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Where were you when I was bored and saw this?

The triggers are everywhere- Hungry? Thirsty? Bored? Sad? We have something for you right now. Meanwhile your advise is a quiet voice in the back of their mind. There is an entire industry dependent on people’s bad choices, they are not taking a holiday this year working on how to influence them more than your diet and exercise program. There’s another industry depending on those choices so that you- doctor- will prescribe their neatly packaged answer to the expanding waist lines and furred arteries. It’s about the economy. The show must go on.

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How do you know your solution is the best?

Healthcare professionals offer solutions to problems. Doctors at community healthcare offer a solution to another problem every 10-15 minutes. Meanwhile the people seen there are making choices that seem entirely unrelated.

I’ll eat this, I’ll drink that, I’ll spend my money on this. I’ll work here. I’ll interact with these people. I’ll frame my problem like this…..

Some seemingly unrelated choices impact on the solutions offered by their health practitioner. It may be that people carry on making choices that undo all the benefits offered in prescribed, neatly packaged and costly labelled boxes.

If you are in healthcare how do you know the solutions you are offering are effective or even the best available? Could you do better?

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Are you credible as a lifestyle coach?

The commonest conditions doctors encounter are illnesses directly related to poor life style choices. Diseases that arise because we eat too much and don’t take enough exercise.

People who seek healthcare advice will be told more often than not that they must make different choices. How credible is your advice as a doctor? How persuasive are you as the messenger? How could you do this better?

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Do you prepare to disappoint?

In any business there will be time when you don’t see eye to eye with your customer.  In fact there will be times when you disagree with them because what they want is either impossible, illegal, unavailable or otherwise difficult for you to deliver.

You might encounter that situation more than once in the course of your day. You expect it right? So if you are a doctor how do you prepare to deliver that news to a patient?

Once you’ve dumped your baggage and assumptions, approached patients with humanity and compassion, and discovered the real problem, what’s your next step? That depends upon what the real problem you discovered is. Is the problem something that is your fault or one you can solve? Did the patient have expectations that weren’t correct? Have an honest and forthright discussion with them. If you can do that, you’ll be getting thank you cards from your patients for a very long time. David J. Norris, MD

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When did your doctor last ‘do nothing’?

When was the last time your doctor, or you, if you were the doctor, ‘do nothing’ in the consultation? We don’t feel we have received or delivered value in the consultation unless we prescribe something, order a test or make a referral. But what does that tell us about the business of doctoring or the attitude to medicine?

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For sustained behaviour change: show don’t tell

BACKGROUND:
This randomised controlled study evaluated a computer-generated future self-image as a personalised, visual motivational tool for weight loss in adults.
METHODS:
One hundred and forty-five people (age 18-79 years) with a Body Mass Index (BMI) of at least 25 kg/m2 were randomised to receive a hard copy future self-image at recruitment (early image) or after 8 weeks (delayed image). Participants received general healthy lifestyle information at recruitment and were weighed at 4-weekly intervals for 24 weeks. The image was created using an iPad app called ‘Future Me’. A second randomisation at 16 weeks allocated either an additional future self-image or no additional image.
RESULTS:
Seventy-four participants were allocated to receive their image at commencement, and 71 to the delayed-image group. Regarding to weight loss, the delayed-image group did consistently better in all analyses. Twenty-four recruits were deemed non-starters, comprising 15 (21%) in the delayed-image group and 9 (12%) in the early-image group (χ2(1) = 2.1, p = 0.15). At 24 weeks there was a significant change in weight overall (p < 0.0001), and a difference in rate of change between groups (delayed-image group: -0.60 kg, early-image group: -0.42 kg, p = 0.01). Men lost weight faster than women. The group into which participants were allocated at week 16 (second image or not) appeared not to influence the outcome (p = 0.31). Analysis of all completers and withdrawals showed a strong trend over time (p < 0.0001), and a difference in rate of change between groups (delayed-image: -0.50 kg, early-image: -0.27 kg, p = 0.0008).
CONCLUSION:
One in five participants in the delayed-image group completing the 24-week intervention achieved a clinically significant weight loss, having received only future self-images and general lifestyle advice. Timing the provision of future self-images appears to be significant, and promising for future research to clarify their efficacy.

Trials. 2017 Apr 18;18(1):180. doi: 10.1186/s13063-017-1907-6.

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Dog walking may assist weight control

Height and weight were measured for 281 children aged 5–6 years and 864 children aged 10–12 years. One parent reported their own and their partner’s height and weight (n=1,108), dog ownership, usual frequency their child walks a dog, and usual frequency of walking the dog as a family. Logistic regression analyses were adjusted for sex (children only), physical activity, education, neighbourhood SES, parental weight status (children only) and clustering by school.

Dog ownership ranged from 45–57% in the two age groups. Nearly one in four 5–6 year-olds and 37% of 10–12 year-olds walked a dog at least once/week. Weekly dog walking as a family was reported by 24–28% of respondents. The odds of being overweight or obese were lower among younger children who owned a dog (OR=0.5, 95% CI 0.3–0.8) and higher among mothers whose family walked the dog together (OR=1.3, 95% CI 1.0–1.7). Health Promotion Journal of Australia

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What we eat at work may be very bad news

We spend so much time at work- what we eat there matters. What makes it worse is that we may be triggered to eat things that are very bad news for our waist line.

Expressed as terms of a percentage of your life, this 39.2 hours a week spent working is equivalent to

  • 14% of your total times over the course of a 76 year period (based on the average projected life expectancy of 76 for people born in the year 2000 according to the ONS’s National Life Tables for the United Kingdom.)
  • 23.3% of your total time during the course of a 50 year working-life period
  • 21% of your total waking hours over a 76 year lifespan, assuming 8 hours of sleep a night.
  • 35% of your total waking hours over a 50 year working-life period assuming 8 hours of sleep a night
  • 50% of your total waking hours during any given working day. ReviseSociology

I summarise in the video:

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Triggering better health outcomes

The first piece of data we collect in healthcare is: date of birth. Could it be used to trigger better habits?

50th birthday bashes have overtaken 21st celebrations as 50 now considered the “peak” age to throw a party, sales figures for cards and party paraphernalia show.

Sales of 50th birthday cards have for the first time eclipsed the number of 21st birthday cards sold, according to data from Clintons, the UK’s biggest cards retailer.

With 50th birthdays now leading on the birthday league table and accounting for 16 per cent of all card sales, 21st birthday cards now make up 14.1 per cent of all cards sold. Katie Morley. The Telegraph Oct 2017

I explore the possibilities.

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The long-term impact of overeating during the holiday season

We do not gain weight steadily through the year. In fact, it is primarily from the end of November to mid-January that we find ourselves tempted and triggered to eat more than we need. With a seemingly endless round of invitations to partake in sugary treats most people succumb and add up to one kilo to their already growing girth.

The average BMI of males in their 40s in the West is 25.6 to 28.4. The numbers are similar for women.  In other words, most are overweight. Researchers document that during this holiday season adults consistently gain weight during this period (0.4 to 0.9 kg).

Participants seeking to lose weight appeared to increase weight although this was not consistently significant and motivated self-monitoring people also appeared to increase weight. These results must be considered for registered dietitian nutritionists, other health providers, and policy makers to prevent weight gain in their patients and communities during this critical period.

Obesity is an epidemic with a rising tide of chronic and life-limiting illnesses in its wake. As healthcare professionals,
we need to be confident about raising the issue of overindulgence without putting a damper on the festivities.


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