New ideas pleaseBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39056.616898.47 (Published 07 December 2006) Cite this as: BMJ 2006;333:0-f
- Trish Groves, deputy editor ()
Did you know that diabetes kills 3.8 million people worldwide each year, around the same number as HIV/AIDS? Good glycaemic control will at least lower the risk of cardiovascular disease in diabetes, but it's hard to achieve. R J Heine and colleagues, in their guidelines on hyperglycaemia in type 2 diabetes, unpick the tangle of treatment options (p 1200 doi: 10.1136/bmj.39022.462546.80). The authors, who are based in the Netherlands, Cameroon, and Boston, say their proposed management algorithms will help doctors even where resources are poor. But treatments to alter the relentless decline of β cell function and the clinical course of diabetes are still a long way off. Lifestyle change remains, for now, the potentially most effective and most difficult intervention, and we need better evidence and new ideas to make it happen.
In their ABC article on childhood obesity John J Reilly and David Wilson also report a dearth of robust evidence for lifestyle interventions (p 1207 doi: 10.1136/bmj.39048.503750.BE). But they do cite one sound and generalisable randomised controlled trial in 11 year olds at US schools, in which girls' risk of obesity fell and those who were already obese lost weight, mainly through watching less television. It's hardly a new idea, but a feasible and effective one. The face validity of the intervention may well have helped: for instance, Reilly and Wilson warn that the fears of parents, teachers, and health professionals about encouraging eating disorders might scupper dietary interventions in schools. They, too, say we urgently need new ideas and further research.
Meanwhile, dietitian Carrie H Ruxton calls for fewer platitudes and mantras and more common sense (p 1221 doi: 10.1136/bmj.39051.726852.3A). It's all very well to berate multinational food companies, but let's not forget the chip vans parked outside schools, the kids who can't cook, and the low cost home entertainment that keeps too many of us glued to our seats.
Whether home entertainment is low cost is a moot point, particularly among parents looking at their children's Christmas lists. And what about the indirect costs? Minerva reports a woman who broke her fifth metatarsal while using a Sony PlayStation 2 Dance Mat, almost certainly leaving her immobile for more than a month (p 1228 doi: 10.1136/bmj.39051.730463.471). The web is buzzing with debate about whether Nintendo's new Wii games console (whose motion sensitive remote control translates your real golf and tennis strokes into virtual games on the screen) will do more harm through sports injuries than good through getting sedentary people moving. My search for academic articles on this drew a blank, except when “wii and physical activity” pulled up a page from University College London. A red herring, alas: it was a paper from 2003 about physical activity among men with chest disease, from the Whitehall II (WII) study of British civil servants.
I'm not a games console user, but my wish list includes an affordable personal computer that I have to pedal. Again, the web offers plenty of opinions on this, and even the odd prototype. But it seems that I would have to pedal hard, all the time I was working, to generate 200 watts, only about half what a mid-range desk computer uses. Not this Christmas, then.