Wednesday, June 17, 2009

Australia: Health nazis losing obesity war

THE Aussie pie, pizzas and sausage rolls are back in school canteens as the war against child obesity falters and threatens to collapse. Lollies, ice creams, chips and even banned sports drinks have also re-emerged on school menus because thousands of families are snubbing healthier foods.

Nutritionists and dietitians are desperately trying to rescue the $750,000 school health campaign launched five years ago by former Premier Bob Carr. They are offering "low fat" Aussie beef pies, pizzas made with wholemeal pita bread and vegetables and chicken burgers to children who turn their noses up at salads and wraps.

The anti-health push is greatest at secondary level where students leave school grounds to eat at local fast food outlets or order in takeaway pizza on their mobile phones.

Dietitians have told The Daily Telegraph some schools are offering pies to children three times a day - at breakfast, recess and lunch. In a bid to reverse the trend the Healthy Kids School Canteen Association is taking over some school food operations. Low fat pies, pizzas and sausage rolls, with ingredients that meet health guidelines and home-made lasagne are now the front line items aimed at winning customers back.

Friday is pie and pizza day at Holy Cross Primary School at Glenwood in Sydney's west - portion sizes limited to healthy amounts - and the kids are lining up to get their orders. Canteen Association dietitian Jennifer Madz said Holy Cross would become a template across the state. "The problem is parents see the canteen as a treat and expect treat food there. We are trying to change the behaviour," Ms Madz said. "High schools are a special problem where students with money in their pockets go off campus to lunch in local fast food outlets. We are working on a plan to combat that."

Canteens hit by the global recession claim profits have been eroded as students resist low-fat menus.

While most sugary drinks are banned from school canteens, the food industry has manipulated some products to get around the rules. To get a non-milk-based gelato accepted the manufacturer added calcium and reduced the portion size. Banned Powerade became "Powerade Light" and juice was carbonated and sold in a can so children would think it was a softdrink. Under the nutrition rules foods are divided into red (no more than twice a term), amber (to be selected carefully and in smaller servings) and green (fill the menu) categories.

But enforcement has been almost non-existent and the Catholic and independent school sectors are not bound by them.


Trial shows rituximab can slow progress of rheumatoid arthritis

Treating rheumatoid arthritis with a drug currently used only when patients are severely disabled appears to slow the progression of the disease dramatically, a study suggests.

A trial involving rituximab, an advanced antibody drug, has shown a remarkable reduction in symptoms for patients in the early stages of the disease. It has led one expert to claim that it could lead to a “paradigm shift” in the use of arthritis therapies.

Almost 500,000 people in Britain are affected by rheumatoid arthritis, which occurs when the body’s immune system attacks the joints. About 40 per cent of sufferers are forced to stop work during the first five years of their illness. The condition costs the economy about £4 billion a year.

A total of 755 patients took part in the Image trial, led by Professor Paul-Peter Tak, from the University of Amsterdam. All participants had recently received an arthritis diagnosis and had generally suffered the disease for less than a year.

After a year of treatment, those receiving a combination of methotrexate, a “gold standard” early-stage treatment, and rituximab were found to be three times as likely to have fewer symptoms — and a reduction pronounced enough to meet the criteria for remission — than those on methotrexate alone. During the second six months, continuing joint damage was almost completely halted in patients treated with rituximab.

Currently most patients go through a set order of treatments as the disease progresses, moving from ordinary anti-inflammatory painkillers, such as ibuprofen, to anti-rheumatic drugs such as methotrexate, which slow progression and delay joint damage.

In severe cases newer drugs called biologics may be used, including treatments that block an immune system signalling molecule called tumour necrosis factor (TNF). Under current guidelines, patients qualify for rituximab, which is marketed as MabThera, only on failing to respond to an anti-TNF. Originally developed to treat leukaemia, the injected drug targets specialised white blood cells that play a key role in the immune response behind rheumatoid arthritis.

Of the patients receiving the methotrexate and rituximab combination, 30.5 per cent experienced significant reduction of symptoms, compared with 12.5 per cent taking only methotrexate. A course of rituximab treatment costs £3,492 — significantly less than the £12,000 cost of a typical anti-TNF drug. Coupled with the new trial data, this is likely to have a bearing on how rituximab is made available.

The findings were presented last week at the annual meeting of the European League Against Rheumatism (Eular) in Copenhagen. Professor John Isaacs, a leading rheumatologist from the Institute of Cellular Medicine at the University of Newcastle, said: “These positive data clearly show the efficacy of using rituximab earlier and could signal a paradigm shift in the use of this drug.”

A task force of Eular experts is developing new evidence-based guidelines for the management of rheumatoid arthritis. Ailsa Bosworth, of the National Rheumatoid Arthritis Society, said: “These results are a very encouraging sign for the future for patients in the early stages. If I could have prevented damage when I was first diagnosed, it would have changed my life.”


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