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Bruce Kirkham

Consultant Rheumatologist, Guy’s & St Thomas’ NHS Foundation Trust, London, and Professor of Translational Rheumatology, Kings College London

Professor Kirkham is a Consultant Rheumatologist at Guy’s & St Thomas’ NHS Foundation Trust, London, and Professor of Translational Rheumatology, King's College London.

Professor Kirkham qualified as a doctor in New Zealand, then undertook his postgraduate rheumatology training at Guy’s Hospital, London. After working at the Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia, in 1991 he became a Consultant Rheumatologist in Adelaide and Sydney. His work focussed on clinical trials of new treatments and investigation of immune mechanisms, in particular IL-17 pathways, in inflammatory arthritis.

He was appointed to Guy’s & St. Thomas’ NHS Foundation Trust in 2000. In 2001 he was co-CI of the first study of infliximab in psoriatic arthritis. He set up a dedicated service to optimise care of patients with rheumatoid and psoriatic arthritis which received the British Society of Rheumatology inaugural Outstanding Best Practice Award in 2013. A close working relationship with the St John’s Institute of Dermatology, the largest centre for psoriasis in southern England is integral to this service, with a large patient group. In 2016, his team was named by GRAPPA as one of seven international best practice centres. His translational research is focussed on IL-17/23 immunology and best practice in inflammatory arthritis.


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Ellie Korendowych

Consultant Rheumatologist and Clinical Lead for Rheumatology

Dr Korendowych is a Consultant Rheumatologist and Clinical Lead for Rheumatology at the Royal National Hospital for Rheumatic Diseases in Bath. She undertook her medical training at Cambridge and Oxford Universities. She was appointed as a Consultant at the RNHRD in Bath in 2005. She became Clinical Lead for the Rheumatology Unit in 2007 and was appointed as Medical Director of the RNHRD in 2014. Dr Korendowych’s main clinical and research interests are in Psoriatic Arthritis (PsA) and the Autoimmune Connective Tissue Disorders especially Lupus.

Dr Korendowych was awarded an Arthritis Research Campaign Travelling Fellowship to undertake a PhD in Australia in 2001-2003. In 2004 she was awarded her PhD by the University of Bath for ‘An Immunogenetic Study of Psoriatic Arthritis’. She has published widely on PsA and has led national workshops on the clinical assessment of PsA. She is a member of the International Consortium of experts in PsA known as GRAPPA (Group for Research and Assessment of Psoriasis and Psoriatic Arthritis). She is a member and former Steering Group founding member of PAGE (PsA Genetics European Consortium) which facilitates collaborative research across Europe into the Genetics of PsA. She is a founder member of BRIT-PACT (British PsA Consortium). She is a medical advisor for the Psoriasis and Psoriatic Arthritis Alliance. She undertakes Clinical trials in PsA and contributes to a number of non-commercial research programmes at the RNHRD in Bath on outcome measures, genetics, biomarkers and biologics in PsA. She is the National Expert for NICE appraisals for biologics in PsA for the British Society of Rheumatology. In 2007, she established one of the first dedicated PsA biologics clinics in the country which attracts referrals from around the UK. Her main areas of expertise are in biologic therapy, outcome measures and assessment, co-morbidities and the immunogenetics of PsA.

Dr Korendowych also leads the Lupus service at the RNHRD and developed a dedicated Lupus clinic to assess outcome measures and co-morbidities in patients with Lupus. In 2015, Dr Korendowych and her team were recognised as a Lupus Centre of Excellence by Lupus UK.


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James Faukner

Harrow Smile Clinic

Welcome to Harrow Smile Clinic!

The Harrow Smile Clinic in Wealdstone focuses on offering painless dental treatment using latest technologies, techniques and procedures delivered with utmost comfort and friendly environment.

Dental Implants in Harrow delivers painless teeth implants a better long term solution to broken and missing tooth. Implants by Harrow Smile Clinic is known as a safe option for achieving back a great smile and confidence to bite & chew.

Teeth Straightening in Harrow is an effective orthodontic treatment focused on straightening and aligning teeth through wires and brackets. It helps correct the bite problems.


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Philip Helliwell

Associate Professor in Rheumatology, University of Leeds, UK; Honorary Consultant Rheumatologist, Leeds Teaching Hospitals and Bradford Teaching Hospitals NHS Trust

Philip Helliwell is currently Associate Professor in Rheumatology at the University of Leeds, UK, and Honorary Consultant Rheumatologist for the Leeds Teaching Hospitals and Bradford Teaching Hospitals NHS Trust.

Dr Helliwell qualified in Oxford in 1972 and worked initially in London before returning to work in his native Yorkshire in medical physics. After a period working in Australia and New Zealand he returned in 1985 to Leeds to join Prof Verna Wright and to work on psoriatic arthritis and biomechanics.

Dr Helliwell is a member of ASAS (Assessment of Spondyloarthropathy Society) and co-founder and President of the Group for Research and Assessment of Psoriasis and Psoriatic arthritis (GRAPPA). He established and led the CASPAR study for classification of psoriatic arthritis. He has worked with GRAPPA in developing single and composite outcome measures in psoriatic arthritis and completed the first treat to target strategy study (TICOPA) in early psoriatic arthritis.

He is co-founder and co-lead for the Bradford (University) Diploma in Rheumatology and Musculoskeletal Medicine and is an active member of the Bradford and Airedale Musculoskeletal Alliance, a tier 2 service provided to GPs in the designated geographical area.

Dr Helliwell is co-founder of the Leeds foot and ankle studies group and has published widely on foot and ankle problems in inflammatory arthritis including rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. He has contributed to several guidelines on management of foot and ankle problems in the UK.

Dr Helliwell has published over 300 peer reviewed papers. Current and past research in psoriatic arthritis includes treatment paradigms, clinical features and classification of psoriatic arthritis and community based studies of psoriasis and psoriatic arthritis. He has also published on biomechanics of joints, gait assessment and foot disorders in inflammatory and non-inflammatory arthritis, and epidemiology of rheumatic diseases.


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  • 'Drunkorexia' is a growing and dangerous trend among young people to eat less, purge or exercise excessively before binge drinking
  • Purging prior to drinking includes vomiting, laxatives or self-starvation
  • The intention is to save calories for binge-drinking
  • 41% of 18 to 24 year olds in a 2016 survey of 3,000 say they are not concerned about their overall health
  • Health providers are wasting millions on traditional healthcare education
  • Experts say we need to rethink how to encourage people to assume greater personal responsibility and accountability for their health
  • Healthcare providers have failed to leverage ubiquitous technologies and people’s changed lifestyles to engage and educate patients
  • To reduce the burden of drunkorexia healthcare providers will need to gain a better understanding of patients’ behaviors and ubiquitous 21st century technologies

Drunkorexia: a devastating and costly growing condition
 
Drunkorexia is using extreme weight control methods as a means to compensate for planned binge drinking. The French refer to it as alcoolorexie: l'ivresse sans les kilos. Manger moins pour être ivre plus vite et ne pas trop grossir. Drunkorexia is a term coined by the media to describe the combination of disordered eating and heavy alcohol consumption. The condition is gaining recognition in the fields of co-occurring disorders (people who have both substance use and mental health disorders), psychiatry, and addictionology. The term attempts to reconcile 2 conflicting cultures: binge drinking and a desire to be thin. The former involves ingesting significant amounts of unwanted extra calories, so people starve themselves in preparation for a night out drinking. Drunkorexia results in significant human costs from hypoglycaemia, depression, memory loss, and liver disease, and substantial and unnecessary costs to healthcare providers.
 
Experts argue that traditional methods to lower the burden of drunkorexia cost millions and are failing, and suggest there is an urgent need to, “rethink how we try and engage with people and try and encourage them to assume greater personal responsibility and accountability for their health.” This Commentary describes drunkorexia, reports some research findings on the condition, and suggests health providers would lower the large and growing burden of drunkorexia by leveraging ubiquitous technologies such as the Internet and smartphones.
 
Not an officially medical diagnosis

Drunkorexia is not an officially recognized medical condition. There is no mention of it in Mediline Plus, the US National Institutes of Health's online medical information service produced by the National Library of Medicine. It is not mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association, and popularly known as  “The Psychiatrist’s Bible”. Neither is the condition included in the World Health Organization's International Classification of Disease; nor in WebMD, the UK’s NHS online, NHS Choices, and the UK’s General Medical Council’s (GMC) website.
Signs and symptoms
 
Signs and symptoms include calorie counting to ensure no weight is gained when binge drinking, missing meals to conserve calories so that they can be spent on the consumption of alcohol, over-exercising to counterbalance calorie intake, and binge drinking to vomit previously digested food.

A dangerous condition

Despite evidence to suggest that more people are turning away from alcohol and becoming teetotallers, the prevalence of drunkorexia is increasing.

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Orthorexia: when eating healthily becomes unhealthy

It is a dangerous trend, especially among young people, which can lead to an array of physical and psychological consequences. For example, drinking in a state of malnutrition can predispose you to a higher rate of blackouts, alcohol poisoning, alcohol-related injury, violence, or illness. Drinking on an empty stomach allows ethanol to reach the blood system more rapidly, and raises your blood alcohol content often with dangerous speed. This can render you more vulnerable to alcohol-related brain damage. In addition, alcohol abuse can have a detrimental impact on hydration and your body's retention of minerals and nutrients, further exacerbating the consequences of malnutrition, and damaging your cognitive faculties. This can lead to short and long-term cognitive problems, including difficulty concentrating and making decisions, which ultimately can have a negative impact on academic and work-related performance. Drunkorexia also increases the risk of developing more serious eating disorders and alcohol abuse problems. As binge drinking is involved there is also a greater risk of violence, of risky sexual behavior, alcohol poisoning, substance abuse and chronic disease later in life.
 
Research

Although much of the research on drunkorexia is focused on university students, the condition is believed to be more widely spread. A challenge for researchers is the attitudes of university administrators and parents who are reluctant to admit that there is a problem either in their institutions or homes. The condition is often dismissed as a rite-of-passage. Notwithstanding, there have been a number of research studies, which suggest that drunkorexia is significant, growing fast and dangerous.
 
University of Missouri study

A 2011 University of Missouri study of the relationship between alcohol misuse and disordered eating, including calorie restriction and purging, suggests that drunkorexia is predominately a young women’s condition, which could affect their long-term health. The study found that 16% of respondents reported restricting calories to "save them" for drinking. 67% of students who restrict calories prior to binge drinking did so to prevent weight gain, while 21% did so to facilitate alcohol intoxication. 3 times as many women reported engaging in the behavior than men, and their stated motivations included “preventing weight gain”, “getting intoxicated faster” and “saving money”, which could be either spent on food or to buy alcohol. According to Victoria Osborne, Professor of Social Work and Public Health at the university, and lead author of the study, drunkorexia can have dangerous cognitive, behavioural and physical consequences. It also puts people at risk for developing more serious eating disorders or addiction problems.
 
Australian study

In an Australian context, a 2013 study surveyed 139 female university students, aged between 18 and 29 to examine compensatory eating and behaviors in response to alcohol consumption to test for drunkorexia symptomatology. 79% of respondents engaged in characterized drunkorexia behavior. The study also found that social norms of drinking, and the social norms associated with body image and thinness, impacted significantly upon the motivation for these behaviors.
 
University of Houston study

Findings of a University of Houston study on drunkorexia presented at the 2016 annual meeting of the Research Society on Alcoholism in New Orleans, found that 80% of the 1,200 students surveyed had at least one heavy night of drinking in the previous month, and engaged in drunkorexic behavior. The methods of purging prior to drinking include vomiting, use of laxatives or missing meals. The study also reported that the condition is not limited to the US, and is present in both men and women.
 
Benenden’s National Health study
 
Healthcare group Benenden’s 2016 National Health Report suggests that drunkorexia is gaining ground among young people in the UK, and creating concerns among healthcare professionals. According to the study, young people in the UK prefer to eat less in order to “save” calories for alcohol consumption. Of the 3,000 people surveyed, 2 out of 5 (41%), between the ages of 18 and 24 said they eat healthily only to look good, but are not concerned about their overall health. According to the report, “Pressure to be slim, an awareness of exercising calorie control, and peer pressure to drink large amounts of alcohol are all factors in this phenomenon”, adding that a growing number of men are following this trend.

Survey participants were also asked general questions about healthy lifestyles. “By and large, the findings highlight that the public is in denial about how much they think they know about healthy eating, they claim to be near-experts, but when drilling down to real-life examples, the vast majority of respondents failed to choose the right answer to simple diet-related questions, or the healthier option when offered the choice between everyday food and drinks,” the report found.
 
There also seems to be a woeful lack of awareness about basic dietary advice, despite legislation and attempts by the food production and manufacturing industry. It isn't clear whether this is down to poor education or a lack of interest, but I think we need to rethink how we try and engage with people and try and encourage them to assume greater personal responsibility and accountability for their health," says Dr John Giles, Benenden’s medical director.

Traditional healthcare providers failing

Traditional healthcare providers continue to waste billions on failing traditional methods of engaging and educating patients. Increasing self-management of your health is relevant, especially as primary care resources are shrinking as the prevalence of drunkorexia is rapidly increasing. However, achieving effective education and self-management requires a fundamental transformation of the way healthcare is delivered. The majority of people living with drunkorexia regularly use their smartphones for 24-hour banking, education, entertainment, shopping, and dating. Health providers have failed to effectively leverage this vast and rapidly growing free infrastructure and people’s changed lifestyles to introduce effective educational support systems to enhance the quality of drunkorexia care, increase efficiency, and improve patient outcomes. Today, mobile technology is part of everyday life and people expect to be connected with their relevant healthcare providers 24-7, 365 days of the year from anywhere. 

Takeaways

A necessary pre-requisite for effective healthcare education to reduce the burden of drunkorexia is the actual engagement of people with the condition. Once patients are engaged, education should inform and empower people, and provide them with access to continuous self-management support. This is substantially different to the way traditional healthcare education is delivered as it transforms the patient–educator relationship into a continuous, rich, collaborative partnership. 
 

 

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Oliver Fitzgerald

Newman Clinical Research Professor; Consultant Rheumatologist

Professor Oliver FitzGerald is a Consultant Rheumatologist at St Vincent's University Hospital, and a Newman Clinical Research Professor at the Conway Institute, UCD.

Professor FitzGerald has published over 240 peer-reviewed papers, many on the subject of psoriasis and psoriatic arthritis. His main research interests in psoriatic arthritis include clinical and therapeutic studies; the development of novel imaging techniques for measuring synovial or entheseal inflammation, including ultrasound and MRI; analysis of synovial and skin cellular and cytokine profiles; and more recently, studies of gene and protein expression in diseased tissue. He currently receives research-funding support from the Irish Health Research Board and a number of pharmaceutical companies.

Professor FitzGerald has served on a number of editorial boards. He is a council member of the Group for Research and Assessment in Psoriasis and Psoriatic Arthritis (GRAPPA) and a member of both the European Synovitis Study Group and the Assessment of SpondyloArthritis international Society (ASAS). As a GRAPPA member and in his work with the Outcome Measures in Rheumatology Clinical Trials (OMERACT) group, he is leading the effort to develop soluble biomarkers in psoriatic arthritis.


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