Thursday, April 27, 2017

Heightened Health Risks Due to First and Second-Degree Relative's Illness History

A person's family history can be instrumental in diagnosing and treating a number of illnesses, including cancer, obesity, type 2 diabetes and other diseases. The focus on a person's family history typically involves first-degree relatives, however, there may be some value in looking at second-degree family history, especially for clinical management of metabolic diseases.

When a physician examines a patient, the physician obtains, among other things, the patient’s weight, height, and medical history. The physician also asks questions to learn more about the patient’s parents’ medical history, and the patient's siblings' medical history. This is done to help the physician resolve health issues and possibly mitigate the effects of future health issues. When a doctor asks about the patient's immediate or first-degree relatives' medical history, the physician asks these questions because a patient’s relatives’ history can influence the patient’s health.

For example, if one of a patient's immediate relatives has diabetes, the patient's risk of diabetes is higher than normal. And if the patient's parents are obese, this raises the likelihood that the patient might need to pay special attention to his or her weight. The same holds true for some forms of cancer. There is available evidence that at least five cancers are linked to overweight and obesity. These cancers are "adenocarcinoma of the esophagus; colorectal cancer; breast cancer in postmenopausal women; and uterine and kidney cancers."

Not only are first-degree histories important, second-degree relative histories are also important in the management of certain diseases. For example one study concluded that "second-degree FHD [family history of diabetes] could be used as a public-health screening tool to identify children at risk of adverse metabolic outcomes and of possible future disease."

Providers should of course consider the medical histories of their patient's first degree relatives' medical histories. These medical histories can add to the provider's knowledge of the patient, and enhance the patient's clinical treatment. However, some consideration should probably be given to medical histories of second-degree relatives. Because, for some diseases like metabolic diseases, these histories might also be useful.

Tuesday, April 18, 2017

Clinical Management of Obesity Can Compete with Bariatric Surgery

The typical approaches to weight loss and weight management are diet, exercise, medication, lifestyle change and bariatric surgery. And it is assumed by most people that bariatric surgery is more effective than diet, exercise, anti-obesity drugs or lifestyle changes. But a recent study asserts that an intensive clinical management approach to obesity can be as effective as bariatric surgery.

There have been studies that suggest that bariatric surgery consistently leads to weight loss and improved metabolic parameters including better glucose management. For example, One "study comparing 1-year outcomes in obese patients who followed a medical weight-loss program vs others who had bariatric surgery has found that both groups lost weight and had improved levels of HDL cholesterol and other obesity-linked biomarkers but the improvements were greater in those who underwent surgery."

Then again, a recent study suggests that clinical management of obesity can successfully treat the disease under the right circumstances. According to the researchers,  the reasons that clinical management of obesity fails is because of the following reasons: “(1) anti-obesity medications are administered as monotherapies (or pre-combined drugs); (2) lack of combination between pharmacotherapy and non-pharmacological modalities; (3) short duration of pharmacotherapy for obesity; (4) lack of weight-loss maintenance strategies; (5) misunderstanding of the complex pathophysiology of obesity; and (6) underprescription of anti-obesity medications."

The researchers, therefore, set out to resolve the issues just mentioned. The researchers followed a protocol, for example, that included the use of anti-obesity medications in different combinations depending on effectiveness. After using the protocol to resolve some of the clinical management issues, the researchers concluded that "An intensive clinical approach to obesity management can be an effective alternative to bariatric surgery, although further randomized controlled studies are necessary to validate our findings."

Indeed, more research is needed to confirm the findings of the above referenced study. And ways to cost-effectively apply the approaches that the researches used should be found. Bariatric surgery, while relatively safe, is not as safe as many non-surgical approaches to weight loss. Therefore, focusing on the methods used in the intensive clinical-management study could eventually benefit overweight and obese patients.

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