Tag Archives: obesity

It’s a fat world, after all.

17 Nov

We know that weight matters. We know obesity is a major health issue and that many illnesses are solely or largely due to being overweight.  Yet surprisingly often, neither doctor nor patient will raise the issue of being overweight. Obesity is – if you excuse the expression – the elephant in the room.

Why do doctor’s not raise the issue?  Sometimes because it’s just too difficult a problem to deal with. Sometimes because we are afraid of insulting a patient or hurting their feelings. Sometimes because we’ve tried so often before (with that patient, or with others) that it’s easier just to give up.

And patients? Well sometimes it’s because they have tried and tried and have also given up. Other times it’s because they don’t think doctors can do much to help.  And sometimes it’s because they don’t realise – or admit – that they have a problem.

In fact the vast majority of obese patients don’t recognise that they have an issue.  A study published this week in the British Medical Journal looked at patients who were obese and what terms they would use to describe their own weight.  In medical jargon, the word obese means a BMI* of 30 or more; Overweight is a BMI of 25 or more.

Amongst patients who are obese only 10% would use that term to describe themselves.  Even the term overweight was only used by about 30%. In both cases, men were less likely to use the term which most accurately describes their condition.

If patients don’t perceive themselves as being overweight or obese, they are less likely to think about the health issues and consequences, much less raise the issue with their doctor.

One of the interesting findings in the study is that it was first conducted in 2007 and again in 2012. The results showed that whilst the number of people who are obese is increasing, the number of people who use the term to describes themselves is decreasing.

Perhaps we live in a world where obesity is now so common that we simply fail to recognise it when we see it – especially in ourselves.

So next time you see your doctor – if they don’t take the initiative to weigh you – then you be the one to raise the issue.

* BMI stands for body mass index. The formula is  Wt (in kg) divided by height (in Metres) squared

BMI = wt/ht^2.   So if you are 75kg and 1.7m tall, your BMI is 75/(1.7)^2 = 75/3.0625 = 24.5.


2 is worse than 1

24 Aug

Medical students (and by extension doctors and then their patients) are taught that Type 1 Diabetes is worse than Type 2. Turns out, at least some of the time, that’s wrong.

Type 1 diabetes – also called Insulin Dependant diabetes or “juvenile onset diabetes” – is what young kids get. They develop antibodies which attach their own pancreas, the insulin-producing cells stop working, they produce no insulin and they get very sick. Before the discovery of insulin in 1921, Type 1 diabetes was an early death sentence. Now, it commits the patient to a lifetime of sugar testing and insulin injections.

Type 2 diabetes – Non-Insulin Dependant diabetes or “adult onset diabetes” – is classically associated with overweight, inactive middle-aged patients. In fact we see a wide variety of people with Type 2 diabetes and not all fit that mould, but it is true that lack of exercise and excess weight do make the likelihood of developing diabetes much greater. However there is probably also a gene which makes the condition more likely, though not inevitable, in many patients.

With the progressive increase in obesity in society we are seeing increasing numbers of diabetics, and in particular Type 2 diabetes at younger and younger ages. Whereas even a generation ago, we never saw Type 2 diabetes in teenagers or children, now about 1/3 of kids who develop diabetes have type 2.

Frighteningly – and against traditional teachings – it turns out Type 2 is much more dangerous in kids than Type 1. Research at Royal Prince Alfred Hospital in Sydney shows the death rate for teens with adult-type diabetes is double that of those with juvenile-onset diabetes. They also develop more severe complications, develop them sooner and do so even if their sugar control after diagnosis is the same as the Type 1 patients.

There are lots of theories as to why that might be – perhaps the genetic predisposition that allowed Type 2 diabetes to develop might be the cause of the complications, or perhaps the lifestyle issues which triggered the diabetes are the cause.

In any event, the study (care.diabetesjournals.org/content/early/2013/07/09/dc12-2455.abstract) noted that most treatment offered to adults with diabetes (particular types of cholesterol and blood pressure medications) are not normally given to kids because most research excludes children from drug trials. But something needs to be done to help these kids. And foremost, is trying to prevent diabetes in the first place.

Whilst we can’t do anything about the genetic factors, it’s critical for parents, doctors and society at large to look at the lifestyle choices and behaviours that may cause diabetes and that can be altered to improve our kids overall health.