The United States is dealing with an obesity epidemic costing the healthcare system large sums of money that some experts project may result in the collapse of our economy. In 2010, 86 percent of all the U.S. healthcare spending was allotted for individuals with one or more chronic medical conditions, with the majority of these conditions brought about by poor diet, lack of exercise, smoking and alcohol consumption.
Obesity is not only a cost issue, but also completely alters an individual's quality of life. Barbara Bergin, MD, is a board-certified orthopedic surgeon practicing in Texas who frequently encounters patients fighting obesity. Dr. Bergin worries about the nation's future with the soaring obesity rates and the emotional toll it has on patients.
She says, "One-third to half of my patients are obese or overweight. Usually their weight either causes, contributes to or exacerbates their pain. When I see 45-year-olds with degenerative joint disease and no history of injury or connective tissue disorder, I must draw the conclusion that their weight has had a causative effect on this process. We have to step around this issue carefully because there is a tremendous emotional cost to the rapid association of obesity to their arthritis. There is a financial cost as well. Patients see me for second opinions because the first physician told them they had knee pain because they are overweight. I have to spend twice the amount of time just working on regaining their trust in the system. Then we can have an honest and productive conversation regarding their knee and their weight."
In addition to the emotional toll associated with obesity, there is no great option for orthopedic surgeons to combat the obesity problem. Surgeons are faced with limited options to fight a problem that results in health issues for millions of Americans.
Dr. Bergin says, "Unfortunately, there is not much we can do for them. Surgery of any type is usually not an option. Anti-inflammatories are inadequate and injections have their eventual limitations as well. I see no important breakthroughs on the horizon and simply asking these patients to push away from the table is unreasonable and ineffective. Many of them are surprised to hear there is a relationship between their knee pain and their weight. Most have a clear understanding, but are unable to do much about it."
Various factors hinder an individual's ability to lose weight such as genetics or lifestyle habits. Although losing weight would ultimately benefit the patient, many patients cannot lose the weight on their own and patient efficacy may not be a viable solution for weight loss. The healthcare system may have to devise other solutions to fight the obesity epidemic.
Dr. Bergin says, "In the long run, we need a pill. Obesity must be approached like hypertension, like the disease it is. The sooner we accept this, the sooner we can reach an understanding with our patients and maybe we can be the ones to lead them down a path to wellness. We would never speak with disdain to a person with hypertension. We would recommend a pill and a low salt diet."
She believes that physicians must be conscious of how they approach weight loss with patients. A patient will respond better to an understanding approach, rather than a judgmental approach. Even if a physician is simply stating the facts, perception is what truly matters, and better communication may yield the necessary results benefiting patients.
She says, "Orthopedic surgeons are faced not with the treatment of obesity, but with the sequelae of the disease. Yet, we often find ourselves in the position of handing out ultimatums — lose weight or suffer. We must be kind and not disdainful of these patients who suffer from a problem for which there are few solutions. Our kindness and understanding might be all there is for them."
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