Gluttony is not the cause of obesity
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