By Diana Long.  At the end of May I participated in Disruptive Women’s  Breakfast Series, Childhood Obesity:  A Big Fat National Challenge.  We were supporting the First Lady’s Let’s Move campaign. 

Don Mathis, a fellow panel member, and CEO Community Action Partnership provided an interesting perspective.  “We’ve watched the obesity numbers for adults more than double over the last three decades.  Why didn’t we realize that it was just a matter of time before we saw the same trend in our children?”  Childhood obesity has tripled over the last 30 years and now stands at 17% of children and adolescents (ages 2-19); the percentage of overweight children is at, or above, 30 percent in 30 states.  Obese children and adolescents are more likely to suffer from high blood pressure, cholesterol, Type 2 diabetes and are more likely to have learning problems.

At the end of last month the CDC released a new report on adult obesity.  The news is “America’s waistline is still growing, or holding steady in some states, but not shrinking at all.”  In other words, we’re still fat.  Thirty-four percent (34%) of us are overweight and another 31% are obese.  If you’re wondering if this includes you, according to the National Institutes of Health “anyone with a body mass index (a ratio between your height and weight) of 25 or above – that’s someone, for example, who is 5-foot-4 and 145 pounds — is considered overweight.  Anyone with a body mass index of 30 or above — such as someone who is 5-foot-6 and 186 pounds — is considered obese.”  You can check out your own BMI using the quick calculators on the CDC or WebMD websites. 

So who’s the fattest?  The CDC Report states “In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women”.  Some good news, however, “The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.”  A 2009 analysis commissioned by Trust for America’s Health and the Robert Wood Johnson Foundation found that “the Baby Boomer generation has a higher rate of obesity compared with previous generations.  As the Baby Boomer generation ages, obesity-related costs to Medicare and Medicaid are likely to grow significantly because of the large number of people in this population and its high rate of obesity.  And, as Baby Boomers become Medicare-eligible, the percentage of obese adults age 65 and older could increase significantly.”

In her June 6, 2010 DW blog Fox TV’s Dr. Archelle Georgiou shared questions from her viewing audience that were especially interesting to her.  Charles, a 5’8” gentleman weighing in at 215 lbs., wrote in for help with his weight problem.  When he received Dr. Georgious’ advice, however, he seemingly took offense (or had a good sense of humor) and asked “So what you’re saying is I’m fat?”  “Yup!”, she replied, then editorialized “I’m amazed at how often people convince themselves that the BMI definitions of overweight and obesity don’t apply to them.” (more…)

“What appears to be non-compliance from a medical perspective may actually be a form of asserting control over one’s own behavior.”

I’ve always liked this characterization of patient adherence from Peter Conrad, The Meaning of Medication: Another Look at Compliance. It takes into account the fact that we’re dealing with people. What many times seems irrational to us as healthcare professionals, has most times been rationalized by the people for whom we provide care.

Human behavior is complex. Behaviorists describe human development as a 4-part process: physical (how we grow or age), cognitive (how we think), emotional (how we feel) and social (how we are valued). In listening to (researching) tens of thousands of patients – across therapeutic categories – over the last two decades, I’ve found that the following hold true:

How Patients Think: Most people know only the most superficial facts about their health. However, when presented with unexpected, personally relevant information many are motivated to act (e.g. adhere). Women were motivated to do annual mammograms when they were told how much “finding a lump the size of various millimeter-size pearls” equated to surviving breast cancer.

This is not to say that we all need a Ph.D. in what ails us. Judith Hibbard’s work at the University of Oregon suggests that “controlling costs and achieving health care quality improvements require the participation of activated and informed consumers and patients”. Her model focuses on patients acquiring knowledge, confidence and skills to act.

How Patients Feel: Fear operates to produce adherence in one patient and rapid non-persistence in another. Trust, on the other hand – in the healthcare system, our personal healthcare providers, and health products and services – resonates across audiences.

Most of us don’t see or directly interact with many of the stakeholders involved in our heathcare (e.g. our governments, managed care organizations, pharmaceutical companies). Instead, we see or talk to our personal physicians, pharmacists, and health agents who provide service. Trust in daily, health interactions is key to patient adherence to a recommended plan of action.

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