RCGP Online Zoom Call - Covid-19: A lifestyle disease

https://twitter.com/user/status/1276473814461886464


This looks quite problematic. Already framing Covid-19 as a lifestyle disease, with GPs being prepared to prescribe physical activity, mindfulness, and yoga.

https://rcgpportal.force.com/s/lt-event?id=a1U1i000001nsCLEAY&site=a0d0Y00000AeOP6QAN


A one-day interactive online conference on lifestyle medicine for GPs during COVID-19 and in the post-pandemic phase.

COVID-19 is a communicable virus but it is also a lifestyle disease. Obesity, diabetes and other lifestyle diseases are associated with poorer outcomes from infection. The tragedy of the pandemic, as well as lockdown itself, has acted as a catalyst for positive behaviour change for many people and primary care plays a vital role in harnessing and supporting people to make and maintain these changes.

The Physical Activity & Lifestyle clinical priority team brought together some of the leading lights from across the expanding lifestyle medicine field to bring you a free, evidence-based and interactive event exploring how GPs can play a key role as we emerge from the pandemic. Delegates can expect practical 'easy wins', top tips for encompassing lifestyle medicine into day-to-day general practice, opportunities to quiz the speakers and active breakout sessions. Sign up and enjoy from the comfort of your own home!

Learning Objectives:

• To learn about how principles of lifestyle medicine are more important now than ever
• To discover why remote medicine shouldn't be a barrier to lifestyle medicine consultation
• To add to your toolkit of top tips to ensure you're offering your patients the latest and best advice and resources around physical activity, sleep, stress and more.

Topics Covered

• Physical Activity as a prescribed treatment during lockdown
  
• Surviving Shielding and how a GP can help
• Moving Medicine
• Video Consulting & Virtual Group consulting

Sessions will also include social prescribing, yoga, mindfulness and sleep.

Chairing this virtual conference are:

• Dr Zoe Williams, RCGP Clinical Champion for Physical Activity and Lifestyle priority
• Dr Andrew Boyd, RCGP Clinical Champion for Physical Activity and Lifestyle priority
• Dr Dane Vishnubala, RCGP Clinical Fellow for Physical Activity and Lifestyle priority

 

I think it's meant for prevention not as treatment.

 

It would appear, based on where most deaths have occured, that being economically disadvantaged (i.e. poor) is a lifestyle choice that has a most significant effect on people's outcomes after acquiring covid-19. It also appears that being 'old' is another lifestyle choice that has a significant effect, as does the lifestyle choice of being male.

All of these lifestyle choices can of course be treated online with people being encouraged to make healthier choices, about their age, sex, or income.

 

You could be right, but that's not explicit in any of the material.

 

Although I'm far from a shining good example, if some of the risk factors for severity can be reduced by lifestyle choices then it is valid to address that I would think.

 

Exactly. I hope we can all agree that even if the interventions here are preventative, framing Covid-19 as a lifestyle illness is anti-scientific and actually quite insulting. It seems others on Twitter have picked up on this.

 

I’m sorry but even though I practise mindfulness meditation and have done so even before it was “cool”, for the past nearly 14 years, as well as yoga intermittently also in that timeframe, until I fell too ill to do so - I really, really dislike seeing things like this.

It’s kind of like the mindfulness courses I’ve seen which they send mentally ill people to - people I know who have significant mental health challenges which haven’t been ever addressed properly, which actually perpetuate in large part often from systemic issues such as poor housing, poverty, not being included in daily life, treated badly from all quarters, then are told to go to these courses.

Maybe rather than getting GPs to focus on these things, do things like increase funding for mental health services, physical health services, social services, less working hours, a 4 day work week even, secure pay, so that people will be healthier & more secure. Very often people who are happier & healthier will then by themselves seek out things that make them happier and more peaceful, and if that’s meditation, or a exercise hobby they like, that’s fine - they’ll find that themselves.

 

Agree. These interventions are fine, but not when they come in lieu of a proper acknowledgement of and solutions for the problems you mention.

 

Bit late for that. As in several decades late. Those factors take years to have a positive health effect and only from the day they are made accessible to all.

Almost all "lifestyle" diseases are socioeconomic in nature, are treated by solving poverty. UK has adopted austerity, nothing the medical profession can do to change those economic risk factors. Instead medicine in the UK has played along with austerity, thanks to such ethical champions as Wessely and Gerada in the form of the BPS ideology, essentially medical austerity.

It's basically as cruel an application of the just-world fallacy as exists. People are made to be disadvantaged, then are blamed for being disadvantaged, then denied help for having been disadvantaged in the first place.

This is not the remit of medicine unless there's an admonition to change the circumstances. This is the opposite of that. Just horrible. This is "let them eat brioches" level of disconnected from reality. This organization deserves to be deleted from existence and the entire leadership system of medicine rebuilt from scratch without the influence of horribly cruel people.

There were a few articles some months ago about the rotten culture of medicine in the UK, how bullyish it is, how it squeezes the life out of its employees. This rotten culture comes straight from the top and it shows.

 

I find the casual framing of diabetes as a lifestyle choice fairly shocking. While admittedly Type 2 or insulin resistant diabetes may very well be controllable, if not reversible, through lifestyle choices I don't believe it's that cut and dried.

It certainly wasn't to my neighbour who was diagnosed with it in his mid-50s. Eventually his wife insisted he go back to the GP - he was slim, used a gym in his garage several times a week, went dancing (salsa, tango etc) regularly. Yep, type 2 diabetes alright but caused by pancreatic cancer not lifestyle. Precious time early on in the disease lost trying to improve a lifestyle better than most peoples.

Perhaps my niece, diagnosed with Type 1, insulin dependent diabetes when she was a tiny little 4 year old waif should have pulled up her socks and gotten her act together?

What about those reliant on what's available through food banks rather than what they might choose to eat? Working zero hour contracts all the hours they can get, no time to exercise or have a life because if you turn down hours once they might not be offered again.

By all means lets yet again focus on where the blame often doesn't lie.

While we're at it, where were you guys when the food parcels sent to the shielded contained almost pure, cheap carbs?

By the way - for those who don't know - Dr Zoe Williams is a TV personality. She was a rugby player and was the character"Amazon" in Gladiators (UK TV). She has also appeared in "Trust Me, I'm A Doctor" alongside Dr Michael Mosley.

 

Also, those from BAME (Black and Minority Ethnic) groups have much higher death rates.

A doctor friend of mine who has been following this, says some research shows that people from these ethnic groups, appear to have more ACE-2 receptors on their cells. (ie the receptor that COVID 19 binds to). This could also link in with increased risk of people from Asian backgrounds having a higher risk of developing Type 2 Diabetes.

So much is still unknown/not understood.

 

I realise that the ‘Online Conference’ was today but, interestingly, the RCGP have deleted the tweet.

And the RCGP have issued an apology

https://twitter.com/user/status/1276896955197788165


edit: added more recent tweet.

 

They did a very large study looking at the lean offspring of type 2 diabetics and found that they processed sugars differently. this makes sense as it appears to be caused by genetic mutations which give people an advantage in marginal environments which may explain some of the increased risk in certain populations.

Having the genes for the risk of type diabetes could well be a factor in people becoming obese rather than the other way round. Obesity is also another thing which does not have a simple cause.

So while diabetes and obesity are worsened by the modern lifestyle that lifestyle is not always so different from what the rest of the population gets away with. Some people are thin, fit and healthy because of their lifestyle choices but the majority have their outcome decided by other factors. It is certainly not true that some of the population have these diseases because of what they do and that no one else does them.

 

That part of medicine that deals in preventative health and wellness has become a coercive social force.

Their prescriptions are based on the most superficial psychological moralising. A 'we can do this therefore so can you'. With no appreciation of any social or biological or even psychological milieu outside their own.

And yes, exercise is good for you. Apparently so is walking in nature. How about lobbying for more parkland in poorer neighbourhoods with a long list of 'and so on'.

They are also too restrictive in that they lack diversity. Not every body type tends toward skinny for example. There is a range of normal.

Just IMO, these people are moralising zealots who gain psychological benefit from shaming others not like them.

 

Lots of dissatisfaction among doctors about " lifestyle medicine", various tweeter feeds.

 

"Clinical Champion? What’s that?"

https://www.rcgp.org.uk/clinical-an...cal-news/2019/february/clinical-champion.aspx

 

On this topic of lifestyle medicine..

https://www.thetimes.co.uk/edition/...s-boris-johnson-puts-nation-on-diet-vccfrdvjs

“Boris Johnson is planning to put the nation on a diet, including the wider use of bariatric surgery, as he draws up a new obesity strategy to try to limit the impact of a potential second wave of Covid-19.

The prime minister, who is on a slimming regime himself, is expected to outline plans next month to help shrink the population’s waistline and increase fitness levels, after his own brush with death led to a “Damascene conversion” about how to combat obesity.

The health department has presented a series of proposals to No 10. They include better access to programmes ranging from family exercise schemes and healthy eating to bariatric surgery, which includes the fitting of gastric bands.

Other possible measures include banning price promotions such as “buy one, get one free” offers and unlimited refills on unhealthy foods and drinks, bringing in legislation to mandate calorie labelling for restaurants, cafés and takeaways, and increasing the number of outdoor gyms

All the focus and energy is going to be on getting the nation fitter because, as the coronavirus has shown us, it will save lives,” said a Department of Health insider with knowledge of the plans.

People have gone to extraordinary lengths to remain safe, including staying at home for the past 12 weeks, so encouraging them to eat more healthily and take more exercise should not be that difficult. This is clearly our moment because if people want to do their bit to beat this virus then losing weight would be the best thing they can do.””

But nothing about austerity, poverty and housing and peoples work situations, even people’s illnesses & chronic conditions impacting how they can eat, no?

 

So the basic rate of ESA is £74.30 a week, for disabled, sick and chronically ill people (£58.90 if they are under 25 years old)...Only someone with a complete lack of empathy or understanding of real world economics could suggest you can afford to meet your household bills (including disability expenses) and eat healthily on that amount of money. The government won't even give these people the £20 a week increase given to those on Universal Credit!

 

Hmmm, people on Twitter are calling for a video of him doing press ups - just cos you can do a single one as pictured on Daily Mail this morning doesn't really count for anything! He's obviously still very unfit - you only have to look at him on PMQs. (Our chosen entertainment every Wed lunchtime!)