Are We Losing The Battle Of The Bulge?

By Jeff Hall, Editor-in-Chief

The statistics from a recently released government survey are staggering to say the least. Approximately 59 million adults in the United States over the age of 20 are obese. That’s almost a third of the country who are 30 or more pounds above a healthy body weight. According to the American Diabetes Association, the new figures on obesity have doubled from a similar survey done two decades ago. There’s no doubt about the link between these statistics and the increasing prevalence of Type 2 diabetes. Obviously, obese people are at a greater risk of insulin resistance and glucose intolerance, which fuel the rise of diabetes. In fact, the numbers may not be all that surprising for podiatrists. Gathering informal estimates from a handful of DPMs found that between 50 to 60 percent of their diabetes patients are obese. Given the fact that these patients are frequent visitors to podiatric offices, can DPMs help make an impact in countering the prevalence of obesity? 1. Have a heightened awareness of high-risk groups. According to the study of over 4,000 people which was reported on in the Journal of the American Medical Association, there were increases in obesity across the board for men, women and children. However, particularly alarming obesity percentages were noted for African-American women (50 percent) and Mexican-American women (40 percent). Re-emphasizing to your staff the importance of obtaining a thorough family history may also help identify at-risk patients. 2. Discuss weight loss with patients who need it. This may not be the easiest subject to broach and if you’re seeing 40 or more patients a day, you certainly don’t have much time to do a lot of hand-holding. Certainly, it would help to point out weight loss can have a positive impact on a particular condition that a patient has come to see you about. While the degree of subtlety or bluntness you use would be on a case-by-case basis, it’s important to remind or point out to obese patients their increased risks for stroke, coronary heart disease and Type 2 diabetes. It’s also essential to point out that patients can make lifestyle changes that can improve their health. According to the JAMA study, “Clinical trials have demonstrated that a structured lifestyle intervention including dietary change, weight loss and increased physical activity can reduce the risk of progressing to diabetes mellitus from impaired glucose tolerance.” 3. Get the patient to be an active participant in his or her turnaround. Granted, affecting significant change can be difficult, but emphasizing empathy and encouragement can’t hurt. Perhaps you can draw upon your own experience in shedding a few pounds or a family member’s dedication to regular exercise. Another approach might be getting the patient to talk about an exercise he or she used to do or would like to start doing. 4. Make appropriate referrals when necessary. If the patient is struggling to manage his or her blood sugar, getting a nutritionist consult may be in order. One DPM notes that you may need to obtain lab tests, such as food allergy testing, neurotransmittter testing and testing of the thyroid gland function, in order to identify underlying metabolic problems that are affecting a patient’s weight. Another DPM notes that morbidly obese patients may need to be evaluated by other specialists for possible gastric bypass surgery. While taking all of these steps may be difficult in a time-challenged, managed care environment, it’s clear that DPMs can play a key role in facilitating improved care and encouraging self-care for this patient population.

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