Obesity -- part one

Now this might be definitely a long project since there is much to be discussed in terms of obesity. Single-handedly, obesity can raise the costs of health care tremendously over the next 20 years. Why? There are just too many comorbidities associated with being obese.

It all starts with cheap eating, most likely the kind you see at McDonald's and other fast food restaurants across the country. Then you have a lack of exercise, since apparently many people in America do not even want to exercise outdoors and prefer a more sedentary lifestyle. Once you have these two components it tends to feed itself in a vicious cycle that results in the end with an additional 60 or more pounds added to your waistline. Once this happens, you more than likely will have increased your likelihood of developing diabetes. You will also have developed increased atherosclerosis as well as sleep apnea, and it is not isolated to early arthritis or joint pain just from the added stress.

So the simplicity of multiple patient will allow us to see that these problems add up rapidly. First you me to look at diabetes, there is no cure for this disease. Once you develop diabetes it becomes an issue of management most likely for the rest of your life. Management would definitely involve modifying your diet and also introducing exercise in addition to using insulin or other hypoglycemic agents. Medication is not cheap by any means, and one month of insulin or hypoglycemics costs far more than a big Mac meal.

The laundry list for diabetes complications is too long to go into detail. There is a list courtesy of the national Institute of health:

http://diabetes.niddk.nih.gov/complications/index.htm

But I suppose an important comorbidity to discuss is obstructive sleep apnea. Most of what happens with people who are obese is that they have excess weight on the upper airway that results in obstruction. Usually this manifests itself with snoring (although patients never acknowledged that they snore) and and also with people complaining that they wake up abruptly in the middle of the night (usually when the weight compresses enough to obstruct flow once again). Quite often these people should get a sleep study. More information is available here from Wikipedia: http://en.wikipedia.org/wiki/Sleep_apnea.

Another area where sleep apnea can cause significant problems is with surgery. For cases where a patient has to go under general anesthesia, it almost always requires endotracheal intubation and ventilatory support. Putting these people on ventilatory support is problematic from the standpoint of weaning them. More often than not these individuals require longer mechanical ventilation times than ordinary people.

Now although people do not like to bring cost into the equation, you must be able to see that intensive care is much more expensive than having a patient on a regular floor bed. There are many estimates out there for the cost of intensive care, and they range from approximately 3 to 4 times the cost of regular hospital care. Here is an interesting article you can read regarding this topic:

http://www.anesthesia-analgesia.org/cgi/reprint/96/2/311.pdf

Again, does that big MAC with fries look so cheap now? there will be many posts on obesity in the future.