Is Obesity Now Considered A Disease?

Depending on where you look, the definition of a ‘disease’ includes such phrases as a change from the normal state, a state of disorder, an abnormal or pathologic condition of the body, and being in dis-ease.  A disease can be brought about by personal factors, genetics, environmental influences, and lifestyle habits.  Common diseases include autoimmune conditions, hypertension, high cholesterol, diabetes, thyroid problems, cancer, endometriosis, ulcers, acne or more.  As of June 2013, the American Medical Association (AMA) has recognized obesity as a disease which could change the way insurance companies reimburse on prevention and treatment options for weight loss however those that oppose the AMA feel that obesity requires some personal responsibility as well.

According to the Centers for Disease Control and Prevention (CDC), almost 36% of Americans are in the obese category.  The classifications for ‘overweight’ and ‘obese’ are not perfect however the Body Mass Index (BMI) chart is most commonly used as it takes into account height and weight but not bone structure or lean muscle ratio.  A BMI between 18.5 and 24.9 is considered a normal, healthy weight.  Between 25 and 29.9 is in the overweight category and above 30 is officially classified as obese.  To give you an example, a 5’6” woman who weighs roughly between 160 and 185 pounds is considered overweight however if she weighs above 185 pounds then she is obese.  Another example would be a 5’4” woman who weighs between 145 and 175 pounds is considered overweight and if she were over 175 pounds she is considered obese. 

As many in the health field feel that abdominal obesity is more concerning as it means there is increased fat around the key abdominal organs, the waist circumference is gaining popularity when determining overweight, obesity and health risks.  Measure around your abdomen just above your hip bones (not necessarily your narrowest section) and women should be under 35 inches and men under 40 inches.  Higher numbers equals an increased girth which increases the risk for high blood sugar/pre-diabetes/diabetes, high cholesterol, high blood pressure and overall increased risk for cardiovascular disease. 

The overall concern is that excess weight can lead to long term consequences that could be preventable and there is an ongoing national push to get America healthier, reduce the number of obese and overweight adults and children, educate on proper nutrition, eliminate high sugar foods and drinks and encourage regular exercise.  Obesity is costing Americans millions of dollars as it can also cause an increased risk of cancer, joint pain, sleep problems, lethargy and more.  Please do not be a statistic – educate yourself and your family and start making healthy changes today!

References:

1.       Frellick, M.  AMA Considers Obesity A Disease.  Web.  23 June, 2013.

http://www.medscape.com/viewarticle/806566

2.        Centers for Disease Control and Prevention (CDC).  Adult Obesity Facts.  Web.  23 June, 2013.

http://www.cdc.gov/obesity/data/adult.html

3.       Centers for Disease Control and Prevention (CDC).  Defining Overweight and Obese.  Web.  23 June, 2013.

http://www.cdc.gov/obesity/adult/defining.html

4.       National Heart, Lung and Blood Institute.  According to Waist Circumference.  Web.  23 June, 2013. 

http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/txgd/4142.htm

What Causes Osteoarthritis?

Many women experience joint pain whether it’s in their knees, hips, fingers or shoulders.  The pain might come and go, be worse in the morning, or feel aching and stiff most of the day.  The diagnosis is typically done with symptoms and possibly an x-ray that shows joint changes.  Arthritis can start as early as the late teenage years/early twenties however more than 50% of people over 65 years old exhibit symptoms of arthritis.  What causes the joints to begin to deteriorate and create arthritis?

1.       Joint injury – Research shows that those who sustained a joint early at a young age are more apt to develop arthritis in that joint at a later age.  As an example, 51% of women developed knee arthritis 12 years after tearing their anterior cruciate ligament (ACL) in soccer.  Many can point back to a car accident, sports injury, broken bone or other trauma when discussing their problem area(s). 

2.       Obesity – Extra weight on the body coupled with daily activities and gravity means more load on the hips, knees, ankles and feet causing those joints to become more strained and inflamed over time plus it increases the wear and tear on the cartilage that leads to osteoarthritis. 

3.       Age – Sorry ladies, aging does take its toll on the joints considering more than 50% of people over 65 have arthritis symptoms (as stated above).  Many women will say “I didn’t have these problems in my 20’s or 30’s!” but over time joint injuries happen, diet/lifestyle choices take effect, genetics kick in, hormones change, weight fluctuates…and suddenly one day women find themselves waking up more stiff and aching.  Those of you who can still go from sitting cross-legged on the floor to a standing position without (much) assistance count yourselves lucky. It will probably change.

4.       Congenital abnormalities – If someone were born with joint problems or cartilage issues, then over time the stress on the joints will cause arthritic changes.  For example, scoliosis in the spine, or one leg shorter than the other will shift the way the body carries itself causing joint problems. 

5.       Endocrine disorders – Diabetics and those with low thyroid hormone are at risk for more joint and cartilage problems that can lead to arthritis.  Women heading into menopause often complain of more joint pain because their estrogen levels are gradually (or suddenly) decreasing. 

What does all this mean?  It means, take good care of yourself!  This is your one body.  Eat healthy, stay hydrated, maintain a healthy body weight, limit sugars and processed foods, and stretch regularly.  Thankfully there are articles here for tips to reduce the symptoms of arthritis if your joints are causing you pain on a regular basis.  Lastly, talk with your health care provider about appropriate work-up and treatment suggestions. 

References:

1.       Sofat, N., Ejindu, V., Kiely, P.  What Makes Osteoarthritis Painful?  Rheumatology. 2011;50(12):2157-2165.

2.       Roos, E.  Joint Injury Causes Knee Osteoarthritis in Young Adults.  Curr Opin Rheumatol. 2005;17(2):195-200.

3.       Kramer, P.  Prevalence and Distribution of Spinal Osteoarthritis in Women.  Spine. 2006;31(24):2843-2848.

5 Health Questions To Ask Your Mom

Sunday was Mother’s Day and many were celebrating with cards, calls, flowers and brunch to honor the women in their lives.  Yet, how many know the full health history of their mom, grandmother and aunts?  This information could prove to be critical when it comes to your own health therefore these are 5 questions to ask the female family in your life.

1.       How was menopause?  This question is important as women tend to follow them other women in their family when it comes to peri-menopause and menopausal changes.  Do the hot flashes and night sweats start in the 40’s or 50’s?  How long did it take?  Was it rough?  Was it easy?  How did she treat it?  Any complications? 

2.       Who has had cancer in the family?  And at what age?  This applies to both the men and women however mom tends to know this information.  If grandma and the aunts had breast cancer at a younger age, this is more concerning than finding out grandma had it later in life.  Has anyone had thyroid cancer? Prostate cancer? Ovarian, cervical or uterine cancer? Skin cancer?  Know your family’s cancer history.

3.       What are the family trends?  If all the women eventually develop thyroid disease and go on thyroid medication, this helps both you and your health care provider to be extra diligent and pro-active.  Does heart disease run in the family?  What about obesity?  Fertility problems?  Endometriosis?  Osteoporosis?  Do the women tend to lose their hair as they age?  Everyone have their gallbladder?  What about digestive or food allergy problems?  All of this information is critical for future planning and may shed light into current symptoms.

4.       Any outliers in the family?  The 2^nd cousin with celiac’s disease may not strike you as important however as your gas and bloating worsens, it could be a direct link.  The weird uncle whose mood alternates from really happy and hyper to down and depressed may be suffering from undiagnosed bi-polar.  This can be genetically linked as can depression in the family.  If just grandma had aches and pains it could have been undiagnosed fibromyalgia or a certain type of arthritis – how is your pain?

5.       What about your siblings?  Not all brothers and sisters are close therefore they may not inform each other about different health issues, concerns, scares and symptoms but mom usually knows.  Ask her if your symptoms sound like anyone in the family or periodically check in on the health of the rest of the family.  You may find out that your older sister has been having problems getting pregnant too or that your brother experiences the same types of migraines that you do and the same medications are not working.

While some people may prefer to keep some of their health history private, the more you know the more you (and your family) can be pro-active and prevent when possible.  Let your health care provider know of any changes as well to routinely keep your chart up-to-date and help them provide the best care possible for you.

 

Learn more on the women's health website, Emowher!

References:

1.       Segurado, R., Deterawadleigh, S., Levinson, D., Lewis, C., Gill, M., Nurnbergerjr, J., Craddock, N. Depaulo, J.  (2003). "Genome Scan Meta-Analysis of Schizophrenia and Bipolar Disorder, Part III: Bipolar Disorder". Am J Human Genetics 73 (1): 49–62.

2.       Steiner, A., Baird, D., Kesner, J.  (2008). Mother’s Menopausal Age is Associated with her Daughter’s Early Follicular Phase Urinary, Follicle Stimulating Hormone Level.  Menopause. 15(5): 940–944.

5 Facts About Gastroesophageal Reflux Disease (GERD)

Millions of people experience gastroesophageal reflux disease (GERD) on a regular basis.  When food passes from the esophagus down into the stomach, there is a ring known as the lower esophageal sphincter that is responsible for opening up to let food in and then close to keep it in the stomach.  If the ring is weak and does not close tightly it can cause food and stomach acid to come back up into the esophagus resulting in mucosal changes and symptoms of heartburn.  Here are five facts about GERD you may not know:

1.      Diagnosis is often made by symptoms however endoscopy, where a tube with a camera on the end is passed through the mouth and down the throat in order to best view all the tissue down into the stomach.  If warranted, a biopsy may need to be done.

2.      Extra weight around the middle is considered a real risk factor for those with both GERD and heartburn.  A primary treatment is weight loss as it may help avoid taking acid blockers.

3.      Eosinophilic esophagitis is being seen more regularly with patients who have GERD.  This condition has an increased number of particular white blood cells known as eosinophils that cause a number of chronic symptoms such as difficulty swallowing, sensation or actual choking, coughing, regurgitation, chest pain particularly behind the breast bone and vomiting.  A biopsy of the esophagus will help determine if someone has this disease.

4.      Consider food allergy elimination from the diet.  In eosinophilic esophagitis, the most common food allergies to remove are dairy, gluten, soy, eggs, peanuts, fish/shellfish.  These foods are also the most common food allergies to humans therefore if someone eats a food that causes inflammation, GERD may occur.

5.      Most that have GERD symptoms are on some form of acid blocker, either as needed or daily.  In fact, some take them twice a day because their symptoms are so severe.  Unfortunately, long term use of acid blockers also blocks the absorption of important minerals such as calcium and magnesium as well as vitamin B12.  These vitamins are critical for bone health, muscles, energy, brain health and more.

If you are experiencing symptoms of heartburn or are looking for different treatments to help your upper gastrointestinal problems, talk with your health care provider about options and consider taking out those common food allergens for six weeks and see how you feel.

 

Learn more at www.empowher.com

 

References:

1.      Reuters. (2013). New Guidelines for Diagnosis and Management of GERD.  Web.  17 March, 2013.

http://www.medscape.com/viewarticle/780737

2.      Johnson, D. (2012).  The Food-Elimination Diet in Adult Eosinophilic Esophagitis. Web. 17 March, 2013. 

http://www.medscape.com/viewarticle/768563

3.      Cochran Upper Gastrointestinal and Pancreatic Diseases Group. (2012).  Medical Treatments for Eosinophilic Esophagitis (a chronic disease associated with increased numbers of eosinophils in the esophagus and symptoms of esophagitis).  Web.  17 March, 2013.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012515/

4.      The Harvard Medical School Family Health Guide.  (2006).  Do PPIs Have Long Term Side Effects.  Web.  17 March, 2013.

http://www.health.harvard.edu/fhg/updates/do-ppis-have-long-term-side-effects.shtml

Do You Have PCOS?

Polycystic Ovarian Syndrome (PCOS) affects millions of women in the United States and causes a variety of fertility, hormone, skin, and ovarian problems.  In January 2013, a panel based on the Evidence Based Methodology Workshop at the National Institutes of Health suggested renaming and redefining the diagnostic criteria as they reported that PCOS should be determine by having 2 out of 3 criteria: excess androgens, ovulatory issues and multiple cysts in the ovaries.  This eliminates the requirement for ovarian cysts in absolute diagnosis as many people currently believe.

Typical symptoms of PCOS include: acne, excessive hair growth in places women typically do not want it, missed periods or irregular periods, not ovulating, weight gain especially around the middle, blood sugar and insulin problems, fertility problems, and ovarian cysts.  Androgens are a group of hormones such as DHEA, testosterone, androstenedione, and dihydrotestosterone that cause the skin and hair complaints.  Testing for PCOS can be difficult and as it is very multi-factorial .  First, evaluating for symptoms is important. Next, testing for androgens and looking for elevated levels.  Evaluating the menstrual cycle history looking to see if it is regular (roughly every 26 to 32 days) and if she ovulations. Testing for fasting blood sugar and insulin levels may indicate further consequences.  An ultrasound will visualize cysts on the ovary and discussing fertility challenges are important.

One of the issues the panel discussed was the difficulty in diagnosis as women will see different doctors or specialists for different issues.  A woman having trouble conceiving may see a fertility specialist while the woman with no menstrual cycle visits her gynecologist.  Acne and hair growth around the upper lip, chin, neck, nipples and abdomen may be evaluated by a dermatologist or aesthetician. If all symptoms are not accounted for, PCOS may be missed.  Also, women and their doctors may rule PCOS out if the ultrasound does not show multiple cysts on the ovaries yet she still has all the other symptoms.

Treatment for PCOS is important as long term sequelae can include diabetes mellitus, high blood pressure, high cholesterol, obesity, and a higher risk for cancer.  Seeking a healthcare provider who can evaluate all the symptoms, blood work and imaging then come up with a short and long term plan addressing all aspects is critical for health.  If the symptoms of PCOS sounds like you, do not hesitate to seek help as your health is important.

References:

1.       PCOS Diagnostic Criteria Clarified; Name Must Change.  Web.  27 January, 2013.
http://www.medscape.com/viewarticle/778066
2.       Increased Risk of Type 2 Diabetes with Polycystic Ovary Syndrome.  Web.  27 January, 2013.
http://www.medscape.com/viewarticle/767811

What Is Gestational Diabetes?

The saying goes that a woman is ‘eating for two’ when she is pregnant however what she chooses to eat has a drastic impact on her risk of gestational diabetes.  There are the common cravings such as ice cream and pickles but many find themselves also reaching more for bread, crackers or comfort food and avoiding their normally healthy choices out of convenience, nausea or sudden aversion to foods they once loved.  These high carbohydrates, high sugar foods cause a considerable amount of weight gain and fill the system with glucose leading to hyperglycemia and insulin resistance.

It is well known that everything changes with pregnancy.  Anatomically, the body shifts completely to accommodate a growing fetus.  Hormones sky rocket and the brain seems to turn to mush (commonly called, mommy brain).  A pregnant woman’s endocrine system also changes as the body has to adapt to all of the shifts however if the output of insulin by the pancreas cannot keep up with the increase in carbohydrate/sugar heavy foods, she becomes diabetic.  Having gestational diabetes also increases a women’s risk for type 2 diabetes later in life and therefore should be monitored carefully both from a screening glucose/insulin  test and a lifestyle stand point.  It is also important to note that given the current increasing trend in overweight and obesity in the United States, research shows that 50-60% of women go into their pregnancy already carrying too many extra pounds on their frame further increasing the risk.

There is not one set standard for diagnosing gestational diabetes however a woman is more at risk if she has a body mass index (BMI) of 30 or more going into the pregnancy, has had gestational diabetes in a prior pregnancy, or has a strong family history of diabetes.  The most common test is the Oral Glucose Tolerance Test (OGTT) where a pregnant woman drinks a very sweet drink then waits an hour and has her glucose tested.  A normal result (depending on the lab) is under 130-140 mg/dL.  The drink is very syrupy and often can cause vomiting, in which case the test must be repeated at a later date.  Follow up testing can include the 3 hour Oral Glucose Tolerance Test where the same test is repeated however glucose levels are drawn every hour for 3 hours.  If 2 out of the 3 hours have abnormally high levels of glucose, gestational diabetes is diagnosed.

As there are considerable risks for the growing baby (heavy birth weight babies, early delivery, and shoulder dystocia) it is important that gestational diabetes be taken seriously.  Pregnancy is not the time to lose weight or go on a diet however routine glucose monitoring, changes in diet and proper exercise can make a huge difference and possibly avert the use of insulin in order to control glucose levels.  Make sure to eat a variety of vegetables, lean protein, good fats and fiber rich foods for the health of everyone involved!

To learn more, read about the women's health website, Empowher, here!

References:

11) Mild Gestational Diabetes.  Web.  20 January, 2013.

http://www.medscape.com/viewarticle/775396

22)  Gestational Diabetes. Web.  20 January, 2013.

http://www.mayoclinic.com/health/gestational-diabetes/DS00316

33) The Relative Contribution of Prepregnancy Overweight and Obesity, Gestational Weight Gain, and IADPSG-Defined Gestational Diabetes Mellitus to Fetal Overgrowth.  Web.  20 January, 2013.

http://www.medscape.com/viewarticle/777162