Food and exercise can treat depression as well as a psychologist, our study found. And it’s cheaper
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Around 3.2 million Australians live with depression.
At the same time, few Australians meet recommended dietary or physical activity guidelines. What has one got to do with the other?
Our world-first trial, published this week, shows improving diet and doing more physical activity can be as effective as therapy with a psychologist for treating low-grade depression.
Previous studies (including our own) have found “lifestyle” therapies are effective for depression. But they have never been directly compared with psychological therapies – until now.
Amid a nation-wide shortage of mental health professionals, our research points to a potential solution. As we found lifestyle counselling was as effective as psychological therapy, our findings suggest dietitians and exercise physiologists may one day play a role in managing depression.
What did our study measure?
During the prolonged COVID lockdowns, Victorians’ distress levels were high and widespread. Face-to-face mental health services were limited.
Our trial targeted people living in Victoria with elevated distress, meaning at least mild depression but not necessarily a diagnosed mental disorder. Typical symptoms included feeling down, hopeless, irritable or tearful.
We partnered with our local mental health service to recruit 182 adults and provided group-based sessions on Zoom. All participants took part in up to six sessions over eight weeks, facilitated by health professionals.
Half were randomly assigned to participate in a program co-facilitated by an accredited practising dietitian and an exercise physiologist. That group – called the lifestyle program – developed nutrition and movement goals:
- eating a wide variety of foods
- choosing high-fibre plant foods
- including high quality fats
- limiting discretionary foods, such as those high in saturated fats and added sugars
- doing enjoyable physical activity.
The second group took part in psychotherapy sessions convened by two psychologists. The psychotherapy program used cognitive behavioural therapy (CBT), the gold standard for treating depression in groups and when delivered remotely.
In both groups, participants could continue existing treatments (such as taking antidepressant medication). We gave both groups workbooks and hampers. The lifestyle group received a food hamper, while the psychotherapy group received items such as a colouring book, stress ball and head massager.
Lifestyle therapies just as effective
We found similar results in each program.
At the trial’s beginning we gave each participant a score based on their self-reported mental health. We measured them again at the end of the program.
Over eight weeks, those scores showed symptoms of depression reduced for participants in the lifestyle program (42%) and the psychotherapy program (37%). That difference was not statistically or clinically meaningful so we could conclude both treatments were as good as each other.
There were some differences between groups. People in the lifestyle program improved their diet, while those in the psychotherapy program felt they had increased their social support – meaning how connected they felt to other people – compared to at the start of the treatment.
Participants in both programs increased their physical activity. While this was expected for those in the lifestyle program, it was less expected for those in the psychotherapy program. It may be because they knew they were enrolled in a research study about lifestyle and subconsciously changed their activity patterns, or it could be a positive by-product of doing psychotherapy.
There was also not much difference in cost. The lifestyle program was slightly cheaper to deliver: A$482 per participant, versus $503 for psychotherapy. That’s because hourly rates differ between dietitians and exercise physiologists, and psychologists.
What does this mean for mental health workforce shortages?
Demand for mental health services is increasing in Australia, while at the same time the workforce faces worsening nation-wide shortages.
Psychologists, who provide about half of all mental health services, can have long wait times. Our results suggest that, with the appropriate training and guidelines, allied health professionals who specialise in diet and exercise could help address this gap.
Lifestyle therapies can be combined with psychology sessions for multi-disciplinary care. But diet and exercise therapies could prove particularly effective for those on waitlists to see a psychologists, who may be receiving no other professional support while they wait.
Many dietitians and exercise physiologists already have advanced skills and expertise in motivating behaviour change. Most accredited practising dietitians are trained in managing eating disorders or gastrointestinal conditions, which commonly overlap with depression.
There is also a cost argument. It is overall cheaper to train a dietitian ($153,039) than a psychologist ($189,063) – and it takes less time.
Potential barriers
Australians with chronic conditions (such as diabetes) can access subsidised dietitian and exercise physiologist appointments under various Medicare treatment plans. Those with eating disorders can also access subsidised dietitian appointments. But mental health care plans for people with depression do not support subsidised sessions with dietitians or exercise physiologists, despite peak bodies urging them to do so.
Increased training, upskilling and Medicare subsidies would be needed to support dietitians and exercise physiologists to be involved in treating mental health issues.
Our training and clinical guidelines are intended to help clinicians practising lifestyle-based mental health care within their scope of practice (activities a health care provider can undertake).
Future directions
Our trial took place during COVID lockdowns and examined people with at least mild symptoms of depression who did not necessarily have a mental disorder. We are seeking to replicate these findings and are now running a study open to Australians with mental health conditions such as major depression or bipolar disorder.
If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.
Adrienne O’Neil, Professor, Food & Mood Centre, Deakin University and Sophie Mahoney, Associate Research Fellow, Food and Mood Centre, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How old’s too old to be a doctor? Why GPs and surgeons over 70 may need a health check to practise
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A growing number of complaints against older doctors has prompted the Medical Board of Australia to announce today that it’s reviewing how doctors aged 70 or older are regulated. Two new options are on the table.
The first would require doctors over 70 to undergo a detailed health assessment to determine their current and future “fitness to practise” in their particular area of medicine.
The second would require only general health checks for doctors over 70.
A third option acknowledges existing rules requiring doctors to maintain their health and competence. As part of their professional code of conduct, doctors must seek independent medical and psychological care to prevent harming themselves and their patients. So, this third option would maintain the status quo.
PeopleImages.com – Yuri A/Shutterstock Haven’t we moved on from set retirement ages?
It might be surprising that stricter oversight of older doctors’ performance is proposed now. Critics of mandatory retirement ages in other fields – for judges, for instance – have long questioned whether these rules are “still valid in a modern society”.
However, unlike judges, doctors are already required to renew their registration annually to practise. This allows the Medical Board of Australia not only to access sound data about the prevalence and activity of older practitioners, but to assess their eligibility regularly and to conduct performance assessments if and when they are needed.
What has prompted these proposals?
This latest proposal identifies several emerging concerns about older doctors. These are grounded in external research about the effect of age on doctors’ competence as well as the regulator’s internal data showing surges of complaints about older doctors in recent years.
Studies of medical competence in ageing doctors show variable results. However, the Medical Board of Australia’s consultation document emphasises studies of neurocognitive loss. It explains how physical and cognitive impairment can lead to poor record-keeping, improper prescribing, as well as disruptive behaviour.
The other issue is the number of patient complaints against older doctors. These “notifications” have surged in recent years, as have the number of disciplinary actions against older doctors.
In 2022–2023, the Medical Board of Australia took disciplinary action against older doctors about 1.7 times more often than for doctors under 70.
In 2023, notifications against doctors over 70 were 81% higher than for the under 70s. In that year, patients sent 485 notifications to the Medical Board of Australia about older doctors – up from 189 in 2015.
While older doctors make up only about 5.3% of the doctor workforce in Australia (less than 1% over 80), this only makes the high numbers of complaints more starkly disproportionate.
It’s for these reasons that the Medical Board of Australia has determined it should take further regulatory action to safeguard the health of patients.
So what distinguishes the two new proposed options?
The “fitness to practise” assessment option would entail a rigorous assessment of doctors over 70 based on their specialisation. It would be required every three years after the age of 70 and every year after 80.
Surgeons, for example, would be assessed by an independent occupational physician for dexterity, sight and the ability to give clinical instructions.
Importantly, the results of these assessments would usually be confidential between the assessor and the doctor. Only doctors who were found to pose a substantial risk to the public, which was not being managed, would be obliged to report their health condition to the Medical Board of Australia.
The second option would be a more general health check not linked to the doctor’s specific role. It would occur at the same intervals as the “fitness to practise” assessment. However, its purpose would be merely to promote good health-care decision-making among health practitioners. There would be no general obligation on a doctor to report the results to the Medical Board of Australia.
In practice, both of these proposals appear to allow doctors to manage their own general health confidentially.
Older surgeons could be independently assessed for dexterity, sight and the ability to give clinical instructions. worradirek/Shutterstock The law tends to prioritise patient safety
All state versions of the legal regime regulating doctors, known as the National Accreditation and Registration Scheme, include a “paramountcy” provision. That provision basically says patient safety is paramount and trumps all other considerations.
As with legal regimes regulating childcare, health practitioner regulation prioritises the health and safety of the person receiving the care over the rights of the licensed professional.
Complicating this further, is the fact that a longstanding principle of health practitioner regulation has been that doctors should not be “punished” for errors in practice.
All of this means that reforms of this nature can be difficult to introduce and that the balance between patient safety and professional entitlements must be handled with care.
Could these proposals amount to age discrimination?
It is premature to analyse the legal implications of these proposals. So it’s difficult to say how these proposals interact with Commonwealth age- and other anti-discrimination laws.
For instance, one complication is that the federal age discrimination statute includes an exemption to allow “qualifying bodies” such as the Medical Board of Australia to discriminate against older professionals who are “unable to carry out the inherent requirements of the profession, trade or occupation because of his or her age”.
In broader terms, a licence to practise medicine is often compared to a licence to drive or pilot an aircraft. Despite claims of discrimination, New South Wales law requires older drivers to undergo a medical assessment every year; and similar requirements affect older pilots and air traffic controllers.
Where to from here?
When changes are proposed to health practitioner regulation, there is typically much media attention followed by a consultation and behind-the-scenes negotiation process. This issue is no different.
How will doctors respond to the proposed changes? It’s too soon to say. If the proposals are implemented, it’s possible some older doctors might retire rather than undergo these mandatory health assessments. Some may argue that encouraging more older doctors to retire is precisely the point of these proposals. However, others have suggested this would only exacerbate shortages in the health-care workforce.
The proposals are open for public comment until October 4.
Christopher Rudge, Law lecturer, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Flexible Dieting – by Alan Aragon
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This is the book from which we were working, for the most part, in our recent Expert Insights feature with Alan Aragon. We’ll re-iterate here: despite not being a Dr. Aragon, he’s a well-published research scientist with decades in the field of nutritional science, as well as being a personal trainer and fitness educator.
As you may gather from our other article, there’s a lot more to this book than “eat what you like”. Specifically, as the title suggests, there’s a lot of science—decades of it, and while we had room to cite a few studies in our article, he cites many many more; several citations per page of a 288-page book.
So, that sets the book apart from a lot of its genre; instead of just “here’s what some gym-bro thinks”, it’s “here’s what decades of data says”.
Another strength of this book is how clearly he explains such a lot of science—he explains terms as they come up, as well as having a generous glossary. He also explains things clearly and simply without undue dumbing down—just clarity of communication.
The style is to-the-point and instructional; it’s neither full of fitness-enthusiast hype nor dry academia, and keeps a light and friendly conversational tone throughout.
Bottom line: if you’d like to get your diet in order and you want to do it right while also knowing which things still need attention (and why) and which you can relax about (and why), then this book will get you there.
Click here to check out Flexible Dieting, and take an easy, relaxed control of yours!
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Try This At Home: ABI Test For Clogged Arteries
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Arterial plaque is a big deal, and statistically it’s more of a risk as we get older, often coming to a head around age 72 for women and 65 for men—these are the median ages at which people who are going to get heart attacks, get them. Or get it, because sometimes one is all it takes.
The Ankle-Brachial Index Test
Dr. Brewer recommends a home test for detecting arterial plaque called the Ankle-Brachial Index (ABI), which uses a blood pressure monitor. The test involves measuring blood pressure in both the arms and ankles, then calculating the ratio of these measurements:
- A healthy ABI score is between 1.0 and 1.4; anything outside this range may indicate arterial problems.
- Low ABI scores (below 0.8) suggest plaque is likely obstructing blood flow
- High ABI scores (above 1.4) may indicate artery hardening
Peripheral Artery Disease (PAD), associated with poor ABI results (be they high or low), can cause a whole lot of problems that are definitely better tackled sooner rather than later—remember that atherosclerosis is a self-worsening thing once it gets going, because narrower walls means it’s even easier for more stuff to get stuck in there (and thus, the new stuff that got stuck also becomes part of the walls, and the problem gets worse).
If you need a blood pressure monitor, by the way, here’s an example product on Amazon.
Do note also that yes, if you have plaque obstructing blood flow and hardened arteries, your scores may cancel out and give you a “healthy” score, despite your arteries being very much not healthy. For this reason, this test can be used to raise the alarm, but not to give the “all clear”.
For more on all of the above, plus a demonstration and more in-depth explanation of the test, enjoy:
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Olive Oil vs Coconut Oil – Which is Healthier?
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Our Verdict
When comparing extra virgin olive oil to cold-pressed coconut oil, we picked the olive oil.
Why?
While the cold-pressed coconut oil may offer some health benefits due to its lauric acid content, its 80–90% saturated fat content isn’t great for most people. It’s a great oil when applied topically for healthy skin and hair, though!
The extra virgin olive oil has a much more uncontroversially healthy blend of triglycerides, and (in moderation) is universally recognized as very heart-healthy.
Your local supermarket, most likely, has a good extra virgin olive oil, but if you’d like to get some online, here’s an example product on Amazon for your convenience.
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Men have a biological clock too. Here’s what’s more likely when dads are over 50
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We hear a lot about women’s biological clock and how age affects the chance of pregnancy.
New research shows men’s fertility is also affected by age. When dads are over 50, the risk of pregnancy complications increases.
Data from more than 46 million births in the United States between 2011 and 2022 compared fathers in their 30s with fathers in their 50s.
While taking into account the age of the mother and other factors known to affect pregnancy outcomes, the researchers found every ten-year increase in paternal age was linked to more complications.
The researchers found that compared to couples where the father was aged 30–39, for couples where the dad was in his 50s, there was a:
- 16% increased risk of preterm birth
- 14% increased risk of low birth weight
- 13% increase in gestational diabetes.
The older fathers were also twice as likely to have used assisted reproductive technology, including IVF, to conceive than their younger counterparts.
Steven van Loy/Unsplash Dads are getting older
In this US study, the mean age of all fathers increased from 30.8 years in 2011 to 32.1 years in 2022.
In that same period, the proportion of men aged 50 years or older fathering a child increased from 1.1% to 1.3%.
We don’t know the proportion of men over 50 years who father children in Australia, but data shows the average age of fathers has increased.
In 1975 the median age of Australian dads was 28.6 years. This jumped to 33.7 years in 2022.
How male age affects getting pregnant
As we know from media reports of celebrity dads, men produce sperm from puberty throughout life and can father children well into old age.
However, there is a noticeable decline in sperm quality from about age 40.
Female partners of older men take longer to achieve pregnancy than those with younger partners.
A study of the effect of male age on time to pregnancy showed women with male partners aged 45 or older were almost five times more likely to take more than a year to conceive compared to those with partners aged 25 or under. More than three quarters (76.8%) of men under the age of 25 years impregnated their female partners within six months, compared with just over half (52.9%) of men over the age of 45.
Pooled data from ten studies showed that partners of older men are also more likely to experience miscarriage. Compared to couples where the male was aged 25 to 29 years, paternal age over 45 years increased the risk of miscarriage by 43%.
Older men are more likely to need IVF
Outcomes of assisted reproductive technology, such as IVF, are also influenced by the age of the male partner.
A review of studies in couples using assisted reproductive technologies found paternal age under 40 years reduced the risk of miscarriage by about 25% compared to couples with men aged over 40.
Having a male under 40 years also almost doubled the chance of a live birth per treatment cycle. With a man over 40, 17.6% of treatment rounds resulted in a live birth, compared to 28.4% when the male was under 40.
How does male age affect the health outcomes of children?
As a result of age-related changes in sperm DNA, the children of older fathers have increased risk of a number of conditions. Autism, schizophrenia, bipolar disorders and leukaemia have been linked to the father’s advanced years.
A review of studies assessing the impact of advanced paternal age reported that children of older fathers have increased rates of psychiatric disease and behavioural impairments.
But while the increased risk of adverse health outcomes linked to older paternal age is real, the magnitude of the effect is modest. It’s important to remember that an increase in a very small risk is still a small risk and most children of older fathers are born healthy and develop well.
Improving your health can improve your fertility
In addition to the effects of older age, some chronic conditions that affect fertility and reproductive outcomes become more common as men get older. They include obesity and diabetes which affect sperm quality by lowering testosterone levels.
While we can’t change our age, some lifestyle factors that increase the risk of pregnancy complications and reduce fertility, can be tackled. They include:
- smoking
- recreational drug taking
- anabolic steroid use
- heavy alcohol consumption.
Get the facts about the male biological clock
Research shows men want children as much as women do. And most men want at least two children.
Yet most men lack knowledge about the limitations of female and male fertility and overestimate the chance of getting pregnant, with and without assisted reproductive technologies.
We need better public education, starting at school, to improve awareness of the impact of male and female age on reproductive outcomes and help people have healthy babies.
For men wanting to improve their chance of conceiving, the government-funded sites Healthy Male and Your Fertility are a good place to start. These offer evidence-based and accessible information about reproductive health, and tips to improve your reproductive health and give your children the best start in life.
Karin Hammarberg, Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How To *Really* Pick Up (And Keep!) Those Habits
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The Healthiest Habit-Building
Why was that book “Atomic Habits” called that? It wasn’t just because it’s a catchy title…
Habits are—much like atoms—things that are almost imperceptibly small, yet when stacked, they make up the substance of many much larger and more obvious things, and also contain an immense amount of potential power.
About that power…
Habits are the “compound interest” of natural human life. Every action we take, every decision we make, makes our life (often imperceptibly) better or worse. But getting even just 1% better or 1% worse at something every day? That’s going to not just add up over time… It’ll actively compound over time.
Habits will snowball one way or the other, good or bad. So, we want to control that snowball so that it works for us rather than against us.
Thus, we need to choose habits that are helpful to us, rather than those that are harmful to us. Top examples include:
- Making healthy food choices rather than unhealthy ones
- Moving our body regularly rather than being sedentary
- Having a good bedtime/morning routine rather than a daily chaotic blur
- Learning constantly rather than digging into old beliefs out of habit
- Forging healthy relationships rather than isolating ourselves
We all know that to make a habit stick, we need to practice it regularly, with opinions varying on how long it takes for something to become habit. Some say 21 days; some say 66. The number isn’t the important part!
What is important
You will never get to day 66, much less will you get to day 366, if you don’t first get to day 6 (New Year’s Resolutions, anyone?).
So in the early days especially, when the habit is most likely to get dropped, it’s critical to make the habit as easy as possible to form.
That means:
- The habit should be made as pleasant as possible
- (e.g. by making modifications to it if it’s not already intrinsically pleasant)
- The habit should take under 2 minutes to do at first
- (no matter if it takes longer than 2 minutes to be useful; it’ll never be useful if you don’t first get it to stick, so make your initial commitment only 2 minutes, just to get in the habit)
- The habit should have cues to remind you
- (as it’s not habit yet, you will need to either set a reminder on your phone, or leave a visual reminder, such as your workout clothes laid out ready for you in the morning, or a bowl of fruit in plain view where you spend a lot of time)
What gets measured, gets done
Streaks are a great way to do this. Habit-tracking apps help. Marks on a calendar or in a journal are also totally fine.
What can help especially, and that a lot of people don’t do, is to have a system of regular personal reviews—like a work “performance review”, but for oneself and one’s own life.
Set a reminder or write on the calendar / in your diary, to review monthly, or weekly if you prefer, such things as:
- How am I doing in the areas of life that are important to me?
- Have a list of the areas of life that are important to you, by the way, and genuinely reflect on each of them, e.g:
- Health
- Finances
- Relationships
- Learning
- Sleep
- Etc
- Have a list of the areas of life that are important to you, by the way, and genuinely reflect on each of them, e.g:
- What is working for me, and what isn’t working for me?
- What will I do better in this next month/week?
…and then do it!
Good luck, and may it all stack up in your favor!
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