Nerd Alert

September 23, 2011 at 1:33 pm 10 comments

I try not to be a complainer about school on my blog. I’ll drop the occasional hint that I am stressed or that school is difficult, but let’s be real here: I am in medical school and that is to be expected. The last few weeks of school have been legitimately hard for me because I wasn’t enjoying the material. Every second of studying felt like work and by the end of the module, I was left questioning if medicine was something I was truly passionate about. It is so nice to be reminded that the answer to that question is yes! We have moved from studying infectious diseases to the cardiovascular system, and I am really enjoying. There is still a lot of work, I am still stressed and school is still difficult, but I am enjoying learning again!

The best part of this block is the practicality of it (many of my future patients will have heart disease, but I am unlikely to see a rare fungal disease that I just spent hours memorizing!). I am interested in primary care and preventative medicine, and there is no better example of the importance of lifestyle interventions than in the cardiovascular system. First some sobering statistics, then some good news, and then I have a question at the end that I would love your feedback on!

Some sobering stats:

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    • The newest reports show that 68% of American adults and 20% of American children are overweight (BMI > 25). The super obese (BMI > 50) is the fastest growing segment of the population. By 2025, 50% of the US will be obese (BMI > 30). This is some scary stuff! While it is commonly assumed that obesity is an American epidemic, that is not all true either. It is more prevalent here, but upward trends are beginning in many other countries as well.
    • Obesity is the 2nd leading cause of cardiovascular related deaths, second to cigarette smoking. This kills more than 400,00 people per year!
    • Cardiovascular disease is the leading cause of death in the US, and actually kills more women than men annually.
    • Cardiovascular disease and hypertension, when combined, cost more in health care dollars than cancer and trauma-related injury.
    • The estimated annual cost of cardiovascular disease, including productivity hours lost, is $287 billion dollars.

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I could continue. Each of our lectures begin with slides packed with graphs, charts, and statistics that make my mouth drop. We are a nation in a disease crisis, but it is insidious and difficult to confront. Unlike the flu pandemic or vaccination campaign to eradicate small pox, public health initiatives seem to be making little headway against disease. Something needs to change.
Time for some good news… it doesn’t take much! Too often, a healthy lifestyle is seen as an all or nothing approach. For some, jumping head first into a new lifestyle may be effective. But for many, it is overwhelming and prevents them from making any changes. Consider these facts:
  • The biggest gains in cardiovascular health come from just adding minimal physical activity. If the population is divided into five groups, 1 being sedentary and 5 being most active, a person reduces their risk of cardiovascular disease the most by moving from the first to second quintile. What does this mean? You don’t have to run a marathon to be healthy. You don’t even have to run! Just go for a walk at lunch time or before dinner a few times a week! Five 30-minute sessions of light aerobic activity is enough to cut your risk of heart disease in half. There are added gains of even more activity, but the biggest boost is the first step.

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source
  • One in seven new cases of type II diabetes can be prevented by a 7% weight loss and the addition of 150 minutes of physical activity per week. Lifestyle interventions have been proven more effective than medication therapy. 7% weight loss is pretty modest – 14lb for a 200lb person. A person can lose up to 20 lb in one year simply by cutting 125 calories (the equivalent of a can of soda or an extra slice of toast at breakfast). Again, not a major step for huge benefit.
  • Cardiovascular deaths can be cut in half by national and individual efforts to reduce major preventable  risk factors (smoking, obesity, high blood pressure, high cholesterol, etc.) If you are a nerd like me, check out the Million Hearts Initiative.
Enough data spewing, I think the point is pretty clear. Obesity is a real problem, and it has real health consequences. While obesity-related cardiac death kills almost as many people as cigarettes do, health professionals are half as likely to counsel patients on lifestyle changes as they are on smoking cessation. I have talked to my parents, who both have long struggled with their weight, about why this might be true. I have some ideas, but first I would like to hear yours!
Question: Why do you think doctors are reluctant to talk to their patients about weight reduction and lifestyle changes? If a doctor were to address these issues with you, how would you want them to do it? Have you been counseled by a physician before on lifestyle interventions, and what made this a good or a bad experience?
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WIAW Leftover Edition Freezing Summer

10 Comments Add your own

  • 1. Rufus' Food and Spirits Guide  |  September 23, 2011 at 5:11 pm

    No one wants to hear they’re fat or doing the wrong thing. Even if doctors say it nicely, and of course they would, that’s what people would hear. I think they just have to approach it like other issues and be straightforward, not overly judgmental and fact-based. My answer to 3 is no I have not been.

    Reply
    • 2. homemadeadventure  |  September 26, 2011 at 2:18 pm

      I totally agree. Do you think that it is a physician’s responsibility to provide counseling on this issue, or is this a more community level need?

      Reply
  • 3. goingsteadyblog  |  September 24, 2011 at 9:37 am

    Maybe doctors think it’s hopeless because so much of the population is headed toward extreme obesity? I don’t know. I’ve had several doctors talk to me about my cholesterol, and I always appreciate the gentle but firm method (although the one doctor who yelled at me was pretty effective, too!).

    Reply
    • 4. homemadeadventure  |  September 26, 2011 at 2:19 pm

      So many physicians are obese as well, so maybe they aren’t comfortable addressing issues they themselves struggle with. Glad to hear that gentle and forceful methods both had an effect on your healthy lifestyle decision!

      Reply
  • 5. Carol Newcomb  |  September 24, 2011 at 12:00 pm

    I agree, no one wants to hear that they’re fat! My doctor has “suggested” that I should lose weight, but she really doesn’t say much past that or really engage with me in any conversation or offer any real suggestions for achievable goals. It’s kind of like the doctor is writing a quick prescription-“lose weight”- ok I told her, I’ve done my job and now let’s move on. I believe real dialog between a primary doctor and their patients could be more effective. Offering simple little goals like you are giving us on this blog would be more helpful. Primary care has become more of a production line these days with the doctors having less and less time to really take care of their patients. But that is a whole different problem!! Keep it up Dr. Jen, you have been encourgaing me to make these little changes in my lifestyle. I am going to give up my daily glass of orange juice and make sure to walk the dog every night when I get home from work. I’ll let you know how I make out!!

    Reply
    • 6. homemadeadventure  |  September 26, 2011 at 2:21 pm

      I think you addressed a huge problem – who has time to go into deeper conversations about weight loss? It will obviously be hard to stomach if you are simply told, “you need to lose weight” but will be received better if that is backed with data of what health problems you are headed towards and simple ideas of things you can change.

      So proud of you Mom, keep up the small and steady changes!

      Reply
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