1. Integrated Disability Management Focus on Depression and Obesity

2. Today’s Program  Obesity  Depression  Integrated Approach

3. Obesity Defined  Abnormal accumulation of body fat  Usually 20% + over ideal body weight  Hyperplastic (new fat cells – onset childhood)  Hypertrophic (onset adulthood)

4. Obesity Continuum  20% - 40% over ideal weight = Mild  40% - 100% over ideal weight = Moderate  More than 100% over ideal = severe or morbidly obese

5. Causes of Obesity Basic premise: more calories consumed than burned by body  Genetic Factors  Eating Habits  Physical Activity / Inactivity  Medications  Mental Health  Medical Condition

6. Medical Conditions & Disorders  Endocrine Disorder - Cushing’s Syndrome (excessive cortisol release)  Hypothyroidism (underactive thyroid)  Neurologic (damaged hypothalumus which regulates appetite)

7. Medication Effects  Steroids – weight gain, bloating, hunger…  Anti-depressants - dry mouth, weight gain, headache, nausea…

8. Psychological Disorders  Depression - Low self-esteem - Lethargy - Low energy - Inactivity

9. Risks or Results of Obesity  Hypertension  Type II D Mellitus  Coronary / Cardiac Disease  Infertility  Stroke, asthma, apnea  Ortho / Arthritis  Menstrual Abnormal  Shortness of Breath

10. Cancer & Obesity  Prostate  Kidney  Uterus  Breast  Liver  Pancreas  Esophagus  Colon and Rectum

11. Obesity on the Rise 1988 – 1994 56% Overweight 23% Obese 1999 – 2000 64% Overweight 30% Obese

12. 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”

13. Culture Bound Statistics  50% African American Women  80% American Indian Adults  Pacific Islanders highest prevalence

14. 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)

15. Sample Population U.S. Veterans  73% men overweight  33% men obese General Population  67% men overweight  27% men obese

16. 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….

17. Two Main Types  Major Depressive Disorder - Moderate to severe depression 2+weeks - Loss of interest in activities once enjoyed - Concentration, worthless, hopeless, etc…

18. Two Main Types  Dysthymic Disorder - Chronic, underlying depressed mood & affect - Mild to moderate depression - Lasts 2+ years, w/ average duration 16 years

19. 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

20. Associated Symptomatology  Dysthymic Disorder  Under / over eating  Insomnia / hypersomnia  Low energy or fatigue  Low self-esteem  Poor concentration  Feelings of hopelessness

21. 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

22. 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)

23. 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*

24. 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

25. Differential Diagnosis  Axis I: Clinical Mental Disorders  Axis II: Personality Pathology  Axis III: Medical Factors  Axis IV: Stressors  Axis V: Global Assessment of Functioning

26. 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

27. 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

28. Questions & Case Discussion? Dynamic Claims Solutions, Inc.

29. Thank you! Peter R Reilly Director – Injury Analysis & Training Dynamic Claims Solutions 800.630.8606 www.dynamicclaimssolutions.com