Christmas 2009: Christmas Fayre

Santa Claus: a public health pariah?

BMJ 2009; 339 doi: http://dx.doi.org/10.1136/bmj.b5261 (Published 16 December 2009)
Cite this as: BMJ 2009;339:b5261

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Santa Claus has received criticism for promoting an unhealthy lifestyle, with his rotund body habitus, penchant for alcohol and mince pies, and predilection for airborne travel.

Yet little consideration is given to the possibility that all is not always as it may seem. Santa is a famously private individual. Without the opportunity to undertake a full history and examination, we are limited in what conclusions we may draw regarding his health.

What we do know is that he spends a great deal of time in soot lined chimneys, seemingly without adequate personal protective equipment (PPE). It seems feasible that cumulative exposure to these conditions might result in some form of chronic interstitial lung disease while alighting in tobacco smoke-filled living rooms might contribute an obstructive component. His centripetal obesity and round face could therefore derive from a cushingoid effect of regular systemic corticosteroids, with his dependence on airborne transportation and multiple helpers indicative of a limited exercise tolerance. Indeed his functional residual capacity may be such that wheezy monosyllabic utterances, such as "ho ho ho", are all that he can routinely muster, with the break neck speeds of his open sleigh necessary to deliver continuous positive airway pressure support.

As good clinicians we ought to be wary of misdiagnosis based on lazy assumptions.
Santa Claus may suffer from disabling medical comorbidities which in conjunction with his advanced age, might easily justify State support. Shamefully, despite the huge progress made in access for the disabled, we still insist on him making home visits via unregulated chimneys. Nevertheless, his dogged determination to continue working, and deliver results in a reliable and timely manner, suggests why in common with many other skilled migrant workers, he remains in such high demand.

Far from being a public health pariah, Santa’s public health relevance extends beyond the mental wellbeing of the paediatric population and their grateful parents. By managing chronic illness without allowing it to dominate his life, he may be a powerfully enabling and destigmatising force.

Competing interests: None declared

Roshan Vijayan, Junior Clinical Fellow

Gregory Scott

Queen Victoria Hospital, East Grinstead, RH19 3DZ

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Time has come to start thinking that there is more that one obesity. Obesity is an adipose tissue expansion and aesthetically might be out of fashion. However, in some cases being obese is an advantage in some chronic diseases. Therefore, the first think we should be doing is to define when obesity has to be treated. Let's not get ahead of ourselves...Santa may be a metabolically healthy obese.

Competing interests: None declared

JM Arbones-Mainar, Obesity Researcher

IACS, Hospital Miguel Servet. 50009 Zaragoza. Spain

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On Christmas Eve, spurred on by the images in the article Santa Claus: a public health pariah?(1) my two children aged 6 and 9 felt prompted to take immediate action to help Santa Claus with his weight loss program. Despite my protestations they insisted on leaving him a satsuma and two hazelnuts, instead of the usual sherry and mince pies. Santa Claus was still good enough to fill their stockings but I can't help feeling he was a little hard done by!

References

1. Grills NJ, Halyday B. Santa Claus: a public health pariah? BMJ 2009;339:b5261

Competing interests: Stephen Harper has helped Santa Claus deliver presents to his children for several years now

Competing interests: None declared

Stephen Harper, GP Partner

Mill Stream Surgery Benson OX10 6RL

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Grills and Halyday give a humorous account of Santa’s ability to influence people, especially children (1). The authors suggest that one of the things that Santa promotes is the harmful message that obesity is synonymous with cheerfulness and joviality.

To be very old and obese, yet cheerful and jovial, it must mean that Santa must be very healthy. So, children and grownups would have to investigate Santa’s dietary habits at the North Pole for identifying the reason for this anomaly.

Firstly, however, it would be advisable to consider Santa’s age. No one will dispute the fact that he is very, very old, as exemplified by his snow white hair and beard. Secondly, as a North Polian, Santa consumes a fatty diet abundant in omega-3 fatty acids (2). Also, it is a well known fact that one puts on weight with age (3,4). Santa needs the excess adipose tissue to keep him warm at the North Pole and as he travels in the cold confines of the atmosphere, on his reindeer-drawn sled.

When many have succumbed to heart disease, cancer and other diseases we find Santa working tirelessly year after year, giving joy to children around the world. The ideal omega-3/omega-6 ratio in Santa’s diet is hypothesized as the reason for his lack of heart disease (2) or prostate cancer (5). It would be of interest to see if this diet has anything to do with the observation that that he does not gradually lose muscle mass and become frail as the years pass.

In addition, he does set an example for healthy living, despite his obesity. He encourages his young helpers to work very hard, to prepare presents for delivery to the world wide wonderfulkids, in time for Christmas. Thus, Santa’s Elves are all slender and live a very active lifestyle, a model for youngsters everywhere.

Santa is very helpful and resourceful as well. In the off season, he outsources part of “Elf storage” to Washington DC, USA to help stimulate the economy (Figure 1). With no recession ever, at the North Pole, Santa can afford to give one of the biggest stimulus packages ever delivered to the USA. Therefore, we should be thankful even after Christmas for the numerous jobs that would be made possible by this thoughtful gesture. The stimulus package would be more than enough to provide for the food, clothing, housing, transportation (Polar Express) and other needs of the Elves.

Kids of all ages can take comfort in the knowledge that Santa is not at all bad at heart and all the negative images portrayed are just a sad example of the precocious greed of mankind who attempt to use his influence to peddle their wares.

Therefore, kids and grownups can emulate Santa for his healthy eating style, for enforcing a strict work routine for his helpers, for his generous heart and his resourcefulness.

References

1. Grills NJ, Halyday B. Santa Claus: a public health pariah? BMJ 2009;339:b5261

2. Burr ML. Lessons from the story of n-3 fatty acids. Am J Clin Nutr. 2000;71(1 Suppl):397S-8S.

3. Williams PT. Evidence for the incompatibility of age-neutral overweight and age-neutral physical activity standards from runners. Am J Clin Nutr. 1997;65:1391-6.

4. Williams PT, Wood PD. The effects of changing exercise levels on weight and age-related weight gain. Int J Obes (Lond). 2006; 30:543-51.

5. Dewailly E, Mulvad G, Sloth Pedersen H, Hansen JC, Behrendt N, Hart Hansen JP. Inuit are protected against prostate cancer.Cancer Epidemiol Biomarkers Prev. 2003; 12:926-7.

Competing interests: None declared

Competing interests: None declared

Biji T Kurien, Senior Research Scientist

OMRF, Oklahoma City, OK 73104, USA

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23 December 2009

Get a life. Baaaah Humbug

Competing interests: None declared

Competing interests: None declared

John MS Pearce, retired consultant neurologist

Private address HU10 7BG

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21 December 2009

Dear authors:

This article is most entertaining, but has been widely reported in the lay press as a totally serious article. These poor journalists, and their readers, clearly don't understand the concept of medical humour and parody, and that this can be subtle! I ask you, please let them know it is supposed to be humourous (or at least most is) before someone thinks you're really anti-Santa and want to spoil everyone's fun!

sarah.abrahamson@med.monash.edu.au

Competing interests: None declared

Competing interests: None declared

Sarah J Abrahamson, PhD Candidate

Monash University

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20 December 2009

Our Nation’s attention was drawn, via our National Press, to a study published in your Journal warning that Santa is a bad role model for children, ‘Santa promotes a message that obesity is synonymous with cheerfulness and joviality!’ Please be advised that here in the Antipodes a gaunt, anorexic old man with long grey hair and beard is always considered a vagrant, regardless of address or wardrobe. Best keep the weight on.

Competing interests: None declared

Competing interests: None declared

Guido P. Haakmeester, retired

n/a

retired

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What and excellent article to bring a smile to the faces of those who no longer believe in the red faced bearded wonder. However, surely the authors miss several key points in their assessment of Santa's fitness. Surely when hopping from chimney to chimney he is contributing to his 30 minutes excercise for the day. Extreme sports also raise the heart rate effectively and build on leadership and team skills between Santa and his reindeers. In addition, with the BMA now supporting a greener world, using sleigh and reindeer is carbon neutral and opting for their choice of bicycles would run the risk of enducing repetitive strain injuries, muscles strains or if out on the ice, a nasty fall and possible fracture. Jogging has also been shown to cause high levels of stress on joints - middled aged gents may be therefore at higher risk of inducing osteoathritis?

In addition, Santa is only around for 1 month of the year. Should we be attacking the Easter bunny in the same way? On the face of it a healthy animal that is active but underneath that lies a darker side with eggs full of fat and calories.

Maybe a suitable remedy to the infection risk would be to e-mail children, webcast and even Twitter to ask what they want for Christmas?

The most important point of the Santa saga is that we do look at him as the symbol of Christmas and not the nativity. Who knows, maybe in years to come we will have the baby Jesus being visited by Santa himself?

Until then, I will leave my mince pie (low fat); non alcoholic fizzy wine and a wish list in the hope that Santa will visit me on Christmas Eve.

Competing interests: Believed in Santa Claus until the age of 7

Competing interests: None declared

David G samuel, F2 Care of the Elderly Medicine

Prince Charles Hospital, Merthyr Tydfil CF47 9DT

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17 December 2009

Grills and Halyday's work is the most entertaining parody of a research paper I have seen in a very long time. It beautifully magnifies and skewers the pompousity, pettiness, panicky alarmism, and unabashed ivory-towerism that can creep into some strains of scientific writing. I laughed until my head hurt.

Competing interests: None declared

Competing interests: None declared

Bryan J Maloney, Technician and Laboratory Manager

Indiana University School of Medicine, 47904

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