Diabetes is a worldwide health problem affecting just under 10 percent of the United States population, according to the American Diabetes Association. Though there have been many advances in diabetes care over the past decade, these advances have failed to translate into more patients meeting treatment goals.
The Journal of the American Medical Association recently published a population-based study that suggests only one in four adults with diabetes achieved their treatment goals – a composite of various personal “targets.” The study demonstrated no significant improvement in any individual treatment targets being realized between 2005 and 2016.
Even with advances in insulin pump technology, medications, bariatric surgery and lifestyle modifications, diabetes care still has not meaningfully improved for diagnosed patients on a societal level. But individually, it doesn’t have to be like that. At Advanced Laparoscopic Associates, we aim to give our patients both the treatments and the tools they need to control or even beat their diabetes.
Barriers to Diabetes Management
Treatment and management of type 2 diabetes cannot be a one-size-fits-all approach. It’s more complicated than that, and it’s going to be different for each patient. But, similar barriers to successful diabetes management show up in the JAMA study and others. Here are two of the most common.
Cost of care. This factor plays a major role. According to JAMA, “Having health insurance was the strongest predictor of linkage to diabetes care.” This same predictor played out in other studies. Patients who lacked health insurance, drug insurance, or financial resources were unable to meet their treatment outcome targets. According the American Diabetes Association, in 2017, average medical expenses among people with diagnosed diabetes were 2.3 times higher than what their expenses would have been if they didn’t have diabetes.
Not only the cost of care comes in to play; the cost of a proper diet is also a barrier, and healthy foods required for diabetic management can be. Patients with obesity are particularly at risk for a cost of food barrier.
Patient self-management. Even with proper clinical support and advances in health care, patients bear the burden of managing their disease day-to-day. Optimal self-management is affected by a multitude of personal factors for each patient, including their access to care, their experience with medical care (positive versus negative), their financial status, the presence of co-morbidities and general health status, and other personal circumstances.
Patients’ adherence to their treatment plan, attitude, cultural and personal beliefs, and knowledge about their disease all may affect whether they meet their outcome targets. None of these factors are under the control of the treating clinician, who may be unaware of them.
Obesity and Diabetes
Obesity is the leading risk factor for developing type 2 diabetes, and over 90 percent of patients with diabetes are also overweight or obese. Both obesity and diabetes are also independent risk factors for the development of cardiovascular disease, which remains the leading cause of death for women in the United States.
Weight gain and obesity worsen insulin resistance. Losing weight slows the progression of diabetes complications. Though clinicians may provide options for counseling and behavioral management or referral to weight loss programs, these do not address some of the challenges obese patients face. Medication management becomes more complex and exercising is more difficult, or sometimes contraindicated, in obese patients. Additionally, options such as bariatric surgeries need to be examined, as their role in decreasing other health risks such as diabetes and depression are now starting to be realized.
We Can Help
At Advanced Laparoscopic Associates, we specialize in getting our patients down to a healthy weight through surgical or nonsurgical means. Bariatric surgery should be—and increasingly is—considered a first-line treatment for diabetes in addition to obesity.
If you have diabetes and a body mass index (BMI) of 35 or greater, you may be a candidate for bariatric surgery. If you don’t qualify, you still have options. We are dedicated to helping people live their best and healthiest lives, so request an appointment at ALA. Our bariatric experts will be with you every step of the way, from initial consultation to treatment, surgery, recovery and beyond.
Recent studies both in the U.S. and other countries show an alarming link between obesity and depression. Obesity and mental health effects, specifically depression, are associated with many health risks, including diabetes, cardiovascular disease, cancer and limitations on the ability to function in normal day-to-day activities. Not only does the research suggest higher rates of obesity in people with depression, but the converse is also true: People who are obese have a greater risk of depression.
Obesity and Depression: the Psychological Link
Being overweight or obese, and even the perception of being overweight, increases psychological distress in people. In both the United States and Europe, appearing as the socially defined version of “thin” is considered the ideal body image. Social acceptance and cultural factors play a role in the link between depression and obesity.
Being obese may increase dissatisfaction with body image and decrease self-esteem, both of which are risk factors for depression. These factors increase stress and anxiety. Eating disorders and disturbed eating patterns are also known to increase the risk of depression. In addition, the physical pain individuals suffer as a direct consequence of being obese adds to the risk of depression.
The Genetic Link Between Depression and Weight Gain
Research recently published in the International Journal of Epidemiology suggests that the psychological effects of obesity—not other obesity-associated illnesses such as diabetes—cause depression. To show this, the researchers used a genetic approach. The psychological aspect of being obese was separated from the impact of obesity-related health issues by using genes that predispose certain individuals to a higher body mass index (BMI), but a lower risk of diseases like diabetes.
The findings suggested that these genes were as strongly associated with the risk of developing depression as they were with a higher BMI and diabetes. This genetic component suggests that being overweight causes depression, whether the individual has obesity-related health problems or not, especially in women. Being overweight not only increases the risk of chronic diseases, but can also lead to depression.
Can Depression Cause Weight Gain and Vice Versa?
According to the Centers for Disease Control:
- Research shows 43 percent of adults with depression being studied were obese.
- Adults suffering from depression are also more prone to obesity than adults without depression.
- As the severity of depressive symptoms increases in adults, the proportion of adults with obesity rises as well.
- In all age groups, women suffering from depression are more likely to be obese than women without depression.
- Race and ethnicity have an impact on the relationship between obesity and depression among women. Obesity rates are higher for white women of non-Hispanic ethnicity with depression compared with white women of non-Hispanic ethnicity without depression.
- Obesity was present in fifty-five percent of adults with moderate to severe depressive symptoms who were also taking antidepressant medication.
According to the Journal of the American Medical Association (JAMA):
- The overall association between obesity and depression is stronger among Americans; however, the mean adult BMI is higher in the United States compared with different European countries, which may account for this difference. The exact cause is unknown.
- Being overweight is associated with depression in persons 20 years or older, but not in younger individuals.
- A clinical interview is key to making the association between depression and obesity. The overall association is shown to be stronger when depression is assessed with a diagnostic clinical interview by a medical professional rather than when individuals provide a self-reported list of symptoms.
- When persons experiencing depression are exposed to depression for a longer period (≥10 years), the risk of obesity increases. Studies showed obese persons had a 55 percent increased risk of developing depression over time, whereas individuals with depression experienced a 58 percent increased risk of developing obesity.
- The association between depression and obesity is stronger than the association between depression and being overweight.
- Time may play another role in the association between depression and obesity between men and women. Initial short-term research effects show the association only in women. However, when long-term data is examined, a reciprocal association between obesity and depression is found in both men and women.
Expert Help for Depression and Obesity
Seeking medical help as early as possible for either or both issues is key for patients. Understanding the relationship between depression and antidepressant usage and obesity is key for clinicians, as it may help them form the best treatment and prevention strategies for both conditions.
Time is of the essence in treatment and prevention for both patients and clinicians. The link between depression and obesity is reinforced by duration. The longer obesity or depression is experienced, the greater the risk of the developing the other. Clinicians of depressed patients must monitor them closely, as weight gain is shown to be a later consequence of depression. For the overweight or obese patients, mood must be closely monitored.
Awareness of this link by both patient and clinician can lead to prevention, early detection, and treatment for those who have already developed obesity and depression. For at risk patients, being cognizant and vigilant about medical follow-up care could ultimately reduce the burden of both conditions. Whether the clinician or the patient, the best strategy is speaking up and dealing with these conditions as early as possible.
If you are obese and ready for a change, request an appointment at Advanced Laparoscopic Associates. We can get you back on the road to health through many conservative and surgical treatments, including medically monitored weight loss and bariatric surgery.
Advanced Laparoscopic Associates congratulates our own Dr. Amit Trivedi and Dr. Sebastian Eid for their inclusion in New Jersey Monthly’s Jersey Choice Top Doctors award for 2019.
Dr. Trivedi has published numerous scholarly articles and textbook chapters, and is considered an expert in robotic surgery. He performed actress Rosie O’Donnell’s weight loss surgery, which she credits with losing more than 50 pounds and changing her life. Dr. Trivedi is Pascack Valley Medical Center’s 2019 Provider of the Year, and he even dabbles in beekeeping.
Dr. Eid is the author of more than a dozen journal articles and abstracts in such prestigious peer-reviewed journals as Surgery, Cancer and Advances in Nutrition. He gives presentations to expert audiences around the country and the globe. Included in his long list of awards over his career are multiple Jersey Choice Top Doctor awards.
The Jersey Choice Top Doctors award is the result of a rigorous screening process carried out on behalf of New Jersey Monthly magazine by Ringwood, New Jersey research firm Leflein Associates. The firm sends surveys to every doctor in New Jersey licensed for more than five years and asks them to recommend colleagues.
Dr. Trivedi and Dr. Eid have been selected by their peers for their dedication to learning and teaching, their compassion and bedside manner and, above all, their outstanding care provided to each of their patients. Advanced Laparoscopic Associates is proud of Dr. Trivedi, Dr. Eid and all of our exceptional clinical staff for making our practice one of the most successful in the state and best-loved by our patients.
If you have been considering bariatric or general surgery, request an appointment with Advanced Laparoscopic Associates. Our surgical team will sit down with you and together will come up with a personalized treatment plan that suits your situation, lifestyle and circumstances.