Eating a balanced diet

Unfit in middle age

After accounting for other factors (including socio-economic status, a number of long-term conditions, smoking, alcohol and BMI), researchers found men between the ages of 37 and 45 were over two-and-a-half times more likely to die than non-frail people of the same age.

The figures were similar in all the other age groups (45-55, 55-65, and 65-73).

Similar associations were found in women who were judged to be frail and were 45 or older.

Frail people were also far more likely to have conditions such as multiple sclerosis and chronic fatigue syndrome.

Lead author of the study, Prof Frances Mair, from the University of Glasgow, said the findings suggested there was a need to both identify and treat frailty much earlier in life.

So what can we do?

Dr Peter Hanlon, a co-author on the frailty study, said the good news is that frailty might be reversible in people, particularly if it is identified early.

The key for those who are unfit in middle age is making healthy changes "as soon as possible", says Ilaria Bellantuono, professor of musculoskeletal ageing at the University of Sheffield.

"The key is a healthy diet and exercise. It's the only thing we know that works," she says.

Losing weight, stopping smoking, cutting back on alcohol, exercising regularly and eating less salt are just some of the things you can do to lower your blood pressure.

And similar advice applies to reducing your risk of dementia and helping to keep your brain healthy as you age, says Dr Laura Phipps from Alzheimer's Research UK.

But the million pound question is how do you get people to change their habits?

Prof Bellantuono said that for some, health warnings won't be enough.

Instead, finding an "internal motive that speaks to them" will be key to getting some people to exercise and be healthier.

"That could be picking up the grandchildren or going to watch the football," she adds.

The UK health tax hurting foreign nurses

When a Kenyan nurse took up a job in the UK a few years ago, he felt his family's future had been secured.

But now the distraught father-of-three is struggling financially to reunite his family.

Ken, not his real name, lives with his wife and daughter.

But his twin children, a boy and a girl, remain in Kenya where they live with relatives.

That's because Ken is unable to raise enough money to cover a British health tax, known as the immigration health surcharge (IHS).

'Struggling to stay afloat'

Migrant workers coming to the UK from outside the European Economic Area (EEA) and their dependents have to a pay an annual fee of £200 ($268) each.

Ken is also required to have £2,185 in his account for three months before he can apply to bring his twins into the country - on top of the £400 he will need for their health tax.

"It's very difficult to explain to them when they ask me when they will join me here.

"Ideally, every parent would love to be with all their children."

Top five nationalities of non-EEA NHS staff in England

1. Indian - 18,348
2. Filipino- 15,391
3. Nigerian - 5,405
4. Zimbabwean - 3,899
5. Pakistani - 3,375

One in eight National Health Service (NHS) England staff are not British nationals, and people from a total of 201 foreign nationalities work for NHS England.

Source: House of Commons Library

The time difference and the nature of his job also make it difficult for him to give the twins the attention they need.

"Sometimes when you're at work, they call and you cannot speak with them as you'd love to, since you're really busy," he says.

The health surcharge was introduced in 2015 to boost funding for the National Health Service (NHS) and as a way to discourage health tourism.

Later this year, the annual charge is to be doubled from £200 to £400, with the discounted rate for students set to increase from £150 to £300.

A double tax?

A Home Office spokesperson reiterated that the government was aware of the "contribution" made by international professionals "to the UK and to our health service".

But it said the surcharge offered access to healthcare that was "far more comprehensive and at a much lower cost than many other countries".

"The income generated goes directly to NHS services, helping to protect and sustain our world-class healthcare system for everyone who uses it," the spokesperson said.

Prostate cancer spit test is trialled

A spit test to detect men at increased risk of prostate cancer has started early trials.

The new DNA test looks for high-risk genes that are thought to affect one in every 100 men.

Three hundred men are taking part in the trials, from three London GP surgeries.

Developing better diagnostic tests that could be used as part of a nationwide screening programme is a research priority for prostate cancer.

At present, there is no single, reliable test for prostate cancer. The PSA blood test, biopsies and physical examinations are all used.

But the PSA can give false positives and sometimes misses more aggressive cases.

The new DNA test was created by a group of international scientists based at the Institute of Cancer Research (ICR) in London.

They studied more than 140,000 men and identified 63 new genetic variations that can increase the risk of prostate cancer.

The DNA test combines those variants with more than 100 others previously linked to prostate cancer.

Ros Eeles, professor of oncogenetics at the ICR, said the study was "very significant".

"By looking at the DNA code of tens of thousands of men in more depth than ever before, we have uncovered vital new information about the genetic factors that can predispose someone to prostate cancer, and, crucially, we have shown that information from more than 150 genetic variants can now be combined to provide a readout of a man's inherited risk of prostate cancer."

Only those men found to be at higher risk of prostate cancer would then be scanned and have a prostate biopsy, so researchers hope it could prevent unnecessary procedures.

"It could have a substantial impact on how we actually manage those at increased risk because if you find the disease earlier it's much easier to treat it and much more easy to cure," says Prof Elees.

The trial will be expanded to 5,000 men next year.

Prof Paul Workman, chief executive of the Institute of Cancer Research, said the study also provided important information about the causes of prostate cancer and the potential role of the immune system "which could ultimately be employed in the design of new treatments".

The study is published in the journal Nature Genetics and was funded by the the National Cancer Institute in the US, with additional support from the European Research Council, Cancer Research UK and Prostate Cancer UK.

Dr Iain Frame, director of research at Prostate Cancer UK said: "This new research could help men to understand their individual genetic risk of prostate cancer, which could prompt them to speak to their GP about the disease.

"Given that one in eight men will be diagnosed with prostate cancer in their lifetime, we urgently need more accurate diagnostic tests which are suitable for use in a nationwide screening programme."

Carl Alexander from Cancer Research UK, said the study was "an exciting example" of how research can find clues in our genes to help us uncover those more likely to develop the disease.

"The next steps should be to understand how this research can be developed into tests which could identify men who might be more likely to develop aggressive cancers, and how this could be rolled out to patients.

Smoked mackerel pilau rice

This is a great one-pan family meal that’s tasty and healthy too. If you like more spice, add some ginger and chilli to the vegetables at the start. You can also add boiled eggs at the end too bulk it out.

Ingredients

• 1 tsp rapeseed oil
• 1 onion, roughly chopped
• 1 garlic clove, finely chopped
• 1 tbsp medium curry powder
• 250g/9oz basmati rice
• 500ml/18fl oz vegetable or chicken stock
• 200g/7oz smoked mackerel or smoked peppered mackerel, skin removed and flaked into large pieces
• 80g/3oz frozen peas
• 1 lemon, juice only, plus wedges to serve
• 2 tbsp roughly chopped flatleaf parsley (optional)
• sea salt and freshly ground black pepper

How-to-videos

Method

1. Heat a large saucepan until medium hot, add the oil and onion and stir well. Cover with a lid and leave to cook gently for 10 minutes, until softened.
2. Add the garlic and curry powder and stir fry for 1 minute. Add the rice and stir, then add the stock. Stir well and cover with a lid.
3. Bring to the boil, then turn the heat down and simmer gently with the lid on for about 15 minutes, checking that it doesn’t dry out. When the rice has absorbed all the stock it should be tender. If not, add a splash of boiling water then cook for a further 5 minutes and check again.
4. Stir in the flaked mackerel, peas, lemon juice and parsley and mix carefully, as you don’t want the mackerel to break up too much. Season to taste with salt and pepper and cook for 1 more minute to make sure it’s hot through, then serve.

Brain 'can be trained to prefer healthy food'

The brain can be trained to prefer healthy food over unhealthy high-calorie foods, using a diet which does not leave people hungry, suggests a study from the US.

Scientists from Tufts University say food addictions can be changed in this way even if they are well-established.

They scanned the addiction centre in the brains of a small group of men and women.

The results showed increased cravings for healthy lower-calorie foods.

Prof Susan B Roberts, senior study author and behavioural nutrition scientist at the Boston university, said: "We don't start out in life loving French fries and hating, for example, wholewheat pasta.

"This conditioning happens over time in response to eating - repeatedly - what is out there in the toxic food environment."

Scientists know that once people are addicted to unhealthy foods, it is usually very hard to change their eating habits and get them to lose weight.

But Prof Roberts' research, published in the journal Nutrition & Diabetes, suggests the brain can learn to like healthy foods.

They studied the part of the brain linked to reward and addiction in 13 overweight and obese men and women, eight of whom were taking part in a specially designed weight-loss programme.

This focused on changing food preferences by prescribing a diet high in fibre and protein, and low in carbohydrates, but which did not allow participants to become hungry because this is when food cravings take over and unhealthy food becomes attractive.

The other five adults were not part of the weight-loss programme.

When their brains were scanned using MRI at the start and end of a six-month period, those following the programme showed changes in the brain's reward centre.

When participants were shown pictures of different types of food, it was the healthy, low-calorie foods which produced an increased reaction.

The study said this indicated an increased reward and enjoyment of healthier food.

The brain's reward centre also showed decreased sensitivity to the unhealthy, higher-calorie foods.

The Boston researchers say that gastric bypass surgery, while solving the problem of weight loss, can take away food enjoyment rather than make healthier foods more appealing.

"There is much more research to be done here, involving many more participants, long-term follow-up and investigating more areas of the brain," Prof Roberts said.

Barnsley bans sugary drinks in 'sugar-free borough' bid

Sugary drinks have been barred from sale at Barnsley Council in a bid to make the town a "sugar-free borough".

The authority launched its food strategy after its public health department identified smoking, excessive drinking and poor diet as major problems for the town.

Council staff said food habits were the "most challenging" things to change.

A full food plan is expected to be adopted by the authority later in the year.

As well as cutting out full-sugar drinks from sale and removing vending machines from council buildings, the cafe at the council's Westgate Plaza headquarters now gives a calorific value on its sandwiches, the Local Democracy Reporting Service said.

The council is working with prospective tenants of the new Market Food Hall, which is currently under construction, with the aim of introducing similar labels.

Will the sugar tax work?

'More to come' after sugar tax

More Yorkshire stories

Takeaways are being encouraged to offer healthier meal choices and to introduce simple measures like salt shakers with smaller holes, or healthier fats for frying.

Diane Lee, head of public health, said the authority wants Barnsley to become a "sugar-free town."

She said: "Our long-term goal is for all food sold to have its calories displayed, every sandwich in every shop.

"That's a long way off, but it's about giving people the information to lower their sugar and calorie intake."

The council said Barnsley has fewer overweight children than the national average, and public health staff will monitor future results in the hope that it is the start of a positive trend.

Work is being done to maximise school meals' nutritional value and to address "holiday hunger", when children from impoverished backgrounds do not get a good diet once school dinners stop for the holidays.

The town has already adopted a scheme to give weekly healthy food vouchers to families.

Clementine and cod curry

Ingredients

For the curry

• 2 tbsp vegetable oil
• 2 garlic cloves, crushed
• 1 small onion, chopped
• 2 green chillies, split lengthways
• 1 tbsp tomato purée
• 1 tsp turmeric
• ½ tsp chilli powder
• ½ tsp curry powder
• 3 clementines, peel only
• 400g/14oz cod fillet, cut into bite-size chunks
• large handful fresh coriander leaves
• fine sea salt

Method

• 1. For the curry, place a large lidded pan over a medium heat and add the oil. Add the garlic and onion and cook until softened. Add 1 teaspoon salt and if the onions stick to the pan add splashes of water.
  2. Add the chillies and tomato purée and cook for 2 minutes. Add the turmeric, chilli powder and curry powder. Add a little water and cook for 5–7 minutes, or until the oil rises to the surface.
  3. Meanwhile, thinly slice the clementine peel and add it to the pan with the 200ml/7fl oz water (or clementine juice). Cook for 10 minutes, or until the peel has melted down.
  4. Add the cod, stir and put the lid on. Cook for a few minutes, or until firm, white and cooked through. Remove from the heat and add the coriander.
  5. Put the spinach in a large pot with the garlic and a pinch of salt. Dry steam on a low heat for 3 minutes, until wilted right down; it should keep its bright-green colour. Dry steaming is cooking without any oil; rinsed spinach has enough moisture on it to steam it and cook the garlic.
  6. Serve the fish curry with the spinach on the side.

'I thought if I was fat nobody could see that I was evil'

Girls who are sexually abused in childhood are more likely to become obese when they grow up. Like many women, Pauline Sharp used binge-eating as a coping strategy, wearing her 24-stone weight as a "mask, providing padding from the outside world".

I can barely remember the taste of anything I ate as a child. For the 17 years I endured emotional and physical abuse at the hands of my parents, every one of my senses was http://24wikiss.blogspot.com/numbed. When you are in survival mode, you don't feel anything.

My family home looked like any dull suburban detached house, but inside it was hell. It was my father who carried out most of the abuse, but my mother was completely under his control. She had to be waiting by the door with his briefcase when he left the house in the morning and have dinner on the table for him when he got home. Whatever she cooked, it was never meant to be enjoyed by me.

At the dining table, I was told by my father that I was poisonous and lucky to be fed at all. At dinner, I would sit in silence carefully eating my mother's pies, trying not to drop pastry crumbs. I was terrified to say anything that might upset them. I believed if I could just be "good" for my parents I could win their love, but that never happened.

When I was "naughty" they wouldn't let me have any food, so I would resort to stealing whatever I could get my hands on. I remember being so desperate I scraped a piece of chewing gum from the playground to eat. I would stash cheese, slices of bread and tomatoes and eat them in secret in my bedroom. If they caught me, I would suffer for it. My parents never needed much of an excuse to punish me. I am sure they made things up. If I didn't make my bed properly or if I was five minutes late from school I could be hit with a wooden spoon, cut, burned or sexually abused depending on how my father felt that day. They would use food to ritually humiliate me. One morning, I was fed porridge that made me sick and my mother forced me to eat my own vomit. I still struggle with the shame of those memories.

My parents strictly forbade me from visiting other people's houses, but one day I was allowed to go to my friend's house. There was laughter and noise and it smelled of warm biscuits. I can remember thinking how odd it was that the children could open the fridge without being punished. I didn't dare go anywhere near it.

After decades of being sexually abused by my father and other men, I failed to escape their emotional control, until, aged 22, I left my parents' house for a job as a nanny in Canada. I flew as far away as I could, but I was never really free from them.

I tried to build a "normal" life away from my parents. I was convinced I was gaining control, but with them living inside my head, I began forming more destructive habits.

Since the age of eight, I had abused my body. I was always told it was full of poison and wanted to inflict as much damage on it as I could. Alongside the self-harm, I started drinking heavily and mindlessly, frantically gorging on food.

My father made me believe everyone was watching me, that people could see that I was rotten. I was trying everything in my power to cover it up. Being fat was all part of the cover-up. "I'm already ugly," I thought, "so why not make it a double whammy? Then people really won't want to know me."

When I was feeling low I would order Indian food and eat it in my bedroom. I would look at the piles of curry and rice in front of me and say to myself: "I don't want to do this, but I need to do this." When I had finished bingeing, I would feel a split-second rush of relief from the pain my parents had inflicted on me. I'd do anything to feel something. I would eat and eat until I felt sick and ashamed. Then, a few hours later, I would start eating again.

Gluten-free chicken nuggets

These gluten-free chicken nuggets have a crisp coating thanks to ground almonds. Try them with throw-together BBQ sauce.

Each nugget with a little BBQ sauce provides 77 kcal, 6.7g protein, 0.8g carbohydrate (of which 0.7g sugars), 5g fat (of which 1g saturates), 0.1g fibre and 0.3g salt.

Ingredients

For the chicken nuggets

• 180g/6¼oz ground almonds
• 2 free-range Egges
• 4 chicken breasts cut into nuggets
• 1½ tsp salt
• freshly ground black pepper, to taste
• 1 tbsp butter

For the seasoning (optional)

• ¾ tsp onion powder
• ¾ tsp garlic powder

For the BBQ sauce

• 3 tbsp tomato purée
• 2 tbsp butter, melted
• 2 tbsp balsamic vinegar
• ½ tsp smoked paprika, to taste
• salt and freshly ground black pepper

Recipe tips

Method

1. Preheat the oven to 200C/180C Fan/Gas 6. Line a baking tray with baking parchment.
2. Pour the ground almonds into a bowl and stir in the seasoning. Beat the eggs in a separate bowl.
3. Season the chicken pieces all over with the salt and pepper. Dip each chicken piece first in the egg, then roll in the almonds until completely covered. Arrange the nuggets on the prepared baking tray.
4. Melt the butter in a small saucepan over a low heat. Drizzle the melted butter over the nuggets. Bake in the oven for 18-20 minutes, turning halfway through cooking, until cooked through and golden-brown.
5. Meanwhile, for the BBQ sauce, whisk together the tomato purée, melted butter and balsamic vinegar until well combined. Season with salt, pepper and smoked paprika.
6. Transfer the BBQ sauce to a sterilised, airtight jar and chill in the fridge until needed. It will keep in a sealed jar for up to 1 week.