Risks or Results of Obesity Hypertension Type II D Mellitus Coronary / Cardiac Disease Infertility Stroke, asthma, apnea Ortho / Arthritis Menstrual Abnormal Shortness of Breath
Cancer & Obesity Prostate Kidney Uterus Breast Liver Pancreas Esophagus Colon and Rectum
Obesity on the Rise 1988 – 1994 56% Overweight 23% Obese 1999 – 2000 64% Overweight 30% Obese
FDA Obesity Working Group February 2004 Obesity has no single cause, “there will be no single solution; obesity will be brought under control as a result of numerous coordinated, complimentary efforts from a variety of sectors of society”
Culture Bound Statistics 50% African American Women 80% American Indian Adults Pacific Islanders highest prevalence
Reversal of Life Expectancy Trend (i.e. shortened) Already 1/3 to ¾ of a year shorter than if maintain ideal body weight In coming decades could be reduced 2 to 5 years Since 1980 U.S. adult obesity up 50% (i.e. 2/3 overweight or obese)
Sample Population U.S. Veterans 73% men overweight 33% men obese General Population 67% men overweight 27% men obese
Depression Defined… Mental illness characterized by a profound and persistent feeling of sadness or despair and / or a loss of interest in things that were once pleasurable….
Two Main Types Major Depressive Disorder - Moderate to severe depression 2+weeks - Loss of interest in activities once enjoyed - Concentration, worthless, hopeless, etc…
Two Main Types Dysthymic Disorder - Chronic, underlying depressed mood & affect - Mild to moderate depression - Lasts 2+ years, w/ average duration 16 years
Associated Symptomatology Major Depressive Disorder Sign. change in weight Insomnia / hypersomnia Agitation / retardation Fatigue / loss of energy Worthlessness / guilt Diminished thinking Poor concentration Thoughts of death / suicide
Associated Symptomatology Dysthymic Disorder Under / over eating Insomnia / hypersomnia Low energy or fatigue Low self-esteem Poor concentration Feelings of hopelessness
Related Statistics Depression affects est. 17 million annually Indirect cost of $53 billion (human suffering costs immeasurable) First episode usually in mid-20s (though all ages from children to elderly) 25% of women experience a severe episode during life, compared to 5-10% for men
Causes of Depression Complex and not well understood Imbalance of neurotransmitters (serotonin, dopamine…) Heredity (3x chance of developing if family member is depressed) External stressors & significant life changes (trauma, loss of loved one, divorce)
Causes of Depression Physical changes - stroke, heart attack, cancer, hormonal changes Change of life patterns – serious loss, difficult relationship, financial problems * very likely a combination of genetic, psychological and environmental factors*
With that said, What’s next? Differential Diagnosis Corroboration of evidence / data Formulate treatment / wellness plan (“multi- modal +” approach) Big picture, don’t get mired down in details, but don’t overlook them either
Differential Diagnosis Axis I: Clinical Mental Disorders Axis II: Personality Pathology Axis III: Medical Factors Axis IV: Stressors Axis V: Global Assessment of Functioning
Treatment Focus Psychological – complete psycho-social, “talk” therapy, cognitive behavioral, realign worldview / perspective Psychiatric – prominent symptom management, scrutinize medication schedule Medical – maintenance, control and rehabilitation of conditions and disorders Behavioral change – level of activity, eating habits
Issues that deserve further consideration Co-morbidity: depression and obesity Rx alone insufficient – must change quick fix mindset Future Impact: Generation of youth growing up heavy, exponentially increasing probability for future pathology
Questions & Case Discussion? Dynamic Claims Solutions, Inc.
Thank you! Peter R Reilly Director – Injury Analysis & Training Dynamic Claims Solutions 800.630.8606 www.dynamicclaimssolutions.com
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