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Dr Suzie Edge started the What If Health podcast to explore people’s thoughts and experiences on many aspects of lifestyle medicine.

It was exciting to be invited on and, well, we could have continued for hours! Fortunately for listeners, Suzie’s editing skills mean it’s only an hour long and it’s out today. You can download it from iTunes or Soundcloud or hear it on the What If Health website.

We talked about workplace health and office cake, of course, but also the challenges of the general food environment, the Public Health Collaboration, the Dept of Health’s new prevention focus, dietary guidelines, lifestyle medicine and more. 

Hope you enjoy it!
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Main photo source: https://www.lifestylemedicine.org/What-is-Lifestyle-Medicine

Lifestyle medicine is becoming more prominent.  It’s an approach to medicine which uses lifestyle changes (for example in nutrition, physical activity, sleep, stress management and social support) to prevent, treat and reverse chronic diseases.  

In the UK, GPs Rangan Chatterjee and Ayan Panja are well known to TV viewers for BBC1’s Doctor in the house and Street doctor respectively, both using a lifestyle medicine approach to improving health. Dr Chatterjee’s lifestyle medicine book The Four Pillar Plan topped the book sales charts for weeks when it was launched earlier this year and Dr Aseem Malhotra and Donal O’Neill’s 2017 book The Pioppi Diet – A 21-day lifestyle plan continues to be a best seller. GP Dr Rupy Aujla’s website and accompanying book The Doctor’s Kitchen promotes food as medicine and he has 120,000 followers on Instagram. Every week the media report new research, books and stories about the importance of sleep and physical activity, mindfulness and managing stress on our health and wellbeing. And updates about the gut microbiome’s role in physical and mental health are very exciting. So it appears that the lifestyle medicine approach might be starting to make sense to the public.

But although professional lifestyle medicine associations are established in the UK (British Society of Lifestyle Medicine (BSLM)), Europe and internationally, it looks like GPs and other healthcare professionals are not always supported in their efforts to use a lifestyle approach with their patients.  


At the recent Inspired Medics Lifestyle Medicine Conference in Leeds, I spoke to several GPs who were keen to use a lifestyle medicine approach but were not supported by their GP partners. “It’s not proper medicine” and “you were trained to treat sick people with medication not to advise them on nutrition” were typical admonishments.  This is interesting because the use of nutrition in medicine is not exactly new. Hippocrates is reported to have said, “Let food be thy medicine and medicine be thy food”…


However, as a 2017 BMJ (British Medical Journal) article entitled Students need to understand the role of diet in health promotion and disease prevention pointed out, “The National Institute for Health and Care Excellence guidelines state that a first line intervention for diabetes, obesity, and high cholesterol is to give “lifestyle advice”—but this phrase is so vague that it is left up to doctors and patients to define it and, potentially, ignore it” (my bold text)(1). Supporting this comment, many questions to the panel of speakers at the end of the Inspired Medics conference asked whether a lifestyle approach met NICE guidelines and asked for guidance and evidence to support lifestyle medicine efforts.   One of the speakers, Dr David Unwin, a GP from Merseyside, reminded delegates that NICE recommends that with type 2 diabetes patients, an individualised approach (para 1.3.1) and low glycaemic index sources of carbohydrate (para 1.3.3) should be used – both lifestyle medicine approaches.


Dr Unwin’s presentation outlined how he has worked to improve the health of type 2 diabetes patients in his surgery (not an affluent area) using lifestyle advice, all within the usual 10 minute appointment slot. In fact, not only is patients’ blood sugar successfully managed, around half could be said to be in remission, ie technically no longer diabetic. So successful has this approach been over recent years that his surgery now has the lowest per patient spend on diabetes medication in the area, spending around £40,000 less than the average surgery in the CCG (Fig 1). If this could be replicated by all NHS GP surgeries, it would save the NHS £375m annually on diabetes medication alone – around half of the current total spend(2). But diabetes medication represents only about 6% of the cost of type 2 diabetes(2).  So if type 2 diabetes is being put into remission, the total costs including non-diabetes medication (cardiovascular disease medication constitutes the largest proportion of prescription costs for people with diabetes) as well as spend on short and long term complications will also reduce.


Fig 1: Dr Unwin’s Northwood Surgery diabetes mediation spend compared to other surgeries in the same CCG (reproduced with permission) 

Several conference delegates I spoke to had moved to the private sector, were working part time or had retrained in a lifestyle-related speciality such as functional medicine. They had suffered burn out or had lost their GP mojos through the strain of trying to treat patients within a 10 minute appointment, following protocols that tackled symptoms but not root causes.  Some of the speakers mentioned this, too – that becoming a doctor to help people but never seeming to improve patients’ health was very wearing. Last year, Rangan Chatterjee and Ayan Panja set up Lobe Medical to run Royal College of GPs-accredited lifestyle medicine courses. They have said that course attendees report increased energy and satisfaction at work, partly because they can see they are making a real difference to their patients. We are short of GPs so it makes sense to keep and motivate the ones we have and encourage medical students to take an interest, both in general practice and lifestyle medicine. In fact there is a growing student-led movement to improve nutrition training for medical students. Nutritank was originally set up as a student society by Bristol University medical students to promote awareness of the need for nutrition training for medical students. It has now spread to 15 UK universities plus others in Europe. Bristol and Cambridge universities are reportedly redesigning their student curriculum to increase nutrition tuition.



A parallel education focus is encouraging UK universities to include physical activity science and therapy as part of medical and health-based curricula. A recent report commissioned by Public Health England and Sport England found universities recognised the value of physical activity education for health professionals. Even more important, they seemed keen to make the changes. Report author Ann Gates, of physical activity advocates Exercise Works said, “A qualified doctor, nurse, midwife or allied health professional may see half a million patients during their professional career: this has enormous potential for advocacy and the promotion of physical activity.”   This concept has been given a boost by organisers of the free weekly 5k runs, parkrun, who partnered with the Royal College of GPs to launch parkrun practice earlier this year.  Over 450 GP surgeries have become ‘parkrun practices’, forming close links with their local parkrun. Staff and patients benefit from any or all of the parkrun benefits of walking or running, being outside n a green space, talking to others, volunteering and being part of a community.


Looking in as an interested observer, I perceive a real appetite for lifestyle medicine. It makes so much sense in terms of prevention and treatment.  Just think. Data from Dr Unwin’s patients shows that a low GI diet and lifestyle approach not only improves diabetes symptoms, it also improves liver function, blood pressure and lipid scores.  Other research indicates improvement with mental health, gut and kidney issues and cardiovascular health.  A win for patients, a win for GPs, a win for the NHS and a win for society.


So let’s hope the lifestyle medicine movement continues to grow.


Watch this space!

 

 

 

 

 

References
  1. Womersley K, Ripullone K (2018) Medical schools should be prioritising nutrition and lifestyle education. British journal of sports medicine 52, e6-e6.
  2. Diabetes.co.uk Cost of diabetes in the UK. https://www.diabetes.co.uk/cost-of-diabetes.html (accessed Oct 2018)
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After completing my training, I’m now officially a Public Health Collaboration ambassador. This is an exciting honour and a great opportunity to help a great group of people make a difference to public health… although I know the work won’t provide an easy ride. 

The Public Health Collaboration (PHC) is a charity dedicated to improving public health through diet (its hashtag is #RealFoodRocks). It is tackling the root cause of the UK’s health problems by working to improve the UK’s healthy eating and weight loss guidelines. It also works with GPs, diabetes nurses and other healthcare practitioners to offer more choice to type 2 diabetes sufferers in their treatment, highlighting the NHS-approved availability of a low-carb approach to put diabetes into remission. 

The PHC works closely with diabetes organisation www.diabetes.co.uk to introduce healthcare practitioners to a dietary approach to type 2 diabetes treatment and to provide support with this new protocol. For years, type 2 diabetes has been considered a progressive, irreversible ie terminal condition. But in recent years, thousands have used a low carb/’real food’ approach in combination with other lifestyle changes to put their diabetes into remission or even reverse it completely. Diabetes.co.uk has developed a 10-week low carb eating programme for patients which is approved by the NHS for GPs to prescribe.   It has also received CE Mark approval. At £30 this represents good value compared to the £300 – £375 the NHS currently spends per person on diabetes treatments (and that does not include spend on complications of diabetes which take up around 80% of the total annual diabetes costs of £14bn – 16bn). But this approach is new to the NHS and it will take time for health care providers to be confident to try something different. Recognising this, diabetes.co.uk developed a 30-minute learning module for GPs and other healthcare practitioners which has been approved by the Royal College of GPs.

More alternatives to drug therapy… and more hope
Another dietary lifestyle approach to type 2 diabetes reversal includes the very low calorie diet featured on recent BBC and ITV programmes, based on the DiRECT study. Therefore, alternatives to drug therapy exist for patients, once healthcare practitioners are aware of this. Patients value being given a choice in treatment protocol and, importantly, being given hope that their condition can be either better managed or reversed. 

Type 2 diabetes affects around 6% of the UK population but takes 10% of the NHS budget. With a third of the UK population estimated to have prediabetes, it is obvious that our struggling NHS could not cope if people’s prediabetes progressed to full diabetes. And the issues that lead to prediabetes and type 2 diabetes, also predispose people to other conditions such as obesity, cardio vascular issues, fatty liver disease, kidney problems and some cancers. Increasing evidence suggests that our carbohydrate-heavy diet, particularly in terms of sugars and starchy carbs such as flour, rice, pasta and starchy bread, is a major contributor to the obesity and diabetes crisis which is why the PHC is working to revise lthe UK dietary guidelines.

Exciting times ahead!
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It’s Monday morning, you’re sitting at your desk and an email from Fred arrives saying it’s his birthday, he’s brought in cakes, they’re on the table by the photocopier, enjoy!  Next day, Jane brings some baklava back from Istanbul – help yourselves from the usual place. The next morning there are pastries left over from your meeting so you let colleagues know they’re up for grabs in meeting room 1. On Friday it’s the regular last Friday of the month Doughnut Day so everyone congregates at 4pm for a catch up over a doughnut.

This is a familiar pattern for many UK office workers according to new research into office cake culture1. The research surveyed nearly 1000 UK office workers and found that for the vast majority (86%) cake was available at least once or twice a week while for a quarter of respondents cake was available at least three or four times a week. 

Workplace cake culture is a controversial and emotive topic with opinions revolving around its contribution to obesity-related ill health, freedom of choice/nanny state-ism, and its ability to boost morale. The new research cuts through the confusion and helps clarify what’s going on. And yes, office cake may have a role to play in workplace morale.

But don’t rush out to buy celebratory cupcakes just yet… because we need to make sure office cake culture develops in a way that really does boost morale. Unfortunately there is potential for it to do the opposite.

First the bad news

Nearly a third (31%) said they thought office cake had contributed to weight gain, 59% said it made it harder to stick to a diet and 38% said it made it harder to eat healthily in the workplace.  Fundamentally, if cake is there people eat it – getting on for half (41%) said they often or always eat it if it’s available.

We can’t ignore the fact that cakes, pastries or chocolates mean extra sugar and calorie intake and, in a climate where 68% of the UK population is overweight or obese 2 this is not helpful to anyone’s health. One Tesco blueberry muffin (307 calories according to Tesco online grocery) twice a week for 48 weeks a year, is potentially an extra 29,000 calories, and sugary calories at that, which we know is linked to obesity and ill-health 3.  

We spend between a third and two third of our waking hours at work so if our workplace environment is healthy it can play an important role in keeping us healthy. But if our workplace makes it hard to eat healthily, we’re more likely to become unwell.  The new research shows that office cake culture changes employee eating habits, and therefore potentially undermines investment in health and wellbeing initiatives such as healthy options in the canteen and free exercise classes.

Now the good news
 
81% said office cake brings people together and 83% said it cheers everyone up.  In fact research has found that workgroups who eat together tend to have higher co-operation, performance and trust 4,5,6 and eating together is associated with enhanced connection between eating companions 7,8. Certainly, the value of building relationships and cross fertilising ideas through socialising between colleagues is well-established and we all recognise the pleasure and sense of connection we get from eating with friends and family.

As Meik Wiking, CEO of the Happiness Research Institute in Copenhagen, points out, “[Food] feeds our friendships, bolsters our bonds and nourishes our sense of community – and those factors are vital to our happiness. Whether you look at the English word ‘companion’, the Spanish word ‘compañero’ or the French ‘copain’, they all originate from the Latin ‘com’ and ‘panis’ meaning ‘with whom one shares bread’.” 9

But, here’s a question.  If cakes are displayed for long periods for people to help themselves to during the day (as is the case in most workplaces) does that provide sociable morale-boosting effects and companionship? Or does it just promote mindless grazing as people wander past? 62% were distracted by cake to some extent and 68% found it hard to resist even if they were not hungry or had just eaten a meal.  

Some would say people should have better self-control but there’s robust evidence showing why this is not straightforward, but that’s for another blog. For the time being, it helps to understand that when we see something sweet and tasty (or see a picture or even think about it), our brain’s pleasure and reward systems kick in, urging us to seek out that reward. It’s a natural physical response that gets our mouth watering and our stomach juices flowing10,11.  And if we want to rely on willpower, some (not all) researchers maintain12 that is in limited supply so don’t beat yourself up if cakes are still there at tea time and you succumb to a muffin.

So how can we harness the beneficial glow of companionship while minimising the potential health risks? This question is answered by one of the most powerful findings from the new research. When asked what was the ideal frequency for office cake, 95% of respondents said once a week or less. I’ll say that again: once a week or less. Getting on for half (41%) said once a month would be ideal – much less frequent than what most people experience currently.

A great opportunity


This presents a fantastic opportunity to make cake special again; a treat to look forward to.  If 95% of the research respondents thought once a week or less was ideal, there’s a good chance that you and your colleagues feel similarly, whether you think cake is the work of the devil or a delicious way to break up the working day.

All that’s needed is a conversation among colleagues so you can work together create a cake plan that suits you (and your health) most of the time.

Importantly, there is no need for cake to be banned. The research does not suggest this is needed, as long as employees get a chance to discuss and understand what is going on. But what will help is if management instigates, encourages and supports the conversation. Research has found that when employees perceive that their management values employee health, employees tend to be healthier with lower BMI13,14. This encourages a virtuous circle of more healthy behaviours becoming the norm which in turn leads to healthier employees.

So, a happy workplace might involve cake. It should probably involve sociable get togethers. But cake doesn’t make a happy workplace if other factors aren’t right. You might find this diagram, from neuroendocrinologist and obesity expert Dr Robert Lustig, interesting. I’d have thought for a happy workplace, you’d need a range of factors leading to the scenario on the right, rather than a collection of people all independently experiencing the scenario on the left.  After all, it’s probably a happy workplace we’re after rather than a pleasurable workplace.

                                                                               Source:  www.businessinsider.com

 

Start the conversation!

  • A short, confidential survey might be useful to help people say what they really think and help the conversation get started.
  • Decide how often you want to have cake. What will you do if there are three birthdays in one week? What alternatives would work to thank or recognise someone?
  • On cake day, store the cakes out of sight (and therefore out of mind) until cake time, then no one has to rely on willpower to resist them.
  • Consider offering an alternative (fruit the most popular alternative to cake in the survey, followed by ‘cake, but less often’).
  • Enjoy the cake while socialising with colleagues.
  • Then put the cakes away, take them home, decide what to do with any left overs – but don’t leave them lying around.  


This way, office cake becomes a real occasion … not just an every day, run of the mill occurrence that potentially harms health.  Making cake an occasion gets people together to reap the benefits of eating together.  Most importantly, it helps keep the workplace healthier by making the healthy choice the easy choice.

So whether you’re an employee or employer, start a conversation.  What have you got to lose? (Other than the weight, obviously!)

 

References

  1. Walker, L. (2018). It’s time to rethink office cake. louwalker.com
  2. Health Survey for England. (2016). Health Survey for England, 2015.
  3. Scientific Advisory Committee on Nutrition. (2015). Carbohydrates and Health.
  4. Kniffin, K., Wansink, B., Devine, C. & Sobal, J. (2015). Eating together at the firehouse: How workplace commensality relates to the performance of firefighters. Human Performance, 28(4).
  5. Allen-Arave, W., Gurven, M., & Hill, K. (2008). Reciprocal altruism, rather than kin selections, maintains nepotistic food transfers on an Ache reservation. Evolution and Human Behavior, 29(5)
  6. Mameli, M. (2013). Meat made us moral: a hypothesis on the nature and evolution of moral judgement. Biology & Philosophy, 28(6)
  7. Alley, T. (2012). Contaminated and uncontaminated feeding influence perceived intimacy in mixed-sex dyads. Appetite, 58(3)
  8. Kniffin, K., & Wansink, B. (2012). It’s not just lunch: Extra-pair commensality can trigger sexual jealousy. PLoS One, 7(7)
  9. Wiking, M. (2017). The Little Book of Lykke. The Danish search for the world’s happiest people. Pub: Penguin Random House, UK
  10. Ferriday, D & Brunstrom, J. (2011). ‘I just can’t help myself’: Effects of food-cue exposure in overweight and lean individuals. International Journal of Obesity, 35(1)
  11. Ramaekers, M., Boesveldt, S., Lakemond, C., van Boekel, M. & Luning, P. (2014). Odors: Appetizing or satiating? Development of appetite during odor exposure over time. International Journal of Obesity, 38(5)
  12. Hagger, M. S., Wood, C., Stiff, C., & Chatzisarantis, N. L. D. (2010). Ego depletion and the strength model of self-control: A meta-analysis. Psychological Bulletin, 136(4)
  13. Tabak, R., Hipp, J. A., Marx, C., & Brownson, R. (2015). Workplace social and organizational environments and healthy-weight behaviors. PLoS One, 10(4).
  14. Lemon, S. et al. (2010). Step Ahead: A worksite obesity prevention trial among hospital employees. American Journal of Preventative Medicine, 38(1).

 

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Yesterday I gave a TED talk at TEDx University of Chester.

What an honour and what an experience! 

As a graduate of the University of Chester I was invited to speak about the research into office cake culture I conducted as part of my MSc in Obesity & Weight Management. The event’s official theme was ‘Ideas connected’ and talks covered a range of topics including tackling plastic overuse, theatre as a tool in deradicalisation and ‘inventapreneurism’.  But a common theme was that we need to start conversations about difficult situations to help people invest in the solutions.

My talk aimed to help people understand that obesity is more complicated than eating too much and moving too little, and examined the roles of our environment, social influencing and our neurophysiology in causing obesity. The main messages were:  

1. By subtly changing the environments we are in control of, we can make it easier for ourselves to make healthy choices more often, without having to rely on willpower. By making our workplaces less obesogenic we could all make a significant improvement to public health in the UK.
2. We need to start a conversation with colleagues about how often we really want office cake. 95% of office workers thought the ideal frequency for office cake was once a week or less  but this is less than the current availability in most workplaces. People don’t find it easy to speak up when colleagues are apparently enjoying cake (even if they don’t really want it) 
3. Discuss with colleagues how we might get the benefits of getting together socially at work, without cake.  
4. By starting a conversation about something specific like office cake, we can all contribute to tackling the wider obesity problem.

The final call to action was for employers, employees, students and group members to start a conversation about office cake. After all, we have nothing to lose but the weight, and we all have our health to gain.



I will update this blog with a link to the talk on youtube when it is available.
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I’m beyond chuffed that my office cake research has been shortlisted for an award.  

The Inspiring Wellbeing Awards are associated with the annual Wellbeing Symposium and recognise efforts to improve wellbeing in the workplace, communities and among individuals. 

Whatever the outcome, it’s exciting that the potential of rethinking workplace cake culture is starting to be recognised. 

You can find out more about the 2018 Wellbeing Symposium here.

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When I was planning my office cake research, cake-related discussions with friends and colleagues often led to the same full and frank discussion.


Some argued that if you eat too much cake or other snacks (at work or elsewhere), you risk weight gain. This carries health risks for individuals and productivity-related consequences for employers. The counter-argument was that office cake provides a valuable chance for colleagues to take a break to catch up with colleagues and cross-fertilise ideas. Obviously, I had no idea what the research would tell us.


Well, the results suggest there’s merit in both positions and, more importantly,  both provide insights that could help improve workplace health and wellbeing, physical and mental.


The research surveyed almost 1000 UK office workers about their attitudes, habits and opinions around workplace cake culture. Cake was available to most respondents (86%) at least ‘once or twice a week’.  31% said office cake had contributed to weight gain, 38% said it made it harder to eat healthily in the workplace and 59% said it made it harder to stick to a weight loss diet. Round one to the ‘office cake is bad’ camp.


But. 61% thought office cake was a good thing, 81% said it brings people together and 83% said it cheers people up. Round two to the ‘office cake is good’ camp.


So how often did the respondents think would be ideal for office cake? This is the ‘wow!’ piece of data that could make some real difference to workplace health. Almost all  respondents (95%) said the ideal frequency for office cake was once a week or less.  41% said once a month.


Make workplace cake special again


So, the evidence is telling us that workplace cake affects many people’s efforts to eat healthily at work and control their weight, yet it also provides a popular way to boost morale and build relationships. But however they felt about workplace cake, almost all respondents considered cake once a week or less to be often enough.


Add all this together and what have we got?


The evidence suggests we could reduce workplace health risk and enhance social benefits while having office cake just once a week.  And it seems this would be acceptable to the vast majority of employees.  


To make this work we’d need small changes to the way office cake happens at most workplaces. For example, displaying cakes all day on a table in the main working area (as happens for nearly three quarters of respondents) encourages mindless grazing and doesn’t provide the social benefits people enjoy. Instead, choose a day and time for cake every week/month/whatever people agree. Until cake time, keep the cakes out of sight (and out of mind) in opaque cake tins, in cupboards.  When cake o’clock has passed, pack the cakes away. This would make cake special again, a treat to look forward to and encourage social interaction.  More ideas can be found in the research report It’s time to rethink office cake.


Employers can have confidence


This research investigated the opinions of office workers so might not translate to other working environments. Even so, I hope it gives organisations the confidence to at least start a conversation among colleagues so they can explore their own cake culture. There is a strong chance they will realise they are all in the “office cake is great, but once a week is enough” camp. Then they might feel able to discuss ways to make this happen. Supportive management can encourage and endorse but won’t need to regulate.


Develop a culture of health in the workplace


In 2013, the World Health Organisation calculated we spend two thirds of our waking hours at work.  So a healthy working environment makes a significant contribution to overall public health. And starting a conversation about office cake culture is a giant step in a healthier direction.



Find out more about the research, how to start a conversation and what small changes can help organisations rethink office cake culture harmoniously at www.louwalker.com.
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