Why US suicide rate is on the rise

A new government study released reveals that suicide has been on the rise nationwide since 1999. The figures were released in the week when the deaths of designer Kate Spade and celebrity chef Anthony Bourdain brought the issue to the fore.

In the days following Spade's death, the US suicide prevention hotline - 1-800-273-8255 - saw a 25% spike in calls, the Wall Street Journal reported.

International research has shown an apparent "contagion" effect after high-profile suicides.

But what has spurred such a steady increase in American suicides?

In 17 years, 30%

That's how much the overall suicide rate has increased in more than half of US states in that time, according to the US Centers for Disease Control and Prevention (CDC). The overall rise nationwide is about 25%.

It means that around 16 out of every 100,000 Americans will take their own life.

Nearly 45,000 Americans took their own life in 2016 alone.

According to CDC data, suicide increased among all sexes, ages, races and ethnic groups.

Lead researcher Dr Deborah Stone told the BBC that the agency had been tracking the rise for some time.

"Knowing the rates were increasing, we [wanted to] look at state level increases and contributing factors," Dr Stone says.

"There were 25 states that had increases of more than 30% - that was a new finding for us."

Nearly all of those states are in the western and Midwestern regions of the US.

Why are suicide rates increasing?

While there is no single factor that leads to suicide, Dr Stone says relationship issues and financial troubles tend to be top factors contributing to suicide across the country.

She also notes that some western states have some of the highest rates of suicide historically, which could be related to the fact that they tend to be more rural.

Rural states, she explained, are still recovering from economic downturns. People also tend to be more isolated, without access to proper care. And, these states have been hit hard by the opioid epidemic.

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Prof Julie Cerel, president of the American Association of Suicidology, noted that having better reporting standards could account for some of the increase, but also pointed to a lack of adequate funding for mental health research and preventative care.

"Our mental health systems are just really struggling across the country," Prof Cerel says. "In terms of training mental health professionals, we're not doing a great job."

As of 2018, only 10 states mandate suicide prevention training for health professionals.

And Prof Cerel raised another related, though often sidelined, public health issue - firearms.

"The gun debate in the US has been about the horrific school shootings, and we want to prevent those, but the vast majority of deaths from firearms are suicides," she says.

In fact, two-thirds of gun-related deaths in America are suicides, according to the CDC.

"We just don't talk about that in the US because there are stigmas against mental health. People think suicides are different - why should they want gun control? Nobody in their family is going do that."

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.

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.

Royal wedding 2018: What is bowl food?

The 600 guests joining Prince Harry and Meghan Markle for their wedding reception will be enjoying a selection of savoury and sweet canapés, champagne (of course) and "bowl food".

Trendy and attractive bowls of food - often healthy and colourful - have been around for a while, often photographed on Instagram.

But now "bowl food" is becoming a popular choice for large catered events.

What is it?

Bowl food is larger than a canapé and around a quarter of the size of a main course.

It is served in miniature or hand-sized bowls and comes ready to eat with a small fork.

The idea behind a bowl food menu is so guests can stay standing up and mingle while they eat. It has been described by caterers as an option which allows guests to "keep on talking".

Although for elderly guests - including 96-year-old Prince Philip who had a hip replacement last month - presumably a seat may be offered.

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According to BBC Good Food, bowl food dishes which might work well could be Thai curry with rice, sausages and mash, or risotto.

For the royal lunchtime reception, the bowl food part of the menu included:

• Fricassee of free range chicken with morel mushrooms and young leeks
• pea and mint risotto with pea shoots, truffle oil and parmesan crisps
• 10-hour slow roasted Windsor pork belly with apple compote and crackling

All the ingredients have been sourced from companies holding a royal warrant.

What has the reaction been like?

"Bowl food is awful. It's like something out of Oliver," said English interior designer Nicky Haslam earlier this week, when he found out the royal wedding plans - although it is not known if he was attending. "It's the most awful thing in the whole world."

Fortunately, his strong reaction seems to be the exception.

Many people responded with confusion, asking what exactly bowl food is.

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.

Call for supermarket price offers on healthy food

Supermarkets should concentrate their price promotions on healthy food to assist in the battle against obesity, according to consumer group Which?

Analysis of 77,165 promotions across the major UK supermarkets found 53% of them were put on less healthy products.

Confectionery was much more likely to be on special offer than fresh fruit and vegetables, Which? said.

The supermarkets' trade body said a balanced diet was now more affordable than ever.

Andrew Opie, director of food and sustainability policy at the British Retail Consortium, said: "Supermarkets offer great value in all the products they sell and it has never been easier or more affordable to choose a balanced diet."

The Which? analysis covered deals found in six major retailers - Asda, Morrisons, Ocado, Sainsbury's, Tesco and Waitrose - between April and June.

It classed less healthy food as any product with a red traffic light label for fat, saturates, sugars or salt - unless an item scored a red for fat and a green for saturated fat - and automatically counted fresh, unprocessed fruit and vegetables as healthier.

It found that 52% of confectionery was on special offer, compared to 30% of fresh fruit and 34% of vegetables.

Also on promotion, the results suggested, were 69% of soft drinks that would fall under the higher sugar band category, with more than 8% sugar, of the government's proposed sugar tax.

Alex Neill, director of campaigns and policy at Which?, said: "Everybody has to play their part in the fight against obesity and people want supermarkets to offer more promotions on healthier foods and yet our research found the opposite.

"It is time for supermarkets to shift the balance of products they include in price promotions and for all retailers to get rid of temptation at the till by taking sweets off the checkout."

'Affordable'

Supermarkets suggest there are high levels of competition, and promotions, along all the supermarket shelves.

They also suggest that with a relatively even mix of promotions across all types of food, it did not follow that people would choose unhealthy food based on the promotions offered by supermarkets.

Paul Mills-Hicks, Sainsbury's food commercial director, said: "Since 2014, we have been working hard to remove promotions and invest money in regular lower prices. In doing so, we have made hundreds of fresh and healthy products affordable all of the time and our fresh produce sales are growing as a result.

"We have also taken a big step by calling on the industry to remove multi-buys, which we believe will lead to healthier diets and reduce household waste."