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FEATURE
Obesity, diabetes take toll on community What’s available in terms of nutrition? What are the competing factors? What are the challenges? By Klaus Krøyer Madsen, MPH with Cities Changing Diabetes – Philadelphia
Editor’s note: The physical and mental cost to a community during the American crisis of diabetes and related comorbidities can be high. Part 1 in the fall 2021 issue of Philadelphia Medicine examined several community efforts to battle obesity and diabetes. Part 2 looks at specific ways to battle these comorbidities.
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ince 2019, Philadelphia County Medical Society has been an active member of Cities Changing Diabetes – Philadelphia, a global program sponsored by Novo Nordisk that creates local private/public partnerships with communities to understand their unique obesity and diabetes challenges, identify areas and populations at greatest risk and design and implement targeted solutions. The program brings together medical and public health institutions, communities of faith, employers, insurers and nonprofit organizations. Philadelphia Medicine asked two of our members involved in Cities Changing Diabetes to share their perspectives about the challenges of obesity prevention: Ajay D. Rao, MD, MMSc, associate professor of medicine, Lewis Katz School of Medicine at Temple University Center for Metabolic Disease Research.
What the specific things that physicians can do in their practice to reduce obesity? Dr. Gadegbeku: First, just be available and develop a relationship. I sometimes talk to a few people who struggle with the conversation around weight and obesity. I know that people also feel challenged by the way we define obesity with the BMI. But I think the most important thing as a physician, that I see that I can do, is have a relationship with my patients where I can have that conversation, where they feel comfortable to talk to me about the challenges that they’re having with their weight. And most of them do, most of them disclose it on their own and start the conversation. But there are other times where I’m able to start that conversation in a comfortable way because I have established that relationship with that patient, and they know that I care and that I want to help. So, asking questions that not only are related to their lifestyle, diet, exercise, their other chronic conditions, medications, all of that, but also asking those questions that delve into the determinants of health. We know that medical care only accounts for 10% to 20% of the modifiable contributors to healthy outcomes. The other 80% is related to these other determinants of health, be it their physical environment, their economic status, their education and what’s available to them in terms of opportunities.
What’s available in terms of nutrition? What are the competing Annette Gadegbeku, MD, associate pro- factors? What are the challenges? Why are there challenges for fessor, Department of Family, Community them to make any kind of lifestyle changes? Do they know that & Preventative Medicine, assistant dean of lifestyle changes are not the end-all, be-all? They are definitely the community health, Drexel University College of first line to addressing this issue, but also as a physician I feel that Medicine; associate program director, DUCOM/ I’m obligated to explore all the options, including medication and Tower Health Family Medicine Residency surgical management, which we know are also effective and, maybe Program chief, division of community health. in some patients, even more effective, in addition of course to the changes in their lifestyle. continued on next page
Winter 2022 : Philadelphia Medicine 21
