This Week's Hot Topic

10-Fold Increase in Gastric Band Operations on the NHS (Friday 27th August 2010)

There's been a 10 fold rise in gastric-band operations to tackle obesity in the last decade. 4,300 gastric band operations alone were carried out on the NHS in 2009, and each procedure costs the NHS around £7,000. Some experts consider this to be a cost-effective method to cut obesity, as the resulting weight loss reduces the risk of other diseases. Others feel that this money would be better spent on methods that encourage exercise and healthy eating, through counselling and even personal training on the NHS.

How does the gastric band work? A small silicone band is fitted near the top of the stomach to create an small upper 'pouch', which enables you to eat only a small amount of food before you feel full.  Because the band is tight, it restricts the speed at which food can leave this upper stomach 'pouch' and enter the rest of the stomach, so you feel full for longer. As a result you eat less, and lose weight. Although the NHS does stress that this drastic solution to obesity is a last resort, is it really used only as a last resort?

Doesn't the availability of these ops on the NHS encourage obese people to think it's a convenient substitute for healthy eating and more exercise? There's a pyschological term called 'learned helplessness' where a patient can convince doctors that they find it absolutely impossible to take responsibility for their own health, safe in the knowledge that they will get an operation to lose weight with no effort on their part.

Just because someone has tried and failed to lose weight through exercise and healthy eating in the past, does not mean that exercise and healthy eating won't work in the future. It just means that the patient needs more support and guidance to eat healthily and exercise more.

The massive downside to the gastric band is that you won't  necessarily eat any more healthily after the op. You might simply eat the same junk food but just less of it. This is why people with gastric bands are advised to take a multivitamin supplement, because they're not getting the nutrients you'd get from eating plenty of healthy foods. 

Eating healthily is not just about eating less, it's about eating nutritious foods in the right quantities - and for many people that means eating more of some foods (fruit, vegetables, wholegrains, beans, pulses), not less. You also need to eat regularly for good health, but the gastric band might encourage you to skip meals, which deprives you of vital nutrients, and slows your metabolism down to a crawl, which ironically makes you hoard  body-fat rather than burn it.

How can you possibly consume enough vegetables, fibre, lean protein, and complex carbohydrates if you feel full after just a few mouthfuls? And how can you exercise properly if you can't eat enough carbs to provide the energy for an effective workout?

Worse still, the gastric band is absolutely no guarantee that you will eat less junk food. You can simply liquidise your junk food and chocolate and cakes, and it will slip easily through the narrow hole between the small upper pouch and the rest of your stomach, so you can end up consuming just as much junk food as you did before. High calorie fatty and refined sugary foods are easy to liquidise, and for someone who is addicted to rich foods, this can be an irresistible 'cheat' method.

Then there's the side-effects. Possible damage to the liver when it's moved out of the way during the op, the risks of general anaesthetic, blood clots, the post-op risk of infection. And the early weeks of the gastric band bring the risk of nausea, vomiting, diarrhoea, pain swallowing if the band is fitted too high, and corrective surgery if the band leaks or slips or deflates. There's also the risk of gall-stones brought on by too-rapid weight loss.

And just because you've had a gastric band fitted, don't mean you'll exercise more. Exercise is vital for good health, yet you can be just as inactive with your gastric band as you were before.

If there's been a 10-fold increase in gastric band ops, there's no way all them are a genuine 'last resort' as the NHS claims them to be. Perhaps a tiny fraction are a genuine last resort (and surely then it should only be an emergency temporary measure to lose life-threatening weight). But for the majority of obese people, the only lasting solution is healthy eating and regular exercise over the long term, with as much support as required.

The gastric band op is based on the misconception that eating less is the only requirement for good health. Nothing could be further from the truth. Gastric bands totally avoid addressing the root causes of obesity, which are poor diet and lack of exercise.

The £7,000 the NHS spends on each gastric band op, would buy an obese patient an intensive month at a health-farm with professional counselling and personalised action plans, followed by a whole year of weekly one-to-one personal training sessions and nutrition advice. It would get them into the habit of active lifetsyles and healthy eating, and transform their quality of life. It would solve the root causes of their obesity. Wouldn't this be a better way to spend NHS money?

Bikram Yoga and Hot Yoga (Sunday 1st August 2010)

If you're looking for a new form of exercise, consider giving Hot Yoga or Bikram Yoga a try. Bikram Yoga was invented by Bikram Choudhury (born 1946 in Calcutta, India). It's a 90 minute yoga session performed in a heated room (95 - 105 degrees F) and also humid, and results in profuse sweating (some studios require you to bring your own mat and towel). There are 26 yoga poses performed twice, including 2 pranayama exercises, which are yoga breathing exercises. Pranayama is just one of the so-called '8 limbs of yoga'.  

Neither Bikram Yoga or Hot Yoga are recommended for pregnant women, and if you have a hard time coping in the heat, it may not be for you. Make sure you drink plenty of water after the session to replace the water lost through sweating. In addition, you need to replenish your electrolytes lost through sweating, so eat a banana.

Many people have reported great benefits from regular sessions: greater muscle flexibility, less stressed, more patient, better concentration, some feel the day after a session like they've had a a deep tissue massage, joint/muscle healing effects. Many describe it as demanding but soothing at the same time.

What's the difference between Bikram Yoga and Hot Yoga?

Bikram Yoga is only taught by instructors trained in the very prescribed Bikram method, according to a rigid script, with no deviation from the Bikram method allowed. Some feel that this results in the instructor coming across as mean, or too strict. Hot Yoga is similar (hot room, similar effects) but Hot Yoga instructors are not affiliated with the Bikram organisation, and not allowed to call themselves Bikram instructors. Some say that Hot Yoga is more flexible, more relaxed, more holistic, and open to variations according to the preferences of each class of students in any particular session.

Some claim that the profuse sweating has a great detox effect, but this is a bit of a myth. Real detoxification can only occur when toxins are eliminated in the urine and faeces. There may be some minor detox through sweating, but this is not the primary benefit. The indirect and longer term detox effect may be to make your body work more optimally, including your liver and kidneys, which in turn will enable you to eliminate toxins more efficiently.

Does Bikram Yoga and Hot Yoga help you lose weight? To the extent that it relaxes the muscles, helps remove muscle knots over time, and boosts circulation, these benefits make the body a more efficient fat-burning machine. There is also some muscle-toning effect, and the more muscle you have, the higher your metabolic rate, and the more fat you burn. Bikram Yoga and Hot Yoga are not the greatest muscle-builders though. And the cardiovascular exercise effect is not as great as going for a run. So don't rely on this form of exercise alone for weight loss. It should be part of a wider programme of varied exercise, which should definitely include resistance training with dumbbells or bodyweight.

Does the heat-effect of Hot Yoga make it a better fat-burner than say Ashtanga yoga with its higher tempo of 'asanas'? Opinion is divided. Some argue that the heat makes your body burn calories faster, as your body is working hard to cool you down. Others say that the heat gives you the illusion that you're working harder than you are, and that your main focus is on not passing out in the heat.

Will regular weekly Bikram or Hot yoga sessions encourage you to eat more healthily? The discipline of 90 minutes exercise in this heated environment may well help you develop the mental toughness and healthy-mindset to stick to a more nutritious diet. And this form of yoga almost certainly relieves stress, which will reduce stress-related food binges. If you think you can stand the heat, give it a try!

Cycle Super-Highways for London (Monday 17th July 2010)

Is London cycle-friendly enough? I've yet to meet a cyclist who says yes.

London Mayor Boris Johnson today launched the first two 'cycle superhighways', South Wimbledon to Bank (A24 and  A3), and Barking to Tower Hill (A13 and Cable Street); bright blue lanes each around 10 -15km long. After this pilot scheme,there will eventually be 12 such cycle-superhighways.

Boris Johnson is a keen cyclist himself, and he appears to be a real champion for safe cycle routes and more cycling in London. "I'm not kidding when I say that I'm militant about cycling, and these Superhighways are central to the cycling revolution I'm determined to bring about," says Boris. But is it enough? Will cars and lorries respect the blue lanes, or ignore them like they ignore the existing green lanes? "On these routes the bicycle will dominate," assures Boris. But will a bright blue lane (albeit wider than the old lanes) provide any security for cyclists at London's many dangerous junctions?

Cycling bloggers in London are saying this superhighway is a poor substitute for the fully segregated cycle lanes found in cities like Amsterdam and Munich, which offer genuine security for cyclists. Others feel that the health benefits of cycling are offset by the dangers of breathing in car exhaust fumes up-close, and think that London will only be truly cycle-friendly when the more harmful vehicle emissions are drastically reduced. One blogger pointed out that cycle-theft is sky high in London, and better security at cycle-parking areas is needed, together with lockable bike-racks. Another points to the need for better shower-facilities at your place of work when you arrive by bike.

One of the biggest problems seems to be that off-peak vehicle parking is allowed on these blue lanes, so cyclists will still have to swerve into the traffic every time they come across a parked car along the route.

This initiative is part of the Mayor's £111 scheme to boost cycling in London. Other projects include the cycle hire scheme, free cycle-training, better signage, more cycle-parking.

What do you think? Send me your comments and I'll add them here.

(TfL adds that 2% of travel in London is by bicycle, and the aim is to increase this to 5%. The next two superhighway routes will be Bow to Aldgate, and Wandsworth to Westminster. There should be 12 routes by end of 2015. The bike hire scheme will give 24 hour access at 400 docking stations, and will launch 30th July 2010.)

London Not Pedestrian Friendly Enough

As a personal trainer in London, I'm always advising my clients to walk more. Walking is a great way to get fit, and easy to build into your daily routine. But it's a shame that London is so hostile to pedestrians.

I remember a news item about an elderly man in north London, somewhere like Finchley or Golders Green. This man couldn't get across the main road from his house to his local shops because the traffic was so busy, and there were no suitable pedestrian crossings. So he ended up having to catch a bus, and when the bus had turned into the road where his shops were, he got off.

Another crazy situation is the time you have to wait at some pedestrian crossings before the green man appears for pedestrians to cross. There's one in Archway, Holloway Road opposite a church, where you have to wait for ages before you can get across. There are similarly atrocious crossings in Ilford.

There are some signs of improvement though. I saw in today's Metro that there are several improvements for pedestrians underway, as part of the London Mayor's strategy called 'Making Walking Count'. Great Queen Street WC2 has been made more pedestrian friendly, described as a 'pedestrian oasis' by a Council transport executive member. There is also a new pedestrian crossing and less street cluttter at High Holborn, and new pavements at Lincoln's Inn Fields.

Another big challenge is to make London more cycle-friendly. A cycle-hire scheme is due this summer, and there's a new cycle-docking station in Great Queen Street WC2. We also need more cycle-lanes, which might encouage cyclists to get back on the road rather than using the pavement.

What improvements could be made in your part of London? Let me know! Fitness4London aims to champion healthier living in London, and a more pedestrian friendly London is a crucial part of this.

Click here to contact me and have your say in response to this article. I'll post some of your replies next week.