Part 5: Diabetes and tobacco and obesity—oh my!
Chronic diseases are responsible for 83 percent of all health-care spending. These are diseases that drag on for years and get slowly worse, and require increasingly complex interventions. These are the diseases that keep doctors in business. And these are the diseases we have power to control. If we eliminate chronic diseases and embrace self-care reform, we could put millions of doctors out of work.
Let me tell you 10 ways to put your doctor out of business:
8. Prevent diabetes. Death rates from cancer, cardiovascular disease and strokes have all gone down in the past decade. All the major diseases are getting better. Except for one. And that one is getting very bad. I’m talking about diabetes.
Most people have only the vaguest idea of what diabetes is, what causes it or what it does. They know it has something to do with sugar, so the image that comes to mind may be something amorphous, like cotton candy.
We can no longer afford to minimize our health problems. So often you will hear someone say, “Oh well, I have a little sugar,” which is like saying, “I’m a little pregnant.” To a doctor, a diabetic is a diabetic. It can cause a loss of kidney function, lead to blindness or cause a loss of feeling in your extremities, and if you are pregnant, it is associated with a higher rate of stillbirths and birth defects.
There are two types of diabetes. Type 1 diabetes strikes in childhood and may be genetic in origin. Type 2 diabetes is far more common. Up until recently, it was primarily a disease of aging, but the age-of-onset has been creeping downward in our lifetime. Today, thousands of children are being diagnosed with type 2 diabetes. The rate of admission for kids to hospitals for diabetes-related disease has increased 200 percent in the last decade.
Diabetes has no single trademark symptom; it delivers no ultimatums, no wake-up calls. It sneaks up on you. It’s a glandular disease that throws your enzymes out of whack. The sugar you eat can’t get into your cells. It backs up in blood. Your body chemistry goes haywire. And almost 20 million Americans have diabetes.Almost a third of them may not be aware of it.
Diabetes keeps a lot of doctors very busy. Not only endocrinologists, who treat glandular disorders, but nephrologists, cardiologists, heart surgeons, urologists, vascular surgeons, podiatrists and eye doctors. That’s because left untreated, diabetes can lead to kidney failure and dialysis, erectile dysfunction, stroke, vascular disease, heart disease, gangrene and blindness.
While there’s no simple way to prevent or cure cancer, there is a “magic bullet” for diabetes. It’s called diet, exercise and avoiding becoming overweight or obese. No one is sure what causes diabetes, but you can virtually eliminate your chances of developing it by getting regular exercise and eating a plant-strong diet. If you have diabetes, you can control and reverse the disease the same way.
9 & 10. Stop smoking and lose weight. Smoking and obesity run like Bonnie and Clyde through every chronic disease condition. They’re implicated in thousands of crimes against the body. Smoking and obesity alone may drive more than half to three-quarters of our current demand for health care. This fact is deeply ironic, because of all the variables that control human health, smoking and obesity are two of the most controllable. We can’t control our genes. We can’t run from viruses and bacteria. But smoking and obesity are 100 precent volitional.
Mark Twain said, “It’s easy to stop smoking. I’ve done it hundreds of times.” As Toby Cosgrove, M.D., the noted heart surgeon and CEO of Cleveland clinic, says, “No single action can have a greater positive effect on individual health than smoking cessation.” It’s like stepping out of the way of an oncoming train. Under Dr. Cosgrove’s leadership, the Cleveland Clinic campus went smoke-free several years ago. Many hospitals across the country have adopted similar policies.
Smoking went from sexy to scary in 1961 with the first study linking it to lung cancer. Now we know smoking is associated with 17 types of cancer, in addition to causing wrinkles, cardiovascular disease, birth defects and emphysema, and it is a factor in everything from osteoporosis to gum disease. If tobacco use disappeared tomorrow, thousands of oncologists, pulmonologists, heart surgeons, vascular surgeons and thoracic surgeons would have to find other lines of work. Gynecologists would go out of work, too, because smoking in women is associated with infertility, irregular menstrual cycles, premature deliveries, premature menopause, and cervical pre-cancer and cervical cancer.
But nothing is more culturally conditioned than our eating habits. Obesity arises from a complex interplay of cultural and emotional factors. People who are overweight deserve our compassion.
One of the most disturbing aspects of obesity is that we are passing these unhealthy habits on to our children. When parents are obese, children are more likely to be obese. One of the most sobering statistics reveals that this generation of young people is one of the unhealthiest groups of kids ever. More children today are diagnosed with diabetes and hypertension than in the history of medicine. As in adults, obesity in children is associated with diabetes, high blood pressure and cholesterol. Sadly, our children will have a shorter lifespan than their parents and grandparents if they continue with the lifestyles they are leading. Car seats are now being made in husky sizes for children because they are too large to fit in the average size ones. By viewing this excessive weight in babies as cute, we underplay the risk to these children’s lives. Get your kids outside to exercise. Limit TV, computers and video gamesto less than one hour daily. Or, in another practical way, for every minute of TV, the kids should engage in an equal amount of exercise.
Obesity is directly related to a long list of chronic illnesses. Foremost is diabetes. Rates of adult-onset diabetes shoot up right alongside the obesity rates.
Health statistics are deceptive. We talk about high rates of cardiovascular disease, breast and gynecological cancers and colon cancer, but being overweight is also linked with orthopedic and joint problems. Hip, ankle and knee replacements and other joint ailments and pain are noted in overweight patients. Accidents, falls and sleep disorders are additional health conditions associated with obesity.
Obesity is a more serious public health problem than smoking. Smoking is one habit, one behavior; obesity is enabled by a galaxy of cultural, psychological, spiritual, economic and political factors that involved every facet of our society.
Tens of thousands of doctors enjoy excellent incomes, thanks to obesity. Over the past 20 years, we’ve seen a national change of heart about smoking, which has banished tobacco to the outer fringes of acceptability. Perhaps over the next 20 years, we’ll see a similar change of heart about food. We’ll talk about where and how our food is grown, how it is processed, what is added to it, when and how we eat and how agricultural subsidies contribute to obesity in this country. We’ll talk about pride and personal responsibility, because unlike smoking, you can’t legislate how and where people eat.
A healthy weight takes sweat. It means learning how to cook your own meals rather than eating out. It means portion control. It means learning how to say “no.” It requires getting used to new tastes, new flavors and modifying recipes so they contain less fat and salt. Try a new spice, herb, flavor or meal plan for 30 days. Usually after 30 days, anything we stick with becomes a habit. If we all stayed in the neighborhood of our ideal body weight, we could put another tens of thousands of doctors out of work. And who wouldn’t like to take some profits from the pharmaceutical companies? People who lose weight suddenly find they can decrease the number and amount of medications or completely stop their medications. Addressing these two problems—tobacco and obesity—would essentially resolve our national health-care crisis by shrinking demand for services down to a manageable size.
That’s my top 10, but there are other ways to cut your doctor’s business. For instance, you can cut your doctor visits by making each appointment really count. Be clear with yourself about what you want from the visit. Be absolutely honest with your doctor. Remember your medical information is a sacred trust. Your doctor can’t help you if you hold back information. Ask questions; listen carefully. Be prepared to talk about your health problems systematically. Discuss your concerns—even if they make you feel awkward. Repeat and summarize what your doctor tells you, and don’t leave without an action plan.
“So what?” you might say. “Who wants to live forever? Everybody has to die of something.”
Certainly, we all will die of something, but death doesn’t have to be slow or painful and well in advance of the biblical three score and 10. Chronic diseases don’t kill you suddenly. With chronic diseases, you get progressively more ill and debilitated, especially if your disease is not managed correctly. The receptionist in the doctor’s waiting room gets to know you very well—and the names of all your children and pets. Death is inevitable, but a long, dragged-out lifetime of ill health is not.
Paying attention to ourselves is not selfishness or narcissism. It’s part of our responsibility to others. Americans suffer from preventable diseases in gross numbers compared to exotic bacterial and parasitic infections seen in third-world countries. We are all connected by invisible cords of mind, body and spirit. Let’s use our minds to take care of our bodies, care for ourselves and recharge our spirits. Get off the pity pot. Start with one small change, be it diet, a pledge to exercise more, smile more, or having gratitude, forgiveness or sharing your wealth with others. It’s never too late to get healthy. Make tomorrow the first day of the rest of your life!
This series first appeared in Career & Lifestyle Magazine.