Women’s odds of obesity nearly 5 times higher than men’s in the region
And obesity 3 times more likely in those with tertiary level education

Female sex and higher education are significantly linked to the escalating prevalence of obesity and overweight in Africa, finds one of the largest and most detailed analyses of body weight trends in the region, published in the open access journal BMJ Global Health.

Women’s odds of obesity in Africa are 5 times greater than those of men’s, while obesity is 3 times more likely in those with tertiary level education than in those with lower levels, the findings indicate.

The global prevalence of overweight and obesity has more than doubled over the past 4 decades. In 2022, 2.5 billion adults were overweight, representing 43% of all the world’s adults, and 890 million were living with obesity, note the researchers.

While recent research suggests that the rate of increase in overweight and obesity may be slowing in high income countries, it seems to be speeding up in low- and middle-income countries, where around two thirds of those living with obesity now reside, they explain.

Africa is particularly vulnerable because of its fragile healthcare systems, limited resources, socioeconomic complexities, urbanisation and sparse public health policies, they add.

The researchers wanted to explore the extent of overweight and obesity in Africa, and capture 20 year trends (2003-22).

They analysed data from 54 nationally and regionally representative STEPS (STEPwise approach to non-communicable disease risk factor surveillance) surveys carried out between 2003 and 2022 for 36 of the 47 countries in the World Health Organization (WHO) Africa region—representing three-quarters of the total population and 156 million adults.

Underweight was defined as a BMI of less than 18.5, overweight as a BMI of between 25 and 29.9, and obesity as a BMI of 30 or more.

The surveys captured weekly physical activity levels from low (below the recommended weekly tally) to high (above this) and daily portions of fruits and vegetables consumed (from 0-1 to 4-5).

In all, data were obtained for 198,901 adults with an average age of 36; half were women. Of the countries included in the analysis, 13 were in West Africa, 9 in East Africa, 5 in Southern Africa, 8 in Central Africa and 1 in North Africa (Algeria).

The analysis revealed that the age standardised and weighted prevalence of underweight, overweight, and obesity was 11.5%, just under 18%, and 9%, respectively.

Twenty year trends showed a significant increase in the overall prevalence of obesity from nearly 15.5% in 2003 to nearly 17% in 2022; of underweight from 12% to just under 13%; and a levelling out in the prevalence of overweight (around 18% between 2003 and 2022).

The prevalence of overweight and obesity was, respectively, just under 18% and 9% higher in women (21% and nearly 13.5%) than in men (15% and just over 4.5%).

After adjusting for potentially influential factors, female sex, older age, higher education level, physical inactivity and poor diet were all associated with overweight or obesity.

The odds of overweight and obesity were, respectively, twice as high and almost 5 times as high, in women as they were in men. And those educated to tertiary level were twice as likely to be overweight and nearly 4 times as likely to be obese than those educated to lower levels.

“Taken together, these findings underscore the need for targeted public health interventions that consider the unique socio-cultural and economic contexts affecting women in the WHO African region,” say the researchers.

“Also, the results raise the point that education and awareness campaigns should not solely target individuals with lower education levels, as those with higher education may also require information and support,” they add.

“The present study further underscores the dual burden of malnutrition in the Africa region, showing significant increased trends in both obesity and underweight,” they continue.

The researchers acknowledge various limitations to their findings including that the WHO Africa region does not cover all of the continent, and that no data were available from South Africa, a country with one of the highest rates of overweight and obesity.

Nor did they study potentially influential factors, including cultural norms, accessibility to preventive healthcare, commercial factors, and household income. And the survey focused only on 18–69 year olds, excluding children and older adults.

But they nevertheless conclude: “These findings support the urgent need to intensify preventive health policies and programmes in the WHO African region.”

13/01/2026

Notes for editors
Research: Prevalence, time trends and associated factors of adult overweight and obesity in 36 countries in the WHO African region from 2003 to 2022: a study of 54 WHO STEPS surveys representing 156 million adults Doi: 10.1136/bmjgh-2025-019988
Journal: BMJ Global Health

Link to Academy of Medical Sciences labelling system
http://press.psprings.co.uk/AMSlabels.pdf  

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People

The post Female sex and higher education linked to escalating prevalence of obesity and overweight in Africa first appeared on BMJ Group.

Time off work and/or loss of earnings reported in over half of cases
Explore mandatory lead use in certain public spaces to boost public safety, urge researchers

Mental trauma, including specific phobias and post traumatic stress disorder (PTSD), succeeds 1 in 7 dog related injuries, while over half of cases result in the need for time off work and/or loss of earnings, suggests a study of personal injury claims data for England and Wales, published online in the journal Injury Prevention.

As most of these claims involved unrestrained dogs in non-residential locations, mandating lead use on highways and in public spaces should now be explored to boost public safety, urge the researchers.

The latest estimates for 2024 indicate that there are 13.6 million dogs in the UK. Hospital admissions for dog related injuries have risen from 4.76/100,000 people in 1998 to 18.7 in 2023 in England. In Wales, they rose from 16.3/100,000 people in 2014 to 23.7 in 2022, note the researchers.

The information on these injuries isn’t as comprehensive as it needs to be, suggest the researchers. Currently, hospital records don’t differentiate between dog bites and dog strikes (any dog-related injury not caused by a bite); not everyone who needs hospital treatment will be admitted to hospital; and there’s little or no information on the longer term effects.

While civil claims data are more informative, these claims are only pursued when there are sufficient assets to cover damages and legal costs, point out the researchers.

Most solicitors’ firms, however, collect initial contextual and impact data before making a judgement as to whether the case can be taken on. If these initial data were routinely collated and analysed, this would remove the inherent socioeconomic bias of analysing court records, they explain.

To find out if this might be a viable option, and how informative these data would be, the researchers analysed anonymised civil claims enquiry data from 1 January 2017 to 31 March 2024, provided by a specialist law firm operating throughout England and Wales.

The enquiry data contained information about the injured person, including their age and sex; date, location/land use, and context of the incident; breed and level of restraint of the dog; and consequences including physical injuries, mental trauma, medical treatment, time off work and loss of earnings.

Data were categorised into incidents involving dog bites and those involving strikes or other types of behaviour.

Analysis of the data showed that 816 dog-related incidents, comprising 842 individual claims, were recorded between January 2017 and March 2024.

Most (94%) incidents occurred in England and primarily involved dog bites (just over 91%); 7% were dog strikes.

Half of dog bite victims were male (53%), while dog strike victims were mainly female (70%). Women were more than twice as likely to be involved in a non-bite incident as men. Most of the injured didn’t know the dog involved (80%).

The three most common locations for dog bites were in front of a private residential property (just over 34%), on a highway or pavement (18%), and inside a private residential property (11%).

Almost half of non-bite incidents occurred in public spaces (49%), the most frequent of which were outdoor recreational areas, such as parks and nature reserves (34%), highways or pavements (23%), and ‘forestry, open land and water’ (11.5%).

Delivery workers made up over 1 in 4  (28%) of those bitten, most often during a delivery to a private residential property, when an unrestrained dog came out of the front door (12%). Other situations involved walking, exercising, playing in public without a dog (11.5%); and walking with one’s own dog (11%).

The most common circumstances for non-bite incidents were either with a dog when out walking, exercising, or playing in public (34%) or without (27%); and when a dog escaped from a private property (10%).

In both types of incident, most of the dogs weren’t restrained at the time: 79% of biting dogs; and 86% of non-bite incidents. Most dogs involved in a bite (69%) or non-bite (77.5%) incident were reported to be with their owner.

Almost all (98%) of bite, and 78% of non-bite, incidents ended up with a physical injury. Fractures comprised nearly 4% of injuries, while tissue loss or amputations made up 3%. Non-bite incidents were primarily described as fractures (73%), muscle/tendon/ligament damage (9%), and soft tissue damage (9%). The head was injured in 1 in 7 bite cases.

Most of those injured reported psychological consequences: (90%) of those who were bitten; and 76% of those who were the victims of other types of injuries.

In all, 15% (1 in 7) of all those injured were formally diagnosed with a mental illness as a result of the incident, while 6.5% were diagnosed with a specific phobia and 4% with PTSD. Other mental health consequences included anxiety, disturbed sleep, and avoidance.

Most of the physical injuries sustained resulted in a hospital visit. A quarter of those bitten, and nearly a third of those who weren’t bitten, required surgery.

Of the claimants still working when injured, 59.5% of those bitten and 56% of those who weren’t bitten took time off work, up to a maximum of 5 years. Over half of those bitten (54%) and 41.5% of those who weren’t reported loss of earnings as a result of their injuries.

There is no centralised registry of these cases across all law firms. And the researchers acknowledge that their study was based on data from one law firm and therefore may not be fully representative.

But they suggest: “These data implicate unrestrained dogs in non-residential locations as a major inciting factor for dog-related injuries, and injury prevention strategies need to explore how lead use can be effectively legislated.”

They add: “Most claimants reported that dogs were with their owners and off lead. Almost half of bite and more than 80% of non-bite incidents occurred in non-residential locations and the majority involved unrestrained dogs… These findings raise concerns over owner control.”

Current national legislation on lead control doesn’t affect public highways or urban green spaces, where most injuries occur, they argue.

The Highway Code advises that dogs should be ‘kept on a short lead when walking on the pavement, road or path shared with cyclists or horse riders’, but this is only guidance, not law. And while local authorities can introduce Public Space Protection Orders (PSPOs), it’s unclear how often these are applied or how much of a deterrent they are, they highlight.

“We recommend that national legislation is updated so that all dogs should be on a fixed- length short lead (less than 2 metres) on public highways and in urban green spaces (unless a local authority provides provisions for off-lead areas, or make areas exempt).

“This exemption provision is to ensure that the important balance between public safety and dog welfare can be achieved. This should be partnered with a nationally coordinated public communication campaign,” they conclude.

09/01/2025

Notes for editors
Research: Using civil claim enquiry data to understand the context and impact of dog- related injuries in England and Wales between 2017 and 2024 Doi: 10.1136/ip-2025-045863
Journal: Injury Prevention

External funding: Biotechnology and Biological Sciences Research Council; Economic and Social Research Council

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Data analysis
Subjects: People

The post Mental trauma succeeds 1 in 7 dog related injuries, claims data suggest first appeared on BMJ Group.

Findings may have important public health implications given the ubiquitous use of these additives, say researchers

Higher intake of food preservatives, widely used in industrially processed foods and beverages to extend shelf-life, is associated with a modestly increased risk of cancer, finds a study from France published by The BMJ today.

While further research is needed to better understand these links, the researchers say these new data call for the re-evaluation of regulations governing the use of these additives by the food industry to improve consumer protection.

Preservatives are substances added to packaged foods to extend shelf life. Some experimental studies have shown that certain preservatives can damage cells and DNA, but firm evidence linking preservatives to cancer risk remains scarce.

To address this, researchers set out to examine the association between exposure to preservative food additives and risk of cancer in adults, using detailed dietary and health data from 2009 to 2023.

Their findings are based on 105,260 participants aged 15 years and older (average age 42 years; 79% women) enrolled in the NutriNet-Santé cohort study who were free of cancer and completed regular 24 hour brand-specific dietary records over an average 7.5 year period. Health questionnaires and official medical and death records were then used to track cancer cases up to 31 December 2023.

A total of 17 individual preservatives were analysed including citric acid, lecithins, total sulfites, ascorbic acid, sodium nitrite, potassium sorbate, sodium erythorbate, sodium ascorbate, potassium metabisulfite, and potassium nitrate.

Preservatives were grouped into non-antioxidants (which inhibit microbial growth or slow chemical changes that lead to spoilage) and antioxidants (which delay or prevent food deteriorating by removing or limiting oxygen levels in packaging).

During the follow-up period, 4,226 participants received a diagnosis of cancer, comprising 1,208 breast, 508 prostate, 352 colorectal, and 2,158 other cancers.

Of the 17 individually studied preservatives, 11 were not associated with cancer incidence, and no link was found between total preservatives and cancer incidence.

However, higher intakes of several preservatives (mostly non-antioxidants including potassium sorbate, potassium metabisulfite, sodium nitrite, potassium nitrate, and acetic acid) were associated with higher risk of cancers compared with non-consumers or lower consumers.

For example, total sorbates, specifically potassium sorbate, was associated with a 14% increased risk of overall cancer and a 26% increased risk of breast cancer, while total sulfites were associated with a 12% increased risk of overall cancer.

Sodium nitrite was associated with a 32% increased risk of prostate cancer, while potassium nitrate was associated with an increased risk of overall cancer (13%) and breast cancer (22%).

Total acetates were associated with an increased risk of overall cancer (15%) and breast cancer (25%), while acetic acid was associated with a 12% increased risk of overall cancer.

Among antioxidant preservatives, only total erythorbates and specific sodium erythorbate were found to be associated with higher incidence of cancer.

While more studies are needed to better understand these potential risks, the researchers note that several of these compounds can alter immune and inflammatory pathways, possibly triggering the development of cancer.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the researchers can’t rule out the possibility that other unmeasured factors may have influenced their results.

However, they say this was a large study based on detailed dietary records linked to food databases over 14 years and results are consistent with existing experimental data suggesting adverse cancer related effects of several of these compounds.

As such, they conclude: “This study brings new insights for the future re-evaluation of the safety of these food additives by health agencies, considering the balance between benefit and risk for food preservation and cancer.”

In the meantime, they call on manufacturers to limit the use of unnecessary preservatives, and support recommendations for consumers to favour freshly made, minimally processed foods.

From a policy perspective, preservatives offer clear benefits by extending shelf life and lowering food costs, which can be particularly important for populations with lower incomes, point out US researchers in a linked editorial.

However, they say the widespread and often insufficiently monitored use of these additives, with uncertainties of their long term health effects, call for a more balanced approach.

Findings from NutriNet-Santé may prompt regulatory agencies to revisit existing policies, such as setting stricter limits on use, requiring clearer labeling, and mandating disclosure of additive contents, while collaborative global monitoring initiatives, similar to those implemented for trans fatty acids and sodium, could also support evidence based risk assessments and guide reformulation by the food industry, they write.

“At the individual level, public health guidance is already more definitive about the reduction of processed meat and alcohol intake, offering actionable steps even as evidence on the carcinogenic effects of preservatives is evolving,” they conclude.

07/01/2025

Notes to Editors
Research: Intake of food additive preservatives and incidence of cancer: results from the NutriNet-Santé prospective cohort doi: 10.1136/bmj-2025-084917
Editorial: Preservatives and risk of cancer doi: 10.1136/bmj.r2613
Journal: The BMJ

External funding: European Research Council, French National Cancer Institute, French Ministry of Health, IdEx Université de Paris, Bettencourt-Schueller Foundation

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Observational; Opinion
Subjects: People

The post Higher intake of food preservatives linked to increased cancer risk first appeared on BMJ Group.

Average regain is 0.4kg/month and all weight lost likely to be regained in under 2 years
Weight regain faster after stopping weight loss drugs than after dietary weight loss programmes

Stopping weight loss drugs is followed by weight regain and reversal of beneficial effects on heart and metabolic health markers such as high cholesterol and high blood pressure, finds a study published by The BMJ today.

It shows that the average rate of weight regain is 0.4kg/month after stopping treatment, with weight and risk markers for diabetes and heart disease predicted to return to pre-treatment levels in less than two years.

It also finds that the rate of weight regain after stopping weight loss drugs is almost 4 times faster than after diet and physical activity changes, irrespective of the amount of weight lost during treatment.

“This evidence suggests that despite their success in achieving initial weight loss, these drugs alone may not be sufficient for long term weight control,” say the researchers.

The development of highly effective weight management medications such as glucagon-like peptide-1 (GLP-1) receptor agonists including semaglutide and tirzepatide has transformed the treatment of obesity.

Yet it is estimated that around half of people with obesity discontinue GLP-1 drugs within 12 months, so it’s important to understand what happens to body weight and risk markers for conditions like diabetes and heart disease after stopping treatment.

To do this, a team of researchers from the University of Oxford searched registries and databases for trials and observational studies that compared the effects of any medication licensed for weight loss in adults with any non-drug weight loss intervention (behavioural weight management programmes) or placebo.

The studies were designed differently and varied in quality, but the researchers were able to assess their risk of bias using established tools.

Thirty-seven studies published up to February 2025 involving 9,341 participants were included in the analysis. The average duration of weight loss treatment was 39 weeks, with an average follow-up of 32 weeks.

Participants treated with weight loss drugs regained on average 0.4 kg/month after stopping treatment and were projected to return to their pre-treatment weight by 1.7 years. All cardiometabolic risk markers were projected to return to pre-treatment levels within 1.4 years after stopping the drugs.

Monthly weight regain was also faster after weight loss drugs than after behavioural weight management programmes (by 0.3 kg), independent of initial weight loss.

The authors acknowledge several limitations. For example, only eight studies assessed treatment with the newer GLP-1 drugs and the maximum follow-up period in these studies was 12 months after medication stopped. What’s more, few studies were at low risk of bias.

Nevertheless, they point out that they used three methods of analysis and all provided similar results, adding certainty to their findings.

As such, they conclude: “This evidence cautions against short term use of weight management medications, emphasises the need for further research into cost effective strategies for long term weight control, and reinforces the importance of primary prevention.”

“The study findings casted doubt on the notion that GLP-1 receptor agonists are a perfect cure for obesity,” says a US researcher in a linked editorial.

“People taking GLP-1 receptor agonists should be aware of the high discontinuation rate and the consequences of cessation of medications,” he writes. “Healthy dietary and lifestyle practises should remain the foundation for obesity treatment and management, with medications such as GLP-1 receptor agonists used as adjuncts.”

“Such practises not only help prevent excess weight gain but can also lead to numerous health benefits that go beyond weight control,” he concludes.

07/01/2025

Notes for editors
Research: Weight regain after cessation of medication for weight management: systematic review and meta-analysis doi: 10.1136/bmj-2025-085304
Editorial: Weight regain after cessation of GLP-1 drugs doi: 10.1136/bmj.r2586
Journal: The BMJ 

Funding: National Institute of Health and Care Research (NIHR) Oxford Biomedical Research Centre

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes (research); No (linked editorial)
Evidence type: Systematic review and meta-analysis; Opinion
Subject: People

The post Stopping weight loss drugs linked to weight regain and reversal of heart health markers first appeared on BMJ Group.

Greatest risk associated with frequent consumption of locally brewed alcohol
Additive effect of chewing tobacco likely accounts for 60%+ of cases nationwide

Even a low daily intake of alcohol—-just 9 g or around one standard drink—is linked to a 50% heightened risk of mouth (buccal mucosa) cancer in India, with the greatest risk associated with locally brewed alcohol, finds a large comparative study, published online in the open access journal BMJ Global Health.

And when combined with chewing tobacco, it likely accounts for 62% of all such cases in India, the findings suggest.

Mouth cancer is the second most common malignancy in India, with an estimated 143,759 new cases and 79,979 deaths every year. Rates of the disease have risen steadily, and now stand at just under 15 for every 100,000 Indian men, note the researchers.

The primary form of mouth cancer in India is that of the soft pink lining of the cheeks and lips (buccal mucosa). Less than half (43%) of those affected survive 5 or more years, they point out.

As alcohol consumption and tobacco use often go hand in hand, it’s not clear how much each factor individually contributes to mouth cancer risk, especially in India, where the  prevalence of smokeless tobacco use is high, point out the researchers.  Nor have the potential effects of locally brewed alcohol, which is particularly popular in rural communities, been assessed, they add.

To find out more, the researchers compared 1803 people with confirmed buccal mucosa cancer and 1903 randomly selected people free of the disease (controls) from five different study centres between 2010 and 2021. Most of the participants were aged between 35 and 54; nearly half (around 46%) of cases were among 25 to 45 year olds.

Each of the participants provided information on the duration, frequency, and type of alcohol they drank from among 11 internationally recognised drinks, including beer, whisky, vodka, rum and breezers (flavoured alcoholic drinks); and 30 locally brewed drinks, including apong, bangla, chulli, desi daru, and mahua.

Participants were also asked about the duration and type of tobacco use so that the extent of the interaction between alcohol and tobacco on mouth cancer risk could be assessed.

Among the cases, 1019 said they didn’t drink alcohol compared with 1420 among the controls; 781 of the cases said they did drink alcohol compared with 481 of the controls.

The average length of tobacco use was higher for cases (around 21 years) than for the control group (around 18 years). Cases were also more likely to live in rural areas and to drink more alcohol every day: nearly 37 g compared with around 29 g.

Frequent alcohol consumption was associated with a heightened risk of buccal mucosa cancer, with locally brewed drinks associated with the greatest risk.

Compared with those who didn’t drink alcohol, the risk was 68% higher for those who did, rising to 72% for those favouring internationally recognised alcohol types, and to 87% for those opting for locally brewed drinks.

As little as under 2 g a day of beer was associated with a heightened risk of buccal mucosa cancer. And just 9 g a day of alcohol—equivalent to around one standard drink—-was associated with an approximately 50% increased risk.

Concurrent alcohol and tobacco use was associated with a more than quadrupling in risk, such that 62% of all buccal mucosa cancer cases in India are likely attributable to the interaction between alcohol and chewing tobacco, calculate the researchers.

But alcohol was a contributory factor to the heightened risk of mouth cancer irrespective of how long tobacco had been used. Ethanol might alter the fat content of the inner lining of the mouth, increasing its permeability and therefore its susceptibility to other potential carcinogens in chewing tobacco products, explain the researchers.

The findings suggest that more than 1 in 10 cases (nearly 11.5%) of all buccal mucosa cancers in India are attributable to alcohol, rising to 14% in some of the states with a high prevalence of the disease, such as Meghalaya, Assam, and Madhya Pradesh, say the researchers.

Possible contamination with toxins, such as methanol and acetaldehyde, in locally brewed alcohol, might help explain the higher risk associated with these drinks, the manufacture of which is largely unregulated, they suggest.

“The current legal framework for alcohol control in India is complex and involves both central and state laws. Central legislation provides protection of citizens where alcohol is included in the State List under the Seventh Schedule of the Indian Constitution, giving states the power to regulate and control alcohol production, distribution and sale. However, the locally-brewed liquor market is unregulated, with some forms used by participants containing up to 90% alcohol content,” they point out.

They conclude: “In summary, our study demonstrates that there is no safe limit of alcohol consumption for [buccal mucosa cancer] risk…Our findings suggest that public health action towards prevention of alcohol and tobacco use could largely eliminate [buccal mucosa cancer] from India.”

23/12/2025

Notes for editors
Research: Association of alcohol and different types of alcoholic beverages on the risk of buccal mucosa cancer in Indian men: a multicentre case-control study Doi: 10.1136/bmjgh-2024-017392
Journal: BMJ Global Health

External funding: Indian Council of Medical Research

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational case-control study
Subjects: People

The post Low daily alcohol intake linked to 50% heightened mouth cancer risk in India first appeared on BMJ Group.

Study contributes to ongoing debate about England’s clock change policy

The week after the autumn clock change is associated with a reduction in demand for NHS services for sleep disorders, cardiovascular disease, anxiety, depression, and psychiatric conditions in England, finds a study in the Christmas issue of The BMJ.

However, there is little evidence that the spring clock change has any short term effect on the number of health conditions, say the researchers.

Daylight saving time was introduced during the first world war and involves moving the clocks one hour forward in spring and one hour back in autumn. It operates in around 70 countries and affects a quarter of the world’s population.

Yet some studies (mainly outside the UK) have suggested that the clock changes, particularly the spring clock change, have a detrimental effect on health, leading to calls for them to be abolished.

To obtain a clearer picture, researchers set out to explore the short term (acute) effects of the clock changes on people’s mental and physical health in England.

Their findings are based on linked primary and secondary care records for 683,809 people with at least one of eight health events in the weeks surrounding the spring or autumn clock changes from 2008 to 2019.

The health events analysed were anxiety, major acute cardiovascular disease, depression, eating disorder, road traffic injury, self-harm, or sleep disorder in primary or secondary care or a psychiatric condition in accident and emergency.

The mean daily number of events (per year, per region) in the first week after the clock changes were compared with those in the control period (four weeks before the changes and weeks 2-4 after).

In the week after the autumn clock change, five health conditions had fewer events: anxiety (a 3% reduction from 17.3 events per day to 16.7), acute cardiovascular disease (a 2% reduction from 50 events per day to 48.9), depression (a 4% reduction from 44.6 to 42.7), psychiatric conditions (a 6% reduction from 3.5 to 3.3), and sleep disorders (an 8% reduction from 5.4 to 4.9).

Little evidence was found of reductions in eating disorder diagnoses, road traffic injuries, or self-harm or of changes after the spring clock change.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors note that health records contain only events for which the individual seeks medical help, and the date that a health event is recorded by a clinician, which is not necessarily the date of symptom onset.

However, they say the results are based on 12 years of broadly representative general practice and hospital data, giving a more complete picture of the effect of the clock changes on demand for health services than previous studies.

They suggest that the extra sleep over the Autumn clock change and the abrupt increase in morning sunlight exposure after the transition may be beneficial to health.

And they conclude: “Our study contributes to the ongoing debate about England’s clock change policy. Future research should explore the mechanisms underlying the reduction in health events that we observed after the autumn clock change.”

17/12/2025

Notes for editors
Research: Acute effects of daylight saving time clock changes on mental and physical health in England: population based retrospective cohort study doi: 10.1136/bmj-2024-085962
Journal: The BMJ

External funding: Wellcome

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People 

The post Autumn clock change linked to reduction in certain health conditions first appeared on BMJ Group.

Condition often poorly recognised, diagnosed, managed and researched, say report authors
This has prompted unfounded fears, particularly on social media, that all steroids are harmful

There is little awareness, particularly among clinicians, of the medical and psychological complexities of ‘topical steroid withdrawal’—the body’s adverse response to the prolonged use of these powerful creams to treat inflammatory skin conditions when they are either tapered or suddenly stopped—warn doctors in the journal BMJ Case Reports.

The condition, also known as ‘TSW syndrome,’ ‘steroid addiction,’ and ‘red burning skin syndrome,’ is poorly recognised, diagnosed, managed, and researched, say the report authors, one of whom speaks from direct experience.

This has prompted unfounded fears, particularly on social media, that all steroids are harmful and should be avoided in favour of other often untested, unproven remedies, they caution.

Steroid creams are widely used for the treatment of various inflammatory skin conditions, such as eczema and psoriasis, for which they are very effective, note the report authors.

They are available in 4 different strengths, ranging from mild to very strong.

But withdrawing treatment—particularly the stronger formulations—after protracted use can prompt a rebound flare-up of symptoms, which can be even more severe and debilitating than the original condition, they point out.

These symptoms can spread well beyond the original areas of treatment and additionally trigger insomnia and depression.

The underlying causes are only partially understood, while diagnosis can be tricky because of the highly variable presenting symptoms, they add.

In a bid to promote wider recognition of the syndrome, the report authors present a case exemplifying some of the challenges involved for both clinicians and patients.

The case involved a middle-aged woman with a history of atopic eczema since infancy that  had been treated with varying strengths of steroid creams for sometimes lengthy periods.

She was referred to dermatology for review and explained that she had had a flare-up of symptoms which had persisted for 18 months until she was treated with a gradually tapering 4-week course of steroid tablets.

She had significant skin thinning, particularly on her arms, and thickened leathery skin (lichenification) in the folds of her elbows and wrists.

She was prescribed further steroid creams to ward off future flare-ups, which she decided to stop using a month after her review. Her skin symptoms then significantly worsened as did her general health.

She had widespread skin reddening and experienced a burning sensation and intense itching. Her skin became dry, scaly, thickened and cracked, exposing deep tears in parts.

She also reported swelling in the thighs, feet, ankles, and around the eyes and extensive skin folds and sagging. Systemic symptoms included dizziness, nausea, hair loss, insomnia, low blood pressure, extremes of temperature and sensations of dampness and numbness. She experienced intense nerve pain and sharp jolts of pain akin to an electric shock. Her symptoms were incapacitating.

She suspected topical steroid withdrawal. It took 28 months for her symptoms to resolve, during which time she decided against any further treatment, even skin moisturisers. She has since experienced occasional mild flare-ups but has not applied steroid creams.

Commenting on her experience, she explains that at times the severity and extent of her symptoms left her unable to get out of bed, and feeling like she might die.

She writes: “I should have liked to have been supported to withdraw safely. Without a diagnosis, this was not possible: I was being treated for eczema, which included continued steroid treatment. It is my understanding that TSW patients will not recover while steroids are part of their recovery plan.”

She continues: “I am pleased that more is now known about TSW, but I should like to see TSW diagnoses routinely being considered where steroids are no longer controlling a patient’s skin or when a patient simply feels that something is ‘different’ to usual. More than that, I should like to see TSW prevention a priority, so that there is no new generation of patients who have to endure the suffering that I have endured.”

The report authors acknowledge: “Despite the increasing recognition of TSW within the dermatological community, it remains underdiagnosed in routine practice. Patients often turn to online forums and self-treatment due to diagnostic challenges, which can lead to inconsistent or even harmful practices.”

They continue: “While social media has raised awareness for poorly recognised conditions like TSW, it has significantly contributed to steroid phobia. From our medical experience, exposure to alarming online narratives has led many patients to refuse [topical steroid] management of their conditions, both dermatological and otherwise, despite reassurance by clinicians about their safe and approved use.”

They conclude: “Breaking the cycle of distrust and enhancing patient care requires clinicians to address patients’ concerns with empathy, prioritising patient education. By fostering open discussions about patients’ beliefs and perspectives while simultaneously providing evidence-based recommendations, clinicians can support well-informed decision making and improve treatment outcomes.

16/12/2025

Notes for editors
Please note, personal details of the case reported here aren’t available for reasons of patient confidentiality.

Case report: Topical steroid withdrawal: a serious, under- recognised skin condition Doi: 10.1136/bcr-2024-264476
Journal: BMJ Case Reports

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf 

Externally peer reviewed? Yes
Evidence type: Case report
Subjects: People

The post Little awareness of medical + psychological complexities of steroid cream withdrawal first appeared on BMJ Group.

Interaction of these 2 factors contributes 17% of overall risk, study findings suggest 

Concurrent physical frailty and depression likely boost the risk of dementia in older people, with the interaction of these 2 factors alone contributing around 17% of the overall risk, suggest the findings of a large international study, published in the open access journal General Psychiatry.

Globally, some 57 million people are living with dementia—a figure that is expected to triple by 2050, note the researchers.

Previously published research has primarily focused on the individual associations between physical frailty or depression and dementia risk, despite the fact that both have physiological and pathological factors in common, they explain.

To explore the potential interaction between these two factors on dementia risk in older adults,  the researchers tracked the diagnosis of any type of dementia in 220,947 participants (average age: 64; 53% women) from 3 large study groups.

These were the UK Biobank, the English Longitudinal Study of Ageing (ELSA), and the Health and Retirement Study.

Physical frailty was assessed using modified versions of the Fried frailty criteria, in which a person is considered to be frail if they have 3 or more of the following indicators: unintentional weight loss; self-reported exhaustion; low physical activity; slow walking speed; and weak grip strength.

Depression was evaluated through responses to mental health questionnaires or combined with hospital admission records.

Compared with those in good physical health, frail participants across all 3 groups were older, more likely to be female, weigh more, have more long term conditions and lower educational attainment.

During an average tracking period of nearly 13 years, 9088 people (7605 in the UK Biobank, 1207 in the Health Retirement Study and 276 in the ELSA) were diagnosed with dementia of any type.

Analysis of the data revealed that compared with those in good physical health, those who were frail were more than 2.5 times as likely to be diagnosed with dementia, while depression was associated with a 59% heightened risk.

And participants who were both physically frail and depressed were more than 3 times as likely to be diagnosed with dementia as those in good physical and mental health.

What’s more, a significant additional interaction between physical frailty and depression was observed, with around 17% of the overall dementia risk attributable to these two factors combined.

“These results underscore the complex relationship between frailty, depression, and cognitive function,” write the researchers.

“Lower levels of frailty may allow the health system to partially offset the cognitive burden of depression and, similarly, lower levels of depression may enable the system to mitigate the burden of frailty,” they suggest.

“However, once both factors exceed a certain threshold, this compensatory ability may be compromised, leading to a sharp increase in the risk of dementia,” they add.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers sound a note of caution in the interpretation of the findings, primarily because the definitions of physical frailty, depression, and dementia varied across the three cohorts.

Nevertheless, the researchers conclude: “Given that physical frailty and depression are modifiable, concurrent interventions targeting these conditions could significantly reduce dementia risk.”

16/12/2025

Notes for editors
Research: Associations of physical frailty, depression and their interaction with incident all- cause dementia among older adults: evidence from three prospective cohorts Doi: 10.1136/ gpsych-2025-102172
Journal: General Psychiatry

External funding: National Key Research and Development Program of China

Link to Academy of Medical Sciences press release labelling system
http://press.psprings.co.uk/AMSlabels.pdf 

About the journal
General Psychiatry is one of 70 journals published by BMJ Group. The title is owned by the Shanghai Mental Health Center.
https://gpsych.bmj.com/

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Concurrent frailty + depression likely boost dementia risk in older people first appeared on BMJ Group.

Fit man in his 50s who drank 8 cans daily developed extremely high blood pressure
Tighter regulation of sales and advertising of these drinks needed, urge report authors

Downing several strong energy drinks every day may pose a serious stroke risk, doctors have warned in the journal BMJ Case Reports, after treating an otherwise fit and healthy man in his 50s with a daily 8-can habit and exceedingly high blood pressure.

The findings prompt the authors to call for tighter regulation of the sales and advertising of these drinks, particularly given their popularity among young people.

The man in question had a stroke in his thalamus—the part of the brain involved in sensory perception and movement. His symptoms included left-sided weakness, numbness, as well as difficulties with balance, walking, swallowing and speech—collectively known as ataxia.

On admission to hospital his blood pressure was 254/150 mm Hg, which is regarded as extremely high.

He was started on drugs to lower his blood pressure, and his systolic blood pressure—reflecting arterial pressure during the heart’s pump action—fell to 170 mm Hg.

But once back home, his blood pressure rose again and remained persistently high despite the ramping up of his drug treatment.

On further questioning, he revealed that he drank an average of 8 energy drinks every day, each of which contained 160 mg of caffeine, adding up to a daily intake of 1200-1300 mg of caffeine: the recommended maximum daily intake is 400 mg.

He was asked to give up this daily habit, after which his blood pressure returned to normal and blood pressure lowering drugs were no longer needed.

But he didn’t regain full feeling on his left side. Commenting on the experience, he said: “I obviously wasn’t aware of the dangers drinking energy drinks were causing to myself. (I) have been left with numbness (in my) left hand side hand and fingers, foot and toes even after 8 years.”

The report authors point out that the man’s lack of awareness about the potential cardiovascular risks associated with heavy energy drink consumption is probably not surprising as they aren’t generally thought of as a potential cardiovascular disease risk.

“The year 2018 saw major UK supermarkets implement a voluntary ban on sales of [these drinks] to under 16s in a drive to tackle obesity, diabetes, and tooth decay, but less explored are the possible increased risks of [energy drinks] for cardiovascular disease, including ischaemic [restricted blood supply or blood clot] and haemorrhagic [bleed in the brain] strokes, particularly in younger demographics otherwise expected to have lower stroke risk,” they emphasise.

Energy drinks contain more than 150 mg of caffeine per litre and typically have a very high glucose-based sugar content and varying quantities of other chemicals, they highlight.

“This declared amount is the ‘pure caffeine’, but other ingredients contain ‘hidden caffeine’— for example, guarana is thought to contain caffeine at twice the concentration of a coffee bean.

“The hypothesis is that the interaction of these other ingredients, including taurine, guarana, ginseng and glucuronolactone, potentiates the effects of caffeine heightening stroke [cardiovascular disease] risk through numerous mechanisms,” they explain.

“The average [energy drink] is said to contain around 80 mg of caffeine per 250 ml serving, compared with 30 mg in tea and 90 mg in coffee, but in some cases can contain up to 500 mg in a single serving,” they point out.

This report represents just one case, but the authors nevertheless conclude: “While the current evidence is not conclusive, given the accumulating literature, the high morbidity and mortality associated with stroke and [cardiovascular disease] and the well-documented adverse health effects of high-sugar drinks, we propose that increased regulation of [energy drink] sales and advertising campaigns (which are often targeted at younger ages) could be beneficial to the future cerebrovascular and cardiovascular health of our society.”

09/12/2025

Notes for editors
Please note, personal details of the cases reported here aren’t available for reasons of patient confidentiality.
Case report:  Energy drinks, hypertension and stroke  Doi: 10.1136/bcr-2025-267441
Journal: BMJ Case Reports

Link to Academy of Medical Sciences press release labelling system http://press.psprings.co.uk/AMSlabels.pdf 

About the journal
BMJ Case Reports is one of 70 journals published by BMJ Group.
https://casereports.bmj.com

Externally peer reviewed? Yes
Evidence type: Case report
Subjects: People

The post Heavy energy drink intake may pose serious stroke risk, doctors warn first appeared on BMJ Group.

No significant variation in risk by type of disorder or timing of child’s exposure
Include dedicated support for these disorders in maternal healthcare, say researchers

Eating disorders in mums-to-be are linked to a heightened risk of asthma and wheezing in their children, irrespective of the type of disorder, presence of co-existing depression/anxiety, or the timing of their child’s exposure, finds research published online in the journal Thorax.

The findings prompt the researchers to call for the inclusion of dedicated support in the healthcare of pregnant women with eating disorders to improve the respiratory health of their children.

To date, research on the effects of maternal mental health on children’s respiratory health has focused predominantly on depression, anxiety, and broadly defined stress, with limited evidence on less common conditions like eating disorders, note the researchers.

And while the evidence on the consequences of maternal eating disorders has consistently reported on their children’s cognitive, social, emotional, behavioural and eating behaviours, the evidence is less consistent for physical health outcomes.

To strengthen the evidence base, the researchers analysed data from 131,495 mother and child pairs from 7 distinct European birth cohorts in the EU Child Cohort Network (EUCCN), looking at potential associations between maternal eating disorders before pregnancy and their children’s preschool wheezing and school age asthma.

They subsequently explored potential associations between women who didn’t have depression or anxiety by type of eating disorder (anorexia or bulimia) and period of exposure (pregnancy or after birth).

The prevalence of maternal eating disorders before pregnancy ranged from nearly 1% to 17% across the 7 cohorts. And the prevalence of co-existing depression/anxiety among women with eating disorders ranged from 11% to 75%.

The prevalence of preschool wheezing ranged from 21% to nearly 50%, while that of school age asthma ranged from just over 2% to nearly 17.5%.

An eating disorder before pregnancy was associated with an overall 25% heightened risk of preschool wheeze, although this varied considerably in each cohort, and with a 26% heightened risk of school age asthma, which was much more consistent across the cohorts.

These heightened risks weakened slightly after excluding mothers who had depression/anxiety.

Similar associations with childhood asthma were found for anorexia and bulimia, while preschool wheezing was associated with bulimia only.

Although the observed associations differed slightly across exposure periods (before, during, or after pregnancy), no distinct window of susceptibility emerged.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect, and the prevalence of eating and respiratory disorders varied widely across the cohorts.

“Although this may make some of the findings less comparable, the direction and the magnitude of the associations were relatively stable in all the analyses,” explain the researchers.

But they add: “The mechanisms underlying the associations between maternal mental health and childhood respiratory outcomes remain unclear.”

They suggest that mental ill health and associated stress may activate the hypothalamic-pituitary-adrenal axis, disrupting the baby’s lung development during pregnancy and maturation of the child’s immune system, thereby increasing susceptibility to immune mediated conditions, including asthma.

“Children born to mothers with [eating disorders] are at an increased risk of foetal growth restriction, prematurity, Caesarean delivery and low birth weight. These are also well-known risk factors for respiratory morbidity, suggesting multiple possible mediating pathways in the link between maternal [eating disorders] and childhood respiratory outcomes,” they point out.

“In addition, research has shown that both mental health disorders and asthma involve dysregulation in immune response and inflammatory pathways, suggesting a common genetic basis that may contribute to both conditions,” they add.

They conclude: “There is a need to include maternal [eating disorders] in research on early- life respiratory risk factors and to integrate [eating disorder] screening and support into maternal healthcare to improve respiratory outcomes in offspring.”

02/12/2025

Notes for editors
Research: Maternal eating disorders and respiratory outcomes in childhood: findings from the EU Child Cohort Network Doi: 10.1136/thorax-2025-223718
Journal: Thorax

About the journal
Thorax is one of 70 journals published by BMJ Group. The title is co-owned with the British Thoracic Society.
https://thorax.bmj.com

External funding: EU Horizon 2020 research and innovation programme

Link to Academy of Medical Sciences Press Release labelling system
http://press.psprings.co.uk/AMSlabels.pdf

Externally peer reviewed? Yes
Evidence type: Observational
Subjects: People

The post Eating disorders in mums-to-be linked to heightened risk of asthma and wheezing in their kids first appeared on BMJ Group.