On Obesity Worldwide

April 19, 2010

The prevalence of obesity continues to increase worldwide. Reports indicate that in 2005, 1.6 billion individuals over the age of 15 were overweight, and at least 400 million were obese. Projected figures indicate that this will continue to increase, and that by 2015, 2.3 billion adults will be overweight, and more than 700 million will be obese. Though data from the Centers for Disease Control and Prevention (CDC) indicate that obesity rates among Americans have peaked, World Health Organization (WHO) statistics point to increasing obesity rates in both the developed and developing world.

Abnormal or excessive accumulation of body fat often indicates that an individual is “overweight” or “obese.” The body mass index (BMI) – the weight of an individual in kilograms divided by the square of their height in meters – provides a crude measure to determine into which category an individual falls. According to the WHO, a person with a BMI between 25 and 30 is generally considered overweight, and over 30 is generally defined as obese. Overweight and/or obese individuals are more susceptible to many serious health complications. Excess body weight has been shown to increase the risk of ischemic stroke by 22 percent in overweight individuals, and 64 percent in obese individuals. The Mayo Clinic reports that obesity can cause a number of additional health complications, including high blood pressure, heart disease, osteoarthritis, and type 2 diabetes. Reports also indicate that “in the U.S…. [an estimated] seven types of cancer…are weight related [and] just under 20 percent could be prevented through people being a healthy weight.”

Obesity is commonly thought of as a condition of the developed world. However, a 2007 survey found that the South Pacific island of Nauru was the nation with the highest percentage of overweight people – 94.5 percent of its population. Other small nations including the Federated States of Micronesia, Cook Islands, Niue, and Tonga were noted among the nations with over 90 percent of the population overweight or obese. The WHO notes that the “increased consumption of more energy-dense nutrient-poor foods…[and] reduced physical activity” have led to increased obesity rates worldwide. According to experts, people around the globe are being introduced to more “Western” lifestyles which often include an influx in the supply of unhealthy choices, reduction in exercise, and higher-stress occupations.

While this shift affects individuals worldwide, they are somewhat magnified in the United States where in the past 30 years, the number of obese adults has doubled, reaching nearly 34 percent, and the number of obese children has tripled to 17 percent. A study from the University of Michigan Health System shows that more Americans are becoming overweight or obese at a younger age and carrying the extra weight for longer than previous generations. According to research from Oxford University, the life expectancy of moderately obese individuals is reduced by about three years, and severely obese individuals’ life expectancy is reduced by 10 years. While obesity can be attributed to poor dietary selections or a lack of physical activity, research from the University of Texas Medical Branch at Galveston shows that a tendency towards obesity can be detected in infants as young as 6 months of age, and many of these infants are likely to continue to carry extra weight as they mature. To identify a means of overcoming obesity, researchers have continued to try to locate a genetic cause and help to improve treatment options. Findings from a indicate that the Chinese studyfat mass and obesity-associated gene (FTO) may be strongly linked to the predisposition for some individuals to gain weight more rapidly than others.

While there may be both genetic and behavioral causes for obesity, it can be prevented. Recent studies indicate that in teenagers who carry the FTO gene, physical activity can help to mitigate its effects. By gaining an understanding of the causes of obesity and preventative measures that can be taken, it may be possible to reduce its likelihood and detrimental effects.

Find out more about a recent study on medical care for obese patients

Check out the iCons in Medicine blog on Obesity and Nutrition or Join in on the iCons in Medicine Forums to discuss this and other public health topics


The Flu Vaccine

October 12, 2009

As new cases and concerns about seasonal flu and swine flu (H1N1) continue to spread worldwide, two vaccines have recently been made available. Both the nasal spray vaccine and injectable vaccine for seasonal flu have proven effective for specific portions of the population, however distribution is still slow. For the H1N1 (swine flu) virus, The Baltimore Sun reports, availability is still an issue and many areas have not yet received enough doses to meet the demand. While many in the developed world do not yet have access to the H1N1 vaccine, Dr. Bernadine Healy notes that the problem is even greater in the developing world. To help these nations fight the pandemic, the United States has agreed to donate 10 percent of its vaccination supply to the World Health Organization (WHO) – eight other nations will make similar donations.

Fantastic Image by Deborah Ervin

Inoculating individuals for both viruses is complicated by the time frame in which the vaccinations can occur. If one chooses nasal spray for both seasonal and swine flu, they must wait four weeks between doses, while if one is injected for one virus and uses nasal spray for the other, they can be administered together. Discovery Health reports that doctors recommend annual flu shots to lessen the chances of becoming ill. Individuals as young as six months can be inoculated, according to the Centers for Disease Control and Prevention (CDC) and side effects are reported to be minor. Because the virus used to make the seasonal flu vaccine is dead, it is not possible to contract flu from a flu shot, however one may expect a low-grade fever 8 to 24 hours following injection, a swollen or tender area around the injection site, a slight headache or chills within 24 hours.

The seasonal flu shot is an inactivated vaccine, and contains three influenza viruses – one A(H3N2) virus, one regular seasonal A(H1N1) virus (which differs from the 2009 H1N1 virus), and one B virus. The viruses used change annually based on international surveillance which track infection trends and scientists estimations about which strains will circulate during the year. In contrast to the flu shot, the nasal-spray flu vaccine contains a weakened but still living flu virus, sometimes called LAIV (live attenuated influenza vaccine). These nasal mists are approved for use in healthy individuals ages two to 49 who are not pregnant. In addition to nasal sprays, Discovery Health reports that researchers at Stanford University and the University of Alabama at Birmingham have been working with naked DNA in an effort to develop a vaccine that could be delivered via shampoo or dermal patch.

Three recent large-scale studies, including a study led by Dr. Arnold S. Monto of the University of Michigan, indicate that while the seasonal flu shot is more effective for adults and safe for women who are pregnant, the intranasal vaccine (nasal spray) is more effective at preventing flu in children. These studies showed 35 to 53 percent fewer cases of flu in children who were given the nasal spray vaccine than those who received injected vaccines. The Los Angeles Times reports that injectable vaccines prevent roughly 50 percent more seasonal flu in healthy adults than the nasal spray vaccines.

Due to the relative newness of the H1N1 vaccine, health authorities have implemented a number of tracking measures to ensure its safety. The Associated Press reports that Harvard Medical School scientists are working to link insurance databases covering 50 million people with vaccination registries to allow them to determine if people visit a doctor after being vaccination as well as the reason for the visit. Johns Hopkins University and the CDC are also working to ensure that any side effects are noted and addressed quickly. These efforts include emailing individuals who have been vaccinated recently to see how they are feeling (Johns Hopkins), and preparing take-home cards asking vaccine recipients to report any side effects to the nation’s Vaccine Adverse Event Reporting system (CDC). These measures are being undertaken as in the Internet-age, the Associated Press notes, one person updating their Facebook status to say that they got a flu shot and feel sick could cause a wave of similar reports.

Discuss This and Other Vaccination Matters in the iCons in Medicine Forums

Associated Press on the Nasal Spray Flu VaccineThe New York Times on CDC Side Effect Tracking Measures

Physicians Using Twitter

September 15, 2009

A recent report from Forrester Research indicates that the use of social networking websites among people aged 35 to 54 increased by 60 percent in the last year. Twitter and Facebook have become popular among federal centers like the Centers for Disease Control and Prevention (@CDCemergency), hospitals like the University of Maryland Medical System (University of Maryland Medical Center – @UMMC), and even individual doctors.

Tweeting Doctors Can Change Healthcare Delivery

Through Twitter, doctors are able to post updates about the events of their day, connect with other healthcare workers, communicate with and inform patients, and even document surgeries and procedures. Results of a recent study by the American Telemedicine Association indicate that doctors and patients have seen beneficial outcomes from using Twitter to connect. Some healthcare providers, like pediatric gastroenterologist Bryan Vartabedian, MD (@Doctor_V), chose to use Twitter as a means to extend their web presence and communicate with existing and potential patients. Clinical nurse Phil Baumann notes additional medical uses for Twitter, including:

  1. Disaster alerting and response,
  2. Diabetes management including blood glucose tracking,
  3. Drug safety alerts from the FDA,
  4. Biomedical device data capture and reporting,
  5. Shift-bidding for healthcare professionals,
  6. Diagnostic brainstorming,
  7. Rare disease tracking and resource connection,
  8. Smoking cessation assistance,
  9. Broadcasting infant care tips for new patients, and
  10. Post-discharge patient follow-up and consultation.

Dr. Joseph Kvedar (@jkvedar), the Director of the Center for Connected Health and iCons in Medicine Member, describes Twitter as “a method of mass communication” that is real-time and “designed for mobility.” The ability to constantly update information also makes Twitter particularly appealing to government health organizations such as the United States Centers for Disease Control and Prevention (@CDCemergency) and the UK’s NHS (@NHSChoices). Using Twitter, these agencies are able to provide up-to-the-minute information regarding disease outbreaks, contact numbers to call for assistance, and other pertinent information. Medical associations such as the Radiological Society of North America (@RSNA), Healthcare Information and Management Systems Society (@HIMSS), and the Biotechnology Industry Organization (@BIOConvention) also use Twitter to keep their members informed about current news, promote events and meetings, and provide a sense of community.

While some providers use Twitter to connect with their patients and peers, others use it to provide information and updates during medical procedures. Recently surgeons in Iowa used Twitter to allow a woman’s family to follow the progress of her surgery in real-time. The Children’s Medical Center in Dallas provided updates when a father’s kidney was transplanted into his son, and the Henry Ford Medical Center (Henry Ford Health System – @henryfordnews) has tweeted during several procedures since January. These updates provide individuals who might not be comfortable watching a surgical procedure to still gain an understanding of the process and a chance to ask questions.

For the 61 percent of Americans who search online for medical advice, Twitter may not provide enough information. The social networking website Facebook allows healthcare workers or medical associations to connect with colleagues and patients. For the reported 55 percent of patients who want to be able to communicate with their doctors via email (according to a Manhattan Research study) it can offer another means of communication. Dr. William Cooper, a cardiothoracic surgeon, says that Facebook presents a way to always be available to his patients. According to Pauline Chen, MD (@paulinechen), it is unclear if engagement via Facebook and Twitter helps or hinders a patient-doctor relationship.

This concern is echoed by other physicians, including Dr. Sachin Jain, a resident physician at Bringham and Woman’s Hospital, who has accepted Facebook friend requests from patients, but “wondered about the appropriateness of the interaction.” In addition to the expectation that a physician would be “instantly available 24/7,” some doctors worry about the security of Facebook and other social networking websites, as well as potential HIPAA violations and litigation concerns. For many physicians, Facebook, Twitter, and other forms of social media are seen as “blurring the line between work and private life” – something that may cause some hesitation and discomfort.

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The New York Times on Twitter UsersUSA Today/Science Fair on the Medical Uses of TwitterAssociated Press on Tweeting During OperationsOn Medical Associations Using TwitterDr. Pauline Chen on TwitterCNN on Physicians on Facebook – More on Physicians and Medical Professionals Using Twitter

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Using Telemedicine to Treat Chronic Disease

April 13, 2009

Chronic diseases pose a threat worldwide, particularly in the developing world. Heart disease, cancer, diabetes, and other chronic diseases account for over half of all deaths each year – double the number of deaths caused by infectious diseases, maternal and perinatal conditions, and nutritional deficiencies combined.  Developing nations are facing an epidemic of non-communicable chronic diseases as risk factors such as obesity, lack of physical activity, and tobacco use continue to increase.  Contrary to the popularly held belief that infectious diseases are the leading cause of death in the developing world, 80 percent of chronic disease deaths occur in low and middle income countries.

International attention and funding has primarily focused on communicable disease, and as a result the healthcare systems of developing nations are not well equipped to manage chronic conditions.  For example, the World Health Organization spends only 50 cents per person on chronic disease (excluding mental health) per year, compared with $7.50 for the major infectious diseases.  Regular doctor visits are necessary for proper treatment and management of chronic diseases, but most low- and middle-income countries have not developed the necessary infrastructure or network of specialty physicians to provide this type of care.

Telemedicine and teleconsultation programs offer a cost-effective solution to this problem. Through initiatives like iConsult, healthcare providers in remote or medically underserved areas can consult with specialty physicians over the Internet to gain access to their clinical expertise. By utilizing iConsult, an Endrocrinologist in New York City or Cardiologist in Portland would be able to offer assistance to a provider in a clinic in Chad, and ensure that a patient with diabetes or high blood pressure receives the highest quality of care.

Find out more about the iConsult program

Reports indicate a nutritious diet, physical activity, avoiding alcohol and tobacco use, and regular medical exams help decrease the risk of developing a chronic disease.

CDC Report on Chronic DiseaseWHO Report on Chronic DiseaseReport from SciDev Net

See also:
Nugent, R. (2008). Chronic diseases: a growing problem in developing countries. DiabetesVoice, 53, 17-20.