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
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