HealthCommentary

Exploring Human Potential

What Obesity and ED Have In Common: A Medical “Trojan Horse”.

Posted on | December 16, 2010 | No Comments

Mike Magee

Ten years ago, during the wild first weeks that followed the release of Viagra, the first effective traetment for erectile dysfunction, much of the debate avoided the issue of effectiveness (most agreed it was effective) and focused on the question, “Should insurers reimburse for this treatment?” Two years later, states far and wide and most nations around the world, as well as their insurers covered Viagra.

The reason why is that by then erectile dysfunction had been accepted as a “marker disease”. What did that mean? It meant that population research showed that for every 1 million men who saw their doctor for evaluation of erectile dysfunction (encouraged to take that initiative because Viagra existed), 15,000 would be diagnosed with diabetes, 50,000 with heart disease and 150,000 with hypertension. These diagnoses would be followed by therapy, which for many would occur years before it would otherwise occur, saving lives and money (even after reimbursing for Viagra).

What we learned from that “experiment” was that prevention is spawned on by motivation and that early detection and effective chronic disease management can be facilitated by addressing disorders of high importance to human beings which contribute to or “mark” the presense of disorders that carry a high burden of disease and cost for the nation.

If ED was the “marker disease” of choice for 2000, obesity is the “marker disease” for 2010. Occuring in ever growing numbers of our citizens, young and old, the presence of obesity carries with it high rates of diabetes, hypertension, heart disease, arthritis and cancer. Taken as a whole, this chronic disease burden insures a high misery index and low productivity.

Obesity is enormously troublesome to individuals, families and communities. Many or most obese individuals are motivated to loose weight for a range of reasons including physical and mental health, self-value and self esteem, and the desire to be more productive and well. Most fail after embracing popularized, ever changing approaches that lack a strong research basis and sound methods to sustain behavioral gains.

That’s the bad news. But lets turn these facts on their heads and see what we have to work with from a public health standpoint. First we know that the desire to lose weight is a strong motivator which effects large portions of our population, and is especially prominent in those who are already compromised in terms of wellness. Second we know that those who do succeed are successful in part because they have embraced new healthier behaviors and attitudes. Third we know that these behaviors reside primarily in the home, and that one family members success is likely to “spread” to other family and friends. (Of couse, recent studies have confirmed the opposite as well – that obesity is contagious due to poor nutrition, lack of exercise, and food used to pacify rather then satiate). And fourth, we know the vast majority of those who try to loose weight do so episodically without the support of their health professionals including doctors, nurses, and pharmacists.

Now let’s think what would be possible if we were to embrace obesity as the “Trojan Horse” for chronic disease that it is, a method or means to engage people dynamically in their health care system. What if health professionals had access to a behavioral modification program that could be accessed and managed in the home? What if highly motivated obese individuals knew they could receive access to the program and personalized support from the health team they trust by coming in for an evaluation of their obesity. What if that basic evaluation (as with ED) was able to uncover early chronic disease – whose elimination or amelioration became a tangible measure of success in addressing the marker – obesity? And what if those who succeeded early became the trainers of those who were yet to succeed?

Might obesity be leveraged as a motivator to accomplish early diagnosis of chronic diseaes, instigate home-based behavioral change, and create sustainable integration and personalized relations with a health care team? If so, obesity would do the heavy lifting for our conversion from an interventional to a preventive system. And that would significantly “lighten the load” for all of us.

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