obesity, gogodoc

Is Obesity A Disease Or A Choice?

Obesity is a very important public health problem. The rates are now very high, with over 25% of the UK population and 33% of the US population classified as obese.

Obesity itself results in significant reductions in quality of life but it also leads to a range of serious health issues, such as type 2 diabetes, cardiovascular diseases and cancer.

Changes in diet and exercise seem to be the most sensible first-line solution, however health education programs have failed to halt the rising numbers of obese people. This suggests that intrinsic factors, such as genetics, might be important.

This raises an important question: Is obesity a disease or a choice?

 

Recent poll

A recent poll on Medscape revealed some interesting opinions about obesity among healthcare providers. One of the questions asked was ‘How often do you think lifestyle choices are the underlying cause?’ 75% of medical professionals chose either ‘often’ or ‘always’.

When asked what interventions they typically recommend for their obese patients, over 90% selected ‘diet and exercise’. Further, more than 30% of healthcare providers do not consider obesity to be a disease state. However, if obesity is viewed as a disease it may aid toward objectively assessing the factors that lead to it, thus offering better prevention and treatment strategies.

 

What makes obesity a disease?

Obesity is a complex entity that can have many causes. The first, most obvious, argument for why obesity is a disease is that it is associated with impaired body function. It causes, exacerbates, or accelerates more than 160 co-morbid conditions that arise as metabolic, structural, inflammatory, degenerative, neoplastic, or psychological complications. Further, it can significantly affect quality of life or impair longevity.

Taking this into account may prove effective in dealing with its biopsychosocial and economic ramifications.

 

Common assumptions about obesity

It is a common assumption among both healthcare providers and the general public that obesity is a self-inflicted condition. In other words, obesity is thought to be the result of a lack of self-discipline due to addiction to excess or unhealthy foods, and thus these patients are largely responsible for this condition. If patients are not losing weight with diet and exercise, it is because they are not trying hard enough or are cheating on their lifestyle modifications.

Another assumption is that obesity started only in the past 50 or so years. Although the incidence has increased significantly in the recent past, it is in fact a centuries-old condition.

Lifestyle modifications have an increasingly robust representation in evidence-based medicine. However, given the complex and multifactorial nature of obesity, management can fail despite earnest efforts by patients and is often successfully augmented by the addition of pharmacotherapy or surgery.

 

Treatment must be individualised

It is important to realise that for many patients, obesity is multifactorial. There is a wide heterogeneity in the causes and manifestation of obesity, which leads to wide interpatient variability in the response to different therapeutic strategies. It is for this reason that management of obesity needs to be individualised for each patient.

It is therefore important to accept that obesity is not merely a condition arising from ‘food addiction’. In fact, more than 100 aetiologies of obesity have been identified, and we’ve merely scratched the surface at recognising the causal factors.

 

 

Conclusion

The question of obesity being a disease or choice is like the false dichotomy of nature vs nurture. There is no simple either/or answer to this question. It is much more likely to be a combination of both factors.

Obesity involves a complex interplay of underlying medical conditions, such as genetic or endocrine factors, in addition to environmental influencers. Environment plays an important role. Factors such as eating schedules, physical activity, sleep health and medications, can affect weight management.

 

The ultimate consequence is failure of the homeostasis of weight and energy regulatory mechanisms, leading to an elevated body fat set-point.

Only when we recognise that obesity is a disease can we take the next steps of screening, diagnosing, assessing, preventing, and treating this condition.

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Gogodoc Goes To TechCrunch Disrupt

Gogodoc goes to TechCrunch Disrupt in San Francisco, USA! That’s right, the American online publisher of technology founded in 2005. They provide groundbreaking tech news showcasing amazing tech companies and startups.

TechCrunch Disrupt is an event formed by TechCrunch which showcases upcoming startups with panels of amazing speakers and one-on-one chats with TechCrunch writers and editors.

 

Our clinical lead commission Dr. Vijay Sivapalan gives a reporter a full breakdown and introduction to Gogodoc.

 

techcrunch-gogodoc

Our team flew out to San Fransico to attend this amazing event! We had the opportunity to display our services in TechCrunch’s Startup Valley which featured various top startups around the world.

 

 

 

Using Gogodoc to book an appointment with a doctor is a breeze. Download the app on your smartphone, tell us your symptoms and sit back while we bring the appointment to you. It’s that simple.

A medical practice on wheels? Now, that’s first class service.

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The new Apple Watch 4 comes with several features, but the one that’s received the
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apple-watch-ecg

How Accurate Is The ECG Function In The Apple Watch 4?

The new Apple Watch 4 comes with several features, but the one that’s received the most attention is the ability to perform an electrocardiogram (ECG). An ECG is typically performed by attaching sensors to the skin which detect the electrical signals produced by the heart each time it beats.

But is Apple’s new feature sufficiently accurate to do more good than harm?

 

Portable ECG devices are nothing new

‘We’ve added electrodes into the back-sapphire crystal and the digital crown, allowing you to take an electrocardiogram’, said COO Jeff Williams, eliciting one of the day’s biggest rounds of applause. ‘This is the first ECG product offered over the counter, directly to consumers’.

It turns out that Apple’s new watch is not the first direct-to-consumer ECG. There are several different monitoring devices on the market that allow you to conduct your own ECG. One example is the monitor from AliveCor. It costs £100 and connects to your smartphone via Bluetooth. The company even offers a KardiaBand, also £100, which works with the original Apple Watch to add the same ECG functionality.

But let’s not concern ourselves with the novelty claim. The bigger question is whether it’s a good idea in the first place. Healthcare providers usually use ECGs in hospitals to measure the heart’s electrical activity and detect abnormalities in its rhythm. But with the latest iteration of its smartwatch, Apple wants to put an ECG on your wrist that you can use ‘anytime, anywhere’.

It sounds like a great idea, in theory.

ecg-iphone-apple

Conducting an ECG

Not only are ECG readings notoriously difficult to grasp even among medical professionals, it usually involves a more complex setup. The standard test is known as a 12-lead ECG, which simultaneously records electrical activity from multiple locations in the body giving you 12 different views of the heart.

 

Contrary to this, the Apple Watch 4 is equivalent to a single-lead ECG. On the back of the watch, there are electrodes built into the digital crown. Touching the digital crown with your finger for 30 seconds will create a closed loop that will then generate an ECG waveform.

Although it gives only one view of the heart it can still be useful. Indeed, some monitors that outpatients wear over an extended duration also offer one view.

 

‘It will save lives!’

‘Do you wind up catching a few undiagnosed cases? Sure. But for the vast majority of people it will have either no impact or possibly a negative impact by causing anxiety or unnecessary treatment’, says cardiologist Theodore Abraham, director of the UCSF Echocardiography Laboratory. The more democratised you make something like ECG, he says, the more you increase the rate of false positives – especially among the hypochondriac set. ‘In the case of people who are very type-A, obsessed with their health, and fitness compulsive, you could see a lot of them over using Apple’s tech to self-diagnose and have themselves checked out unnecessarily’.

A false positive result is when the monitoring device identifies an individual as being at risk of having a heart condition and is subsequently diagnosed as not being so. Direct-to-consumer screening devices, in general, will naturally aim to give an excess of false positives for fear of possible legal action. This would result in hordes of frantic, yet otherwise healthy, individuals rushing to see a doctor, thus placing excess pressure on the health service.

Screening for diseases is only a sieve – it will not pick up all cases, and some will be missed or develop soon after. The concern is whether home screening devices, such as Apple’s new watch, can prevent enough people from developing a serious disease to justify the burden of false positives.

The American Heart Association (AHA) does not endorse the watch, or any other products – and had no role in Apple’s ECG app. Yet this did not prevent Ivor Benjamin, president of the AHA, to give his support during Apple’s official unveiling of the watch: ‘Products that seek to provide deeper health insights, like the Apple Watch Series 4, offer great potential in getting us there’.

It’s also worth noting that the FDA has approved the ECG feature on the Apple watch, albeit with caveats. As expected, the FDA report injected a bit more modesty into the product, stating, ‘The ECG data displayed by the ECG app is intended for informational use only. The user is not intended to interpret or take clinical action’.

 

Conclusion

The Apple Watch 4 starts at £399 for the GPS-only model and increases to £499 if you upgrade to the cellular model. It offers several useful applications besides ECG monitoring and heart rate measurement. It can track falls and call emergency services if it doesn’t detect movement after a minute, alert users to low heart rates, and offers a host of fitness tracking features.

Although the Apple Watch 4 may not be as accurate as some other ECG devices, it could still prove useful for flagging up an undiagnosed heart condition and prompting further investigation. The question is whether Apple’s new feature can prevent enough people from developing a serious heart condition to justify the expense. It’s doubtful. But with all the data collected it could, with your permission, make you a research subject.

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Activated Charcoal: The New Black, Or Just Another Quack?

activated-charcoal-black-bread

I walked into a trendy hipster café the other day – the kind where dishevelled man buns are the norm and the furniture is uncomfortable. I saw a black croissant on the counter. I was impressed with the barista’s confidence that he could flog it off as edible. To add to the ridiculous selection, there was charcoal-containing fruit juice being sold as a ‘shot’. Elsewhere, I opened a pizza menu and saw an option for a charcoal crust. Some weeks later when meeting a friend for dinner, I found her sipping a pitch black mocktail made with charcoal. The next day my sister showed me a bottle of activated charcoal pills from Holland & Barrett and asked me, “does this work”?

 

Don’t be conned.

Let me begin by first saying that if you hear the word ‘detox’ in conjunction with having to take a pill or potion, you are most likely being conned.

We have all looked for a quick fix to wellness, something to cut the link between hard graft and gratification. Maintaining stamina, eating well and exercising can be difficult to balance in our busy lives. This is where pernicious charlatans seize the opportunity to sell you snake oil, tricking you with pseudoscience and the paralogism of celebrity endorsements.

When in doubt, ask for the evidence or do some research yourself. Don’t settle for an anecdote, such as ‘my friend took it and noticed a difference’. I’m talking about empirical evidence in academic journals. If that’s venturing in unknown territory for you, seek advice from your doctor.

 

What is activated charcoal, anyhow?activated-charcoal

It sounds like something you’d use to fire up the barbecue, but there’s a difference. Activated charcoal is made from carbon-containing material, like wood, coal and coconut shells, which is heated at high temperatures. The carbonised material is then exposed to oxidising atmospheres, a process called ‘activation’, which increases its overall surface area and adsorptive capacity.

Activated charcoal has long been used in emergency medicine for the treatment of drug overdose or poisoning. It is a gastrointestinal decontaminant that avidly adsorbs contents of the stomach. It is beneficial if administered to the patient within an hour of ingestion, or later if the ingestion involves an agent that delays gastric emptying or slows gut motility.

It’s not difficult to see why activated charcoal has been associated with detoxifying the body. If it’s used in emergency medicine to reduce toxic load, then it must be good for everyday use as well. However, this is false reasoning and a deep misinterpretation of its application.

 

Is it safe to eat activated charcoal?

Consuming activated charcoal may seem like an innocuous health fad, but it may be doing more harm than good.

The issue is that activated charcoal is not selective in its binding properties, meaning that some of the vitamins, minerals and antioxidants in your food will also be removed (along with the supposed ‘toxins’).

I mentioned the charcoal-containing fruit juice being sold as a shot. If you think about it, the absorption of the vitamins in the fruit would be impaired because of the charcoal. There is literally no good reason for it to be in the drink.

On a more serious note, activated charcoal can bind with some oral medications and impair their bioavailability. This is not mentioned on the bottles or packaging of activated charcoal products, despite it potentially having serious health consequences for some people.

There is also a prevalent belief that it will help cure a hangover by detoxifying the alcohol and kebab you had last night on the lash. But considering activated charcoal will bind with the contents of your stomach or intestines, it would be useless in this case because the alcohol and dodgy food would have already been absorbed into your bloodstream.

 

A bitter pill to swallow

The detox industry is vast and highly deceptive. The products don’t work, despite anecdotal claims to the contrary. You may want to dabble in it anyway for some harmless fun but consume with caution if you are on prescription medication. There is a possibility that it will make your medication less effective.

Here’s some food for thought: instead of implementing useless detox cycles, it is better to adopt a ‘clean’ eating plan – not as a temporary diet, but a lifestyle change. There is a lot of evidence to show that a whole-food, plant-based diet does wonders for our health. This entails eating plenty of fruits and vegetables, whole grains, plant proteins, and healthy fats such as olive oil.

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Honey-cold

A Spoonful Of Honey For That Cold

 

sick-cold-honeyHave you got a cough or cold?

Maybe you should think about treating it with good ol’ fashioned honey…that’s according to recent guidance by Public Health England (PHE) and the National Institute of Health and Care Excellence (NICE)

 

 

 

 

 

 

 

GPs like myself are being urged to encourage patients to use self care products to tackle those nasty bugs!

Self care products such as honey and over the counter cough mixtures including Beechams and Lemsip can be the key to tackle those nasty colds. They can help treat coughs and colds but also reduce the need for antibiotics.

Dr Tessa Lewis, a GP and chairwoman of the antimicrobial prescribing guidelines group, sums up the general management well.

 

“If someone has a runny nose, sore throat and cough, we would expect the cough to settle over two to three weeks and antibiotics are not needed.” 

“If the cough is getting worse rather than better, or the person feels very unwell or breathless, then they would need to contact their GP.”

 

So why is reducing the prescriptions of antibiotics a good thing, well its simple.

Taking antibiotics when you dont need them puts you and your family at risk of developing infections which are difficult to treat. It can have all sorts of nasty side effects including diarrhoea and nausea to name but a few.

You can also increase the likelihood of developing an antibiotic resistance. Which basically means when your older and genuinely in need of antibiotics to treat an infection, the antibiotics may not be as effective in treating the infection, if at all.

 

So that old saying you’ve heard over and over was right. Take a spoonful of honey for that cold.

 

 

 

 

 

 

 

 

 

 

By Dr Ashish Srivastava

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Yes Or No? Vaping From A Doctor’s Perspective

 

 

vapingThe debate continues to rage on over Vaping. Is it safe? Does it help reduce or even stop people smoking cigarettes??

Having not been a smoker myself, but with more of my patients asking me about vaping vs smoking, I decided to look into it a little more.

There is no definitive answer to the above, as NICE (our clinical regulator) has informed us: ‘it’s too soon to tell’. E-cigarettes and Vaping are fairly young in their lives at the moment have only been around for the last decade. This has meant that there is little in the way of testing or evidence to look back at to make any firm conclusions. Basically, people have not been Vaping for long enough for us to know the long-term effects.

 

  1. Vaping is the inhalation of a water vapour.

A battery operating coil heats a liquid which contains nicotine that has been extracted from tobacco. It also includes flavourings and ‘other chemicals’ which together form the vapour that is inhaled.

It is thought that there are less ‘toxic chemicals’ in the vapour produced compared to the approximately 7,000 chemicals in tobacco cigarettes, most of which are toxic.

   

     2. There is still Nicotine in the Vape: the addiction continues:

Nicotine is still present in the vapour which means that users are still at risk of these harmful effects. These can include: addiction, withdrawal symptoms, rise in heart rate and blood pressure.

     

     3. Does it help you stop smoking?

The evidence is patchy here, but it is thought that because you can control the strength of the nicotine you can gradually wean yourself off it. The school of thought is that generally speaking those that vape are more likely to stop smoking than those who go cold turkey.

     

     4. Will it ‘explode’?

There have been several stories about vapes exploding in pockets and bags. This has been put down to misuse of the equipment. There is a standard regulated battery and coil length that is used. People who modify this e.g elongate the coil (allows for more vape), cause the battery to be overworked and can cause it to explode.

 

So – is it safe?  This would depend on the person asking it:

Ask me: a non-smoker, no addiction to nicotine, I would say – no it’s not safe.

Ask a smoker trying to quit – ‘yes, it is SAFER, than smoking a tobacco cigarette.’

 

 

 

 

 

By Dr Vibhu Kaushal

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Top Tip On Migraine Management

Migraines are common in both children and adults and are estimated to affect up to 10% of the population in the UK.

Migraines are characteristically described as headaches, but may not always start as a headache. Migraines can often be preceded by an aura, although not present in all who suffer from migraines. These auras can be visual or an altered sensation. These are then followed by headaches, which can often be one-sided. Other accompanying symptoms may include nausea, vomiting, light or sound sensitivities.

Migraines can have triggers; this can be in the form of food and drink, lack of sleep and stresses amongst other things.

Managing acute migraines can be difficult – some ways of managing migraines can be to ensure you are adequately hydrated, taking pain relief such as paracetamol or ibuprofen, and ensuring you are resting well. There are a few migraine-specific medications available over the counter such as sumatriptan.

 

Dr Thanusha Ananthakumar  “TOP TIP: For acute treatment of migraines you can try aspirin + anti-sickness tablet + sugary carbonated drink”

 

 

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Meat And Health: Assimilating The Facts

Still having dinner according to your grandmother’s advice of ‘meat and two veg’? How very 2017 of you.

 

 

 

 

 

 

 

 

According to Mintel’s Meat-Free Foods UK Market Report, more than one in four Britons are now favouring a vegetarian lifestyle.

Vegetarians have many reasons for not eating meat, including concern for animal welfare, health benefits, and reduced environmental damage. Here are some of the benefits of leaving meat off your plate.

 

Are humans meant to eat meat?

The dietary status of the human species is that of an ‘unspecialised frugivore’ – an animal specialised for nuts, grains, seeds, fruit and vegetables, but can handle ‘unspecialised’ food sources too. Biochemistry, comparative anatomy and genetics do not support the contention that human digestive tract is specialised for meat-eating. ‘But we have canines!’ is the all-too-common quickfire rhetoric.

 

Our pathetic, short and blunt canines may be useful to take a bite out of an apple. But try lunging for the throat of a cow and see if they are of any use then.

Due to limited resources our ancestors became habituated to eating meat, and through evolution our gut can handle it to some degree. But it is not the case that we are specialised for meat eating or need it in our diet to be healthy. In fact, the opposite is the case.

 

The WHO report

A wealth of research indicates that vegetarians have reduced incidences of diseases, and overall greater longevity. In support of this, the World Health Organisation (WHO) has classified processed meats as a Group 1 carcinogen. Tobacco smoking and asbestos are classified in the same category. As stated on their website, ‘this classification is based on sufficient evidence … that eating processed meat causes colorectal cancer’.

Moreover, red meat is classified as Group 2A, which means it’s ‘probably carcinogenic to humans’. My gut feeling is that it is only a matter of time that additional evidence will confirm this positive association.

Put it this way: if you had a choice between a meal that is proven to be protective against cancer (e.g. a wholefood, plant-based meal) and one that is ‘probably carcinogenic’ (e.g. a meal that contains red meat), which one would you choose?

Nevertheless, there are other health risks that are associated with meat eating such as coronary heart disease and diabetes, to which we now turn.

 

Backed up by research

In a study published in The American Journal of Clinical Nutrition, the authors state that ‘Vegetarians had a 32% lower risk of [ischaemic heart disease] than did nonvegetarians’. And a study published in Annals of Nutrition and Metabolism showed that vegetarians had an overall 18% lower cancer incidence. Moreover, the largest study to examine the effects of different sources of dietary protein found that a high intake of proteins from animal sources – particularly processed and unprocessed red meats – was associated with all-cause and cardiovascular mortality, whereas high plant protein intake had an inverse effect. The authors note that, ‘substitution of plant protein for animal protein … was associated with lower mortality, suggesting the importance of protein source’.

To be fair, a limitation of some epidemiological studies is that they do not consider the food source and the quality of the meat. However, in a study published by JAMA Internal Medicine, 73,308 participants were analysed and were controlled for important demographic, lifestyle and food confounders. They found that even a modest amount of red meat, regardless of the source, led to an increased rate of mortality. Whereas vegetarian dietary patterns were associated with reduced all-cause mortality and increased longevity.

In a study published in American Journal of Epidemiology, researchers found that a higher intake of red meat and poultry is associated with significantly increased risk of developing diabetes. Further, in a 2017 Sweden study, it was found that beef, pork and poultry are associated with colorectal cancer, which is considered one of the most common forms of cancer in the Western world. In fact, heart disease and cancer are the biggest killers on the planet, both of which have been directly linked to meat consumption.

 

Colossal damage

Aside from the health issues, rearing livestock for food is highly inefficient and wasteful. Every year over 56 billion animals are slaughtered by humans, not to mention sea creatures whose deaths are so great they are only tallied in tonnes. The crops fed to industrially-reared animals worldwide could feed an extra four billion people on the planet.

Let us not forget the devastating effect of the meat industry has on the environment. A staggering 51% of global greenhouse-gas emissions are caused by animal agriculture, according to a report published by the Worldwatch Institute. Grass fed, and ‘humanely slaughtered’ (an oxymoron) is even more unsustainable.

 

Conclusion

Humans have been facultative meat eaters for a long time, but recent research suggests that a diet with minimal meat is much more healthful. And we certainly do not need meat nutritionally in our day and age.

But the health benefits of keeping meat of the menu is only one side of the argument. For many, it is the ethical implications that make meat indigestible.

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