Mental Illness in the US: Before the happy pills

History of mental illness

Every year, an estimated 42.5 million Americans suffer from some condition linked to mental illness. One could surmise the growth of mental illness reports have risen due to the radical transformation of the relationship between mental illness and its acceptance in society over time.

So how far back can we track mental illness and how was it treated?

Early History

  • Prehistoric times: Mental illness was believed to stem from magical beings and rituals were used to treat these sick people. One of the most primitive ways of dealing with the mentally sick was a procedure called trepanation where a hole in the skull was created using a sharp object, usually a bone. It was believed to release the evil spirits trapped inside curing the afflicted person.
  • Ancient Egypt: The Egyptians believed mental illness was caused by the loss of power or status. They believed the cause of the illness lie within the subconscious and would use opium to stimulate visual dreaming.
  • 400 B.C: There were differing explanations of mental illness during this time from philosophers. Many believed it was a gift or curse from the gods and with no treatment. Hippocrates, however, believed mental illness was caused by physiology. He suggested simple changes to a person’s diet, and physical surroundings would cure them.
  • Middle Ages: Displeasure of the gods and sin were the root causes for mental illness during this time. Causes of illness ranged from witchcraft to demonic possession. For demonic possessions, the patient would be immersed in scalding hot water in an effort to draw the demon out of the body. Women accused of witchery were burned at the stake.
  • Victorian times: Gender bias was experienced fairly often in Victorian times. Menstruation, pregnancy, post-partum depression, disobedience, chronic fatigue, or anxiety could cause women to be seen as unbalanced and labeled as hysteria. These women were then placed in institutions, sometimes for the remainder of their life.

Treatment or Torture?

From the middles ages to the 1800s, the mentally ill were hidden away from society in institutions. Most patients taken to institutions were there to be forgotten and not cured. Behind the walls of the institution, patients were not treated as humans in need of help but prisoners. The rooms that housed patients were jail cells with patients chained to walls, sometimes overcrowded and covered with feces. Bedlam Institute, London’s first asylum for the mentally ill, over the centuries has made a name for itself as a leading example of how the mentally ill were mistreated. For one penny, onlookers could visit the asylum and poke patients through their cells with long wooden sticks.

Gawking at patients as if they were animals was just one form of mistreatment. Their treatment methods are considered inhumane today.

  • Red hot pokers: Patients were branded or poked with a red hot iron to bring them to their senses.
  • Hydro-therapy: Patients stood in a narrow shower while being sprayed by cold water from a hose to stimulate them.
  • Insulin therapy: Used on patients with schizophrenia. The insulin would drop the patient’s blood sugar placing them into a coma and brought on convulsions and brain seizures. Glucose shots either injected or given through nasal passages were used to bring the patients out of their coma.
  • Lobotomy: A brain operation where the cortex of the brain’s frontal lobe was disconnected from the lower centers of the brain. This was normally down by sticking a long needle through the eye of the patient. If the procedure was done incorrectly, the result could be death.

Some of these treatments continued on through the 1970s.

Sermo hub, mental illness resource

If you’re an M.D. or D.O. visit our BiPolar Hub for resources and to collaborate with colleagues

Advancements in mental illness

During a time when mental illness was not prioritized in medicine, two women fought for a change. In the 1840s, Dorothy Dix observed the mentally ill in a Massachusetts institute where she conducted interviews with patients. She documented the treatment of the patients she saw in a piece she wrote to the General Assembly of North Carolina. Her argument was the mentally ill should not be thrown away but committed to institutions devoted to mental health and understanding it’s causes. Over 40 years, she helped to establish 32 state institutes.

Another woman who brought to light the mistreatment of the mentally ill was reporter, Nellie Bly. In an assignment for the local paper in the 1880s, she committed herself to one of the largest institutions in New York as a mentally ill woman where she stayed for ten days. When her story was published, she exposed the mistreatment she experienced and the filthy conditions of the institute. Her story brought attention to the public and politicians bringing in reform for institutions.

It wasn’t until the 1900s that experts began to try and understand the peril of mental illness. During this time, Sigmund Freud proposed the idea of the unconscious. He believed some people had thoughts so upsetting they were buried deep in a person’s subconscious. His practice, known as the “talking cure,” was widely debated then and still to this day.

In the 1940s-50s, the use of medication to solve mental illness emerged. Chemists began experimenting with pills that may “calm imbalances inside the brain and deliver relief.”

Modern Day

While there is still stigma around mental illness, there are many options for help. The mentally ill are not hidden away, but institutions exist to treat and understand their plight. Psychologists offer “talk therapy” while psychiatrists offer talking as well as prescriptive medication if needed. Organizations like the National Alliance on Mental Illness dedicate their cause to bettering lives for those affected by mental illness as well as educating others about illnesses.

As a physician, do you believe there is still a large negative stigma toward mental illness? What do you think are the biggest issues facing mental illness today? If you work in this field, we would love to hear from you.

We will be discussing this and more inside Sermo, our physician community. If you’re an M.D. or D.O., please join us.

Sources:

  1. Treatment of the Mentally Ill
  2. The 10 Worst Mental health Treatments in History
  3. A Short History of Mental Health
  4. History of Mental Health Treatment
  5. Timeline: Treatments for Mental Illness
  6. Early Treatment of Mental Disorders

Sandy Pentland Discusses Wearable Tech and Medicine

credit: World Economic Forum

credit: World Economic Forum

Silicon Valley is clamoring to enter the medical, wearable tech niche.  Every tech company from Apple to Google is trying to solve our health crises with some kind of tracker, some simple, some sophisticated.

Sandy Pentland, PhD., of the MIT Media Lab has been tracking individuals by smart phones and other devices for years. He has gleaned a theory of “Social Physics” that can track and predict behavior and even foresee disease and illness. We had the chance to talk with him about his intriguing research and how physicians can apply it to their patients today.

~ Video Introductions by Ayesha Khalid, MD, MBA, Enterologist

Social Physics and Obesity: In the healthcare world, we have a hard time motivating our patients to follow the plans and pathways we create as doctors. If we can find the right incentives to get people to change their behavior and keep it that way- bingo! Huge win!

Pentland addresses this in a pilot health program. Participants received incentives whenever a person they partnered with worked out.   This buddy system was eight times more effective per dollar than normal financial incentives. More importantly, they kept up the social network and exercise guidelines after the experiment concluded.

 

Social Physics and Genetics: The power of social physics and thinking about the spread of ideas can be very powerful in health care. Disease groups such as depression may be haphazardly grouped based on an accidental clustering of symptoms. Pentland discusses why therapeutics work so differently on individual diseases within a category. One recent project adds a behavioral and phenotypic component to genetics data and starts to tease out the different types of diabetes, or depression.

 

 

Social Physics and mental health: Imagine a world, where soldiers who have PTSD provide their psychiatrist with daily updates via their smart phones. Physicians don’t have to wait weeks for a check-up to see how medication is doing, but can simply check an app to look for tell-tale signs. Changes in behavior, both major and nuanced are tracked relaying a patient’s progression.

 

Social Physics vs Social Media: Recent media discussed the inaccuracy of “Google flu,” an online tracking algorithm that predicts the movement of the flu virus based on people searching for information. Pentland discusses the difference between aggregated data point from individual tracking vs keyword tracking through social media and search.

 

 

Conclusion  

Human beings are highly social and communal in our sharing with one another, a trait signified by the importance of language and sociocultural imprinting. We know that Western healthcare does not pay attention to the power of social dynamics, our external environment, and the role it plays in our own wellbeing. Would it not be interesting if we could measure that in some way and help it to understand the power of the relationship of our genetic makeup with our disease manifestation?

Bios:

Sandy Pentland has been a professor with the MIT Media Lab for nearly 30 years. He is also the co-founder of several companies including ginger.io and Thasos Group. He is the author of two books, Social Physics and Honest Signals.

Ayesha Khalid is a sinus surgeon with an MBA from the MIT Sloan School of Management. Ayesha is interested in the re-design of the health care system with a patient-centered focus, specifically in the area of clinical trials and rare diseases. She is a co-organizer at Hacking Medicine, an interdisciplinary group at MIT that seeks to spark change in healthcare. She also serves as the Young Physician Chair for all ear, nose and throat physicians in the United States.

 

Mammography: To See or Not To See

mammogram

~ by Dennis Morgan, MD, Oncologist

There has been much controversy in recent years over just who should get screening mammography. The greatest contention is over what age to begin and how often to perform. Women will understandably bring a certain amount of emotion to the table. Ideally the medical community would bring curated facts to the table that inform a process of shared decision making. The major challenge for all parties involved is the curation process — not just knowing the facts, but making sense of them.

My overview of this subject comes at the behest of someone who recently underwent a harrowing encounter with mammography. As a medical oncologist my perspective is not necessarily neutral as I have an inherent wariness of the “slippery slope” of investigation and intervention that can lead to unintended, sometimes harmful, consequences. But I have no related service to promote or academic position to defend. Let me share my investigation of this controversy and invite comment.

Our first task is to separate fact from opinion. Opinion comes from personal values or professional goals. I would categorize the relevant literature into studies, reports and positions. Studies are original scientific investigations (facts), reports a critical analysis of such studies (interpretation of facts), and positions, i.e. opinions, about next steps. The landscape is dotted with any number of each. The area of hottest contention is the appropriate age bracket for screening. The value of any screening tool depends on the prevalence of the disease. In our case it is relevant the risk is proportional to age. Young women are  unlikely to have breast cancer, and the oldest women are more prone to getting it but also more often die of another condition. So the firestorm is over which of the ‘middle-aged’ women to screen.

Let’s take as our focal point the era before the publication in 2009 of the — infamous to some — U.S. Preventive Services Task Force (USPSTF) Recommendation Statement(1). This update of a 2002 paper is controversial for it’s radical departure from common practice. While supporting mammography for women age 50-74 it advised only a two-year, not annual, schedule. For women younger and older than this the task force was not persuaded of demonstrated benefit. Nor was any confidence expressed for the alternative imaging methods of digital mammography or MRI. Perhaps most shocking was their position that breast self-exam (BSE) is a waste of time and should not even be taught.

The blow back was swift and vehement, notably by The American Cancer Society (ACS) which maintains to this day that “Current evidence supporting mammograms is even stronger than in the past. In particular, recent evidence has confirmed that mammograms offer substantial benefit for women in their 40s.” Further, “Mammograms should be continued regardless of a woman’s age, as long as she does not have serious, chronic health problems … ”. (2).

And this from a letter in the New York Times by the chairwoman of the Breast Imaging Commission of the American College of Radiology and the president of the Society of Breast Imaging (3):

“Every medical organization experienced in breast cancer (including the American Cancer Society, American Congress of Obstetricians and Gynecologists, American College of Radiology, Society of Breast Imaging and National Accreditation Program for Breast Centers) recommends annual mammograms for women ages 40 and older.”

I think it is notable that every organization cited is either positioned as a patient advocate/protector or is a provider of the service. Perhaps neither would be inclined to retreat from a posture of vigilance.

Their letter was in response to an op-ed piece (4) by a co-author of Quantifying the Benefits and Harms of Screening Mammography — an MD, MPH faculty member of the Institute for Health Policy and Clinical Practice at Dartmouth(5). He cited data from the radiology community itself that the false positive rate for over ten years of annual screening is 50 percent.  He noted, “A screening program that falsely alarms about half the population is outrageous.” and “What about the benefit? Among those thousand women, 3.2 to 0.3 will avoid a breast-cancer death. If you don’t like decimals, call it 3 to 0.”. His paper is, I believe, the most comprehensive and impartial survey to date and is discussed in his interview in the ASCO Post(6).

There is a growing list of studies and reports that recommend a decrease in the use of mammography but the message seems as foreign to the American institutions cited above as the countries originating them.

From Scandinavia 2008 in the Cochrane Database of Systematic Reviews — the Nordic Cochrane report(7):

“If we assume that screening reduces breast cancer mortality by 15% after 13 years of follow-up and that over-diagnosis and over-treatment is at 30%, it means that for every 2,000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.”

From Norway 2010 in the New England Journal — The Norwegian Breast Cancer Screening Program(8):

“The difference in the reduction in mortality between the current and historical groups that could be attributed to screening alone was 2.4 deaths per 100,000 person-years, or a third of the total reduction of 7.2 deaths …”

From Canada 2014 in the British Medical Journal — 25 year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial(9). Annual mammography screening did not reduce long-term breast cancer mortality in women 40 to 59 years of age. An independent commentary on this study observed that “If the … results are correct, the number of “cured” drops to 0.” (10).

From Switzerland 2013 in the New England Journal of Medicine — Abolishing Mammography Screening Programs? A View from the Swiss Medical Board(11): Tasked with a recommendation for all of Switzerland the panel made several observations.

  1. Conventional recommendations are based on outdated trials that do not reflect the effect of modern treatment.
  2. It was not at all obvious that benefits outweigh risks when one compares a generally accepted 20% reduction in mortality with a 21.9% rate of over-diagnosis.
  3. They note women substantially overestimate the benefits. “It is easy to promote mammography screening if the majority of women believe  it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors. We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so.” “The board, therefore, recommended that no new systematic mammography screening programs be introduced and that a time limit be placed on existing programs.”

Why such resistance to change given the benefits are less, and the risks more than previously appreciated? Evidence contrary to closely held beliefs is always hard to accept and confirmation bias, favoring reports that agree with an a priori position, is hard to avoid. In the case of mammography several forces marshal to stave off change. I would suggest that some combination of emotion, defensive medicine, lack of scientific understanding, and a profit motive are responsible for continued over-use of mammography in the US.

Let’s see if we can tie some of this together with a visit to the doctor’s office. The office staff advises the patient that she is due for screening mammography. Often accompanied by fear and hope the staff reinforces her decision by anecdotes about others whose ‘lives were saved’ by mammography. Her hope is that the result will be negative because she could then conclude that she does not have breast cancer. But this is not necessarily so. On the other hand if the mammogram is positive she would then think that while she does have breast cancer her life will be saved by this early detection. Again, neither of these assumptions are necessarily true.

There are four possible outcomes from mammography — a positive or negative reading, either of which may be true or false. These provide the data for Bayesian analysis that is the mathematical rationale for screening tests.

The false results are instructive as to why screening mammography may continue to be overused. With false positive results, further studies — additional imaging and biopsy — will, hopefully, declare the patient cancer-free after all. The patient is reassured, thankful for the vigilance of her physicians. Unnecessary treatment avoided.

With false negative mammograms the cancer may eventually surface by some other means and, when it does, everyone will have a second look at that mammogram. Assuming it wasn’t read in error (not the same as ‘false negative’), the patient will be told that mammograms miss 20% of breast cancers.  They’ll tell her it was a “good thing she was doing BSE” or good thing that some serendipitous event lead to discovery. The fact that the mammogram in her case was of no value will probably be over-looked.

What’s worse? A breast cancer diagnosis within a year or two of a false negative mammogram or no mammogram at all? The patient is likely to have considerable negative feelings and second guess her physician’s value more than the mammograms. Negative feelings about physicians drives lawsuits. Doctors know this and often practice “defensive medicine” — better to get a test of questionable value than face negligence accusations, no matter how unwarranted.

Doctors often do not understand the limitations of screening tests. Bayesian analysis gives answers that are not intuitive for patients or physicians. Physicians routinely over-estimate the chance of cancer based on a positive mammogram. We are all prone to attaching more significance to relative changes than to absolute values as with the Norwegian study cited earlier. Are we to heed the one-third reduction or the absolute difference between 2.4 and 7.2 deaths per 100,000 person-years?

As to a profit motive, we need not necessarily find villains here. I will be quick to recognize the honest efforts of those who make a living fighting cancer. Physicians need not be greedy to cling to a profitable activity but rather just trying to keep the doors open in this era of diminishing reimbursement for physician services. However, we would be naive to dismiss the notion of a “medical-industrial complex” i.e. a socio-economic force that organically organizes to preserve profit as the primary, if not only, motive.

So we are left with a debate that has powerful advocates on both sides. The debate is not whether mammography has any value. It is rather whether we are willing to limit its use as a screening method when the harm exceeds the benefit. And the harm in this sense is both personal and societal. Each life saved comes at some cost of over-treatment death from treatment including fatal heart disease from radiation, secondary cancers and a chronic state of anxiety amongst middle-class women. By analogy, consider automobile speed limits and death rates in pedestrian-involved accidents. We could lower speed limits until the chance of a pedestrian fatality is practically zero. But at some point livelihoods and lives are lost due to the lack of efficient transportation for work and emergencies.

Hopefully, we will develop screening methods for breast cancer that are more sensitive and more specific. Until then, women and their doctors should share the decision about mammography in individual cases based on an open discussion of both sides of the ongoing controversy. We should avoid bad choices based on fear and hope alone but rather employ new information to gain the most benefit for the risk from mammography.

We are left to wonder what indeed are the best practices? Many of the issues are covered in the three-way debate in the New England Journal — screen at age 40, age 50 or not at all(12).  Dr. Welch notes in his New York Times op-ed article(4): “It has been more than 50 years since the last randomized trial of screening mammography in the United States. Now that treatment is so much better, how much benefit does screening provide? What we need is a clinical trial in the current treatment era.”

We should at least have the courage to test in this country the hypotheses posed by breast cancer screening.

Bio

Dennis Morgan MDDennis Morgan, MD is Assistant Clinical Professor University of Connecticut Health Center, Emeritus Staff Johnson Memorial Hospital and Medical Center Stafford CT and Past President Connecticut Oncology Association as well as Past Medical Director Phoenix Community Cancer Center, Enfield CT

References

  1. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. U.S. Preventive Services Task Force. Ann Intern Med. 2009;151(10):716-726.
  2. American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. 2014.
  3.  Weighing The Value of Mammograms. Monsees B, Rebner M. The Opinion Pages. Letters. New York Times. Jan 2 2014.
  4. Breast Cancer Screening: What We Still Don’t Know. Welch HG. The Opinion Pages. New York Times. Dec 29 2013.
  5. Quantifying the Benefits and Harms of Screening Mammograph. Welch HG, Passow HJ. JAMA Intern Med. 2014;174(3):448-454
  6. Confronting Uncertainty About the Harms and Benefits of Screening Mammography. Bath C. ASCO Post. Feb 15 2014, Volume 5, Issue 3.
  7. Screening for breast cancer with mammography (Review). Gøtzsche PC, Jørgensen KJ. The Cochrane Library 2013, Issue 6.
  8. Effect of Screening Mammography on Breast-Cancer Mortality in Norway. Klager M et al. N Engl J Med 2010; 363:1203-1210. Sep 23 2010.
  9. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. Miller AB. BMJ 2014;348:g366.
  10. Annual mammography screening did not reduce long-term breast cancer mortality in women 40 to 59 years of ag. Fletcher SW. ACP Journal Club | Volume 160 • Number 10. May 20 2014
  11. Abolishing Mammography Screening Programs? A View from the Swiss Medical Board. Biller-Andorno N, M.D., Ph.D., Jüni P, M.D. N Engl J Med 2014; 370:1965-1967. May 22 2014.
  12. Mammography Screening for Breast Cancer. Clinical Decisions. N Engl J Med 2012; 367:e31. Nov 22 2012.

Ebola Update: 1.4 million possible infections and the press is finding it harder to get answers

ebola in africa

American troops begin to move into Liberia as the CDC predicts up to 1.4 million infected with Ebola by January 2015 if nothing is done to stem the tide of this deadly disease.

CDC Shocks with a Brutal Warning

The U.S. CDC announced last week that if nothing is done to improve medical conditions in Liberia and Sierra Leone up to 1.4 million people could be infected with Ebola in just those two countries by January 20th, 2015.   The number represents 13.5% of the total population of both countries.

While the official death count is 2,900 the CDC estimates the actual number of cases and deaths is 2.5 times higher due to under-reporting. Many patients avoid medical centers because they fear the treatment won’t help them or expose loved ones. There are also reports of abandoned Ebola victims in their homes.

Health care workers have a higher rate of death than their patients. In Sierra Leone out of 113 HCWs who contracted the disease, 81 have died, a 72 percent death rate, when 40 percent was previously reported.

American Troops Already On the Ground in Liberia

Stripes.com reported the first C-17 flights arrived on September 18th and the first American troops arrived this past weekend.   The troops are in a support function only to help assist and protect medical workers. President Obama submitted a budget reprogramming request of $500 million which could push the Pentagon spending against Ebola to over $1 billion.

There have been sporadic reports of medical teams being attacked by locals as they assist the infected or prepare bodies for cremation.   The troops also will likely help protect medical workers from threats of violence.

Is Ebola Mutating?

This is a big question and our own Jim Wilson, MD of Ascel Bio and the University of Nevada, Reno recently writes that yes, they are seeing mutations.

“While Ebola-Zaire virus has not historically acquired genetic mutations that enable more efficient transmission from human to human, the longer the virus is allowed to transmit in West Africa, the greater the danger for such mutations to occur. At the present time, substantial mutations of Ebola-Zaire virus have been documented, which is the result of a multitude of human-to-human transmission events. So far, a substantive change in the transmission mechanism of the virus has not been reported.”  [bold type Dr. Wilson’s]

Panic helps no one

Wilson also talked about some hysteria he’s starting to see in medical circles, not just the general media.

“As our country engages more deeply in Ebola response, we need our physicians to

1) all be on the same education and situational awareness page,

2) turn to credible sources of information, and

3) be resistant to hype.

But now we directly observe some of our emergency and critical care physicians expressing the opinion that “Ebola is airborne”.  We have directly seen this opinion at the local response level, and once the opinion is expressed in the meeting the thoughtful, measured conversation regarding the proper management of suspect Ebola cases is derailed. “

Neither Does Suppressing Data

Finally, Wilson writes there are indications some government agencies are being less than forthcoming with the state of Ebola in their countries. He writes,

“Over the past two weeks, Ascel Bio has become increasingly concerned about information suppression, which interferes with accurate assessments. In the week ending 20140913, Ascel Bio noted an insistence by Nigeria to journalists to soften their reporting on Ebola, citing fear and panic as unnecessary side effects. In the week ending 20140921, both Liberia and Guinea reported a similar insistence on reducing media coverage, with the government restriction on media being called “an alarming assault on press freedom.’”

What do you think of the CDC’s numbers? Do you think the medical community is panicking over the disease? What do you think of US troops assisting the health care workers already on the front lines of this medical war?

If you’re an M.D. or D.O. you can join the conversation at our Infectious Disease Hub, a collaboration of dozens of physicians looking to share information on Ebola and quell the epidemic as quickly as possible.

Doctors Alarmed with Burgeoning Obesity Epidemic

donutsDoctors have battled obesity for decades. Some patients simply are not interested or lack the will power to make the lifestyle changes needed to overcome obesity. But, many try and fail. Despite trying our hardest to curb the alarming trends, we watch as Americans push their weight to the limit, bite by bite.

As a family practitioner, watching children and adolescents get caught in the epidemic is heart-breaking. We can expect them to lead shorter lives than their parents.

According to the most recent Robert Wood Johnson Foundation Report, 20 states now have obesity rates over 30 percent. Additionally, no state in the US has an obesity rate less than 21 percent. The foundation also reported that one out of every ten children become obese between the ages of two to five years.

According to the American Heart Association, there are 154.7 million people overweight or obese among Americans 20 years and older. A Gallup poll conducted in 2013 reports the adult obesity rate climbed from 26.2 percent to 27.2 percent. This one percent is the largest year-over-year increase since 2009.

Yes, we can break these statistics down into rural vs. city localities and across socioeconomic status levels. But, obesity is found across all strata of life.

This is not about appearance or looks, fashion does not run into a doctor’s goals to curb obesity. What keeps us up at night are the increased rates of other “sister” deadly chronic diseases like diabetes, hypertension, sleep apnea, and even some cancers. The rising morbidity rates directly linked to obesity rates.

Pediatrics and Obesity

Many doctors, especially those of us in family medicine and pediatrics, are seeing a big jump in the number of obese kids and teenagers. It is common to see teens with hypertension and type-2 diabetes mellitus. Teens are starting on life-long medications before they are even starting college. Early studies suggest the younger obesity is established, the harder it is to overcome.

Teens are starting on life-long medications before they are even starting college.

We are treating an increasing number of adolescents for hypertension and diabetes, these kids also face mental stressors. Many overweight and obese kids are stigmatized, not just by other children but also by teachers. Many are left out of activities and could develop depression or low self esteem. This mental anguish, along with their growing risk factors for early cardiovascular events, can play havoc on their well-being. While they are struggling, they are surrounded by a world that enables them to continue to make poor food choices and follow a sedentary lifestyle.

Even lunches at school have a long way to go to earn a healthy label. When an obese child or teen sits in the lunchroom, how is it possible for them to choose healthy food when everyone around them is not? Schools need to take a much more pro-active role in getting healthy foods in their cafeterias and eliminating those that are truly health defying. And, parents need to be better educated on what constitutes good nutrition. Perhaps, this is a task that schools can undertake as well. Because, unless, this is changed, we are facing devastating medical outcomes in younger and younger people.

Obesity and Chronic Disease

The complications of chronic disease occur when patients have been afflicted with these diseases over time. For example, patients who have had diabetes for 15-20 years are more likely to go on to have kidney failure, blindness, heart disease and peripheral vascular disease.

It is easy to see how this will lead to a decrease in our nation’s life expectancy and drive up healthcare costs. Another obesity-related disease is osteo- and degenerative arthritis on weight bearing joints. This will lead to an increased number of joint replacements being performed at earlier ages. The two examples above will require additional rehabilitative and dialysis centers. The stress on our already burdened medical system is very real.

Without significant investments in infrastructure we could literally run out of resources to treat the chronically obese and their co-morbidities.

While many feel this is an American/First World problem, its effects are going global.  The American lifestyle is spilling over to other countries looking to emulate our successes, or should we say excesses. Those nations  have access to more American foods and fast food franchises are now being seen on countries all over the world. The easiest food for our busy lifestyles are often the ones filled with fat and bad carbs. It is difficult to devote the time needed for beneficial physical activity.

The weight of this epidemic is being felt in doctors’ offices and hospitals across the US. In my own practice, our scale used to have a weight limit of 300 pounds.

We purchased a new scale with a limit of 500 pounds because we felt we were doing a disservice to our patients by continually writing 300+ pounds in their medical records.

In imaging centers, CT scanners now accommodate bigger bodies. There are many “wide-open” MRI scanners that provide imaging for more obese patients. Changes in medical facilities include, OR tables for larger patients, purchasing larger waiting room and exam room furniture, longer syringes for spinal procedures and much more. All of these changes likely cost billions across the entire medical spectrum.

Can we do anything to stop this epidemic? Of physicians polled on Sermo, only 27% felt that it can be stopped by healthcare workers in the exam room. While much of it is on the patient to make lifestyle changes, doctors still have a role in motivating our patients to change. It is going to take a concerted effort by physicians and all healthcare workers, schools, public educators, and the government.

Is there any hope that this epidemic can be stopped from turning into the impending healthcare crisis it is shaping up to become, before we start burying our children?

credit:  Linda Girgis, MD

credit: Linda Girgis, MD

Bio:  Dr. Linda Girgis MD, FAAFP is a family physician that treats patients in South River, New Jersey and its surrounding communities. She holds board certification from the American Board of Family Medicine and is affiliated with both St. Peter’s University Hospital and Raritan Bay Hospital. Dr. Girgis also collaborates closely with Rutgers University, University of Medicine and Dentistry of New Jersey (UMDNJ), and other universities and medical schools where she teaches medical students and residents.  She recently completed a medical mission in Egypt.