Lifestyle medicine (Hoboken, N.J.)最新文献

November 26, 2020

Dr. Fraser Birrell

Editor-in-Chief, Lifestyle Medicine

We write to express our concern about a paper you recently published in your newly established journal. The paper examines the association of a non-modifiable measure, IQ, and its relationship to adult body mass index (BMI). We are academics, health professionals, health psychologists and lay experts in weight stigma and discrimination, public health, patient advocacy and risk communication. We believe the contents of this paper are likely to cause unjustifiable harm to people in bigger bodies, some of whom may not be in a position to raise their concerns with the authors or yourselves. We further assert that there are numerous ethical and methodological issues that should be brought to your attention, which limit the applicability of the results.

This paper goes against the stated aims and the scope of your journal. First, your journal states that you “advocate the principles of sound science publishing” and that “if the science is reliable and sound, you will publish.” Yet this paper suffers a number of methodological flaws and, in particular, breaches two ethical principles, namely, beneficence and justice that significantly detract from the soundness of the science. As we demonstrate below, on this occasion your journal has not upheld good scientific principles. Second, you state that your journal “examines clinical and scientific aspects of lifestyle medicine and its incorporation into clinical practice.” This suggests that you are interested in research that identifies potentially modifiable risk factors that might be addressed in clinical practice in a way that is beneficial to people. IQ is neither a "lifestyle" choice nor a modifiable variable (as noted by the authors themselves). IQ is a highly heritable trait,¹ which can be influenced by environmental factors,² most of which are unmodifiable from an individual perspective. We outline our remaining concerns below, along with the scientific evidence that supports them.

The paper is openly available for anyone to read online, including practitioners, researchers, decision-makers, the general public, and media outlets. Indeed, such articles are often misinterpreted in the media, adding to inaccurate portrayals, and the stigmatisation and discrimination of people with bigger bodies.³ The media frequently incorrectly attributes personal responsibility⁴ to people with bigger bodies and we believe that this article feeds into an unhelpful narrative that associates weight and measures of intelligence⁵ and policy decisions like barring children's admission to top schools because of their parents’ weight.⁶

Publishing this study fuels negative stereotypes that people in bigger bodies lack intelligence—a dehumanizing stereotype that serves

A paper recently published in Lifestyle Medicine highlights the importance of informed and respectful debate as part of the scientific endeavour. Appearing in the first edition of the journal, Jacob et al.¹ examined data from 7403 participants from the 2007 Adult Psychiatric Morbidity Survey (APMS), a nationally representative survey of the English adult population conducted by the National Centre for Social Research and Leicester University.² They found that there was a negative association between Verbal IQ, estimated using the National Adult Reading Test (NART), and obesity. During peer review, the manuscript was praised for its clear and robust statistical analyses. However, due to the nature of the topic, editorial review included assessing the manuscript for inappropriate or discriminatory language or conclusions, as well as ensuring both scientific and analytical merit in line with the journal's scope. Perhaps unsurprisingly, the paper still resulted in significant vocal debate on social media (Twitter), including calls for the paper's retraction. As Twitter does not uniformly allow for reasoned discussions, formal letters to the editor were solicited by Wiley to highlight any significant issues and allow for formal response by the original authors. This process is still an important aspect of moving scientific research forward, and as a journal we follow both International Committee of Medical Journal Editors (ICMJE)³ and the Committee on Publication Ethics (COPE) publishing principles,⁴ which include giving a platform for rebuttal to published articles and encouraging logical and reasoned scientific debate. Both the letter to the editor by Redsell et al.⁵ and the response by Jacob et al.⁶ are included in this issue. While we stand by the publication of the manuscript – as further outlined below – we believe that it is the job of the scientific community at large to iteratively move a field forward based on discussions such as those highlighted here. Therefore, to some extent, each reader can and will make up their own minds based on the evidence, following scientific principles to do so. We hope this commentary assists that process.

Using weight or normative estimators of body composition, such as the body mass index (BMI), as predictors of individual health or health outcomes is both controversial and highly emotive.⁷ This is clear from the tone of both the letter by Redsell et al.⁵ and the response by Jacob et al.⁶ One thing that we feel is absolutely necessary in order to move discussions in this field forward is the separation of our personal feelings about a topic from the scientific arguments, as much as that is possible. In line with that, both the letter writers and article authors were given opportuni

There are a range of lifestyle factors which can negatively affect both a person's physical and mental health, and there is increasing evidence that therapeutic lifestyle change can be useful for the prevention and treatment of depression and anxiety disorders. The six core features of lifestyle medicine—regular physical activity, a whole food and plant predominant diet, restorative sleep, stress management, avoidance of substance abuse, and positive social connection—are important foci for mental health providers trying to help patients make meaningful lifestyle changes to improve their well-being. Alongside these elements, there are likely many other aspects of lifestyle important to mental health. The aim of this paper is to provide an overview of five potential lifestyle targets which may play a role in the development and treatment of depression and anxiety, including financial stability, time in nature, pet ownership, materialistic values, and the use of social media. The paper will explore the evidence that these factors contribute to the burden of depression and anxiety in the modern world and will review the potential mechanisms of these effects and clinical implications of interventions targeting these factors.

Covid-19 has led to virtual care (mainly telephone consultations) becoming a default worldwide, despite well-documented shortcomings. Published evidence on virtual group consultations is limited, although interest and front-line experience have grown substantially since pandemic onset. Unpublished data are summarised showing feasibility of transitioning care to this model across different countries, care settings and conditions. An international webinar series has supported development and sharing of best practice and representative data on spread and utilisation of virtual groups. This model of care creates time and space for more questions and answers, so once engaged patients become staunch advocates. Group care supports personalised care and lifestyle medicine, which is growing very rapidly. In the current context, even healthcare providers under pressure can implement virtual group consultations. Most virtual group consultations have a facilitator, so this allows roles to be extended and support education of both students and new team members. These can confer greater access, continuity of care, peer support and timely information about Covid-19 and may result in better health outcomes. Given the rapid and widespread implementation of virtual care during this pandemic, data should be shared effectively and methodologically sound observational studies and clinical trials to test safety and effectiveness should be promoted now.