Good health isn’t about diet alone

QI AM 60 and have been weight-watching since the age of 14. I eat a healthy low-fat, high-fibre diet the majority of the time and exercise three times a week. But I am a stone heavier than in my younger years and try as I do – limiting myself to about 1,400 calories a day – I cannot lose more than 2lb before reaching a plateau. My BMI is 26, which I believe means I’m overweight. Should I be worried? A AS A GP, I look at the holistic health of a patient: looking beyond measurements and results, and seeing the bigger picture. So much illness I see in my surgery is related to unhealthy weight and exercise levels, from diabetes and heart disease to cancer and mental health issues. And of course I recognise that weight and the way we look is also a great obsession within society.

But a BMI that is slightly above the normal range in a non-smoker who exercises regularly is not a cause for worry. It certainly doesn’t justify the stress that weight-watching can cause. In fact I’d argue that dieting to reach what appears to be an unattainable and maybe unrealistic target does not make for a healthy life in the complete sense, mentally as much as anything else.

Weight is only part of someone’s health, interplaying with other both mental and physical factors. Adopting a balanced diet, free from calorie-counting while maintaining the good level of exercise, is likely to achieve better results long-term.

The notion of yo-yoing causing a slow metabolism is not proven; in some people weight continues to go up because of all the extra gain that goes on each time a person falls off the wagon and overeats.

Q MY NIECE, who is in her mid-20s, is suffering problems with her vision, and difficulty moving. We’ve been told it could be a condition called conversion disorder, which means there is no known cause. Could the fact that she had scarlet fever when she was little be the reason? And is there anything we can do? A CONVERSION disorder is a very distressing condition where a psychological trauma appears to set off a functional,

I OFTEN feel frustrated when patients come to the surgery simply to obtain a sick note. It’s frequently the case that they have self-cared, staying at home with a self-limiting illness, but that their employer insists they prove it with a note from me. Of course in some cases it is reasonable, but for a short period of illness in an otherwise good employee, it is a waste of my time and a waste of the patient’s. The BMA is calling for patients to be allowed to selfcertify themselves off for two weeks to reduce the burden on GPs. This may help, but only when employers learn to trust their staff.

physical condition. Its symptoms can be very dramatic – not being able to walk or difficulty swallowing, perhaps – but with no apparent underlying cause. This is very hard to accept for patients and relatives because the symptoms are indeed real, but investigations and examination prove normal.

In the same way that physical pain and illness can cause mental symptoms such as anxiety, mental pain and illness can convert into physical symptoms.

Conversion disorder symptoms do mimic neurological disorders causing limb weakness, paralysis, swallowing difficulties, numbness and even hearing and visual loss.

Since these symptoms are often so substantial and lifealtering, full assessment and investigations are crucial to rule out a serious physical neurological problem.

Acceptance of the psychological basis is vital for successful treatment. Conversion disorder symptoms respond well to psychotherapy, particularly cognitive behavioural therapy, and it is important to seek help quickly as waiting times can be long.

Scarlet fever in childhood can cause late complications in adulthood – such as problems with kidney function and the heart valves – but neurological disorders two decades later would not be anticipated. Problems like these would only be expected in someone who had experienced a meningitis or neurological issue at the time of the scarlet-fever infection.