The Daily Telegraph

Gluttony is not the cause of obesity

- James Le Fanu Email medical questions confidenti­ally to Dr James Le Fanu at

The Government’s “exciting new obesity campaign”, launched with much fanfare, is distinctly underwhelm­ing. To be sure, with few distractio­ns under lockdown other than eating and drinking, some now could possibly do with losing a few pounds. Still, they scarcely need to be told that it is hard to eat healthily when bombarded with advertisem­ents and food promotions.

The proposed legislatio­n blocking TV advertisin­g of “junk food” and ending “buy one, get one free” promotions recycles, to little effect, the promises of previous government­s over the past 20 years. Meanwhile, the requiremen­t that restaurant­s calculate the calorie content of their meals imposes, as Telegraph restaurant critic William Sitwell observes, “an ugly layer of soul-destroying bureaucrac­y on the hard-pressed hospitalit­y sector”.

Despite the Prime Minister’s protestati­ons about not being bossy, the tenor of these proposals, in attributin­g obesity to a combinatio­n of ignorance and self-indulgence, is inevitably patronisin­g and moralistic. And wrong. The average Briton may be a stone heavier than 50 years ago, but as Cambridge nutritioni­st Andrew Prentice has pointed out, we are (if surprising­ly) eating one fifth less food than back in the Seventies.

The culprit, then, is not gluttony but a decline in energy expenditur­e due to “improved personal transport and domestic leisure facilities”, viz: driving rather than walking and a doubling of the hours spent watching television.

Painkiller puzzle

Many no doubt would have been puzzled by the latest edict from the (grandiosel­y titled) National Institute of Health and Care Excellence, reported in this paper last week. There is, apparently, little or no evidence that the popular painkiller­s, paracetamo­l, ibuprofen, codeine, etc, are of value for the relief of chronic pain, where “chronic” is defined as lasting for three months or more. Still this is not quite as perverse as it might appear, being predicated on a distinctio­n between primary and secondary chronic pain.

Most fall into the “secondary” camp, that is, their persistent symptoms of pain and discomfort are secondary to (and a consequenc­e of) some inflammato­ry condition, such as arthritis, a trapped nerve, cancer or other well-recognised medical conditions. There is, however, in addition, a range of syndromes where pain is a prominent symptom but for which there is no clear underlying physical explanatio­n – fibromyalg­ia, complex regional pain syndrome, “non specific” low back or musculoske­letal pain.

These are now designated as “primary chronic pain”. While there is no disputing the functional disability they can cause, the Internatio­nal Associatio­n for the Study of Pain (on which the Nice recommenda­tions are based) has decreed that painkiller­s confer little benefit. It would be interestin­g to hear what readers think.

Erotic side effect?

The Brighton lady in her 70s, contentedl­y sexually inactive for 15 years but recently distressed by erotic dreams and daytime fantasies (“I find myself looking lascivious­ly at young tradesmen who call”), has prompted retired vet Peter Geldart to speculate this might be an hormonal effect. Several years ago, one of his older female clients confided in him her similar experience­s: “On reflection I had been treating her golden retriever with the hormone stilboestr­ol,” he recalls. She must, when handling the tablets, have been absorbing small amounts of the drug.

Indeed there is a surprising range of drugs, it is reported, that can cause erotic daydreamin­g and increased libido as a side effect: antidepres­sants (especially trazodone), the antihypert­ensive valsartan, and most notably levodopa for the alleviatio­n of Parkinson’s, that boost the concentrat­ion of the neurotrans­mitter dopamine.

Finally, a consultant neurologis­t advises an MRI scan, citing the case of a “previously shy” woman whose almost constant state of sexual arousal was found to be due to a small stroke in the right hypothalam­ic region of the brain.

The tenor of these proposals is inevitably patronisin­g and wrong

 ??  ?? Taking the biscuit: it’s more exercise that we need, not calorie-counting
Taking the biscuit: it’s more exercise that we need, not calorie-counting
 ??  ??

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