It’s a bad year for flu, but it’s too early to call it the worst ever – 5 charts on the 2019 season so far



The impact of the flu on a population can be measured by looking at figures including cases, hospitalisations and deaths.
From shutterstock.com

Ian Barr, WHO Collaborating Centre for Reference and Research on Influenza

From early this year it’s been apparent the 2019 Australian influenza “season” was going to be different. Normally, the flu season coincides with the winter months of July and August, sometimes stretching to September and October.

But this year, things have happened much earlier, with a record number of influenza cases reported in summer and autumn.

So what’s been happening, and is it really as bad as the media have been reporting? Here we look at some of the latest data on cases and their outcomes to see if it is indeed “a horror flu season”.



The impact of influenza on the community is measured in several ways. The most basic measure is to simply count the number of cases of people presenting to their GP with influenza-like illness.

Sometimes the doctor will take a swab, and these are tested in the laboratory to confirm that influenza virus is present (it’s possible another respiratory virus or bacteria might be causing the flu-like symptoms).




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Cases of influenza-like illness were increasing in early March, peaked in early June, and are now decreasing. Laboratory confirmed cases (the results of which we see in the above chart) show a similar trend. We haven’t included July in this chart because it’s not finished yet, but we’re still seeing a high number of cases into July.

Compared to previous years, 2019 looks like a big year with more than 120,000 cases of lab confirmed influenza up to the end of June. But it’s not nearly as bad as 2017, which had more than 250,000 cases reported to the National Notifiable Diseases Surveillance System (NNDSS) by the end of the year. As this season occurred much later than 2019’s, 2017 had only 24,000 cases reported up to July 7.

The good news is that as the 2019 season started earlier, it’s also likely to finish earlier than usual. This is because once the main influenza season starts, it usually ends around 12-16 weeks later, when the number of susceptible people drops below the level required to maintain efficient circulation.


FluCAN (via Department of Health Influenza Surveillance Report), CC BY-ND

Another measure of how severe the influenza season is can be gauged by the number of hospitalisations, including admissions to ICU (intensive care units).

Hospital admissions show from April 1 to June 30 this year, there have been 1,309 admissions to the Australian sentinel surveillance hospitals (a number of hospitals where flu admissions are tracked each year).

This figure is much higher than previous years at the same time point. In 2018, there were 90 admissions, and in 2017, 311. But in 2017 the season arrived much later and more seriously and ultimately resulted in 3,969 admissions for that year.




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It’s also useful to look at the proportion of people attending hospital with influenza infections who are admitted directly to ICU. In 2019 it’s been 6.7% of admissions compared to 2018 (a mild influenza year) with 8.1% of admissions, and 2017 (a very severe year) with 8.9% of admissions.

The 2019 ICU rate is at the lower end of historical figures which range from 8.7% in 2015 to 14.2% in 2013. By this measure, the 2019 season is of a similar severity to that seen in previous seasons and is therefore not exceptional.

While hospital admissions can be measured relatively easily, measuring deaths due to influenza is more complicated for a few reasons. The flu often paves the way for secondary bacterial infections, like pneumonia, which can lead to hospitalisation and death, particularly in the elderly. When this happens, it can be difficult to link death directly to an earlier influenza infection.

And, death data is often very delayed. So readily available death data collected by the NNDSS is considered a significant underestimate of the actual number.

To the end of June 2019, there were 231 influenza-related deaths reported to the NNDSS. Virtually all of these were due to the influenza A strain. They spanned all ages, but most deaths were in the elderly (80 years and older).




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This compares to 24 and 21 deaths over the same period in 2018 and 2017 respectively. But these figures grew to 55 deaths and 598 deaths reported by the end of 2018 and 2017 respectively.

Clearly 2019 is more severe than 2018, based on the measures detailed above, but at this stage it looks like it will be less severe than 2017. However, we’ll need to wait for a number of weeks yet to be sure.

When we look at what’s happened in each state of Australia so far this year, we see some interesting differences in how the season has played out. Most states began to see significant rises in cases in April, while South Australia had already peaked in April and this number of cases was maintained into May. This means that most other states still have a number of weeks of influenza circulation to endure.



People of all ages are susceptible to influenza, and this is reflected in the wide range of ages at which people are infected. Young children (especially those under 10 years of age) and the elderly (especially those over 80 years of age) are more susceptible, and are often more severely affected by influenza infections – as are pregnant women.

Interestingly, different types of influenza affect different age groups, with influenza B and influenza A(H1N1) more common in the young and influenza A(H3N2) more common in the elderly.




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At this stage we can conclude that the 2019 influenza season is quite different to our usual seasons and overall, is likely to be one of the more severe seasons seen in the last 20 years.

So while 2019 doesn’t appear to be the worst season we’ve ever seen – that’s likely to remain with 2017 – it may well run a close second place. But we’ll have to wait another month or two before we can be sure.The Conversation

Ian Barr, Deputy Director, WHO Collaborating Centre for Reference and Research on Influenza

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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1 in 10 patients are infected in hospital, and it’s not always with what you think


Drips and other medical devices were potential sources of infection. But no-one expected to find hospital-acquired pneumonia and urinary tract infections.
from www.shutterstock.com

Philip Russo, Monash University and Brett Mitchell, University of Newcastle

Most people expect hospital treatment to make them better. But for some, a stay in hospital can actually make them sicker. Their wound might get infected after an operation or they might get a blood infection as a result of a medical procedure.

Our study, published today in the international journal Antimicrobial Resistance and Infection Control, found one in ten adult patients in hospital with an acute (short-term) condition had a health care associated infection.

In the first study of its kind in Australia for over 30 years, we also uncovered unexpected infections, like pneumonia and urinary tract infections, as well as high numbers of patients with multi-drug resistant organisms (superbugs).




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Why do we need to keep track of infections?

Most of these infections can be prevented. So it is important to know what type of infections they are, how common they are and which patients get them. Once we have this information, we can work out a way to prevent them.

Left unchecked, these infections can make already sick patients sicker, can divert hospital resources unnecessarily, and can kill.

Most hospitals in Australia have ongoing surveillance for specific infections, such as wound and bloodstream infections.

Some states have well coordinated programs like the Victorian program VICNISS, leading to detailed data on health care associated infections. This data is then used to inform hospital strategies on how to prevent infections. However, this type of surveillance method requires extensive resources and does not capture all infections that occur in a hospital.

Instead, we conducted a “point prevalence” survey, which takes a snapshot of the current situation on any given day. This is less resource intensive than ongoing surveillance and it provides valuable information on the distribution and occurrence of all infections in a hospital.




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In Europe, the European Centre for Disease Prevention and Control co-ordinates national point prevalence studies every four years. These have provided valuable insight into the burden of health care associated infections. They have also been used to track the emergence of multi-drug resistant organisms in Europe. The US, Singapore and many other countries also run them.

Most hospital infections can be prevented.
Santypan/Shutterstock

Unlike most OECD countries, Australia does not have a national health care associated infection surveillance program and does not undertake national point prevalence studies.

The only national data routinely collected relates to bloodstream infections caused by the microorganism Staphylococcus aureus. These infections are serious but rare and only represent a tiny fraction of all infections in hospitals.




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To improve our understanding of health care associated infections across Australia, we used the same study method as the Europeans. Over a four month period in 2018, we visited 19 large hospitals across Australia and collected information on all infections in adult acute inpatients. Four of the hospitals were regional, the others major city hospitals.

What infections did we find?

Of the 2,767 patients we surveyed, we found 363 infections in 273 patients, meaning some patients had more than one infection. The most common infections were wound infections after surgery (surgical site infections), pneumonia and urinary tract infections. These accounted for 64% of all the infections we found.

This is important as most hospitals do not normally look for pneumonia or urinary tract infections and there is no routine statewide or national surveillance for these.

Our findings mean these infections are commonly occurring but undetected. A potential source of information on these types of infections is hospital administrative coding data. However, these codes were mainly designed for billing purposes and have been shown to be unreliable when it comes to identifying infections.




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We also found patients with a medical device, such as a large intravenous drip, or urinary catheter (a flexible tube inserted into the bladder to empty it of urine), were more likely to have an infection than those who did not.

Intensive care units treat patients who are gravely unwell and at greater risk of infection. So it was unsurprising to find that 25% of patients in intensive care units had a health care associated infection.

The emergence of multi-drug resistant organisms (superbugs) is a concern worldwide. Previously unknown, our study revealed that 10% of the adult acute inpatients in our study had a multi-drug resistant organism.

What have other studies found?

For the first time in 34 years we have a glimpse of how common health care associated infections are in Australian hospitals. Although the only other previous study was larger, a major strength of our study is that we used the same two trained data collectors to collect the data from all hospitals.

This reduced the potential inconsistency in finding infections that might occur if hospital staff collected their own data. It also minimised the use of hospital resources to undertake the survey.

Importantly though, we did not survey all types of hospitals. It is possible that if the same survey was extended to include children, babies and cancer hospitals, higher rates of infection may be found given the vulnerability of these patients.

What can we do better?

As one of the authors has previously noted, a major gap in Australia’s effort to combat health care associated infections, and the emergence of multi-drug resistance organisms, is the lack of robust national data.

This means we cannot measure the effect of national policy or guidelines despite significant investment.

In the absence of a national surveillance program, we recommend that large-scale point prevalence surveys, including smaller hospitals, specialist hospitals and the private sector be undertaken regularly. Data generated from these studies could then be used to inform and drive national infection prevention initiatives.The Conversation

Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash University and Brett Mitchell, Professor of Nursing, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Paper tsunami: how the move to digital medical records is leaving us drowning in old paper files



What to do with our old paper medical files now that records are going digital? As a recent Brisbane case demonstrates, not all files are heading straight for destruction.
from www.shutterstock.com

Gillian Oliver, Monash University and Peter Bragge, Monash University

The recent case of paper medical files from a Brisbane hospital found on a busy street highlights the need for secure, controlled disposal of medical records.

The files were said to be from out-patient clinics and contained patient names and their appointments, but not medical details. Now Queensland Health is investigating the circumstances of how the files came to be found in public, rather than being safely destroyed by a contractor.

So how are hospitals and clinics handling their old paper records as they move to electronic systems? How are they dealing with the tsunami of files that need to be safely disposed of?




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Your medical records, whether paper or electronic, need to be kept while they’re relevant to your care, with restricted access to protect your privacy. But who decides when medical records are no longer needed? What happens then?

Governments at all levels have legislation for this. For instance, the Queensland health department specifies what is destroyed and when, according to a schedule from Queensland State Archives. This covers medical records in the public health care system in physical form (paper, photographs, film), in electronic form or a mixture of the two.

This, for example, says “records displaying evidence of clinical care to an individual or groups of adult patients/clients” should be kept “for ten years after last patient/client service provision or medico-legal action”. There are a number of exceptions relating to, for example, clinical trials, mental health and communicable diseases. For each exception, there is a specific time period of how long the file needs to be kept.

Queensland State Archives also advises on how records are to be securely destroyed, either by shredding, pulping or burning.




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Hospitals can contract commercial services to destroy paper files. But the document owner, in this case the hospital, is ultimately responsible for ensuring this is carried out legally.

The Royal Australian College of General Practitioners (RACGP) has established practice standards for GP clinics. These require the secure destruction (for instance, by shredding) of paper records before disposal.

So, hospitals and GP clinics need to develop and implement policies and procedures that state explicitly when and how medical records should be disposed of, and also keep a record of when that happens.

However, to determine whether an individual medical record among the vast quantities held has passed its “use by date” can be extremely resource-intensive for administrative staff.

This means the ultimate driver of paper record destruction is more likely to be the need to free up expensive office or storage space. It’s this sort of scenario that might eventually play out into records being accidentally or deliberately dumped wherever, whenever.

The move towards digital records

The Brisbane situation highlights the limitations of “business as usual” in relation to medical records, which includes paper records held in multiple locations, in hospitals, in GP clinics and with specialists.

Consider your own medical record “paper trail”, which may include files from hospital admissions, records held by your local doctor or other specialist, and results of blood tests and x-rays performed elsewhere.

At both a personal and whole-of-population level, there are clearly numerous opportunities for unintended access to these physical documents. Centrally and securely stored electronic records can address this risk, and also carry a number of other advantages.




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Privacy breaches relating to paper medical records are in part a function of a worldwide transition from a trusted familiar environment of paper records to electronic medical records.

This dramatically multiplies the volume of paper records needing to be destroyed — from only those that are “out of date” to every record that is scanned and made redundant.

The Brisbane case also highlights the sensitivity of medical records in all their forms, a factor also playing out in the My Health Record debate.




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Who do we trust to keep our sensitive medical records safe? Should our trust be placed in the old paper records (part of the the status quo) or a centralised electronic medical record?

The Brisbane situation, by highlighting the limitations of paper records, certainly challenges notions of trusting the familiar and favouring the status quo.




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So, what can we expect?

Like all transitions of this scale, there are a range of costs involved in moving from paper to electronic medical records, one of which is the prospect of further paper record data breaches as mountains of redundant records are destroyed. However these transition costs need to be balanced against the ultimate benefit of electronic records.

Even accepting these benefits doesn’t necessarily mean people will automatically become more comfortable with electronic medical records, like My Health Record. For that to occur, people also have to overcome a general lack of trust in government.

However, our research shows it is possible to encourage people to use online government services. By harnessing behavioural science, we have shown that providing customer support and promoting the benefits and ease of online services helps the transition from queuing and paper forms to using online services.

Hope for the future

In the rush to drag people to shiny new online platforms, this illustrates the simple act of talking people through the advantages and supporting their transition can address many of the psychological barriers to change.

Then, hopefully, we can see the end of paper medical records and services, and fewer paper records being dumped on the side of the road. As long as paper records exist they will be vulnerable to unauthorised access – either within a storage facility or in transit to destruction. However, each case of unauthorised access is dwarfed by the number of paper records successfully and securely destroyed, never able to be physically accessed again.The Conversation

Gillian Oliver, Associate Professor and Director, Centre for Organisational & Social Informatics, Monash University and Peter Bragge, Associate Professor, Healthcare Quality Improvement (QI) at Behaviour Works, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The 2019 flu shot isn’t perfect – but it’s still our best defence against influenza



Early indications are that the vaccine has been a reasonably good match in the 2019 season.
Shutterstock

Lauren Bloomfield, Edith Cowan University

Over recent months, reports of “a horror flu season” causing serious illness and death have dominated the headlines.

The high number of cases has led some people to question the effectiveness of the flu vaccine, and whether it’s worth getting if it doesn’t guarantee you won’t get the flu.

The flu vaccine is designed to cover the strains of the flu anticipated to circulate during the season. But even with the most sophisticated scientific processes, determining the right strains to include in the vaccine isn’t 100% foolproof.




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Sometimes the virus undergoes major genetic changes or “mutations” in a relatively short space of time. Reports of a “mutant strain” this year means there’s concern some people might catch a strain the vaccine hasn’t protected against.

It’s too soon to tell the full extent of the effects of this mutation on how well the vaccine has worked. But the 2019 vaccine is showing early signs of being a good match for the common strains of the flu circulating this season.

What’s in a name?

Influenza or “flu” isn’t just one virus; different strains circulate each season.

Flu viruses that cause seasonal epidemics in humans fit under one of two major groups: influenza A or B.

Most flu vaccines protect against four strains of influenza.
Image Point Fr/Shutterstock

Influenza A is further broken down into strains or subtypes based on surface proteins called hemagglutinin (H) and neuraminidase (N).

We’re currently concerned about two subtypes which cause outbreaks in humans: A/H1N1pdm09 and A/H3N2.

Influenza B viruses are similarly categorised into strains based on two distinct lineages: B/Yamagata and B/Victoria.

Understanding the circulating strains is important because it gives us clues as to which age groups will likely be worst affected. Influenza A/H3, for example, has historically been associated with higher rates of disease in people aged 65 and over.

But the circulating strains are also important because they inform how the vaccine will be developed. A good match between the vaccine strains and what is circulating will mean the vaccine offers the best possible protection.

So how do we decide which flu strains are covered by the vaccine?

Every year, a new vaccine is produced to cover the strains that are predicted to be circulating in the northern and southern hemispheres. The World Health Organisation (WHO) uses a range of measures to determine which strains should be included in the vaccine.

Many of us who were vaccinated this year would have received a quadrivalent vaccine. This means it covered four strains in total: two strains of influenza A, and two strains of influenza B.

People aged 65 and over are offered a “high-dose” trivalent vaccine, which covers both A strains, and one B strain.




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The Australian Influenza Vaccine Committee (AIVC) reviews the results and makes recommendations for the Australian vaccine, which in 2019 covered the following strains:

  • an A/Michigan/45/2015 (H1N1)pdm09-like virus
  • an A/Switzerland/8060/2017 (H3N2)-like virus
  • a B/Colorado/06/2017-like virus (Victoria lineage) – not included in the trivalent vaccine recommendation
  • a B/Phuket/3073/2013-like virus (Yamagata lineage).

Do we always get it right?

The basic premise of forecasting is that it’s a “best guess”. It’s a highly educated guess, based on analysis and evaluation, but it’s not a guarantee.

The effectiveness of a vaccine depends on a number of factors, only some of which are within our control. While the choice for the vaccine is made on the best evidence available at the time, the viruses circulating in the population undergo changes as they replicate, known as antigenic “drift” and “shift”.

Flu viruses change every year so researchers have to make an educated guess about which ones might circulate.
Image Point Fr/Shutterstock

If the changes are only small, we can still get good cross-protection.

Less frequently, a big genetic “shift” happens. If this occurs after vaccine development has started and the strains have been chosen, we are dealing with a so-called “mutant flu” and the vaccine will likely not be a good match.

So is this year’s vaccine is working?

Data available for this year are showing the majority of influenza cases in Australia have been influenza A – with some states reporting more H3N2 than H1N1, and others reporting a more even mix of both.

The WHO Collaborating Centre in Victoria is also reporting that the majority of specimens of all four strains they’ve tested this year appear to be similar to the vaccine strains.




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While early indications are that the vaccine has been a good match in the 2019 season, the WHO Collaborating Centre has also recently confirmed there has been a mutation in the A/H3N2 strain this season.

It’s not clear yet if this mutation will have a significant impact on vaccine effectiveness, but it may at least partially explain the high case numbers we’ve seen so far.

Large vaccine effectiveness studies done at the end of the flu season will help assess the impact of this mutation. In the meantime, a mismatch on only one strain means the vaccine will still provide reasonable protection against other circulating strains.

It’s still worth being vaccinated

In the same way wearing a seat belt is no guarantee we won’t be injured in a car accident, a flu vaccine is no guarantee we won’t develop influenza this season.

A person’s underlying susceptibility, due to factors such as their age and health, will also influence how well a vaccine works.




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But the flu shot remains a safe and reasonably effective strategy to reduce your risk of serious illness.

While flu epidemics remain complex, advice to prevent flu transmission remains simple. Regularly washing our hands, covering our mouth when we cough or sneeze, and staying home when we’re unwell are things we can all do to help stop the spread.The Conversation

Lauren Bloomfield, Lecturer, School of Medical and Health Sciences, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Research Check: can drinking coffee help you lose weight?



As keen as we may be to hear about any health benefits of drinking coffee, the headlines aren’t always what they seem.
Janko Ferlic/Unsplash

Andrew Carey, Baker Heart and Diabetes Institute

Researchers from the University of Nottingham in the UK recently published a study in the journal Scientific Reports suggesting caffeine increases brown fat.

This caught people’s attention because brown fat activity burns energy, which may help with weight loss. Headlines claimed drinking coffee can help you lose weight, and that coffee is possibly even the “secret to fighting obesity”.

Unfortunately, it’s a little more complicated than that. The researchers did find caffeine stimulated brown fat, but this was mainly in cells in a lab.

For a human to reap the benefits seen in the cells, we estimate they’d need to drink at least 100 cups of coffee.

Although part of this research did look at people, the methods used don’t support coffee or caffeine as weight-loss options.




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What is brown fat?

Brown adipose (fat) tissue is found deep within the torso and neck. It contains fat cell types which differ from the “white” fat we find around our waistlines.

Brown fat cells adapt to our environment by increasing or decreasing the amount of energy they can burn when “activated”, to produce heat to warm us up.

When people are cold for days or weeks, their brown fat gets better at burning energy.

We understand caffeine may be able to indirectly accentuate and prolong some of these processes, mimicking the effects of cold exposure in stimulating brown fat.

Brown fat – and anything thought to increase its activity – has generated significant research interest, in the hope it might assist in the treatment of obesity.

What did the researchers do in this latest study?

The research team first conducted experiments where cells taken from mice were grown into fat cells in petri dishes. They added caffeine to some samples, but not others, to see whether the caffeinated cells acquired more brown fat attributes (we call this “browning”).

The dose of caffeine (one millimolar) was determined based on what would be the highest concentration that browned the cells but didn’t kill them.

The fat cell culture experiment showed adding caffeine did “brown” the cells.




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The researchers then recruited a group of nine people who drank a cup of instant coffee, or water as a control.

Before and after the participants drank coffee, the researchers measured their brown fat activity by assessing the temperature of the skin near the neck, under which a major region of brown fat is known to lie.

Skin temperature increased over the shoulder area after drinking coffee, whereas it didn’t after drinking only water.

How should we interpret the results?

Some people will criticise the low number of human participants (nine). We shouldn’t make broad recommendations on human behaviour or medicine based on small studies like this, but we can use them to identify new and interesting aspects of how our bodies work – and that’s what these researchers sought to do.

But whether the increased skin temperature after drinking coffee is significant cannot be determined for a few important reasons.

Firstly, although the study showed an increase in skin temperature after drinking coffee, the statistical analysis for the human experiment doesn’t include enough data to accurately compare the coffee and water groups, which prevents meaningful conclusions. That is, it doesn’t use appropriate methods we apply in science to decide if something really changed or only happened by chance.

Enjoy coffee for the taste, or the buzz. But don’t expect it to affect your waistline.
From shutterstock.com

Second, measuring skin temperature is not necessarily the most accurate indicator for brown fat in this context. Skin temperature has been validated as a way to measure brown fat after cold exposure, but not after taking drugs which mimic the effects of cold exposure – which caffeine is in the context of this study.

Myself and other researchers have shown the effects of these “mimic” drugs result in diverse effects including increased blood flow to the skin. Where we don’t know if changes in the skin temperature are due to brown fat or unrelated factors, relying on this measure may be problematic.

Although also suffering its own limitations, PET (poistron emission tomography) imaging is currently our best option for directly measuring active brown fat.

It’s the dose that matters most

The instant coffee used in the study contained 65mg of caffeine, which is standard for a regular cup of instant coffee. Brewed coffees vary and might be double this.

Regardless, it’s difficult to imagine this dose could increase brown fat energy burning when studies using large doses of more potent “cold-mimicking” drugs (such as ephedrine) cause no, or at best modest, increases in brown fat activity.




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But let’s look at the caffeine dose used in the cell experiments. The one millimolar concentration of caffeine is a 20-fold larger dose than 300-600mg of caffeine dose used by elite athletes as a performance-boosting strategy. And this dose is five to ten times higher than the amount of caffeine you’d get from drinking an instant coffee.

Rough calculations therefore suggest we’d need to drink 100 or 200 cups of coffee to engage the “browning” effects of caffeine.

So people should continue to drink and enjoy their coffee. But current evidence suggests we shouldn’t start thinking about it as a weight loss tool, nor that it has anything meaningful to do with brown fat in humans. – Andrew Carey


Blind peer review

This Research Check is a fair and balanced discussion of the study. The limitations identified by this Research Check apply equally to diabetes, which the study encompassed, but didn’t get picked up as much in the headlines.

Coffee contains more than caffeine, and while there is some evidence that modest coffee consumption may reduce diabetes risk, decaffeinated coffee seems to be as effective as caffeinated coffee. This is consistent with the point made by the Research Check that you would need to drink an implausible number of cups of coffee to produce the effect seen with caffeine in the cultured fat cells. – Ian Musgrave


Research Checks interrogate newly published studies and how they’re reported in the media. The analysis is undertaken by one or more academics not involved with the study, and reviewed by another, to make sure it’s accurate.The Conversation

Andrew Carey, Group Leader: Metabolic and Vascular Physiology, Baker Heart and Diabetes Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Had gestational diabetes? Here are 5 things to help lower your future risk of type 2 diabetes



For women who have had gestational diabetes, maintaining a healthy diet can help lower the risk of developing type 2 diabetes later on.
From shutterstock.com

Clare Collins, University of Newcastle; Hannah Brown, University of Newcastle, and Megan Rollo, University of Newcastle

Gestational diabetes is a specific type of diabetes that occurs in pregnancy.

Once you’ve had gestational diabetes, your risk of having it again in your next pregnancy is higher. So too is your lifetime chance of developing type 2 diabetes and heart disease.

The good news is taking steps such as adopting a healthier diet and being more active will lower those risks, while improving health and well-being for you and your family.




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What is gestational diabetes?

Gestational diabetes affects about one in seven to eight pregnant women in Australia.
Women are screened for gestational diabetes at around 24 to 28 weeks gestation using a glucose tolerance test. Gestational diabetes is diagnosed when blood glucose levels, also called blood sugar levels, are higher than the normal range.

Screening is designed to ensure women with gestational diabetes receive treatment as early as possible to minimise health risks for both the mother and the baby. Risks include having a baby born weighing more than four kilograms, and the need to have a caesarean section. Management of gestational diabetes includes close monitoring of blood glucose levels, a healthy diet, and being physically active.

The risk of developing type 2 diabetes increases markedly in the first five years following gestational diabetes, with risk plateauing after ten years. Women who have had gestational diabetes have more than seven times the risk of developing type 2 diabetes in the future than women who haven’t had the condition.

Type 2 diabetes

If type 2 diabetes goes undiagnosed, the impact on your health can be high – especially if it’s not detected until complications arise.

Early signs and symptoms of type 2 diabetes include extreme thirst, frequent urination, blurred vision, frequent infections and feeling tired and lethargic.

Doing regular exercise can lessen the risk of developing type 2 diabetes.
From shutterstock.com

Long-term complications include an increased risk of heart disease and stroke, damage to nerves (especially those in the fingers and toes), damage to the small blood vessels in the kidneys, leading to kidney disease, and damage to blood vessels in the eyes, leading to diabetes-related eye disease (called diabetic retinopathy).

If you’ve ever been diagnosed with gestational diabetes, here are five things you can do to lower your risk of developing type 2 diabetes.

1. Monitor your diabetes risk

Although gestational diabetes is a well-known risk factor for type 2 diabetes, some women have not been informed of the increased risk. This means they may not be aware of the recommendations to help prevent type 2 diabetes.

All women diagnosed with gestational diabetes should have a 75g oral glucose tolerance test at 6–12 weeks after giving birth. This is to check how their body responds to a spike in blood sugar after they’ve had the baby, and to develop a better picture of their likelihood of developing type 2 diabetes.

From that point, women who have had gestational diabetes should continue to have regular testing to see whether type 2 diabetes has developed.

Talk to your GP about how to best monitor diabetes risk factors. Diabetes Australia recommends a blood glucose test every one to three years.

2. Aim to eat healthily

Dietary patterns that include vegetables and fruit, whole grains, fish and foods rich in fibre and monounsaturated fats are associated with a lower risk of developing type 2 diabetes.

In more than 4,400 women with prior gestational diabetes, those who had healthier eating patterns, assessed using diet quality scoring tools, had a 40-57% lower risk of developing type 2 diabetes compared with women with the lowest diet quality scores.




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Glycaemic index (GI) ranks carbohydrate-containing foods according to their effect on blood glucose levels. The lower the GI, the slower the rise in blood sugar levels after eating. Research suggests that a higher GI diet, and consuming lots of high GI foods (glycaemic load), is associated with a higher risk of developing type 2 diabetes, while a lower GI diet may lower the risk of type 2 diabetes.

Take our Healthy Eating Quiz to check how healthy your diet is and receive personal feedback and suggestions on how to boost your score.

3. Be as active as possible

Increasing your physical activity level can help lower your risk of developing type 2 diabetes.

Engaging in 150 minutes of moderate-intensity exercise per week, such as walking for 30 minutes on five days a week; or accumulating 75 minutes of vigorous-intensity physical activity a week by swimming, running, tennis, cycling, or aerobics, is associated with a 45% lower risk of developing type 2 diabetes after having had gestational diabetes. Importantly, both walking and jogging produced a similar lower risk of type 2 diabetes.

In contrast, prolonged time spent watching TV was associated with a higher risk of type 2 diabetes in women with a history of gestational diabetes.

Strength training is also important. A large study of 35,754 healthy women found those who engaged in any type strength training, such as pilates, resistance exercise or weights, had a 30% lower rate of developing type 2 diabetes compared to women who did not do any type of strength training.

Women who did both strength training and aerobic activity had an even lower risk of developing either type 2 diabetes or heart disease.

Breastfeeding has been shown to reduce the risk of type 2 diabetes, even in mums who haven’t had gestational diabetes.
From shutterstock.com

4. Breastfeed for as long as you can

Research shows breastfeeding for longer than three months reduces the risk of developing type 2 diabetes by about 46% in women who have had gestational diabetes. It is thought that breastfeeding leads to improved glucose and fat metabolism.

The Nurses Health Study followed more than 150,000 women over 16 years. It found that for every additional year of breastfeeding, the risk of developing type 2 diabetes was reduced by 14-15% – even in mothers who had not been diagnosed with gestational diabetes.

Organisations such as the Australian Breastfeeding Association and lactation consultants offer support to help all women, including those who have had gestational diabetes, to breastfeed their infants for as long as they choose.




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5. Keep an eye on your weight

Weight gain is a known risk factor for developing type 2 diabetes. In a study of 666 Hispanic women with previous gestational diabetes, a weight gain of 4.5kg during 2.2 years follow-up increased their risk of developing type 2 diabetes by 1.54 times.

Another study saw 1,695 women with previous gestational diabetes followed up between eight to 18 years after their diagnosis. This research found that for each 5kg of weight gained, the risk of developing type 2 diabetes increased by 27%.

Aiming to modify your eating habits and being as active as you can will help with weight management and lower the risk of developing type 2 diabetes. Within interventions that support people to adopt a healthy lifestyle, one review found every extra kilogram lost by participants was associated with 43% lower odds of developing type 2 diabetes.




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The Conversation


Clare Collins, Professor in Nutrition and Dietetics, University of Newcastle; Hannah Brown, PhD Candidate Nutrition and Dietetics, University of Newcastle, and Megan Rollo, Postdoctoral Research Fellow, Nutrition & Dietetics, University of Newcastle

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Health Check: why do we crave comfort food in winter?



You’re not imagining it. Our bodies really do crave macaroni cheese and other comfort foods as the temperature drops. Here’s why.
from www.shutterstock.com

Megan Lee, Southern Cross University and Jacqui Yoxall, Southern Cross University

It’s winter and many of us find ourselves drawn to bowls of cheesy pasta, oozing puddings, warming soups, and hot chocolate with marshmallows.

These and other comfort foods can make us feel good. But why? And why do we crave them in winter and not in summer?

Research tells us there are three good reasons.




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1. The gut ‘speaks’ to the brain

We know from the relatively new field of nutritional psychiatry that our stomachs produce the “happiness chemicals” dopamine and serotonin. When we eat, a complex process involving the brain means these neurochemicals trigger feelings of happiness and well-being.

These happiness chemicals are also produced when we exercise and are exposed to sunlight, which decline in winter.

This results in a change in the fine balance between the good and bad bacteria that live in our stomachs, and consequently, the relationship between the gut and the brain.

So, in winter when we eat our favourite comfort foods, we get a rush of happiness chemicals sent from the gut to our brain and this make us feel happy and content.




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2. Evolution may have a hand

The second reason we crave more comfort foods during the winter months could be evolutionary. Before we enjoyed technological advances such as housing, heating, supermarkets and clothing, humans who increased their body weight during winter to keep warm were more likely to survive their environmental conditions. Craving carbohydrate and sugar rich foods was therefore a protective mechanism.

Although we are not still living in shelters or foraging for food today, food cravings in winter may still be programmed into our biology.




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3. Psychology, craving and mood

Social learning theory says people learn from each other through observing, imitating and modelling. In the context of food cravings this suggests that what our caregivers gave to us in winter as children has a striking impact on what we choose to eat in winter as adults.

A review of studies on the psychological reasons behind eating comfort food says this food may play a role in alleviating loneliness and boosting positive thoughts of childhood social interaction.

We may also naturally experience lower mood in winter and low mood has been linked to emotional eating.

In winter due to it being darker and colder, we tend to stay indoors longer and self-medicate with foods that are carbohydrate and sugar rich. These types of foods release glucose straight to our brain which gives us an instant feeling of happiness when we are feeling cold, sad, tired or bored.




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Comfort food can be healthy

For all the comfort they provide, comfort foods generally receive a bad rap because they are usually energy and calorie dense; they can be high in sugar, fat and refined carbohydrates.

These types of foods are usually linked to weight gain in winter and if you eat too much over the longer term, can increase the risk of heart disease and diabetes.

However, not all comfort foods are created equally, nor are they all bad for our health.

You still get a comforting feeling with a hearty bowl of soup, but without the extra calories.
from www.shutterstock.com

You can get the same comforting feelings from winter foods containing ingredients that are good for you. For example, a hearty bowl of soup with a slice of wholegrain bread can give you all the components you need for optimal physical and psychological health. Steaming bowls of chilli and curries can provide immunity boosting properties with the use of their warming spices. So too are all the wonderful citrus fruits that become available in the winter.

If you are craving something that is carbohydrate rich, try swapping white varieties for wholegrain versions that will dampen carbohydrate cravings. If you crave a hot chocolate try swapping the cocoa powder for cacao which has a higher concentration of vitamins and minerals.

More good news

The good news for all of us who crave comfort foods in winter is studies that assess intuitive eating — eating when you are hungry, stopping when you are full and listening to what your body is telling you to eat — suggest people who eat this way are happier with their body image, feel better psychologically and are less likely to have disordered eating.

So, embrace this wonderful chilly weather. Rug up in your favourite woolly jumper, sit by the fire, cuddle up with a loved one, make some healthier swaps to your classic comfort foods, remove the food guilt and listen to what your body is telling you it needs during these cold winter months.The Conversation

Megan Lee, Academic Tutor and PhD Candidate, Southern Cross University and Jacqui Yoxall, Senior Lecturer in Allied Health, Southern Cross University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Go home on time! Working long hours increases your chance of having a stroke



Is it time to cut back on overtime?
Annie Spratt

Libby Sander, Bond University

Australia is in the bottom third of OECD countries when it comes to working long hours, with 13% of us clocking up 50 hours or more a week in paid work.

These long hours are bad for our health. A new study from France has found that regularly working long days of ten hours or more increases our risk of having a stroke.

Other research has found that employees who work long work hours are likely to have poorer mental health and lower-quality sleep.

Long working hours have also been shown to increase likelihood of smoking, excessive drinking, and weight gain.




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Long hours are bad for our health

The effects of regular long work hours on our health are wide-ranging.

The new French study of more than 143 ,000 participants found those who worked ten or more hours a day for at least 50 days per year had a 29% greater risk of stroke.

The association showed no difference between men and women, but was stronger in white-collar workers under 50 years of age.

Another meta-analysis of more than 600,000 people, published in the British medical journal The Lancet, found similar effects. Employees working long hours (40-55 hours per week) have a higher risk of stroke compared with those working standard working hours (35-40 hours per week).

The association between long working hours and stroke was stronger among white-collar workers.
Bonneval Sebastien

Irregular work hours, or shift work, has also been associated with a range of negative health and well-being outcomes, including the disruption of our circadian rhythm, sleep, accident rates, mental health, and the risk of having a heart attack.




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And it’s not just the physical effects. Regularly working long hours results in poor work-life balance, leading to lower job satisfaction and performance, as well as lower satisfaction with life and relationships.

Why are we working more?

Although many countries have imposed statutory limits on the work week, worldwide around 22% of workers are working more than 48 hours a week. In Japan, long work hours are such a significant issue that karoshi – translated as “death by overwork” – is a legally recognised cause of death.

Concerns around automation, slow wage growth, and increasing underemployment are some of the reasons Australians are working longer. A 2018 study showed Australians worked around 3.2 billion hours in unpaid overtime.




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And work doesn’t end for many people when they leave the office. If they aren’t doing extra work at home, taking calls, or attending after-hours meetings online, working second jobs is increasingly becoming the norm. Many Australians now work additional jobs through the gig economy.

The influence of job control

Autonomy and “decision latitude” at work – that is, the level of control over how and when you perform your duties – is a contributing factor to the increased risk of health problems.

Low levels of decision latitude, as well as shift work, are associated with a greater risk of heart attacks and strokes. Individual control plays a significant role in human behaviour; the extent to which we believe we can control our environment considerably impacts our perceptions of and reactions to that environment.

Early psychology research, for example, showed that reactions to the administration of an electric shock were very much influenced by the perception of control the person had over the stimulus (even if they did not actually have control).

Workers who have little autonomy or control are more likely to experience health problems than those who have a high level of control.
NeONBRAND



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These findings were echoed in data from the Australian Institute of Health and Welfare. It found that a lack of alignment between an individual’s preferences and their actual working hours resulted in lower reported levels of satisfaction and mental health. The results applied both to workers who worked long hours and to those who wanted more hours.

What can employers do?

Effective communication with employees is important. Employees may be unable to complete their work in standard hours, for example, as a result of having to spend excessive amounts of time in meetings.

Employers can take steps to implement policies to ensure that long work isn’t occurring regularly. The Australia Institute holds an annual Go Home on Time Day to encourage employees to achieve work-life balance. While this initiative raises awareness of work hours, going home on time should be the norm rather than the exception.




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Increasing employees’ input into their work schedule and hours can have positive effects on performance and well-being.

The design of the workplace to promote well-being is an important factor. Research on shift work has shown that enhancing the workplace by providing food, child care, health care, accessible transport, and recreational facilities can reduce the effects of shift work.

By improving conditions and benefits, employers can help ameliorate the negative health impact of shift work.
Asael Peña

Finally, implementing flexible work practices, where employees have some control over their schedule, to encourage work-life balance has been shown to have positive effects on well-being.

Such initiatives require ongoing support. Japan instituted Premium Friday, encouraging employees to go home at 3pm once a month. Initial results, however, showed that only 3.7% of employees took up the initiative. The low take-up can be attributed to a cultural norm of lengthy work days, and a collectivist mindset where employees worry about inconveniencing peers when they take time off.

Given the rise in concerns about future work, and workplace cultures where long hours are the norm, change may be slow in coming about, despite the negative health effects of long work hours.The Conversation

Libby Sander, Assistant Professor of Organisational Behaviour, Bond Business School, Bond University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

You can’t get influenza from a flu shot – here’s how it works


You might feel a bit off after your flu shot but this doesn’t last long.
Rawpixel.com/Shutterstock

Allen Cheng, Monash University and Katherine Kedzierska, University of Melbourne

Influenza is a moving target for vaccines. Each year, up to four different strains circulate, and they are constantly evolving to escape our immune system.

So rather than childhood jabs giving long lasting immunity, we need annual flu shots to provide optimal protection against influenza.

But while you might sometimes get sick after having a flu shot, it’s a myth that having a flu shot can give you the flu.

A quick history of the flu vaccine

Influenza vaccines were first developed in the 1930s and 1940s, starting with the isolation of the influenza virus.

Back then, we learned there were many different influenza strains. To be effective, early research showed the vaccine needed to be matched to the circulating strains, and to be able to stimulate a response from the immune system.




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The process to produce modern influenza vaccines now occurs on a much more refined and industrial scale. Hundreds of thousands of influenza viruses are collected by hundreds of national influenza centres around the world.

From these, four strains are selected for the annual flu vaccine, based on the viruses that are circulating at that time, how well the vaccines activate the immune system, how the strains are evolving, and the effectiveness of previous vaccines.

Modern flu vaccine development is slow and labour-intensive process.
hotsum/Shutterstock

Most modern vaccines are manufactured by growing large quantities of live virus – mostly in chicken eggs or less commonly animal cells – which are then purified, deactivated and split into smaller components. These vaccines are inactive and cannot replicate.

There are also two new “enhanced” vaccines that are used in older people, who don’t tend to respond as strongly to vaccines: Fluzone High Dose and Fluad, which is designed to better stimulate immunity and draw immune cells to the site of vaccination.




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How the immune system fights the flu

The human immune system has several strategies to protect against infection. For viral infections such as influenza, the key strategy is known as adaptive immunity. This part of the immune system can “remember” previous exposure to pathogens.

When you get an influenza infection, the virus enters and hijacks the machinery of the host cell to replicate itself, before releasing these copies to infect more cells.

T lymphocyte cells of the immune system can recognise this viral incursion. T cells protect against further spread of the virus by activating pathways that cause infected cells to trigger a “suicide” process.

Another strategy the body uses is to produce antibodies, which are molecules produced by B cells that recognise components of the viral capsule. These antibodies work by sticking to the surface of the influenza virus to prevent it spreading and facilitating disposal.

Flu shots help mount a quicker defence

On a first exposure to a pathogen, our B cells take at least two weeks to ramp up production of antibodies. However, on subsequent challenges, antibody production occurs much more quickly.

Influenza vaccines harness this arm of the immune system, known as “humoral” immunity. By “practising” on viral components, vaccines allow the immune system to react more quickly and effectively when faced with the real virus.

The flu shot takes about two weeks to start protecting you against influenza.
DonyaHHI/Shutterstock

So why do you sometimes get sick after a flu shot?

There are several reasons why you might feel a bit off after getting your flu shot.

First, your flu shot only protects you against influenza and not other respiratory illness which might causes similar cold or flu symptoms. This includes RSV (respiratory syncytial virus), which is common in late autumn and early winter.




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Second, stimulating the immune system can result in symptoms similar to that of influenza, although much milder and short-lived. These include local inflammation (redness, pain or swelling at the site of the vaccine) and more general symptoms (fever, aches and pains, tiredness).

Third, vaccine-induced protection isn’t complete. In some years, the vaccine is not well matched to circulating strains. Usually this is due to mutations that may develop in circulating strains after the vaccine strains are selected.

The flu vaccine also doesn’t “kick in” for two weeks after vaccine administration. In some people, particularly those who are older and those who have weakened immune systems, antibody production is not as strong, and the level of protection is lower.

Despite this, studies have consistently shown that vaccinated people are less likely to get influenza or complications from the flu than those who aren’t vaccinated.




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A better way to protect against the flu

A problem with current vaccines is the reliance on eggs, which results in a relatively slow and labour-intensive production process.

Current work is aiming to speed up this process by using different technologies so that vaccine manufacturers can react more quickly to changes in circulating viruses.

The “holy grail” for influenza vaccines is to stimulate an effective immune response to a component of influenza that doesn’t change each year, so annual vaccination is not required.

These efforts have proved elusive so far.




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A better strategy might be to harness T cell immunity. Recent work has shown that a type of T cell, known as “killer” T cells, can recognise other parts of the influenza virus, and therefore can provide broad protection against seasonal and pandemic strains.

But while we wait for a better alternative, getting an annual flu shot is the best way to avoid the flu.The Conversation

Allen Cheng, Professor in Infectious Diseases Epidemiology, Monash University and Katherine Kedzierska, Academic, Microbiology and Immunology, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Obesity has become the new normal but it’s still a health risk



Exercise is good for you, no matter what your weight.
Pressmaster/Shutterstock

Tim Olds, University of South Australia

Nike’s London store recently introduced a plus-sized mannequin to display its active clothing range which goes up to a size 32.

The mannequin triggered a cascade of responses ranging from outrage to celebration. One side argues that the mannequin normalises obesity and leads obese people to feel that they are healthy when in fact they are not.

The other side argues the representations are inclusive, combat fat stigma and encourage fat women to exercise.

Both arguments have some merit.

The representations of bodies we see around us — including shop mannequins – affect the way we calibrate our sense of what is normal and acceptable. And obesity is indeed associated with a greater risk of heart disease, stroke, type 2 diabetes and early death.

It is possible to be metabolically healthy and fat. But even metabolically healthy obese people may still have a shorter life expectancy than their lean peers.

On the other hand, exercise is almost universally beneficial, and people of all shapes and sizes should be encouraged to participate.




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Overweight and obesity have become the new normal

Based on body mass index (BMI), about two-thirds of Australian adults and one-quarter of kids are overweight or obese. While this proportion has flattened out for children in the last 20 years, it continues to rise for adults.

There is strong evidence parents consistently misjudge the weight status of their children because they see more and more fat kids.

The same is true for adults: a recent study from the United Kingdom found 55% of overweight men and 31% of overweight women considered their weight to be in the healthy range.




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I would guess the Nike mannequin is close to 100 kg, with a BMI maybe in the low 30s, well into the obese category.

But given the average female shop mannequin has a BMI of about 17, there are probably at least ten times as many Australian women like the plus-size mannequins than like the usual minus-size variety.

Obesity is not a lifestyle choice like smoking

Obesity is necessarily the result of behaviours — eating too much, exercising too little — albeit heavily constrained by genetic predispositions, and social and economic pressures.

But unlike, say, smoking, being fat is also part of what a person is: most people who are fat have usually been fat for a long time. It’s not something a person has complete control over.

Divergent paths into fat and lean start very young, and once you’re on the obesity train it’s hard to get off.

While it is possible to “give up obesity”, for many it can be a very hard road, involving a lifelong struggle with hunger and recidivism.




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Empowering vs shaming

Anti-obesity campaigns that are built on disgust, fear or shame – such as Measure Up – have been criticised as being stigmatising, ethically problematic and ineffective.

Australia’s 2009 Measure Up campaign is built on fear and shame.

There has, to my knowledge, been no high-quality research comparing the actual effectiveness of shaming versus empowering anti-obesity, or pro-physical activity, campaigns.

However a number of studies show, unsurprisingly, that obese and inactive people prefer empowering campaigns, find them more motivating and less stigmatising.

Health risks of obesity

It has been argued one can be “fit and healthy at any size”: that an obese person can be as fit and healthy as a lean person.

Depending on definitions, about 25-50% of obese people have “metabolically healthy obesity” – normal levels of inflammation, blood sugar, insulin, blood fats, and blood pressure. Other than being obese, these people appear healthy.

But obese people — fit or unfit, active or not — remain on average at greater risk of heart disease, diabetes and early death than lean people with similar behaviours.

Similarly, the claim that people can be both fit and fat, and that fit, fat people are at less risk than unfit, lean people depends on how we define fitness and fatness.

One study, for example, might compare overweight people in the top 20% of fitness with lean people in the bottom 20%. Because there are modest differences in fatness and big differences in fitness, fat people are much more likely to have a similar risk to lean people.

But if another study compares obese people in the top 50% of fitness to lean people in the bottom 50%, the fatter people will be much less healthy.

What is certain is that whoever you are, exercise will almost certainly improve your health.




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The Nike mannequin controversy is a morality tale of how we navigate between the devil of normalising obesity and the deep blue sea of excluding obese people from the world of exercise.

Obesity has been called both a disability and a disease, and just another way of being in the world. The reality is that for most people, it’s something in between.The Conversation

Tim Olds, Professor of Health Sciences, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.