British Columbia Medical Journal, October 2010 issue Please download or visit this entire issue online at http://www.bcmj.org/october-2010

1. editorials
Patient self-management
recently attended a patient self- for your health and I am concerned
I management seminar. The idea is
to involve patients in their own
care, thereby increasing the chance
about you.”) Next, I got Bob thinking
about the issue while encouraging him
to be an active part of the solution.
I wanted to tell Bob
that they will actually make appropri- “Bob, there are two basic factors that he was the only
ate lifestyle changes. After complet- involved in weight control. Do you living creature on the
ing the course, filled with religious know what they are?”
self-management fervor, I was unleash- “No.” planet capable of
ed upon my unsuspecting patients. I was taken aback, but sometimes creating mass . . .
I found the most applicable issue more groundwork is required. “Well,
in my practice to be weight control, so Bob, the two factors are how many
when faced with an obese middle- calories you consume—diet—and
aged man I launched into action. First how many you burn off—exercise.”
I established rapport. “Bob, you are Now it was time to give control back ing, is there any other type of exercise
really fat and are going to die.” (I actu- to the patient. “Which of these would you like?”
ally started with, “Bob, there is lots of you like to talk about?” “I love to exercise.”
evidence that being overweight is bad “We can talk about diet but I don’t “I notice you live by the pool. How
eat anything.” about swimming?”
“Bob, you’re 5'9" and 300 pounds “I don’t like to get wet.”
but you don’t eat anything?” “There’s a gym at the pool, how
“That’s right Doc. You would be about using the stationary bike?”
surprised by how little I eat and what “My thighs rub.”
I do eat is all healthy.” “Elliptical trainer?”
I think Bob and I would both be “I get dizzy.”
surprised by what he eats. If the patient “Rowing machine?”
isn’t ready to talk reasonably about “I don’t like the sound they make,
one item then it’s probably better to it creeps me out.”
try a different approach, “Well, Bob, In the seminar they did say that
since your diet is so good how about sometimes you have to accept that some
we talk about your activity level?” patients just aren’t ready to change.
“I walk everywhere.” However, I have a problem with this
“Everywhere?” whole self-management thing. It feels
“Yes, everywhere.” a little like babysitting. Who doesn’t
“So let’s get this straight. You know that being overweight isn’t good
don’t eat anything and walk every- for you? Have any of you ever had a
where but continue to gain weight?” I conversation with a patient like this?
wanted to tell Bob that he was the only “Hey Bob, probably no one ever told
living creature on the planet capable you this before but being overweight
of creating mass and that I wanted to is bad for you.”
study him in the lab, but I remember “Really, you’re kidding. Shut the
the kind people at the seminar stating front door! Bad for you? I’ve been see-
that ridicule isn’t an effective self- ing doctors for years and you’re the
management technique. “Well, Bob, first one to tell me. Well, if it’s bad for
if you can’t improve your diet and me then I’ll lose weight and take bet-
you’re already walking everywhere, ter care of myself. Thanks Doc.”
the only solution is to increase your Another life saved.
activity a little more. Other than walk- —DRR
384 BC MEDICAL JOURNAL VOL. 52 NO. 8, OCTOBER 2010 www.bcmj.org

2. editorials
Type 2 diabetes in youth
ntil recently, type 2 diabetes today’s children will become the first ing the importance of preventing obe-
U mellitus was almost unheard
of in children, but over the
past few years there has been a signif-
generation in some time to potentially
have a shorter life expectancy than
their parents!
sity and promoting health. It was esta-
blished in 2005 as a cross-government
health promotion initiative and their
icant increase in incidence of this con- Currently, the economic costs re- mandate involved achieving five goals
dition in children and adolescents. It lated to obesity and its consequences by 2010. Three of these related to
has occurred too rapidly to be solely are not insignificant but relatively healthier food and exercise habits and
attributable to genetic predisposition, small. Without effective intervention, resulted in new guidelines for food
indicating that environmental factors though, they may well become stag- and beverage sales in public schools
are likely to play a key role in its devel- gering in the future. in BC. These were developed with
opment. Preventing childhood obesity in registered dietitians and implemented
The hallmark of type 2 diabetes is the first place is obviously the goal in 2008. New recommendations for
insulin resistance and the most com- and comes down to a need for com- physical activity in schools were also
mon cause of this is overweight and prehensive changes in dietary and introduced in 2008. Their web sites
obesity (overweight is defined by a lifestyle habits. This is a very complex and links for parents and families try-
body mass index of 25 to 29.9 or waist issue and intervention must take place ing to adopt a healthier lifestyle are
circumference of > 80 cm in females at a number of levels—the family, excellent tools.
and > 94 cm in males and obesity as a schools and community, the food and There is promise that we can begin
BMI > 30 or waist circumference of entertainment industry, policymakers, to stem the tide of childhood obesity,
> 88 cm in females and > 102 cm in and government agencies. but it will take a massive shift in our
males). About 50% of the Canadian The fast food industry in particu- current habits. Little steps can start at
population is overweight or obese. lar needs to get on side and make rad- home!
The proportion of obese children has ical changes. For the most part, unfor- —SEH
almost tripled in the last 25 years in tunately, they offer “bad” foods. Bad
both females and males in all age foods are cheap, heavily promoted,
groups except preschoolers. Children and engineered to taste good. They are Liquid Nitrogen
of obese parents have a 66% risk of loaded with calories, sugars or refined for Medical Use
being obese before adulthood. It is carbohydrate, fat, and salt. Portion Westgen has been providing Liquid Nitrogen
estimated that 26% of Canadians age sizes have exploded. “Supersized” to doctors for the past 10 years. We have
2 to 17 (more than 1 in 4) are over- portions of fries, burgers, and pop established a reputation for prompt, quality
weight or obese, up from 15% in 1978. are typically two to five times larger service at a reasonable price.
We also offer MVE Cryogenic Refrigera-
Ninety-five percent of children with than when first introduced. Some fast
tors in 10 and 20 litre sizes. These can be
type 2 diabetes are obese. food chains have introduced healthier acquired on a one year LEASE TO OWN
With the seemingly unabated in- meals, but they are generally more option, a system that allows you to own your
crease in prevalence of obesity, type 2 expensive than the standard burger tank after a year of low monthly payments
diabetes in youth is emerging as a seri- and fries. which includes free liquid nitrogen for the
ous public health concern. It is associ- Regular physical activity is key to lease period.
ated with increases in morbidity and achieving and maintaining a healthy MVE Cryogenic
mortality from both microvascular weight. It’s recommended that chil- Refrigerators
and macrovascular disease, and we dren get at least 60 minutes of physi- • No Stop Charge
are now seeing these complications, cal activity daily, and sadly this is • No Cartage Fees
• No Dangerous
particularly coronary artery disease, often not achieved. Goods Handling
appearing in young adults. This child- On a positive note, the ActNowBC Charges
hood obesity epidemic means that initiative has led the way in recogniz- • Lease to own
option
Service provided to practitioners on Vancouver
Island, Lower Mainland and Okanagan area.
For more information contact Westgen at:
1-800-563-5603 Ext. 150 or 778-549-2761
www.bcmj.org VOL. 52 NO. 8, OCTOBER 2010 BC MEDICAL JOURNAL 385