Integrated Disability Management Focus on Depression and Obesity.
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Transcript of Integrated Disability Management Focus on Depression and Obesity.
Integrated Disability Management
Focus on Depression and Obesity
Today’s Program
Obesity
Depression
Integrated Approach
Obesity Defined
Abnormal accumulation of body fat
Usually 20% + over ideal body weight
Hyperplastic (new fat cells – onset childhood)
Hypertrophic (onset adulthood)
Obesity Continuum
20% - 40% over ideal weight = Mild
40% - 100% over ideal weight = Moderate
More than 100% over ideal = severe or morbidly obese
Causes of Obesity
Basic premise: more calories consumed than burned by body
Genetic Factors Eating Habits Physical Activity / Inactivity Medications Mental Health Medical Condition
Medical Conditions & Disorders
Endocrine Disorder - Cushing’s Syndrome (excessive cortisol release)
Hypothyroidism (underactive thyroid)
Neurologic (damaged hypothalumus which regulates appetite)
Medication Effects
Steroids – weight gain, bloating, hunger…
Anti-depressants - dry mouth, weight gain, headache, nausea…
Psychological Disorders
Depression - Low self-esteem
- Lethargy
- Low energy
- Inactivity
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 GroupFebruary 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 ReillyDirector – Injury Analysis & TrainingDynamic Claims Solutions800.630.8606www.dynamicclaimssolutions.com