Integrated Disability Management

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Integrated Disability Management

• Focus on Depression and Obesity

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Todays Program

• Obesity
• Depression
• Integrated Approach

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Obesity Defined

• Abnormal accumulation of body fat
• Usually 20 over ideal body weight
• Hyperplastic (new fat cells onset childhood)
• Hypertrophic (onset adulthood)

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Obesity Continuum

• 20 - 40 over ideal weight Mild
• 40 - 100 over ideal weight Moderate
• More than 100 over ideal severe or morbidly
  obese

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Causes of Obesity

• Basic premise more calories consumed than burned
  by body
• Genetic Factors
• Eating Habits
• Physical Activity / Inactivity
• Medications
• Mental Health
• Medical Condition

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Medical Conditions Disorders

• Endocrine Disorder - Cushings Syndrome
  (excessive cortisol release)
• Hypothyroidism (underactive thyroid)
• Neurologic (damaged hypothalumus which regulates
  appetite)

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Medication Effects

• Steroids weight gain, bloating, hunger
• Anti-depressants - dry mouth, weight gain,
  headache, nausea

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Psychological Disorders

• Depression

• Low self-esteem
• Lethargy
• Low energy
• Inactivity

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Risks or Results of Obesity

• Hypertension
• Type II D Mellitus
• Coronary / Cardiac Disease
• Infertility

• Stroke, asthma, apnea
• Ortho / Arthritis
• Menstrual Abnormal
• Shortness of Breath

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Cancer Obesity

• Prostate
• Kidney
• Uterus
• Breast

• Liver
• Pancreas
• Esophagus
• Colon and Rectum

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Obesity on the Rise

• 1988 1994
• 56 Overweight
• 23 Obese

• 1999 2000
• 64 Overweight
• 30 Obese

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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

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Culture Bound Statistics

• 50 African American Women
• 80 American Indian Adults
• Pacific Islanders highest prevalence

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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)

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Sample Population

• U.S. Veterans
• 73 men overweight
• 33 men obese

• General Population
• 67 men overweight
• 27 men obese

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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.

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Two Main Types

• Major Depressive Disorder
• - Moderate to severe depression 2weeks
• - Loss of interest in activities once enjoyed
• - Concentration, worthless, hopeless, etc

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Two Main Types

• Dysthymic Disorder
• - Chronic, underlying depressed mood affect
• - Mild to moderate depression
• - Lasts 2 years, w/ average duration 16 years

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Associated Symptomatology

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

• Major Depressive Disorder

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Associated Symptomatology

• Under / over eating
• Insomnia / hypersomnia
• Low energy or fatigue
• Low self-esteem
• Poor concentration
• Feelings of hopelessness

• Dysthymic Disorder

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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

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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)

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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

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With that said, Whats next?

• Differential Diagnosis
• Corroboration of evidence / data
• Formulate treatment / wellness plan (multi-modal
  approach)
• Big picture, dont get mired down in details, but
  dont overlook them either

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Differential Diagnosis

• Axis I Clinical Mental Disorders
• Axis II Personality Pathology
• Axis III Medical Factors
• Axis IV Stressors
• Axis V Global Assessment of Functioning

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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

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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

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Questions Case Discussion?

• Dynamic Claims Solutions, Inc.

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Thank you!

• Peter R Reilly
• Director Injury Analysis Training
• Dynamic Claims Solutions
• 800.630.8606
• www.dynamicclaimssolutions.com