There’s a common catch phrase used by those championing efforts to prevent childhood obesity: “This may be the first generation of kids to not outlive their parents.” Sounds terrifying – except that so far, there is little evidence to support this idea.
Over the past several decades we have seen a remarkable increase in adult and childhood obesity, yet life expectancy has continued to increase and may well continue to do so.
This is not to say that obesity is not a major driver of health risks. Obese individuals are far more likely to develop diabetes, heart disease, arthritis, sleep apnea and even breast cancer. But survival of individuals with these conditions continues to increase. In fact, never have so many with these conditions lived to a ‘ripe old age.’
This ‘success’ poses important challenges to our health care system. No doubt obesity will drive some health conditions, but rather than translating into premature deaths, it is far more likely that today’s kids will live even longer — and live longer with chronic diseases — than their parents.
Thus the obesity epidemic’s real burden is an unprecedented increase in ‘chronic diseases of the young.’ This has implications for both our workforce and for our health care system.
For the workforce, this means that more employees will be living with obesity and the resulting increase in diabetes, hypertension sleep apnea, arthritis and other chronic health conditions. While these conditions can be managed, the resources and the delivery of health care cannot remain the same as it is today for the ‘chronic diseases of the elderly.’
While the retiring baby-boomers with these conditions can perhaps afford to sit around in waiting rooms for their clinic appointments, younger workers will be unable to leave their workplace as often as would be required for the management of their conditions. Indeed, success of managing chronic conditions is directly related to the number of visits with a health professional — the more frequent and regular these visits, the better the condition tends to be controlled.
So our health care system will need to develop and adapt to providing regular visits to a large proportion of the workforce, which can ill afford to take time off for lengthy day-time consultations.
There are essentially three ways to deal with this challenge, all of which must be considered: We need to open community chronic care clinics after hours; we need to relocate chronic care clinics to the workplace; and we need to use technology to deliver disease management programs to employees.
It is unlikely that the first option will acceptable to most health professionals. A far better approach would be to relocate chronic care clinics to our places of employment, making it possible for employees to consult with a health professional during the course of their work day. It is not the length but the frequency of such encounters that matter. Simply stepping on a scale, having your blood pressure taken or your glucose levels checked with a quick word of encouragement from a health professional is often enough to keep patients on track, and does not require a lengthy visit to the doctor’s office.
Finally, electronic communication including telehealth consultations that employees can participate in from their desk computer or handheld devices could replace frequent and expensive in-person visits to a health professional.
The sooner our governments and employers prepare for this obesity driven epidemic of ‘chronic diseases of the young,’ the more likely we will be able to avoid the expensive complications of these conditions — and save our health care system in the process.
This should, of course, not distract from obesity prevention efforts, but even the most optimistic forecasts do not foresee any significant reduction in the number of Canadians living with obesity and related health problems at least well into the middle of this century.
Not preparing for the expected consequences of the obesity epidemic will surely burden the health care system and negatively impact the productivity of our workforce. All of this can be avoided by changing how we deliver health care — taking chronic disease management directly to the community — and providing care at the workplace.
This blog is reprinted with the kind permission of our friends at EvidenceNetwork.ca
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This seems like a likely future, and one that (I hope) we can come together as a community to try to avoid. Still, it’s pragmatic to plan for this scenario, so I’d like to share some thoughts.
1) In addition to the concerns expressed already (specifically, privacy being compromised by having clinics in workplaces) I wonder how feasible it would be?
2) Because obesity is a reality, and because many of us work desk jobs (and there are known health risks from being sedentary), it seems that a compliment to this schema would be making workplaces more responsive to minimizing these deleterious health effects (e.g. walking meetings, gyms in the workplace with reduced membership rates, etc)
3) I have concerns about suggesting physicians balance out these earlier-in-life-chronic-conditions by scheduling after-hours and weekend clinics, as if the default should be drive-thru treatment.
Elizabeth Doyle (www.elizabethdoyle.weebly.com @Says_LizDoyle)
A dismal picture in the crystal ball, but I think likely accurate. There are certainly potential benefits in workplace-located chronic care programs. I’m still going to vote for option 1 though. The health services literature demonstrates improved outcomes for chronic diseases from continuity of care. I spent most of my career practicing in the US, where (because health insurance is linked to employment) changing jobs often means having to change physicians. I’ve seen first hand how disruptive linking care relationships to jobs is to continuity, and would hesitate to replicate that here. Where I practiced before, most family physicians’ offices were indeed open extended hours. My practice was open late Mon-Thurs and during the day on Saturday, and that was typical. If we family physicians really want to practice patient-centred care, as we claim, it’s time for us to suck it up and be there when our patients need us to be. That’s what I’d rather see us replicate here.
I agree with the idea of improving access to healthcare for working people. Unfortunately, I have a lot of concerns about establishing connection between health care and work, especially for a stigmatized condition such as obesity. Telehealth and secure forms of electronic communication are great, although people need assurance of privacy to participate, which is hard to come by in the era of open office designs and employer monitoring of computer use (not to mention people who don’t spend much of the workday on a computer).
While I agree with much of what you are saying in becoming more approachable and working at working with accommodating schedules. I am sad to see that you do not talk about health promotion at the same time. If all we do is plan for the expected outcome we are letting our communities fail.