Archive for October, 2012

The Obesity Epidemic

October 26th, 2012

It’s growing. And we’re growing. A news article in the October 17th JAMA summarizes a report from the Robert Wood Johnson Foundation on obesity in America. At our current rate of growth, by 2030 more than half of adults will be categorized as obese in 39 of our states. In 2011, Mississippi had the highest obesity rate and Colorado the lowest.

And echoing the blog I wrote on October 18th about health care costs, the price tag of treating obesity-related diseases will be $66 billion additional dollars. Productivity losses could be between $390 and $580 billion. America’s expanding waistlines will create additional cases of type 2 diabetes, coronary heart disease, stroke, hypertension, and arthritis. We are on track to see the incidence of diabetes in adults over age 20 rise from 11% to more than 31%. Obesity could contribute to more than 400,000 additional cancer cases over the coming two decades.

Psychiatrists see patients whose underlying disorders and life styles contribute to weight gain, and many of our medicines contribute additionally. BTP will soon report on work with metformin (Glucophage and others) to attenuate some of this problem, but at the forefront should be efforts to encourage healthy eating choices and portion control, exercise, and modest but important lifestyle changes, such as walking rather than riding and preferring stairs over elevators.

Walking down a street—more often in some parts of the country than others—I see visual evidence to support the data about the increase in obesity. The clinical facts are overwhelming, and the economic figures are sobering. Attention must be paid.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

The times they’ll be a-changing

October 18th, 2012

I think the figure I heard yesterday about the amount the United States spends on health care today was $2.6 trillion annually. That’s a lot of zeros! And hard to get my mind around. What it does tell me is that no matter who wins control of the White House and the two chambers of Congress, our current system must and will change dramatically. One expert who addressed our group said that unless the rate of health care cost growth is arrested, the cost of care per employee will exceed wages over the next decade or so. That cannot and will not happen.

Some colleagues advocate for a single-payer system, which might be our ultimate destination. The Affordable Care Act is relatively conservative but will definitely bring big change. Even if conservative forces prevail politically, the market will force change. The change will inevitably involve greater focus on efficiency, effectiveness, evidence-based treatments, and long-term management of patients with chronic illness. Behavioral and psychiatric conditions will ascend in importance. Information technology—for medical records, communication among clinicians and with patients, decision support, and patient education and adherence—will take on growing importance.

Change is inevitable and imminent. Psychiatrists and other physicians must stay attuned and prepared for the implications of change on their lives and practices.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry