BSLM Newsletter: January - March 2019

Dear Friends,

Welcome to the latest newsletter.

I am delighted to tell you that we have a full programme for the BSLM 2019 Annual Conference. The latest draft programme can be seen here and on the event page on the BSLM website.

We are expecting 300+ delegates over the course of the Conference — most of whom will be medical, but many disciplines are expected and some members of the public.

We have 29 invited speakers, local and international, (including patient voices) covering many of the important areas of Lifestyle Medicine, such as sleep science, nutrition, physical activity, behavioural change, health inequality, consultation methods, mental health and connectedness. There will be plenty of laughter, music, movement and networking along the way.

I hope you are impressed enough to buy your ticket and take advantage of the low price, Welsh hospitality and a stellar cast! Spreading the news and bringing colleagues will make the days even more special for you!

More information will appear in the newsletter over the next few months.

As ever there is plenty of BSLM activity and much more planned. With a new website just launched, hopefully there will be even greater engagement between us all led by our Regional Directors.

Meanwhile, there are already more signed up here for the Diploma exam this year than last — and a larger spread of disciplines represented amongst the ‘students’.

All of this is very inspiring so many thanks to all and wishing you well.

Rob Lawson FRCGP Dip BSLM/IBLM
Chairman

The 5 ‘As’ of Obesity Management

by Dr Sue Kenneally

For so many of us a new year means a new year resolution, and we plunge headlong into what is effectively just another day with the very best of intentions to — well, that depends. Lose weight. Eat better. Exercise more. Stress less. Quit smoking. Do dry or vegan January. During what is widely acknowledged to be the most depressing month of the year for many, we put even more pressure on ourselves by deciding to stop doing something we enjoy. Equally, after the excesses of the festive season, it can seem like the perfect opportunity for change.

So briefly, let’s look at how we can help our many patients who descend upon us at this time of year with the goal of losing weight, or how to appropriately discuss weight loss with someone who hasn’t considered it yet, but maybe should. In the UK, many health care professionals use the Canadian 5 ‘As’ approach: ask, assess, advise, agree, assist. For more details see here, but I have summarised the main points below.

ASK

This is the most important one! Bringing up the subject of a patient’s weight when they haven’t mentioned it is a minefield and a source of considerable tensions all round if you don’t get it right. So before you do anything else, ask permission to discuss it. In my own practice, I often wait for the patient to mention it in passing, or ask some pointed questions in order to encourage them to mention it, so something like ‘I have a few ideas about things we could potentially do to help you feel better, but I’m interested to know – what do you think we could do?’ and then ‘You mentioned that you might feel better if you lost some weight. I think you’re right, and I think it’s something I could probably help with – would you like to talk about that today or would you rather focus on something else?’ Assuming they agree, you can explore how ready they are to change, than assess….

ASSESS

Obesity can be either classed by BMI or staged by the degree of functional impairment the person is experiencing because of their excess weight. Broadly speaking, there are 4 ‘M’s of functional impairment, these are mental, mechanical, metabolic and monetary, please see the link above for more details. Establish to what extent the person with overweight/obesity is struggling, and then determine what you can do to help.

ADVISE

Having assessed the problem, it is time to think about what needs to be done, both in terms of addressing any existing functional impairment and also how to reduce weight, assuming the person wants to do so (do check!). So a discussion about their diet, physical activity, sleep and stress would be worthwhile, along with some details about the therapeutic options – behavioural therapy, medication, dietary interventions, and of course bariatric surgery if appropriate.

AGREE

Having discussed the options, it’s time to agree a plan. Firstly, agree on what you both think is an achievable weight loss, and also how you think this is going to happen. Make SMART (specific, measurable, achievable, relevant and time limited) goals that are reasonably easily achievable in order to inspire confidence and a sense of self efficacy in the patient.

ASSIST

Finally, help the patient where you can – change any prescription medications that may be associated with weight gain to a weight neutral or weight negative alternative where possible, and help them to address any other psychosocial or other barriers that may be impeding their weight loss. Refer to other agencies as appropriate, e.g. the exercise referral scheme.

And arrange follow up — keep cheering them on!

Up until this point I haven’t mentioned weighing the patient — I always do this at some point during the consultation, but when it feels right to do so. Very often I will leave it until the very end of the first conversation, just as a way to monitor the success that we have agreed is going to follow — which they need to celebrate by finding a non-food based way to reward themselves!

Member Spotlight:
Mishkat Shehata

Hi all! I am Mishkat Shehata, an Academic GP trainee in Birmingham, an RCGP AiT West Midlands committee member and ST3 representative for Birmingham City VTS. As part of my academic role, I am an Academic Clinical Fellow at the Unit of Academic Primary Care in the University of Warwick, where I am currently working on a feasibility study on the utilization of the Low Carb Program for treatment of diabetes and pre-diabetes. I am also in the process of applying for an RCGP Practitioner’s Allowance Grant to investigate the knowledge, perceptions and experience of GP trainees and GPs in Birmingham with respect to social prescribing.

I completed my undergraduate medical training in Sudan and my postgraduate dual Masters degree in public health (MPH) with specialization in health service delivery and disease prevention in Sheffield and Copenhagen. I also briefly interned with the WHO Regional Office for Europe on a project exploring different types of accountability and the mechanisms in place to ensure them within EU member states’ health systems.

I worked as a hospital doctor in Sudan for one year prior to embarking on my postgraduate degree and it was truly an eye-opening experience. The country was, and remains, fraught with the double burden of non-communicable and communicable diseases. My interest at the time lay in educating patients on their diets with little focus on exercise due to the culture’s resistance to discuss it with their doctor. Following on from that, I accumulated a cornucopia of knowledge in my MPH that included, but was not limited to, the integral role of health policy, the structure of a health system in bringing about meaningful change to population health and the importance of behaviour change communication. I learnt about the importance of social determinants of health and, although slightly disheartened at the time at the difficulty of bringing about change myself, I started to fall in love with a more ‘upstream approach’ in tackling non-communicable disease.

I am currently undertaking nutrition and CBT online courses and looking forward to completing the BSLM diploma in due course. I am keen on social prescription and group consultations as means to improving patient health from a holistic point of view. I am hoping that my role as West Midlands Regional Director will be beneficial in my negotiations with the CCG/STP to introduce group consultations for certain chronic diseases such as diabetes and obesity.

I feel as though I have found ‘my kinfolk’ of like-minded healthcare professionals in the BSLM family and was ever so excited to become a part of this fantastic movement after listening to Dr Helen Lawal and Dr Punam Krishan talk on a Medic Footprints 2018 webinar about how to develop a portfolio career in lifestyle medicine. I am grateful to them for their advice, as it has helped shape my strategy in developing my career as a portfolio GP more robustly.

In the preceding years and most certainly in my current training, I am proud to be ‘that doctor’ that asks about your diet, sleep, exercise & stress levels for a large proportion of the consultation in order to prescribe a non-pharmacological intervention as a first line treatment instead. I have recently made my practice a ‘Parkrun practice’ and we strive to prescribe (and run with our patients!) the Parkrun (walk or jog!) to our patients who suffer with diabetes, hypertension, obesity and mental health issues amongst other conditions. It makes my day when the first thing I hear through the door as a patient walks in is, ‘I’ve lost a stone and I feel great! Thank you doctor!’

I recognize the existence of ‘Status Syndrome’ as coined by Sir Michael Marmot but it reinforces my emphasis on the importance of patient autonomy and education to be able to take control of their health despite the battles they may face within society such as social deprivation and poor food choices that are marketed well. I am hopeful that movements across the UK, especially ours, are pivotal and successful in reducing these battles for the population by campaigning for better public health policies and spreading the message to promote a healthy lifestyle for all.

Member Spotlight:
Maureen Evans

My name is Maureen Evans. I’m a Pilates Coach as well as a Maths Graduate, MBA and practising Executive Coach. I joined the British Society of Lifestyle Medicine (BSLM) 12 months ago because it is leading the way in a debate that I consider needs to happen across the developed world. I like how it brings together the medical profession with the many great practitioners in the wider health industry to encourage this learning and debate.

I came to the world of Pilates 8 years ago after suffering from lower back pain for 20 years. As an ex Audit Director, I have long been interested in the efficiency of systems and processes and I’ve been curious to see how related health professionals share information and communicate. From my experience, I see greater opportunity for this to happen in the health sector and consider the BSLM to be an enabler for this.

What I also love about BSLM is the opportunity to get to the root cause of problems. This is probably the auditor in me coming out again! As an experienced Pilates Coach, I mainly work on a one to one basis with clients in pain and my role is education so that people understand how pain works and how it feels to move well. In this way, clients are started on a process of taking control of their own pain and their own health again. I know that my role is small, but I am excited that through the BSLM, I will meet kindred spirits in medical practices, wellness centres and fitness centres making their focus the education and empowerment of clients and patients.

I have been asked to speak at the conference in Cardiff in June. I feel honoured and humbled to do so and am excited to share ideas with such a diverse group with a common interest and look forward to meeting many of you then.

Member Spotlight:
Colin Hayes

I am a Chartered Physiotherapist and registered health professional. I have been involved in health and fitness for over 35 years and adult coaching/teaching for 30 years. In that time, I have seen and experienced many changes.

In the mid 1990s, I was involved in developing and delivering one of the biggest GP exercise referral systems in England. As part of this, I developed a health and exercise diploma for the local FE college, that was designed to educate those working in the field of exercise referral. The qualification was based around what was the recent published ‘National Service Frameworks’. It was at this point I developed my interest in the study of adult learning and teaching theories.

In the late 90s and early 2000, I was approached by the local NHS coronary care services lead and cardiac support group charity committee, to develop what was believed at the time to be the first direct NHS phase 3-4 community-based rehabilitation and education program. The success of this program led to a forward-thinking GP practice to commission myself to lead the development of a new purpose-built cardiac rehabilitation gym and patient education program within the grounds of the practice. This would provide one to one advice and group consultation programs for those needing a clinical support bridge back into the community/home setting.

In the early to mid-2000s, I was physiotherapy services manager at a leading orthopaedic and sports injury centre of excellence and I was tasked with leading and developing a university student placement education program, and a service provision for occupational health and wellbeing, that would include an extensive education package.

What I learned from developing this provision inspired me for what I believe was my move into the world of lifestyle medicine.

In 2006, whilst working as an undergraduate lead at the University of Central Lancashire, I was approached by the education development director at the Royal Institute of Public Health (now The Royal Society of Health) to develop a new qualification in health training. After initial discussion and proposal, I was offered the post of Chief Examiner for the new qualification, that would be 2 qualifications named as Understanding Health Improvement 1 and 2. These 2 qualifications became the backbone for the new NHS health trainer award.

In 2013, I met with leading professors from a higher education Institute in Hong Kong, who invited me to become a visiting academic and help them to develop what would be the first and only Sports therapy/exercise rehabilitation degree in Hong Kong/China. I took up the offer of Assistant Professor in Hong Kong, where I learned much about Eastern education life and education systems. Whilst in Hong Kong, I also had the privilege of being a consultant for the Hong Kong Jockey club and the development of their occupational health/education program, that also provided a research provision for students looking to research the area of well-being and back pain injury prevention and education.

As well as clinical aspects of professional development, my interest in adult learning and education has been continual with my post graduate development and I am currently looking to finish a professional Doctorate in adult learning.

Shortly after returning from Hong Kong, I joined the BSLM as a founder member and have since been working on the development of a learning academy platform and a vocational level 3/4 certification pathway for future lifestyle coaches, that will be supported by the BSLM learning academy. I am pleased to have taken up the role of Learning Academy Director to steer and facilitate this new and exciting development.

The BSLM Learning academy (a brief intro)

The new BSLM Learning academy will have its launch at the BSLM 2019 conference in June.

The academy will use the Moodle learning platform for its delivery and development. Moodle is an extremely versatile and professional platform designed for educators and learners that has a solid reputation for being robust, secure and able to provide integrated learning environments.

An evidence led approach to education and learning will play a key role in the development and delivery of educational package’s in the learning academy.

Expertise from within the membership will be used to develop and deliver learning modules that will form the new BSLM lifestyle coach certification. Ongoing learner support and community special interest groups will also form part of the platform and will be secure and monitored. The platform will also provide a research area for use by members and learners to ensure that the BSLM stays at the front of lifestyle medicine practice.

The BSLM learning academy is an exciting development and I look forward to its launch in June and presenting more detail about it and the BSLM lifestyle coach certificate.

If any member would like to express an interest in developing/teaching or supporting students etc please email me at colinhayes@bslm.org.uk

Update on the One Billion Steps for Health Challenge

by the Inverclyde Globetrotters & World Walking

What a great start to the year! Mission accomplished — the 'One Billion Steps for Health Challenge' has been successfully completed thanks to the collective efforts of individuals and 39 groups, including 16 groups supporting people living with heart, lung and stroke disease. It has been a terrific team effort. Thank you one and all.

We would like to say a special word of thanks to Inverclyde HSCP for very kindly providing the funding for the special landing page which enabled us to automate the collation of all the steps and made the challenge run like a dream.

An amazing total distance of 432,265 miles (17 times round the world) has been logged to date. The landing page will remain live until 31 March 2019. Please keep your steps/miles coming in until then and we'll see how far we get.

Thank you all once again. You are awesome!

Rose's Sugar Free Journey

Article from ULMS

I thought it would be a huge struggle to go refined ‘sugar’ free.

I help with the social media at NULMS and I feel like going refined sugar free for 1 month has CHANGED MY EATING FOR LIFE.

I am the person who eats loads of veggies, but also will grab half a big bar of dark chocolate before the gym - and then will finish it for pudding … and sometimes eat 2 slices of cake instead of dinner! (Whoops), So, I thought that going sugar free would be very hard.

SUGARNYMS

I avoided Refined Sugar, Glucose and most Fructose, Glucose and Dextrose. I did eat Argan Syrup.

How I think about food:

I often like to look at food as being on a scale of nutrient dense to nutrient low, or ‘empty calories’. I then try and eat as much from the nutrient dense side and as little from the other side as possible.

Refined sugars are pure glucose and have no essential micro-nutrients. This means that when you consume them, you are not nourishing your body with fibre, anti-oxidants, vitamins or minerals, which are the part of our diets which keep our digestive system healthy. As sugar adds nothing but calories, it is strongly associated with chronic disease and obesity.

So as I approached being sugar free, I looked to replace my sugar indulgences with more nutrient dense sweet hits, such as dried fruit and fresh fruit, which also have micronutrients and cause a healthier lower insulin spike.

Where I found refined sugar hides:

Cereals, cans, soups and sauces, drinks.

What happened?

1) It was surprisingly EASIER than I thought it would be

I had a lot of momentum and motivation to cut out refined sugar at the start. I loved using lots of spices and seasoning to experiment with flavours. Label checking was a little frustrating, but it encouraged me to cook all my meals from scratch!

2) My skin got clearer

I have NEVER had clear skin and struggled with acne since being a teen. Recently, I had to go on 4 months of antibiotics for a severe break out. I finished these at the start of October and I still had a few clusters of spots on my face. After 3 weeks of sugar free-ness, my skin is clear, without one active eruption, for the first time I can remember since being 16. Coincidence? I don’t know. I am a little gobsmacked.

3) My sleep was a little disturbed to start with

I had to up my meal portion size to replace the empty calories I had been eating. This left me feeling a little full and bloated at night. But it didn’t last long!

4) Going out and socialising was a challenge!

I went out a few times and I managed to check what I was eating with the restaurant, or by checking their menu beforehand. However on two occasions, I felt socially pressured not to be super awkward (I mean … I am already meat and dairy free!) and did not check. I still ordered intelligently and carefully to avoid sugar. I also did not use sauces and condiments.

5) My energy didn’t dip!

I expected to feel sluggish and tired. I normally used dark chocolate and sugar tit bits to charge me up before a run or work out. However, eating starchy food portions, especially bananas, a few hours before a work out meant that I found that I didn’t miss my chocolate buzz at all!

6) I am looking forward to a super low sugar future

My eyes have been opened to the secret sugar I have been consuming in my otherwise healthy diet. I have proven to myself that I do not need the sugary filled snacks I thought I did in order to fuel my workouts.

So, I was pleasantly surprised at how easy I found being sugar free. I also loved that I was full of energy, even without my sugar habits. I would definitely recommend trying out being sugar free to anyone and everyone! It makes you reconsider your relationship with sweet foods, educates you on food choices, and can help you learn healthier habits!