In the north-east we are particularly concerned by the devastating impact of young people drinking alcohol. The recently published Local Alcohol Profiles for England showed that the north-east continues to have the highest rate of under-18s admitted to hospital with alcohol-specific conditions, and it is clear that "early onset" drinking is having a dire impact on our children and young people's health.
As Dr Wollaston's private member's bill acknowledges, youth culture is heavily influenced by marketing and our children are saturated by alcohol advertising. The Academy of Medical Sciences report Calling Time showed a consistent correlation between consumption levels among 11- to 15-year-olds and the amount spent on alcohol marketing – £800m per year according to recent estimates. If alcohol advertising did not work, the industry would not pay for it, and we are gravely concerned about the impact this is having on the health and wellbeing of our nation's children.
Equally worryingly, the European School Survey showed our children have the most positive expectations of alcohol of any children in Europe and they were least likely to feel it might harm them. Such expectations clearly derive from alcohol marketing and, as the World Health Organisation recently stated: "In such a profoundly pro-drinking environment, health education becomes futile."
The health select committee report published earlier this year highlighted the fact that: 96% of 13-year-olds from a sample of 920 were aware of alcohol advertising in at least five different media; 91%-95% were able to identify masked alcohol brands. Nearly half owned alcohol-branded products, such as clothing. These findings are clearly shocking and it is time that the government and the alcohol industry took some responsibility for the issues facing our children and put their welfare first.
Chris Record Liver specialist at Newcastle University and Newcastle hospitals
James Crosbie Consultant gastroenterologist, City Hospitals Sunderland
Kate Lambert Consultant in emergency medicine, City Hospitals Sunderland
Deborah Smith Alcohol liaison nurse specialist, City Hospitals Sunderland
Richard Thomas Consultant gastroenterologist at North Tees and Hartlepool NHS Foundation Trust
Anjan Dhar Consultant gastroenterologist at Darlington Memorial and Bishop Auckland hospital
• The UK government has chosen to address obesity and alcohol problems increasingly through collaboration with business. We recently explored the "healthy eating option" on the NHS Choices website, which provides an example of how an existing public-private partnership works in practice, and were surprised to be offered bargain buys on fairy cakes, peanuts, all-butter croissants and chocolate crisp brioche (among others).
Having chosen the "make your weekly shop healthier" option, we were directed by the link on this NHS website to the "supermarket health checker" on mysupermarket.co.uk. Clicking on the link required registration and agreeing with 10 pages of terms and conditions, one of which stated in relation to the health content information: "We do not warrant that such information is true or accurate", begging the question whether the information is any use at all. Leaving aside this potential pitfall one arrives – if not distracted by the "wine store" where you can save up to 50% on your wine shopping (and we thought that the most effective public health intervention for alcohol was price rises) – at the front page of mysupermarket.co.uk. The website opens to the special offers section, where we were presented with the plethora of calorie-rich but nutrient-poor options identified above. There was little healthy food on view at all.
Miyerkules, Setyembre 14, 2011
Obesity doctors find Weight Watchers works
Overweight people referred by their doctors to Weight Watchers lose twice as much fat as those who receive standard dieting and exercise advice from their GP.
A study funded by the Medical Research Council – the results of which were first revealed a year ago in the Guardian – will encourage GPs to send overweight patients to the commercial organisation. Few other strategies work as well with severely overweight people, who risk heart disease, stroke and diabetes.
The study published online in the Lancet medical journal compared people sent by their doctor to Weight Watchers in three countries – the UK, Australia and Germany – with those who just received standard advice and care. The results in all three countries were similar.
The trial involved 772 overweight and obese adults who were randomly assigned a 12-month Weight Watchers course or standard care from their doctor. At the end of the year, those enrolled in the commercial programme lost an average of 5.1kg, compared with 2.2kg for the rest.
Not everybody completed the course. The weight loss among those who did was 6.7kg at Weight Watchers and 3.3kg for the rest. Those enrolled in the commercial programme were more than three times as likely to lose a substantial 5% of their bodyweight, compared with the others.
A study funded by the Medical Research Council – the results of which were first revealed a year ago in the Guardian – will encourage GPs to send overweight patients to the commercial organisation. Few other strategies work as well with severely overweight people, who risk heart disease, stroke and diabetes.
The study published online in the Lancet medical journal compared people sent by their doctor to Weight Watchers in three countries – the UK, Australia and Germany – with those who just received standard advice and care. The results in all three countries were similar.
The trial involved 772 overweight and obese adults who were randomly assigned a 12-month Weight Watchers course or standard care from their doctor. At the end of the year, those enrolled in the commercial programme lost an average of 5.1kg, compared with 2.2kg for the rest.
Not everybody completed the course. The weight loss among those who did was 6.7kg at Weight Watchers and 3.3kg for the rest. Those enrolled in the commercial programme were more than three times as likely to lose a substantial 5% of their bodyweight, compared with the others.
Experts targeting obesity raise hope of drugs to stop us feeling hungry
The hour is late and you sit down for dinner with a friend. Both of you are hungry. You demolish your starter along with a few of chunks of bread and then dig into your main course. Your partner begins to slow down, but you plough on. Your eat everything on your plate and then order a dessert. Only after you have scoffed that do you stop, aware that you have lost your appetite and at last feel full. If nothing else, your performance explains why you are so much rounder and heavier than your companion.
Such diversity in eating habits reveals a simple culinary truth: that some people find it easier to stop eating than others. Somehow the chemicals in their digestive systems react more quickly to their food than other people's and so quickly switch off their hunger pangs.
The exact mechanisms involved in humans' response to food have baffled scientists for decades. But recently a series of breakthroughs has raised hopes it will soon be possible to interfere with this process and create drugs to suppress our appetites and control our weights. Appetite suppressants based on hormones that are produced in our gut after we have eaten are already producing encouraging results.
"Humans evolved at times when food was scarce and when we faced starvation all the time," says Professor Waljit Dhillo, at Imperial College, London. "Those who survived were the ones who were able to eat most food and could sustain themselves through periods of famine. They passed on the genes for that ability to future generations. It was useful then, when times were hard, and it ensured our species survived famines.
"But now food is plentiful. We live in a world of McDonald's and Kentucky Fried Chicken, and that ability to gorge ourselves is proving harmful. Our genes keep telling us to eat more."
In 2009, 22% of men and 24% women in Britain were classed as being obese, while a total of 39% of adults had abnormal waist circumference compared with only 23% in 1993.
Even worse has been the impact on younger individuals. In 2009, 16% of boys aged two to 15 and 15% of girls were classed as obese, an increase from 11% and 12% respectively since 1995. Nor is there any sign that this swelling tide of numbers of overweight people is turning back.
"The crucial factor is that not everyone is badly affected by the problem," added Dhillo. "There is a range of different responses within the population. Finding out why some people respond well and others do not is proving to be crucial in developing potential appetite suppressors."
This point was backed by Dr Alasdair Mackenzie, of Aberdeen University. "It is a simple fact that some people crave food more than others. It is not addiction. It is just that some people, when they start eating, find it a lot easier to stop. Finding what is going on, and uncovering the precise biochemical mechanisms involved, is proving to be highly enlightening."
In the past, scientists assumed that the hormones produced in the gut during digestion were involved in breaking down food.
But in the past decade they have discovered that many of these chemicals play a very different role. They are messengers which tell the brain that it is time to halt taking in food as enough has now been consumed.
"There appears to be many chemicals involved in sending chemical messengers from the gut to the brain," added Dhillo. "The trick is to find the most important ones."
A region of the brain called the hypothalamus plays a critical role in dealing with digestion and controls chemical messengers that pass between the brain and the gut. Researchers have isolated two of these messengers, chemicals released by cells in the intestine which are closely linked to appetite suppression. One is known as Glucagon-like peptide-1, or GLP-1, and the second is known as Peptide YY, or PYY. "We recently carried out experiments on adults who had fasted for 12 hours," added Dhillo. "We monitored their brain activity and found, when we showed them pictures of food, particular areas of their brains lit up in our scanners. It was a measure of how interested they were in food.
"Then we gave them an infusion of GLP-1 and PYY and again showed them the pictures of food. Their brains did not light up nearly so much. In other words, they were less stimulated by the sight of food. They had lost their hunger. Essentially, PYY and GLP-1 suppressed their appetites."
Both hormones break down easily in the gut and so their direct use as a drug is limited. However, chemically altered versions of GLP1 – known as exenatide and liraglutide – are already used as a treatment for diabetes because they cause weight loss and also boost insulin secretion in the body. "The trouble with these drug hormones is that they are short-acting," added Dhillo. "Most break down quickly. So pharmaceutical companies are developing analogue versions which have the same effect but last for longer in the body. Some could be administered once a week.
"The future will be to develop a multi-hormone injection that is given in a low dose, so that you do not get any side-effects, and will be long-acting enough so that you need only take it once a day or once a week.
"You will wake up hungry, but because you have had an injection of gut hormone you will only eat half what you would otherwise consume because your appetite has been suppressed.
"Unlike the current suppressors that are on the market, these gut hormones should have very few side-effects. They are versions of chemicals our bodies produce naturally after every meal we eat. That is another important point."
At present scientists are only at the stage of carrying out proof-of-principle studies. Nevertheless, Dhillo said he was optimistic of ultimate success. This hope was also backed by Mackenzie. His work has focused on a different messenger, a chemical known as galanin. Its output in the body is controlled by the hypothalamus. When it is released, it stimulates a desire to eat fatty foods and consume alcohol.
"We have found that there are two versions of this galanin switch. A person could have a weaker one that produces relatively low amounts and so triggers only a mild urge to consume fatty foods or alcohol. Alternatively a person might have the strong version which triggers a high output of galanin and stimulates a strong urge to eat fatty foods."
Intriguingly, Mackenzie has found that Europeans are more likely to carry strong versions of the galanin switch than Asian populations, so Europeans will have, on average, a greater urge to eat fatty foods and to drink alcohol.
"We are now trying to find the chemical pathways in the brain that control that weak-strong switch. We could then manipulate that pathway with drugs, so that we could turn a strong switch into a weak switch and so turn down an individual's interest in eating fatty foods. In that way we could begin to suppress people's appetite and reduce their urges to eat fatty foods."
In short, we are not yet at the point where we can make a pill that we will be able to take when we want to stop feeling hungry. But we may not be far off.
OBESITY IN THE UK
About 70% of men and 63% of women in the UK are overweight or obese.
The number of obese people in the UK has tripled over the last 20 years. By 2020 at least one-third of adults, one-fifth of boys and one- third of girls will be obese.
One in five children in Britain eats no fruit at all.
In 2008 the amount of fruit and vegetables British people bought fell. Purchases of fresh fruit fell by 7.7% between 2007 and 2008 and the volume of fresh vegetables bought fell by 9.6%.
In 2009 about one in 10 schoolchildren aged between four and five was classified as obese.
Obesity reduces life expectancy by an average of nine years.
The body mass index (BMI) – your weight in kilograms divided by the square of your height in metres – is used to define obesity. Obese people have a BMI reading of more than 30. A person with a BMI of between 25 and 29.9 is considered overweight.
Such diversity in eating habits reveals a simple culinary truth: that some people find it easier to stop eating than others. Somehow the chemicals in their digestive systems react more quickly to their food than other people's and so quickly switch off their hunger pangs.
The exact mechanisms involved in humans' response to food have baffled scientists for decades. But recently a series of breakthroughs has raised hopes it will soon be possible to interfere with this process and create drugs to suppress our appetites and control our weights. Appetite suppressants based on hormones that are produced in our gut after we have eaten are already producing encouraging results.
"Humans evolved at times when food was scarce and when we faced starvation all the time," says Professor Waljit Dhillo, at Imperial College, London. "Those who survived were the ones who were able to eat most food and could sustain themselves through periods of famine. They passed on the genes for that ability to future generations. It was useful then, when times were hard, and it ensured our species survived famines.
"But now food is plentiful. We live in a world of McDonald's and Kentucky Fried Chicken, and that ability to gorge ourselves is proving harmful. Our genes keep telling us to eat more."
In 2009, 22% of men and 24% women in Britain were classed as being obese, while a total of 39% of adults had abnormal waist circumference compared with only 23% in 1993.
Even worse has been the impact on younger individuals. In 2009, 16% of boys aged two to 15 and 15% of girls were classed as obese, an increase from 11% and 12% respectively since 1995. Nor is there any sign that this swelling tide of numbers of overweight people is turning back.
"The crucial factor is that not everyone is badly affected by the problem," added Dhillo. "There is a range of different responses within the population. Finding out why some people respond well and others do not is proving to be crucial in developing potential appetite suppressors."
This point was backed by Dr Alasdair Mackenzie, of Aberdeen University. "It is a simple fact that some people crave food more than others. It is not addiction. It is just that some people, when they start eating, find it a lot easier to stop. Finding what is going on, and uncovering the precise biochemical mechanisms involved, is proving to be highly enlightening."
In the past, scientists assumed that the hormones produced in the gut during digestion were involved in breaking down food.
But in the past decade they have discovered that many of these chemicals play a very different role. They are messengers which tell the brain that it is time to halt taking in food as enough has now been consumed.
"There appears to be many chemicals involved in sending chemical messengers from the gut to the brain," added Dhillo. "The trick is to find the most important ones."
A region of the brain called the hypothalamus plays a critical role in dealing with digestion and controls chemical messengers that pass between the brain and the gut. Researchers have isolated two of these messengers, chemicals released by cells in the intestine which are closely linked to appetite suppression. One is known as Glucagon-like peptide-1, or GLP-1, and the second is known as Peptide YY, or PYY. "We recently carried out experiments on adults who had fasted for 12 hours," added Dhillo. "We monitored their brain activity and found, when we showed them pictures of food, particular areas of their brains lit up in our scanners. It was a measure of how interested they were in food.
"Then we gave them an infusion of GLP-1 and PYY and again showed them the pictures of food. Their brains did not light up nearly so much. In other words, they were less stimulated by the sight of food. They had lost their hunger. Essentially, PYY and GLP-1 suppressed their appetites."
Both hormones break down easily in the gut and so their direct use as a drug is limited. However, chemically altered versions of GLP1 – known as exenatide and liraglutide – are already used as a treatment for diabetes because they cause weight loss and also boost insulin secretion in the body. "The trouble with these drug hormones is that they are short-acting," added Dhillo. "Most break down quickly. So pharmaceutical companies are developing analogue versions which have the same effect but last for longer in the body. Some could be administered once a week.
"The future will be to develop a multi-hormone injection that is given in a low dose, so that you do not get any side-effects, and will be long-acting enough so that you need only take it once a day or once a week.
"You will wake up hungry, but because you have had an injection of gut hormone you will only eat half what you would otherwise consume because your appetite has been suppressed.
"Unlike the current suppressors that are on the market, these gut hormones should have very few side-effects. They are versions of chemicals our bodies produce naturally after every meal we eat. That is another important point."
At present scientists are only at the stage of carrying out proof-of-principle studies. Nevertheless, Dhillo said he was optimistic of ultimate success. This hope was also backed by Mackenzie. His work has focused on a different messenger, a chemical known as galanin. Its output in the body is controlled by the hypothalamus. When it is released, it stimulates a desire to eat fatty foods and consume alcohol.
"We have found that there are two versions of this galanin switch. A person could have a weaker one that produces relatively low amounts and so triggers only a mild urge to consume fatty foods or alcohol. Alternatively a person might have the strong version which triggers a high output of galanin and stimulates a strong urge to eat fatty foods."
Intriguingly, Mackenzie has found that Europeans are more likely to carry strong versions of the galanin switch than Asian populations, so Europeans will have, on average, a greater urge to eat fatty foods and to drink alcohol.
"We are now trying to find the chemical pathways in the brain that control that weak-strong switch. We could then manipulate that pathway with drugs, so that we could turn a strong switch into a weak switch and so turn down an individual's interest in eating fatty foods. In that way we could begin to suppress people's appetite and reduce their urges to eat fatty foods."
In short, we are not yet at the point where we can make a pill that we will be able to take when we want to stop feeling hungry. But we may not be far off.
OBESITY IN THE UK
About 70% of men and 63% of women in the UK are overweight or obese.
The number of obese people in the UK has tripled over the last 20 years. By 2020 at least one-third of adults, one-fifth of boys and one- third of girls will be obese.
One in five children in Britain eats no fruit at all.
In 2008 the amount of fruit and vegetables British people bought fell. Purchases of fresh fruit fell by 7.7% between 2007 and 2008 and the volume of fresh vegetables bought fell by 9.6%.
In 2009 about one in 10 schoolchildren aged between four and five was classified as obese.
Obesity reduces life expectancy by an average of nine years.
The body mass index (BMI) – your weight in kilograms divided by the square of your height in metres – is used to define obesity. Obese people have a BMI reading of more than 30. A person with a BMI of between 25 and 29.9 is considered overweight.
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