And why you should have a family doctor.
Dr. C. V. Alert, MB BS, DM. FCCFP
Family Physician.
Founder and Director, the Wellness Clinic, Barbados.
The heart attack at 50 began at 20.
The Alzheimer’s at 70 began at 40.
The loss of independence at 80 started at 30.
The ageing you want tomorrow begins with the choices you make today.
I recently came across this quotation from Mark Hyman, MD, an internationally respected physician, researcher, educator, activist, and 15 times New York Times best-selling author.
I have always promoted this concept as 1. Many persons believe that they should only think about their health when they feel sick, or a close relative or co-worker collapses ‘out of the blue’, 2. We have many persons who are overweight or obese, who generally ‘feel well’, not realizing that they are at high risk for developing (or actually incubating) one or more of the non- communicable diseases, the NCDs, and 3. Many persons harbor the NCDs for months or years without any symptoms, while their eyes, brains, hearts, kidneys and lower limbs are being destroyed ‘silently’. Our National Health profile is dominated by persons who seek medical attention only after they have had a heart attack, a stroke or kidney failure, and in many cases the health services can offer little help to them at that point. Our health services are so overwhelmed with treating ‘sick’ patients, that ‘health promotion and disease prevention’ have been placed on the back burner, while the focus is on setting up Emergency Clinics.
Since the vast majority of persons emerge from the womb in perfect health, where/when does disease start?
There is a condition called gestational diabetes mellituis, in which a mother develops a high blood sugar during pregnancy. Gestational diabetes mellitus (GDM) is a significant health concern in Barbados, with studies indicating a prevalence of approximately 11.9% to 19% of pregnancies affected. For the mother, possible complications include higher risk of pre–eclampsia (dangerously high blood pressure) and a greater likelihood of requiring a C-section instead of a normal vaginal delivery. For the baby, GDM can lead to excessive birth weight (macrosomia), premature births, traumatic births, low blood sugar after delivery, and a higher risk of obesity/type 2 diabetes later in life.
The higher risk of obesity/type 2 diabetes is critical in our population. At least one study has shown that, in Bajan children up to 5 years of age, about 10 percent may already be overweight. By the time they reach secondary school, at age 11-12 years, about 30 percent are overweight and 15 percent are obese. Childhood obesity is linked to increased risks of non-communicable diseases (NCDs) like type 2 diabetes and hypertension, in our adolescents and our adults. In our adult population, over 66% of adults 25 years and older are either overweight or obese (based on our most recent national figures). So as we get older, more and more people are becoming overweight or obese.
These observations and statistics suggest that, even before birth, many of us are prone to develop an NCD(s) like obesity, diabetes, diabetes and/or hypertension, and eventually their complications like heart disease, strokes, amputations and kidney failure. Being born with a propensity to develop these conditions does not necessarily mean that you will develop them, but if our children are fed with a diet of sugar sweetened beverages and sweet/salty/greasy fast foods instead of fruits and vegetables, and instead of running, jumping and playing outside they hold a screen in their hands or sit down in front of a large screen all day long, these habits fuel the progression from ‘healthy’ to ‘diseased’.
Preserving a healthy population must start even before birth, and continue throughout life.
Overweight and obesity are not merely cosmetic issues. Significant evidence shows that overweight and obese individuals die sooner than their normal weight neighbors, so being overweight or obese is associated with a shortened lifespan. In recent medical terminology, patients with overweight or obesity are classified as Cardiovascular-kidney-metabolic (CKM) syndrome stage 1, meaning that these patients are prone to develop cardiovascular, kidney and/or metabolic disease(s). The observations linking overweight/obesity with disease has been slow to reach the general population, even many health professionals, and here the medical insurance companies, who do not treat overweight/obesity as a disease and decline to reimburse clients for the potent anti-obesity medications that have been developed in the last few years. This is in spite of our national health profile being dominated by obesity-related diseases. Our Health officials have been particularly silent on this, over many years.
The overweight or obese person is also more likely to suffer poor health and miss time from school or work. They may die sooner, but they suffer more while they are still alive. They have to spend more time (and money) in doctors’ offices, or in the Emergency Rooms. They even help to fill up our hospital wards. They are more prone to develop disabilities like blindness, amputations, heart and kidney failure, conditions that remove one’s ability to enjoy life, or even take care of himself/herself – a loss of independence. Sometimes this may be 50 years in the making.