Acute whiplash injuries are a common cause of soft tissue trauma for which the standard treatment is rest and initial immobilisation with a soft cervical collar. Because the efficacy of this treatment is unknown a randomised study in 61 patients was carried out comparing the standard treatment with an alternative regimen of early active mobilisation. Results showed that eight weeks after the accident the degree of improvement seen in the actively treated group compared with the group given standard treatment was significantly greater for both cervical movement (p<005) and intensity of pain (p<0-0125). IntroductionRear end collisions causing soft tissue injuries of the neck are common and constitute about 20% of all vehicle accidents.' The term whiplash has been coined to describe those injuries due to sudden flexion and hyperextension of the cervical spine. Hyperextension is thought to be the main cause of damage,2 and the severity of injury depends on the degree of movement of the head and neck on the trunk and the acceleration.3 These injuries frequently result in prolonged disability, but because of subsequent litigation the authenticity of such symptoms has been queried.43 Recently Merskey reviewed published reports and concluded that many patients genuinely have protracted symptoms.6 The reports, however, have not placed any emphasis on treatment, concentrating instead on prognosis because of its medicolegal importance. 8 Treatment of whiplash injuries entails a period of immobility using a soft cervical collar and simple analgesia before gradual mobilisation. As the efficacy of this treatment is unknown we examined the response of patients to the standard treatment compared with that of another group given alternative treatment of daily neck exercises and mobilisation using the Maitland technique.

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The prevalence of obesity is rising, with current UK statistics indicating that 68 % of men and 58 % of women are classified as overweight or obese (1) . Consequently, effective weight management is of increasing importance and considerable attention is being placed on the use of functional ingredients in foods that are less energy dense and more satiating. The aim of this study was to investigate the effect of SlimBiome, a commercially available product, on food cravings and the responsiveness of individuals to the food environment, which are characteristics associated with hunger (2,3) , in overweight and obese women following standard nutritional advice. SlimBiome contains fibre (glucomannan), prebiotics and chromium, which have been shown to increase satiety and reduce energy intake, hunger and fat cravings in overweight and obese adults (4)(5)(6) .A double-blind, randomised, placebo-controlled study was conducted in 20 overweight and obese women over a 4-week period. Inclusion criteria included women aged 18-65 years, with a body mass index between 25-35 kg/m 2 , no significant health problems, and no history of dieting within the month prior to starting the study. Participants attended three study visits at week 0, week 1 and week 4. At week 0 they were randomly assigned to receive the test drink or placebo and were instructed to consume the drink three times a day for 4 weeks. At each visit, participants rated subjective sensations of appetite before and after consuming the test drink or placebo and completed the Control of Eating Questionnaire (CofEQ) (7) and the Power of Food Scale (POF) (8) . During the week 0 visit, standard nutritional advice based on the Eat Well Guide was provided to all participants. Differences in week 0 and week 4 POF Scale scores for both groups were assessed using Wilcoxon signed-rank tests. Differences between group week 4 CofEQ scores were assessed using analysis of covariance (ANCOVA), including baseline scores from week 0 as covariates.For the CofEQ, ratings in response to 'How hungry have you felt?' at week 4 were significantly lower in the treatment group compared to the placebo group (P = 0·034). No significant differences were observed between the groups at week 4 for CofEQ items assessing frequency or strength of food cravings (P > 0·05 for all items). For the POF Scale, scores decreased significantly after the 4-week intervention period in both the placebo group (P = 0·035) and the treatment group (P = 0·007).In conclusion, subjective feelings of hunger measured by the CofEQ were significantly reduced in women who consumed SlimBiome compared to placebo. Although cravings appeared to subside more in women consuming SlimBiome, no significant difference was seen compared to placebo. This may be due to both groups becoming less responsive to the food environment, a characteristic shown to predict strength of and ability to resist cravings (3) .

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