Dr. Hussain Al-Zubaidi

As well as being a renowned lifestyle TV doctor, Al-Zubaidi spearheads a pioneering NHS-based lifestyle clinic and fitness club, educating and supporting patients in adopting healthier lifestyles. He talks to WellNation about how the health and physical activity sectors can work together to create a healthy nation – and save the NHS

Many will recognise Dr. Hussain Al-Zubaidi as a “TV doctor” – but he is also an accomplished Team GB age group long-distance triathlete. He also holds a number of key roles, including Lifestyle and Physical Activity Lead at the Royal College of GPs and Personalised Care Lead in Leamington. As a Clinical Advisor for Swim England and Nutritank, he brings expertise to diverse sectors.

Emphasising health span, he advocates for sustained wellbeing and is a dynamic force in promoting holistic wellbeing, community engagement and longevity.

You’re a huge advocate of physical activity and exercise as medicine, where does that passion come from? It’s not something I’ve always had. In fact, I didn’t enjoy exercise or sport growing up! I was very much the last one picked for teams and had quite a negative experience of how PE was delivered. In my mid-20s, however, I was diagnosed with non- alcoholic fatty liver disease. It’s a condition often associated with being overweight – which I was at the time. The sonographer told me that I had one of the fattest livers he’d ever seen, which isn’t a league table you want to be top of. The initial talks with hospital doctors and my GP centred on what medications I could try. The thing is, my father had been diagnosed with the exact same condition five or six years previously – and his health had been deteriorating because of it. So I considered whether there was an alternative to taking all these pills.

Today, being physically active is an absolute cornerstone of my existence

I did a bit of researching and realised that a lot of what I had been taught at medical school didn’t even cover the basics when it came to key lifestyle interventions which have a massive, positive impact on a number of conditions. This was particularly true for metabolic health, which is what fatty liver disease sits under.

So with the support of my incredible wife, who was already physically active when I received the diagnosis, I was encouraged to start doing a bit of walking, which then eventually became running. It “escalated” step by step.

Today, being physically active is an absolute cornerstone of my existence. I wouldn’t want to live without it. Thanks to it, I managed to not only reverse the condition, but also have better mental health, improved confidence and a real purpose in life – because I want to support patients to go on a similar journey that I have.

I now utilise my own personal journey when treating patients. I run NHS Lifestyle group clinics and, at the beginning of sessions, I connect with them and share how I’ve been in the same position they find themselves in.

Our success has been down to motivating both the activity providers and the health care professionals and to help them see the benefits

Is the message – that prevention can save the NHS – being heard in Westminster? In some sense yes, but not enough. There have been changes already within healthcare. Small but important changes where we’re seeing more physical activity being embedded, for example, within GP and hospital consultations. But we need to see a lot more of it.

It’s also happening in pockets. Take the group clinics where we be support people to get active. We go on walks and runs with patients and we have swimming sessions where we’ve linked up with our local leisure centre operator, which provides pool access to those with long-term conditions. These kind of interventions would have been pretty rare to see just 10 to 15 years ago. So in that sense, we are seeing positive noises.

MPs like Kim Leadbeater have done fantastic work in trying to champion this, but I do want to see a lot more of it. Because when we look at the amount of money we spend on trying to correct the impact of long term health conditions and compare it to the tiny amounts we spend on supporting patient journeys through connecting the physical activity sector with health, it is just very disappointing.

We have seen that for every pound spent on physical activity, you get four pounds back in terms of social, health and economic benefits. So I do want to see more action from Westminster. I think it’s now clear that the health sector needs to work together with the physical activity sector if we really want to create a nation that isn’t burdened with long-term health conditions.

According to the World Health Organization, if we could encourage people to adopt diets and exercise habits that we know provide health, then 60% to 70% of the long-term health conditions that are currently diagnosed would not exist. That would completely transform the NHS. We know that this is possible – the question is do we have the will to make it achievable.

How big a role can physical activity and exercise play in that preventative model? Physical activity is a cornerstone of good health. Simply put, if we aren’t physically active, we will not maintain a healthy life. However, because of the lack of training that healthcare professionals get on physical activity, we’re not equipped to support patients effectively.

There are a few doctors that are lifestyle doctors, like myself, who have done additional training to become adept at supporting patients embark on a journey involving exercise. But 85% of GPs don’t even know what the chief medical officers’ physical activity guidelines are. And that is exceptionally disappointing because those GPs aren’t going to feel confident to support patients to become more active. In fact many healthcare professionals struggle to get active themselves – and if they’re not leading by example, they’re going to be unable to encourage and support patients to do the same.

That’s where I feel there is a need for a piece of work to educate and support healthcare professionals. To make them more comfortable talking about physical activity – and the physical activity sector could do that for us.

Those within the sport, physical activity and fitness sectors are experts in supporting people to become more active in a way that’s meaningful to them. I believe it’s our role, within the healthcare sector, to signpost and to refer patients towards those exercise and activity providers – the sports clubs, the walking or dance groups, personal trainers, the leisure centres and swimming pools. If we do that, then together we can achieve the end goal which is an active and healthy patient.

Is the sports and physical activity sector fulfilling its role? It’s a mixed picture at the moment. We have areas you’d describe as gold standard and others where nothing is happening. For example, my local leisure centre, operated by Everyone Active, works collaboratively with my GP practice to put health and wellbeing high up the agenda. They support us in delivering swim sessions for patients with long-term health conditions, accompanied by healthcare professionals and social prescribers. So the patients receive all the support they need on their journey. We also work with a number of local clubs – from cycling to dance.

Our success has been down to motivating both the activity providers and the health care professionals and to help them see the benefits. And I believe that’s the only way to make it work. There are other areas, where either the healthcare workers or the physical activity providers aren’t engaged in getting patients on that journey. As a result, getting patients active isn’t seen as a priority. When this happens, it is often difficult to get the conversation started. There might be activity providers keen to get involved but hit a brick wall trying to talk to the local GPs – or the other way around. That’s something we need to work on – to establish clear lines of communication between these two sectors.

What will help is placing wellbeing high in the agenda within those working in the physical activity sector – from sports to fitness. And that’s where language is important. Sport isn’t just about competition and fitness isn’t just about hitting the gym hard. If we’re going to engage a wider proportion of people then we have to look further than the competitive element. We have to incorporate the elements of community and stress that being active has these huge health benefits.

Physical activity is crucial for a healthy, happy life

Is the healthcare sector ready to support patients getting active? If I’m being brutally honest we’re not there yet – but we are improving. In the past 10 years we’ve seen GP practices get involved with operators such as ParkRun to get patients to walk, run or even just to volunteer at weekends. Around 1,800 out of 6,000 practices in the UK have signed up to that initiative, so we’re getting close to a third being involved.

There is definitely a growing trend for more clinicians to practice lifestyle medicine. This year’s British Society of Lifestyle Medicine (BSLM) conference was the biggest ever and BSLM’s membership is at a record level. So there is growth and more clinicians are wanting to support patients through behaviour change and getting active. But I don’t think it’s happening fast enough.

I really hope over the next five years we will see an exponential increase, because patients need it. The NHS needs it. Otherwise, it will soon become unsustainable to have a national health service.

Are there ways to help create that growth and speed things up? We can very much improve the situation – it is within our hands. I think there are two main things that are required for it to be achievable.

One is that we need government and senior leadership explaining, explicitly, the importance of healthy lifestyles to promote health. It sounds crazy, but we do not have enough of that. It needs to be really clear that both our senior clinicians and our senior politicians are singing from the same hymn sheet, explaining how physical activity is crucial for a healthy, happy life.

The second element is to learn from and expand the programmes that are currently achieving great results in pockets across the UK. We need to fi nd ways to grow out the projects in areas that are doing fantastic work – perhaps through supported funding.

This is something that I’ll be working on in 2024, together with a number of organisations, including Sport England, the Royal College of GPs and many more. We want to take what we call the Leamington blueprint, which involves group education on exercise, physical activity sessions and GP practices integrating with facility and activity operators.

By working collaboratively, we want to blur the lines that patients experience between the health and physical activity sector – we want patients to think of it as one service. We call it the Leamington Personalised Care Service, because we’re focused on helping their health – whether that be a personal trainer delivering chair-based exercises, a social prescriber helping them to access art therapy groups or dance classes, or a health and wellbeing coach supporting them with behaviour change. We need to look beyond having health, physical activity and community services in their own silos. We need to communicate and work with each other, together.

If you could introduce a new piece of legislation or change an existing law - what would that be for maximum impact? I would remove VAT from the provision of anything that’s related to promoting physical activity. We should not be charging a tax on anything to do with promoting healthy behaviours.

It’s about friction. You want to increase friction on activities that are detrimental to health, such as tobacco and alcohol, so you add taxes to those. But you want to reduce friction on activities that do the opposite, to the activities and items that provide health.

People who are being active – alongside those who support them to be active – are improving the finances of the country. They are reducing their impact on the NHS and other services, so we should not be charging taxes on those activities. ●