BMJ  2005;330 (11 June), doi:10.1136/bmj.330.7504.0-g

Editor's choice

More miles, fewer biscuits

Editing is a sedentary profession. We sit at our computers doling out decisions and emailing colleagues sitting at the next desk. We might, if the mood takes us, wander out for a spot of lunch before the afternoon's editorial meeting, at which we pick over piles of manuscripts and plates of BMA biscuits. Only the stress of it all keeps us thin.

Hospital medicine is by comparison far from sedentary. As house officers in the mid-1980s we averaged several miles a day along the hospital corridors. I don't know what the current mileage is but the European Working Time Directive is likely to have reduced it to some extent, cutting the miles walked by junior doctors as well as the hours worked. More importantly, as many have commented in the seven years since it became law in the UK, the directive has dramatically reduced the available time for training, created huge potential gaps in medical staffing, and threatened continuity and quality of care across Europe.

It may sound a good thing that a consultant surgeon in the UK can now be trained in as few as 6000 hours, as compared with over 30 000 hours a few years ago. But as Graham Read points out (p 1397), the result may not be a service we would want to work in or be treated in. We have moved, he says, from a "consultant led" to a "consultant provided" service, with onerous on-call duties for senior doctors, who have little time and energy to train their junior staff, and junior staff who are not around on the wards or in theatre enough to be trained even if they did.

The working time directive—now mired in disputes about the legal definition of active and inactive on-call time (p 1346)—is just another complication for the European Union, after the shock of its "No" votes in France and the Netherlands. But while it licks its wounds, Europe is facing another major health challenge that it cannot afford to ignore—the obesity epidemic. The prevalence of obesity in Europe has increased by up to 50% over the past 10 years and in some countries exceeds the prevalence in the United States. In this issue, Reilly et al (p 1357) find that possible contributory factors to childhood obesity include watching television and insufficient sleep but no good evidence of a protective effect from breastfeeding. Viner and Cole (p 1354) find that only half of obese children go on to become obese adults, and most obese adults were not obese as children. European GPs have expressed concern that they don't know how to deal with an epidemic on this scale (p 1348). In his editorial accompanying the two studies on obesity in this week's journal, M E J Lean presents a straightforward solution: we need to encourage people to move a little more and eat a little less—2000 steps a day more, and a couple of biscuits less.