Yes, both Ozempic and Wygovy are brand names of the same medicine, semaglutide. They are made by the same company Novo Nordisk. Ozempic is the brand that they originally produced for diabetes. It comes in strengths of 0.25mg. 0.5mg and 1mg. After they found out that it helped with weight loss, Novo Nordisk started to produce a brand targeted for weight loss called wygovy. It comes in the same strengths as Ozempic but also the higher strengths of 1.7mg and 2.4mg.
Semaglutide works by delaying stomach emptying so that you feel fuller for longer. It promotes weight loss by suppressing your appetite and hunger, and reducing the amount you eat. It also gives you the ability to control your food intake better, and reduces cravings for fatty, energy-dense foods.
Semaglutide is currently only available from an NHS GP for diabetes, although other drugs are more likely to be used for this purpose.
For weight loss, you will need to be referred by your GP to a tier 3 or 4 specialist weight management service if you meet the criteria: have at least one weight-related illness and a body mass index (BMI) of at least 35kg/m2 or between 30kg/m2 – 34.9kg/m2 who meet the defined criteria.
Semaglutide does come in tablet form by the name of Rybelsus. However, it is licensed for diabetes and not weight loss.
Novo Nordisk has done a study that shows that 50mg tablets give a similar weight loss to the injections. However, the maximum dose of tablets currently available is 14mg.
The cost of semaglutide varies depending on where you buy it. Currently, it is around £110-120 per injection pen that will last 4 weeks. The higher doses of Wygovy 1.7mg and 2.4mg may be up to 2-3 times that price.
In the STEP 1 study, the most common side-effect was nausea. Out of around 2,000 patients, 3 of them were seriously ill with pancreatitis.
In practice, nausea is still common but generally mild and well tolerated. People can also get vomiting, become constipated or have loose stool. Recently, there have been reports of a small number of people in the US having bowel obstruction needing hospital care.
For many women and couples, a pregnancy test can be a turning point—a moment filled with a mix of excitement, hope, and anxiety. With a myriad of pregnancy tests available in the UK market, it’s crucial to understand how they work, their accuracy, and when to use them. This guide aims to demystify the pregnancy testing process, using some of the most frequently searched terms about the subject.
Types of pregnancy tests
1. Home Pregnancy Tests (HPTs)or Pregnancy Test Kits
These are the most common tests available and are designed to be used in the comfort of your own home. Do cheap pregnancy tests work? Yes, even budget-friendly tests can be accurate. It’s more about using the test correctly than the price. They are often sold in multiples of 2 or 3 as women may not rely on just one test, and want to do repeated tests on one occasion or over a period of time for confirmation.
Standard Stick Test: These are the most commonly recognised tests. You pee directly onto the stick, and after a few minutes, the result will be displayed, usually as lines, a plus/minus sign, or even words like “pregnant” or “not pregnant.”
Digital Tests: These provide results in words and often include a timer on the digital display, letting you know the test is working. They might be slightly more expensive than the stick test but can eliminate the guesswork of interpreting lines.
Test Strips: These are often more affordable and come without the plastic casing. You dip the strip into a collected urine sample.
2. Clinical Urine Test
This is performed at a doctor’s office or a clinic. It works similarly to HPTs, but the results might be considered more trustworthy, given that healthcare professionals read the test. However, most NHS general practitioners do not do these tests as they are similar to those that can be bought over-the-counter and patients are expected to do them.
3. Blood Pregnancy Tests
These are the most accurate and can detect pregnancy earlier than urine tests. They are done at a clinic or laboratory. There are two main types:
Qualitative hCG Blood Test: It checks to see if the hormone hCG is present. It provides a simple yes or no answer to whether you are pregnant.
Quantitative hCG Blood Test: This measures the exact amount of beta-hCG in the blood. It can detect even very low levels of beta-hCG, making it very accurate. Additionally, it can help track potential problems during pregnancy. A number of companies offer this type of pregnancy test online but this is a little misleading. You can pay for the test online but then have to visit the clinic or laboratory to do the test.
Things to Consider:
Timing: The accuracy of a pregnancy test largely depends on timing. Testing too early, even with an early detection test, can lead to false negatives. If in doubt, wait a few days and test again.
Sensitivity: Some tests are more sensitive than others. The packaging usually indicates the sensitivity level, with those detecting lower levels of hCG being more sensitive. Some early detection tests claim they can detect pregnancy a few days before a missed period. While they test for the same hormone, they might be sensitive enough to detect lower levels of hCG earlier in the pregnancy.
Expiration Date: Always check the expiration date. An expired test might not provide accurate results.
Follow Instructions: Each test might have slightly different instructions. For accurate results, always follow the manufacturer’s guidelines.
When to take a pregnancy test
The best time to take a urine pregnancy test is at least a week after your missed period. This will reduce the chances of the result being a false negative. If it is negative and you still suspect that you might be pregnant, then test again after a week. The best time of day to do a pregnancy urine test is first thing in the morning after waking as the urine is more concentrated.
A pregnancy blood test can detect pregnancy much earlier than a urine test and is more reliable. It is the best way to detect pregnancy within the first month.
This indicates the presence of hCG suggesting pregnancy. Urine pregnancy tests used correctly have a very low false positive rate of 1% or less due to taking certain medications or a medical condition. Nevertheless, a positive result is highly reliable.
Negative Pregnancy Test:
No hCG was detected, implying no pregnancy. If you still suspect that you are pregnant then repeat the test after a week.
False negative pregnancy results have been found to be as high as 5% in some studies. This can be due to:
Testing too early: This is the most common reason for a false negative result. The earlier you do a home pregnancy test, the harder it is to detect hCG. That’s why it’s better to wait until you have missed a period.
Checking the result too early: Follow the instructions for your particular pregnancy test and only read it after the right amount of time has passed. Reading too early can give a false negative result.
Taking the test later in the day: For the most accurate results, take the test using the first urine passed in the morning on waking.
Faint Line on Pregnancy Test:
The dreaded faint line can still be positive. However, if the test is read too late then an evaporation line from the drying of the urine on the stick can be mistaken for a pregnancy test faint line. In this case, it is better for you to take another test.
Advantages of blood pregnancy tests
Beta-hCG blood pregnancy tests are not only accurate in confirming pregnancy but are instrumental in various health scenarios. These include:
Early Detection: Blood tests can detect hCG levels even before they’re high enough to be caught by urine tests. This means potential pregnancies can be identified sooner, allowing for early intervention and care.
Quantitative Insights: Unlike most urine tests that provide a simple positive or negative result, blood tests quantify the exact level of hCG. This specific measurement can be crucial for doctors to monitor the progress of the pregnancy and the effectiveness of the fertility treatment.
Monitoring Treatment Efficacy: In fertility treatments such as IVF or IUI, tracking the rise and fall of hCG levels can provide insights into the success of the procedure. It can also help in adjusting dosages or treatment methods if required.
Detecting Ectopic Pregnancies: Elevated hCG levels combined with other symptoms can hint at an ectopic pregnancy. Early detection via blood tests can save lives, as untreated ectopic pregnancies can be life-threatening.
Predicting Multiple Pregnancies: Extremely high hCG levels can sometimes indicate multiple pregnancies, like twins or triplets. This information can be vital for planning prenatal care.
Reduced Uncertainty: Unlike urine tests, which may sometimes display faint lines leading to confusion, blood tests offer clear, numerical results, reducing uncertainty and anxiety.
Consistency and Reliability: Blood tests for hCG are consistent and are less influenced by factors that can affect urine tests, such as the dilution of urine or the time of day.
In conclusion, while pregnancy tests available in the UK are generally reliable, it’s essential to use them correctly and understand their nuances. When in doubt, do repeated tests over a period of time, do a pregnancy blood test or consult with a healthcare professional.
In an era where digital transformation is not only welcomed but expected, healthcare isn’t left behind. As a prescribing clinician, unnecessary paperwork and manual processing consumed both my private practice and my administrative staff. We were immersed in these inefficiencies and dedicated valuable time and resources that could be better used in patient care. Electronic private prescriptions software has completely changed that with reduced workload for all of us. I have tried numerous solutions in the past, using software built by IT professionals who didn’t understand my work or that forced me to use a specific pharmacy. These limitations often impeded the efficiency and flexibility of my practice until I discovered e-Private Prescription software. Clinicians built e-Private Prescription software to be used by clinicians, offering a solution where prescriptions can be sent to any participating pharmacy. This ensures freedom and flexibility in choosing where prescriptions are filled.
Unmatched Efficiency
Every prescribing clinician is familiar with the cumbersome, time-consuming process of traditional prescription management. E-Private Prescription, has turned the tables, offering a streamlined, efficient, and user-friendly interface. I can swiftly input data to create, manage, and transmit prescriptions with unprecedented ease using the E-Private Prescriptions software. The software ensures that patients receive their prescriptions without delay thereby enhancing the overall experience for both patients. I send my e-prescriptions to partner pharmacies who prioritise my prescriptions and give a great service to my private patients. That means that my patients get the same great service as my private clinic provides.
Cost and time saving
I no longer have to worry about posting the original prescription to different pharmacies as e-Private Prescription carries an Advanced Electronic Signature. This feature means that a prescription it generates is as valid in the UK as one carrying an ink signature. The Royal Pharmaceutical Society endorses electronic private prescriptions software using an Advanced Electronic Signature, making it acceptable to all pharmacies.
A complete audit trail means that there is no such thing as lost prescriptions and the need for duplication. I can remember the days of handwriting private prescriptions and not knowing what happened to them afterwards. Now, a quick glance at a screen lets me see if and when pharmacies have dispensed my electronic private prescriptions. The administrative staff have more free time on their hands to focus on important tasks instead of chasing lost or missing prescriptions. My patients also give me glowing comments about the participating pharmacists who get their medication to them in a timely-fashion. Convenience in healthcare and improved patient experience is absolutely possible!
The ability to send electronic private prescriptions has transformed by my remote consultations. I can send prescriptions to my patients wherever they are in the UK. The partner pharmacies that I use can even deliver the medication directly to the patient’s home make life easier.
Robust Security
In the world of healthcare, the security of sensitive data is paramount. E-Private Prescription software boasts robust, world-class security protocols ensuring that every piece of data is encrypted, stored, and transmitted securely. Every prescription is traceable creating a complete audit trail, making discrepancies and errors virtually non-existent. As a clinician, the confidence that comes with the knowledge that patient information is impervious to unauthorised access is priceless.
Real-time Updates and Accessibility
Clinicians often face challenges with accessibility and receiving real-time updates in prescription management. The e-Private Prescription software’s cloud-based system affords instant, anytime-anywhere access. As a doctor, this flexibility ensures that I can manage prescriptions whether I am in my office or travelling. This flexibility translates into enhanced patient care, as the prescriptions are always accessible at the touch of a button.
e-Private Prescription software: Innovation at Its Finest
In the competitive landscape of electronic prescription software, innovation is often the dividing line. E-Private Prescription software is perpetually evolving, integrating the latest technologies to offer more features, enhanced security, and superior user experience. The company that created the software is E-Health Solutions. They are proactive in taking feedback from clinicians, pharmacists and patients to continually improved their product.
Electronic private prescriptions: the verdict
In my long career, I have yet to encounter a software solution that has made as big a difference to my practice as e-Private Prescription. Every prescribing clinician seeking to elevate their practice, enhance patient satisfaction, and ensure confidentiality need not look further. In a world inundated with electronic prescription options, E-Private Prescription software unequivocally stands as the zenith.
Join me, and myriad other satisfied clinicians, in the journey to unparalleled healthcare service delivery. Electronic Private Prescription software isn’t just an option; it is the future of personalised patient care.
The Revolution of Online Private Prescriptions in the UK
In the progressive world of medical advancements and technological evolution, a dynamic shift is underway that is transforming the way you can access online private prescriptions. Say goodbye to the tiresome waits and inconvenient appointments and embrace the future. We now live in a world where getting a repeat prescription online is possible privately as well as the NHS, and is as easy as a few clicks. The inception of the system of online repeat prescriptions is not just a technological advancement, it is a lifeline, bringing medication directly to your doorstep.
Online Private Prescriptions: Your Health in Your Hands
Imagine a world where your medication needs are met with speed, efficiency, and utmost confidentiality. That’s precisely what online private prescriptions in the UK offer. Whether you’re looking for online STD treatment or want to buy antibiotics for a UTI, the power to get online prescriptions is now within your grasp. Make an online appointment with a UK doctor and avoid the unscrupulous online pharmacies that sell medication without the necessary safeguards.
Beyond the Conventional Paths
Navigating the electronic prescriptions landscape may appear complex, but in reality, it’s a breeze. Have you ever wondered, “Can I get a private prescription online or can I order a private prescription online?” The answer is a resounding yes! With services offering private online prescription refills and next day medicine delivery, getting a prescription has never been easier.
The Digital Bridge to Your Medication Needs
The process to get private prescription online is straightforward. You can receive an online diagnosis and prescription, including online birth control prescriptions (recent blood pressure measurement may be required) without stepping out of your comfort zone. It’s swift, it’s convenient, and it’s changing the game in healthcare.
Seamless, Fast, and Efficient
For those contemplating, “How do I set up an electronic prescription?” there’s no need to worry. The ease of e-prescribing software makes electronic prescriptions easy to do for the doctor. He will ensure that your medicinal needs are met with efficiency and speed. The pharmacy can deliver your medication to your home by the next day.
Private, Personalised, and Tailored
We would not recommend getting a prescription without seeing a doctor. You can get an online doctor consultation and then have the medication prescribed based on a sound diagnosis. A doctor cannot prescribe online private prescriptions for certain controlled substances, but can prescribe regular medication including online antibiotic prescribing, for example.
Embrace the Change: the future is now
With options to fill private prescription online, the revolution is here. Can a private prescription be sent electronically? Absolutely!
We are at the frontier of a healthcare transformation where the intersection of technology and medical excellence is redefining possibilities. Welcome to a world where your health and convenience converge, welcome to the future of online private prescriptions.
Say goodbye to the old ways, and embrace the empowered path of convenience, confidentiality, and choice. The future of health and wellness is a click away. Join the revolution!
The good news is that it is perfectly possible to do your own tennis elbow treatment at home. The not-so-good news is that a cure for tennis elbow can be challenging. Patience is essential in this process. There are no new treatments for tennis elbow that are proven but there are tried and tested treatment options which do work.
As described earlier, the changes in tennis elbow have developed over a long period of time and will therefore take typically months to heal. However, patient expectation tends to be the opposite as many people think that tennis elbow should get better more quickly such as over a couple of weeks. They often ask how to heal or cure tennis elbow fast which is really not possible.
1. Relative rest
Since tennis elbow is an overuse disorder then you will need to either stop the activity that caused it for a period of time or modify it so that you get relative rest.
One of the main factors that can make tennis elbow last longer is if patients continue to do the same activity which caused the tennis elbow to develop in the first place. In the case of hobbies, it might be easy to stop for a period of time to allow healing to take place. However, if that activity is related to your work, then it may be completely impractical to ask you to stop altogether. It is especially difficult if you have your own business and work by yourself.
Examples of modifications include taking regular breaks during work, using the other hand, using a lighter grip or getting help with certain tasks. Do you have a holiday coming up? That would be great because you would get complete rest from work. If you use a keyboard, then consider using speech recognition software to give your hands some rest or use the wrist supports mentioned below. All of these things will take some, but not all the strain from your muscles and tendons.
Modify the way you lift objects
A:This is the correct way to lift an object with your palms facing upwards. This allows you to use your big biceps muscles to do the lifting and avoid strain around the elbow.
B: In this diagram, the hands are held so that the palms are facing each other. You are still using the biceps a little but are now straining the smaller muscles around your elbows.
C: Now the palms are facing downwards and all the strain is being taken by the smaller muscles around the elbow. This is the worst possible position for tennis elbow and should be avoided.
Modify the way you use a keyboard and mouse
Incorrect position:The wrist is angled upwards or to the side. This puts the muscles around the elbow under tension for long periods of time. This can cause tennis elbow or wrist pain. Sometimes it is called RSI or a Repetitive Strain Injury.
Correct position:The wrist is not angled either upwards, downwards or sideways. This prevents strain of the muscles and tendons around the elbow. You can achieve this position more easily by getting a rest for your wrists when using a keyboard and mouse.
Use a rest in order to keep your wrist level when using a keyboard or mouse. This is a really simple solution for tennis elbow if you spend long hours in front of a computer. It will keep stop you from falling into bad habits and straining your muscles and tendons. Most people also find it a more comfortable position and you will wonder why you did not use one before.
2. Take simple painkillers
Simple pain-relieving medicines can give you symptomatic relief. Examples include paracetamol and ibuprofen. These can commonly be bought over the counter.
Of course, the medicines give you temporary relief only and do not treat the underlying cause of the problem. However, they can make the pain more bearable whilst you are doing other forms of treatment. No painkiller is better than another. You should find what suits you best.
3. Do regular stretching exercises
You can stretch the correct muscles and tendons affected by tennis elbow by holding your elbow straight and then flexing the wrist using your other hand. In the second diagram above, notice how the hand is also rotated inwards at the same time to get a better stretch.
Then you will need to stretch in the opposite direction and hold the wrist in extension using the other hand.
All stretches should be held for about 30 seconds and repeated 10 times. They should also be passive. This means that it is the other hand that is holding the tennis elbow arm in stretch. Applying ice for 10-15 minutes to make the area feel numb before stretching also adds to pain relief.
4. Eccentric exercise
Eccentric exercises are one of the few proven therapies for tendon pain as there is in tennis elbow.
See the video below for an eccentric exercise for tennis elbow:
This exercise involves holding a 1-3kg weight in the affected hand whilst the forearm is supported. The weight is then lowered slowly over 4-5 seconds using a wrist movement. At the bottom of the movement, you then use the other hand to lift the weight to its starting position. This is to avoid straining the affected muscles and tendons. You then lower the weight again slowly over 4-5 seconds.
This movement effectively stretches the muscles and tendons under strain from the weight held in the hand.
5. Tennis elbow massage
Using massage balls is an effective method to treat tennis elbow. Simply use a small rubber ball for this purpose. The goal is to target and massage the muscles on the side and back of the forearm associated with tennis elbow, applying extra pressure on tender areas. It is beneficial to perform this massage prior to the stretching exercises mentioned above. You can use a single massage ball or some people find that the peanut-shaped ball is more stable and easier to use. Take a look at the video below to see the technique for using massage balls.
6. Use a tennis elbow brace
A tennis elbow brace is worn around the broadest part of the forearm and not over the elbow itself. It gives temporary relief of pain whilst it is worn. It can therefore be used during the day and can be useful whilst at work. It works most likely by putting pressure on ‘trigger points’ in the affected muscles similar to acupressure. It is sometimes called a tennis elbow strap or support. Studies show that it is effective.
7. Wear a wrist splint
A wrist splint consists of a material which overlaps your wrist joint and contains a metal insert which stops the wrist from moving. Unlike a tennis elbow brace, a wrist splint is difficult to wear at work. The best time to wear it is after work and at bedtime. It works by allowing the muscles and tendons around your elbow to rest and allow healing to take place.
8. What about a steroid injection for tennis elbow?
Steroid injections are the treatment most used by doctors to treat tennis elbow. Studies show that they do give short-term relief for up to a few months.
However, evidence suggests that the problem ends up lasting much longer in people who have had injections after the initial period of relief.
Steroid injections do not treat the underlying cause. They were initially used because we thought that the problem was due to inflammation. However, we now know that this is not the case.
Summary
Tennis elbow is an overuse problem. The most important first treatment is relative rest or modification of the movements causing it.
Active treatment works best in the form of massage and stretching, plus eccentric exercises.
Passive treatment in the form of a tennis elbow brace or wrist splint works less well. These should only be used as an addition to the exercises and not relied on to work by themselves.
Steroid injections may be useful for some people for short-term relief.
Tennis elbow is an odd name to give to a problem which affects mostly people who do not play tennis! It is also called lateral epicondylitis, lateral epicondalgia or lateral elbow pain.
The pain from tennis elbow is felt on the outer side of the elbow and the back of the forearm. Sometimes the pain radiates to the wrist or the back of the hand.
How common is tennis elbow and who gets it?
Tennis elbow affects about 1-3% of people and is more common in manual workers (7%). It also includes those using a keyboard or mouse for many hours per day. This is because tennis elbow is a mainly a problem or repetitive movements and of overuse.
Tennis elbow affects men and women equally. It can affect people of any age but is most common in the 30-50 age group.
Types of work
Professions like chefs, butchers, carpenters, and painters which involve repetitive wrist and arm motions are at a higher risk of tennis elbow. It is also common in people using a keyboard and mouse for many hours per day such as IT workers, secretaries and PAs.
Hobbies
Hobbies like knitting, typing, or playing musical instruments for extended periods can also be culprits.
What are tennis elbow symptoms?
Pain over the outer part of the elbow.
Many describe the sensation as a persistent ache, especially when lifting.
Pain worse with hand gripping or twisting activities of the hand or forearm.
A weakened grip if the problem becomes more severe.
Stiffness when trying to extend or straighten the elbow.
Tennis elbow tests
Tennis elbow can be diagnosed with examination alone in most cases. Doctors commonly use three different tests to diagnose tennis elbow.
Resisted wrist extension test
This is meant to reproduce the patient’s pain by activating the muscles and tendons that are affected. The patient is asked to extend their wrist against the doctor’s resistance. Pain or discomfort felt on the outside of the elbow during this test indicatives tennis elbow. You can reproduce this yourself using the chair test in which you try to lift a chair with your arm straight and palm facing downwards. Pain felt around the outside of the elbow whilst you do this suggests that you have tennis elbow.
Pain location
The doctor will press on or around the outside of the elbow, looking for the area of maximum tenderness or pain. This is usually around the lateral epicondyle – the bony bump on the outside of the elbow.
Grip strength
This is usually done by asking the patient to squeeze the doctor’s hands. The affected hand will have a weaker grip than the other side and may reproduce the same tennis elbow pain.
X-rays and scans
can be used to make sure you do not have other causes of pain but cannot confirm a diagnosis of tennis elbow. This is why they are rarely used in such cases.
What causes tennis elbow?
We used to think that tennis elbow was due to inflammation of the . However, we now know that it is mostly to chronic changes that occur over months or years in the tendons and muscles around the elbow. It is due to overuse.
Inflammation might still play a part in the early stages of the problem but is not present by the time tennis elbow becomes painful.
1. Repetitive Movements
Tennis and other racket sports:
The repeated motion and stress of hitting balls can strain the forearm muscles and lead to inflammation. Especially, backhand strokes without proper technique can be a significant contributor.
Manual work
Activities like plumbing, painting, carpentry, or even gardening which require repeated movements or gripping tools for extended periods can lead to the condition.
2. Improper Technique
Sports technique
Using improper techniques, especially while playing racket sports, can cause undue stress on the tendons. For example, hitting a tennis ball with a late backhand.
Using inappropriate equipment:
Utilizing rackets with a too small grip or stringing them too tightly can increase the risk. Using tools with a small a grip can have the same effect.
3. Direct Blow or Trauma
A direct blow to the lateral epicondyle, the outer part of the elbow, can lead to inflammation and pain typical of tennis elbow.
4. Lack of Flexibility or Strength
Weak wrist and forearm muscles may not provide adequate support for the tendons, making them more susceptible to injury. Similarly, lack of flexibility can strain the tendons.
5. Previous Elbow Injuries
If you’ve previously injured your elbow or had an elbow surgery, your chances of developing tennis elbow might be increased, especially if you return to repetitive activities without adequate healing.
How long does tennis elbow take to get better?
Typically, tennis elbow takes a number of months to get better. That is because it takes many months or even years of doing an activity for it to develop in the first place before the pain actually starts.
You may have heard of some amazing weight loss injections and wanted to find out more about them. Ozempic is the brand name for the drug semaglutide which has shown amazing results for weight loss. The other brand name in the UK is Wygovy.
The standard exercise myth is that you will lose weight if you eat less and exercise more. That is true to a certain extent especially if you are eating significantly more than your required calories to begin with. But overall it is recipe for failure. Let us see why calorie counting does not work.
1st Law of thermodynamics
The first law of thermodynamics goes something like this:
Perfectly logical so far. ‘Energy in’ is easy, that is the food and drink that you ingest. ‘Energy out’ is quite a different matter. We think of energy out as exercise; something that is within our control. However, 70% of the energy we use daily is actually our Basal Metabolic Rate (BMR) which is not in our control. The other 30% of the energy we use daily is a combination of passive energy use (walking, fidgeting, cleaning) and active energy use (exercise).
Therefore, most of our energy expenditure is not in our control and is the reason why burning a few hundred calories in the gym makes little difference to our weight. In addition, for the rest of the day your body then tries to conserve energy. Read on and you will discover why it makes even less difference than you think.
What decides our obesity risk?
The popular misconception is that fat people are fat because they are lazy and eat too much. In fact, free will or personal choice only accounts for a small percentage of our weight. The obesity risk is:
Hereditary predisposition (genes): 75%
Free will: 15%
Home environment / parental influence: 10%
That means that our genes account for most of our obesity risk. Everybody has a particular body type that we inherited, but a hundred years ago most people were a normal weight. Sure, people would come in a range of sizes but they would mostly be in the normal weight range. Fast-forward to the modern day and again we have a range of sizes but now two-thirds of people are in the overweight and obese range. The genes have not changed in such a short period of time. The only thing that has changed is our environment, especially our food environment, chronic lack of sleep and increasing stress.
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1st law of thermodynamics is true only for machines
Let us put the energy in and energy out equation to the test.
If we eat 100 kcal more than we need each day (1 banana, or a few plain biscuits, or half a chocolate bar), then after 1 year we would have consumed 365 x 100 = 36,500 kcal extra.
1 Kg of fat = 7,000 kcal
So, we would expect to gain 36,500 divided by 7000 = 5.2 Kg of fat over a 1 year period.
Does that make sense to you? Let me put it another way. If we continue to eat 100 kcal extra for 5 years, then we would gain 26 kg. That is 57.3 lb or 4 stone 1.3 lb. Believe me when I say that does not happen and here is why.
The Vermont Overfeeding Study 1971
Prison volunteers, with the promise of an early release, were overfed in this experiment to reach a 25% increase in their weight over a 3 month period. At the start of the experiment they were eating around 2,200 kcal daily.
The scientists calculated that they would need to feed the prisoners approximately 3,000 – 4,000 kcal daily to help them achieve the 25% weight increase. In fact it took 8,000 – 10,000 kcal per day! Even then, many of the prisoners never managed to achieve the target weight whilst eating such a massive calorie load.
All the subjects returned to their pre-study weigh within 3 months after returning to their previous eating pattern.
A clue to why it took so many calories to achieve the weight gain comes from the observation that the prisoners were hot to the touch. They were literally burning up as their bodies ramped up their Basal Metabolic Rate to try and burn the extra calories. Their metabolic engines were running hot!
The Minnesota Starvation Experiment 1944
Another experiment performed earlier in the last century tried to study how the human body would cope with starvation. The Minnesota Starvation Experiment was performed in conscientious objectors who volunteered to make themselves useful during the Second World War.
The study subjects were fed a calorie-restricted diet of 1,500 kcal daily for 24 weeks. During this time, they lost an average of 25% of their body weight. However, their Basal Metabolic Rate dropped by 50%. Their heartbeat and breathing became slow and they were cool to touch as they had developed low body temperature. They suffered from depression, anxiety, hypochondria, poor concentration, and low libido. Unsurprisingly, they were preoccupied by thinking about food and especially fantasised about high calorie foods. Why would anyone want to this to themselves, but this is what dieters around the world do to themselves every day.
Refeeding of the subjects caused rapid weight gain and overshoot; i.e. they weighed more afterwards than they did to begin with. They lost muscle mass during their weight loss phase but this was never regained. The weight they gained was almost entirely fat.
It is surprising that this study is not more widely publicised. Low calorie diets are harmful. We have known this for more than 70 years. Why are NHS dieticians and diet companies allowed to propagate this disproven method of weight loss?
The weight set point
The two studies above highlight the important principle that the human body is very good at regulating itself, i.e. homeostasis. For example, we do not need to think about regulating the amount of fluid in our bodies. Our thirst mechanism takes care of our fluid intake, and our kidneys remove any excess.
In the same way, our brain has a weight set point which it tries to maintain. This is regulated through our Basal Metabolic Rate. As soon as we start overeating, our BMR speeds up to get rid of the excess. That is why the Vermont study subjects were hot to the touch; their BMR was high. When we reduce our calorie intake to less than we need, then the opposite happens and our BMR immediately slows down to conserve energy. This is why the Minnesota study subjects started feeling cold.
Just like any living organism, the survival instinct is powerful in human beings. Our bodies work hard to maintain homeostasis and try to overcome our efforts to cause imbalance. When we under-eat and lose weight this threatens our survival and our weight then rebounds afterwards. It then settles at a higher weight set point just in case we decide to starve ourselves again. During the weight loss and then weight regain, we lose muscle mass and gain fat. Our BMR, which relies on our muscle mass, then declines and we find it even harder to control our weight in the future.
The result of yo-yo dieting is a progressively higher weight set point and a body composition of more fat and less muscle that makes weight control difficult.
Hormones control our weight
Our weight is controlled, not by calories, but by the interaction of various hormones acting on the weight set point to maintain homeostasis. What disrupts this balance is the obesogenic environment that we live in. When body weight goes over a certain amount then we become insulin and leptin resistant and our brain becomes deaf to the signals that our hormones are trying to give it. We become permanently hungry despite our high intake of calories.
How to normalise weight
The calories in/calories out mantra has been going on so long that people cannot understand how they can possibly lose weight. Calorie restriction involves misery, going against our survival instinct and is unnatural. The best way to normalise weight is to target the weight set point.
That means:
Stop counting calories; not only the ones we eat and drink, but also the calories we burn on the treadmill. Our bodies adjust our BMR immediately to conserve energy if we eat too little or exercise too much.
Start thinking long term and not day-to-day. Any drastic cut in calories or over-exercising will be seen as a threat to your survival and will raise the weight set point for the future. The weight set point will take time to settle at a lower level, typically months or years depending on how much your weight is out of step with your optimal weight. You did not become overweight overnight and you will not reduce your weight overnight.
Eat real food like people used to eat before the processed, high calorie, high sugar, high fat, high salt, and low fibre food revolution came around. Processed food disrupts your normal weight control mechanism. Your body has not evolved to deal with processed food in a healthy way yet.
Sleep 8 hours per day. Lack of sleep increases insulin resistance, increases stress and raises your weight set point.
Reduce stress. The stress hormone cortisol raises the weight set point.
Your body is made to move. Tone your muscles with activities you enjoy (reduces cortisol and increases insulin sensitivity to reduce the weight set point). You do not need to run a marathon.
Some people may be at the point where their metabolism is completely dysfunctional and the will need the help of medication or weight-loss surgery to help them. That typically happens when the BMI goes over 30-35. Their bodies are telling them that they are always hungry despite getting more than adequate calories.
In all cases, it is best to seek the help of a clinician with an interest in obesity in order to get personalised advice and treatment.
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