagnosed sleep apnea.

Natural ways to lower blood pressure
If you were diagnosed with high blood pressure, what can you do to lower it naturally? Diet and exercise are key, as well as eliminating things that may be increasing your blood pressure.

That’s right: Exercise, diet and losing weight can truly lower your blood pressure. Pills are supplements, not a substitute for treating high blood pressure.

Diet
Most people only need 1,500 mg of sodium a day. Did you know there are 2,300 mg of salt in one teaspoon?

Before you add salt to your meal, think about that. The average American’s diet has 3,400 mg of sodium a day! People with blood pressure issues should ideally get around 2,000 mg a day.

A good diet to follow to lower your blood pressure is the DASH diet, which stands for Dietary Approaches to Stop Hypertension. It’s an eating plan that emphasizes vegetables, fruit and low-fat dairy, as well as whole grains, fish and reduced amounts of fat and red meat.

If you want to make an impact on your blood pressure, you also have to become a label reader.

Remember to read serving size. Ignore the percent daily value, and focus on the amount of sodium per serving.

Also, reduced sodium just means it’s 25 percent less sodium than the comparable food product.

In general, use fresh and frozen ingredients, and choose low-sodium soups, meats, cheese and condiments — ketchup has a lot of salt! Bread, too, has a lot of sodium, so be careful.

There are numerous salt-free seasonings, such as basil, cinnamon, chili powder, cumin, dill, ginger, marjoram, nutmeg, oregano, parsley, rosemary, sage, thyme and turmeric. Use those if you can.

Exercise
Finally, please exercise. Losing weight and exercising consistently can lower your blood pressure by 5 to 10 mmHg.

Aim for 75 minutes of vigorous exercise a week or 150 minutes of moderate exercise a week to see a benefit. Find what you like to do, and do it consistently.

There is no magic exercise; focus on what you like to do and don’t mind doing most days of the week.

This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.