Stanley Feld M.D.,FACP,MACE
There has been little progress in this war because of cultural conditioning and a lack of emphasis on personal responsibility.
Every New Year’s Day millions of Americans make New Year resolutions to lose weight. They are initially successful. They then regain the weight they have lost.
If America is going to solve the healthcare systems unsustainable cost, it is going to have to solve the increasing Obesity problem.
The National Institute of Diabetes (niddk.nih} recently published Overweight and Obesity statistics:
“ More than 1 in 20 (6.3 percent) have extreme obesity.”
“ Almost 3 in 4 men (74 percent) are considered to be overweight or obese.”
Each year the obesity problem gets worse. Companies have sprung up selling weight loss formulas. These companies advertise their great success.
However, most of the iconic personalities used in their advertising have regained their weight after experiencing mild or significant weight loss.
- Sixty-three percent of men and 55% of women had a body mass index of 25 kg/m2 or greater.
- A graded increase in the prevalence ratio (PR) was observed with increasing severity of overweight and obesity for all of the health outcomes except for coronary heart disease in men and high blood cholesterol level in both men and women.
- With normal-weight individuals as the reference, for individuals with BMIs of at least 40 kg/m2 and who were younger than 55 years, PRs were highest for type 2 diabetes for men (PR, 18.1; 95% confidence interval [CI], 6.7-46.8)
- Women (PR, 12.9; 95% CI, 5.7-28.1]
- Gallbladder disease for men (PR, 21.1; 95% CI, 4.1-84.2) and women (PR, 5.2; 95% CI, 2.9-8.9).
- Prevalence ratios generally were greater in younger than in older adults.
- The prevalence of having 2 or more health conditions increased with weight status category across all racial and ethnic subgroups.
The Prevalence Ratio of Obesity and Type 2 Diabetes is 18.1 for men and 12.9 for women.
Therefore Type 2 Diabetes is very prevalent in both Obese and Overweight men and women.
- Up to 75% of adults with diabetes also have hypertension, and patients with hypertension alone often show evidence of insulin resistance.
- Hypertension and diabetes are common, intertwined conditions that share a significant overlap in underlying risk factors (including ethnicity, familial, dyslipidemia, and lifestyle determinants) and complications.
- These complications include microvascular and macrovascular disorders. The macrovascular complications, which are well recognized in patients with longstanding diabetes or hypertension, include coronary artery disease, myocardial infarction, stroke, congestive heart failure, and peripheral vascular disease.
- Although microvascular complications (retinopathy, nephropathy, and neuropathy) are conventionally linked to hyperglycemia, studies have shown that hypertension constitutes an important risk factor, especially for nephropathy.
Eighty percent of the treatment costs for diabetes and hypertension to the healthcare system is the result of the treatment of the complications of hypertension and diabetes.
In order for a healthcare system to be sustainable diabetes and hypertension must be cured. It is essential that each must be recognized early and treated aggressively.
Patients must be taught to be “the professor of their disease” so they can self-manage the control of their disease. Blood pressures and blood sugar are changing continuously. Patients live with their disease 24/7.
This takes a lot of personal responsibility and personal discipline.
Equally important is the morbidity resulting from the complications of diabetes and hypertension, two diseases that result from obesity.
Complications from the onset of both hypertension and diabetes take about eight years to develop. This is the reason to diagnose and discover Pre-Diabetes at the onset.
- The shared lifestyle factors in the etiology of hypertension and diabetes provide ample opportunity for non-pharmacological intervention.
- Thus, the initial approach to the management of both diabetes and hypertension must emphasize weight control, physical activity, and dietary modification.
Lifestyle intervention is remarkably effective in the primary prevention of diabetes and hypertension. These principles also are pertinent to the prevention of downstream macrovascular complications of the two disorders.
This is the where my story of the importance of personal responsibility comes in.
A restaurateur, in his early 50’s, who runs a large restaurant in Dallas, that I frequent, was slowly gaining weight. At 269 lbs. he had difficulty standing on his feet all day long. He was being treated for hypertension and hyperlipidemia (high cholesterol).
His physician told him he must lose weight. He informed him of his risk factors for the complications of these diseases.
This was all he needed hear. The thought of having to quit the job he loved and the possibility of dying from the complications of his diseases was enough to make him decide to loss the weight.
He was told he would be fine if he lost the weight.
He has lost 70 lbs.so far without assistence. He has decided to be personally responsible for his weight loss.
He now gets up at 5 am each morning and exercises for one hour each day before work.
He has stopped eating his wonderful pasta dishes. He eats nothing that is white.
Every time I meet a friend at the restaurant, the restaurateur sits down at our table for a chat. We usually talk about how great he is doing in the weight loss department.
I had initiated an obesity program at Endocrine Associates of Dallas P.A. in the mid 1980s. A California clinical endocrinologist, with whom I did my endocrine fellowship with, had a very successful obesity program. He convinced me to start one at EAD.
Patients on large doses of insulin were totally off insulin after two weeks. It was successful until the patients graduated from the program.
Unfortunately the recidivism rate (regaining weight) was around 80%. This rate was not dissimilar to the national overage at the time.
EAD stopped the program.
In my view there were not enough patients who turned the corner and stuck to the program.
I believe the restaurateur has turned the corner. This fellow has turned the personal responsibility corner to control his food intake and exercise output. I do not believe he will regain his weight.
He has exhibited personal responsibility for his health and well-being.
If only physicians could solve the obesity problem so easily, the cost of healthcare would plummet to sustainable levels.
The development of Type 2 Diabetes Mellitus would also plummet and the cost of the treatment of its complications would vanish.
Social change is necessary in restaurants and fast food chains.
People have to be taught to eat wisely in restaurants and at home.
People have to be provided with education about the perils of obesity.
People have to understand the natural history of obesity.
People have to be motivated to not only maintain their health. They have to be given financial incentives to control their health.
This can only be achieved with a consumer driven healthcare system in which people are provided with incentives to control their healthcare dollars.
The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.
All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE
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