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Doctor's Diary We're not a bunch of slobs, says Dr James Le Fanu

SINCE Auberon Waugh's departure for heaven, life has lost some of its sparkle with no one left to mock officialdom's idiotic statistics. Recently, we learnt that one in five adults is now "obese", which is apparently a lot more than 20 years ago. You could have fooled me.

Certainly, lots of people would like to lose a bit of weight, but from the perspective of a doctor's surgery, I don't think of my patients as being fatter than they were, or consider that every fifth one through the door is life-threateningly obese.

No. This latest "shock report" is part of a well-established and offensive tradition among health do-gooders of portraying the public as being variously fat, ignorant and lazy slobs who have to be bullied by their betters into changing their ways.

Whenever I have been bothered to examine the statistics behind these claims, they have invariably turned out to be deliberately misleading - and there's no reason why this latest lot should be an exception.

Mr GT from Bristol - cheerfully active in winter, gloomy in the summer - is not alone. His is a typical case (though I have never seen it before) of reverse Seasonal Affective Disorder (SAD), that curious depressive illness associated with the short days and lack of sunshine in the winter months. The symptom of reverse SAD, however, is not lack of sunshine but too much, especially when associated with high temperatures. As Mrs JW from Bedford writes: "I'm not saying I like the extra hours of darkness in winter, but it is a small price to pay for cooler temperatures. In spring, autumn and winter I'm a busy, happy 57-year-old, but as soon as the temperature soars in summer, I am a worn-out, grumpy old crock."

For most, moving to a colder climate is not an option. There is a report of a woman whose mental state improved after five days of taking long cold showers every few hours. Standard anti-depressive medication during the summer months may help, and a couple of readers recommend St John's wort.

There have also been some further suggestions for Mr RC from Dorset about the kipper smell attributed two weeks ago to the light fitting on his desk. The first is "fish odour syndrome" - an inherited disorder of protein metabolism that is usually first noted in infants, but may not present itself until adulthood, when it probably accounts for about 10 per cent of those afflicted with malodour and who are frequently told their problem is "psychological" or they should improve their personal hygiene. Treatment requires a restrictive diet with no fish, for reasons to do with absorption of the offending proteins through the gut wall, and some may benefit from antibiotics. The other suggested sources for the kipper smell are a "smelly" tummy button and a "jam" of sweat and dead skin that may collect on the inner aspects of a wristwatch.

The "mystery syndromes" featured in this column, I discover, have become quite famous with doctors, who have been overheard in hospital canteens arguing the toss of what their cause might be. Here is a further brace - unusual variants of the two common problems: chest pain and headache.

Mrs MA from Oxford, writing on behalf of her sister-in-law, reports that for several years she has suffered stabbing pains that make her catch her breath, first on the left back side of the chest and then moving around to the front, associated with "pains going up both sides of the neck from behind the ear into the head". During these episodes, which can last up to five days, "she feels extremely ill, cannot remain in bed at night" and "does not know what to do with herself".

Mrs D M from Penarth, writing on behalf of her husband, seeks advice for the daily headache he has experienced for the past 18 months: "It starts as a buzzing, stuttering sensation that develops into a constant pain." He has been told by a neurologist that he has "cramp of the scalp muscle". Painkillers and muscle relaxants are ineffective and no other precipitating factor has been identified.

-- Anonymous, March 02, 2001