New Obesity Statistics Out for the Past Decade!

All of this can be seen on the Journal of the American Medical Association (JAMA) website:  http://jama.ama-assn.org/content/early/2012/01/11/jama.2012.40.full

Some Key Points for Adults:

1.   In 2009-2010, the age-adjusted prevalence, or amount of cases, of obesity was 35.5% among adult men and 35.8% among adult women, with no significant change compared with 2003-2008.  This means that over 1 in 3 adults in the United States are considered obese, regardless of age.

2.   In 2009-2010 the age-adjusted average BMI was 28.7 for men and also 28.7 for women.

3.    Over the 12-year period from 1999 through 2010, overall women had no significant increase of obesity rates BUT  non-Hispanic black women and Mexican American women had increases in obesity that were statistically significant.

4.    For men, there was a significant increase in obesity over the 12-year period.

Flegal KM, Carroll MD, Ogden CL, Curtin LR.  Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010 Jan 20;303(3):235-41. Epub 2010 Jan 13.

Some Key Points for Children and Adolescents:

1.    In 2009-2010, 16.9% of children and adolescents from 2 through 19 years of age were obese.  9.7% of infants and toddlers had a high weights for their corresponding length. 

2.   There was no difference in obesity rates among males or females between 2007-2008 and 2009-2010.

3.   Between 1999-2000 and 2009-2010, there was a significant increase in obesity rates in males aged 2 through 19 years.  There was no significant increase for females aged 2-19 years. 

4.   There was a significant increase in BMI among adolescent males aged 12 through 19 years but not among any other age group or among females.

Ogden, C.L., Carroll, M.D., Kit, B.K., Flegal, K.M.  Prevalence of Obesity and Trends in Body Mass Index Among US Children and Adolescents, 1999-2010.  January 11, 2012, Vol 307, No. 2, pp 115-213.

 

Full Disclosure: the Case for CAM in Informed Consent

The Article:

This interesting article describes the ethical and legal considerations for informed consent and disclosure of complementary and alternative medicine (CAM) treatments by medical physicians, specifically pediatricians.  The author uses a case study of a chemotherapy-induced naseau and vomiting (CINV) in a pediatric patient to illustrate where disclosure and discussion of acupuncture, which has been shown to be efficacious in adults with CINV, is appropriate.

The article outlines two ethical obligations that physicians have regarding informed consent; an obligation to fully educate a patient and a duty to promote good, preserve life, and ease suffering.  Discussions about treatment decisions that include CAM fully inform a patient and potentially promote good care and ease suffering, especially in supportive or palliative oncology care.  Legally, physicians must ensure that they are obtaining full informed consent from the patient or family.  Currently, there is little law regarding the disclosure of CAM modalities in treatment decisions.   

In the conclusion, the authors suggest that with the growing amount of CAM research, pediatric physicians should keep abreast of the research findings and apply that knowledge to their clinical practice.  In certain situations, the discussion of CAM use may be limited to only those therapies and symptoms where enough evidence-based research exists.

What it Means:

Informed consent is the belief and legal obligation to ensure that a person has adequate faculty, comprehensive information, and a clear understanding of the available choices and consequences of an action.  In medicine, it is the cornerstone of physician counseling and medical decision making.  When advising a patient, a physician is ethically obligated to describe all risks and benefits of all possible courses of action, including the possibility of taking no action.  The addition of CAM modalities into informed consent decisions is a rather new concept in the medication community.

My Take:

This article is an exciting step forward for the education and acceptance of CAM for medical physicians.  I believe that physicians cannot argue with the importance of adequate knowledge of treatment choices for their patients.  However, it is likely unrealistic to expect physicians to keep abreast of CAM research, especially considering the multiple modalities and varying findings in medical literature (see my previous posts on the efficacy of aromatherapy).

When a physician is not comfortable with a certain aspect of a patient’s care, he/she will often refer the patient to another physician, often a specialist in the area of question.  This admittance of discomfort and consult to peers is an integral part of Western medicine.  CAM consults are a potential way to educate patients and collaborate with medical providers.  Here at ITPCU, we are implementing that model.   Physicians and patients can request CAM consults and consequent treatment; inter-department CAM consults are also completed.  As a result, each provider has a list of primary patients that they care for.  At our meetings, we discuss patient treatment plans with both a Western medical and CAM perspective.  The interaction between ITPCU and the physicians and nurse practitioners results in an integrated system, CAM-friendly and educated providers, and happy patients!

Gilmour J, Harrison C, Asadi L, Cohen MH, Vohra S.  Informed consent: advising patients and parents about complementary and alternative medicine therapies. Pediatrics. 2011 Nov;128 Suppl 4:S187-92.