Integrated Disability Management

Focus on Depression and Obesity

Today’s Program

Obesity

Depression

Integrated Approach

Obesity Defined

Abnormal accumulation of body fat

Usually 20% + over ideal body weight

Hyperplastic (new fat cells – onset childhood)

Hypertrophic (onset adulthood)

Obesity Continuum

20% - 40% over ideal weight = Mild

40% - 100% over ideal weight = Moderate

More than 100% over ideal = severe or morbidly obese

Causes of Obesity

Basic premise: more calories consumed than burned by body

Genetic Factors Eating Habits Physical Activity / Inactivity Medications Mental Health Medical Condition

Medical Conditions & Disorders

Endocrine Disorder - Cushing’s Syndrome (excessive cortisol release)

Hypothyroidism (underactive thyroid)

Neurologic (damaged hypothalumus which regulates appetite)

Medication Effects

Steroids – weight gain, bloating, hunger…

Anti-depressants - dry mouth, weight gain, headache, nausea…

Psychological Disorders

Depression - Low self-esteem

- Lethargy

- Low energy

- Inactivity

Risks or Results of Obesity

Hypertension

Type II D Mellitus

Coronary / Cardiac Disease

Infertility

Stroke, asthma, apnea

Ortho / Arthritis

Menstrual Abnormal

Shortness of Breath

Cancer & Obesity

Prostate

Kidney

Uterus

Breast

Liver

Pancreas

Esophagus

Colon and Rectum

Obesity on the Rise

1988 – 1994

56% Overweight

23% Obese

1999 – 2000

64% Overweight

30% Obese

FDA Obesity Working GroupFebruary 2004

Obesity has no single cause, “there will be no single solution; obesity will be brought under control as a result of numerous coordinated, complimentary efforts from a variety of sectors of society”

Culture Bound Statistics

50% African American Women

80% American Indian Adults

Pacific Islanders highest prevalence

Reversal of Life Expectancy Trend (i.e. shortened)

Already 1/3 to ¾ of a year shorter than if maintain ideal body weight

In coming decades could be reduced 2 to 5 years

Since 1980 U.S. adult obesity up 50% (i.e. 2/3 overweight or obese)

Sample Population

U.S. Veterans

73% men overweight

33% men obese

General Population

67% men overweight

27% men obese

Depression Defined…

Mental illness characterized by a profound and persistent feeling of sadness or despair and / or a loss of interest in things that were once pleasurable….

Two Main Types

Major Depressive Disorder

- Moderate to severe depression 2+weeks- Loss of interest in activities once enjoyed- Concentration, worthless, hopeless, etc…

Two Main Types

Dysthymic Disorder

- Chronic, underlying depressed mood & affect- Mild to moderate depression- Lasts 2+ years, w/ average duration 16 years

Associated Symptomatology

Major Depressive Disorder

Sign. change in weight Insomnia / hypersomnia Agitation / retardation Fatigue / loss of energy Worthlessness / guilt Diminished thinking Poor concentration Thoughts of death /

suicide

Associated Symptomatology

Dysthymic Disorder Under / over eating Insomnia /

hypersomnia Low energy or fatigue Low self-esteem Poor concentration Feelings of

hopelessness

Related Statistics

Depression affects est. 17 million annually

Indirect cost of $53 billion (human suffering costs immeasurable)

First episode usually in mid-20s (though all ages from children to elderly)

25% of women experience a severe episode during life, compared to 5-10% for men

Causes of Depression

Complex and not well understood

Imbalance of neurotransmitters (serotonin, dopamine…)

Heredity (3x chance of developing if family member is depressed)

External stressors & significant life changes (trauma, loss of loved one, divorce)

Causes of Depression

Physical changes - stroke, heart attack, cancer, hormonal changes

Change of life patterns – serious loss, difficult relationship, financial problems

* very likely a combination of genetic, psychological and environmental factors*

With that said, What’s next?

Differential Diagnosis

Corroboration of evidence / data

Formulate treatment / wellness plan (“multi-modal +” approach)

Big picture, don’t get mired down in details, but don’t overlook them either

Differential Diagnosis

Axis I: Clinical Mental Disorders

Axis II: Personality Pathology

Axis III: Medical Factors

Axis IV: Stressors

Axis V: Global Assessment of Functioning

Treatment Focus

Psychological – complete psycho-social, “talk” therapy, cognitive behavioral, realign worldview / perspective

Psychiatric – prominent symptom management, scrutinize medication schedule

Medical – maintenance, control and rehabilitation of conditions and disorders

Behavioral change – level of activity, eating habits

Issues that deserve further consideration

Co-morbidity: depression and obesity

Rx alone insufficient – must change quick fix mindset

Future Impact: Generation of youth growing up heavy, exponentially increasing probability for future pathology

Questions & Case Discussion?

Dynamic Claims Solutions, Inc.

Thank you!

Peter R ReillyDirector – Injury Analysis & TrainingDynamic Claims Solutions800.630.8606www.dynamicclaimssolutions.com