The Obesity Paradox

We all know that being fat is unhealthy. And that the more overweight you are, the sicker you are more likely to become. Right?

Wrong.

Amidst the overwhelming tide of warnings about the obesity epidemic in America, the outcries that sugar is toxic, and the medical advice given by healthcare providers everywhere to “just lose weight”, is a steadily growing group of researchers in opposition to the fear of obesity. Researchers looking at risk factors related to diabetes, heart failure, and atherosclerosis are discovering some unusual findings.  

In a research study conducted at Northwestern University, Dr. Mercedes Carthenon found that diabetes patients of normal weight are twice as likely to die as overweight or obese diabetes patients. Other researchers are finding these same types of trends when looking at patients with heart failure, and patients on dialysis.

There are many possible theories to explain the paradoxical effect that weight may have on mortality. One idea is that as the body develops a chronic disease, it requires more energy and calories to deal with the disease effects.  Another theory proposes that genetics plays a role: Perhaps thinner people have genes making them more susceptible to chronic diseases.

And yet a third theory asserts that we are measuring overweight and obesity with the wrong yardstick. BMI—body mass index—is actually an arbitrary table that only takes into account height and weight to calculate a number by which all healthcare providers and researchers base their obesity data on. This simple measurement tool does not allow inclusion of other important factors, such as age, gender, and muscle mass. So perhaps our definition of obesity is originating in a faulty system to begin with, which could then be causing us to look in the wrong place for risk factors relating to chronic diseases.

With this growing research beginning to confound the culturally prevalent concept that obesity is unhealthy, researchers are going back to the drawing board to emphasize fitness. Our own Dr. Glenn Gaesser (author of Big Fat Lies) at ASU’s Healthy Lifestyles Research Center has devoted his research efforts to evaluating the effects of different types of exercise programs with overweight and obese individuals on a variety of cardiac risk factors, including insulin resistance, visceral fat, and endothelial function. The results have yet to be determined.

So what can healthcare providers take from this idea of an obesity paradox? Perhaps it is time to rethink obesity as the main concern when promoting healthy lifestyle behaviors. Let’s keep our eyes peeled for the most current literature in this field, and in the meantime, encourage our patients to get fit instead of get thin.

**This post is based on a recent article by Harriet Brown in the NY Times and can be found here. (Further note: Glenn Gaesser is my husband's PhD mentor!)

Chemotherapy in Pregnancy

Spending the day with a perinatologist I can across an unusual and sad case that I wanted to share. S.T. is a 33 year old, gravid 3 para 2. She is pregnant with her third child and is currently 19 weeks and 6 days. S.T. is married and has a 10 year old and 5 year old child at home. Three months ago S.T. found a mass in her left breast. The mass was diagnosed as breast cancer with lymphnode involvement in the axillary region. One week after being diagnosed with breast cancer S.T. found out she was 8 weeks pregnant with her third child. S.T. underwent a mastectomy of her left breast and removal lymphnodes in her axilla shortly after being diagnosed with breast cancer and pregnancy. One week ago she had a port surgically implanted to receive chemotherapy. Four days ago S.T. began her first round of chemotherapy, which she will receive every three weeks until the end of December. Early delivery is planned by the perinatologist at the end of January 2013.

The reason I wanted to share this case was because I was completely unaware that chemotherapy can be given during pregnancy. I thought that the mother would have to choose between ending the pregnancy and receiving treatment or not receiving treatment and putting her life at extreme risk. Although there are significant risks to receiving chemotherapy during pregnancy I was surprised at the results. According to Gzirl et al. (2012), chemotherapy needs to be avoided during the first trimester of pregnancy due to teratogenic risks. Chemotherapy in the second and third trimester may be associated with intrauterine growth restriction, preterm delivery, and rarely cardiotoxic fetal effects. In the majority of patients the cardiotoxic effects were transient. Fetal and maternal monitoring for cardiotoxicity is recommended (Gzirl et al., 2012). In a study by Mir et al. (2008), twenty five pregnant patients received chemotherapy after the first trimester once organogenesis was complete. All the neonates showed a normal physical exam at delivery except for two who had respiratory distress due to prematurity. Of the 25 pregnancies, four patients received chemotherapy within three weeks of delivery, leading to two babies with mild anemia and four babies with neutopenia. It is recommended to stop chemotherapy four weeks prior to delivery due to late transplacental transfer of chemotherapy drugs which lead to neutropenia in the neonate (Mir et al., 2008). Another study conducted by Abdel-Hady et al. (2012), included 118 patients diagnosed with malignancy during pregnancy who were followed over an 8 year period. In the study 61 women received chemotherapy during the second and third trimester. Infant survival, preterm birth, small for gestational age, and malformations were not significantly different between the chemotherapy group and the control group. The conclusion states that exposure to chemotherapy in the second and third trimester carry minimal morbidity to an unborn fetus (Abdel-Hady et al., 2012).

References

Abdel-Hady, E., Hemida, R. A., Gamal, A., El-Zafarany, M., Toson, E., & El-Bayoumi, M. A. (2012). Cancer during pregnancy: Perinatal outcome exposure to chemotherapy. Maternal-Fetal Medicine, 286, 283-286. doi: 10.1007/s00404-01202287-5

Gzirl, M. M., Amant, F., Debieve, F., Calsteren, K. V.,  Catte, L. D., & Martens, L. (2012). Effects of chemotherapy during pregnancy on the maternal and fetal heart. Prenatal Diagnosis 32, 614-619. doi: 10.1002/pd.3847

Mir, O., Berveiller, P., Ropert, S., Goffinet, F., Pons, G., Treluyer, J. M., & Goldwasser, F. (2008) Emerging therapeutic options for breast cancer chemotherapy during pregnancy. Annals of Oncology, 19, 607-613. doi: 10.1093/annonc/mdm460

Social Media & Medical Practice

Sylvia,

I completely agree with you that we as current/future NPs need to listen to our patients and advocate for them. You mentioned using social media as a way for providers to support their patients. However, before you begin interacting with patients via social media, I would encourage you to first read a document recently released by the Federation of State Medical Boards titled: Model Policy Guidelines for the Appropriate Use of Social Media and Social Networking in Medical Practice (http://www.fsmb.org/pdf/pub-social-media-guidelines.pdf). There are a multitude of various issues to consider from legal and ethical standpoints and providers have had their licenses suspended and even revoked for things that took place on social media. Although this guideline basically discourages the use of social media in medical practice, there is an interesting editorial on the American Academy of Family Physician’s website in which one provider discusses her careful use of social media within her practice (http://www.aafp.org/online/en/home/publications/news/news-now/opinion/20120629editbrull.html). Although we have come leaps and bounds in terms of technology and our patients may often express a desire to communicate with us via various social media outlets, it is our professional responsibility to take appropriate precautions to protect both ourselves and our patients.

 

Becky

DNP 710 Stoneking response hayashi

     Nice job on the submission, it is apparent that we have an important role in creating an atmosphere of trust and empathy for our clients. You stated that it is ethically and morally responsible of an NP to be empathetic to clients especially when they are suffering from chronic conditions such as Lichen Sclerosis. Not only do we as providers need to understand the disease, we need to also understand the emotional stress that these diseases place on our patients. Reynolds (2000) stated that in the fields of chronic illness, long-term and stress-related illness, an empathic relationship between the client and practitioner may mean the difference between misery, suffering and pain and a relatively active, satisfactory and productive life. In dealing with hectic schedules and heavy patient loads, practitioners can forget their manners and take a moment to show empathy. But, practitioners can also be unaware of the process of empathy with their relationship to clients and forget about the responsibility for ultimate therapeutic benefit for those who are suffering or experiencing crisis situations. Not only do we need to be knowledgeable about LS we need to also be knowledgeable about our patients feelings and how they play a role in the healing process. I look forward to continuing this conversation. Tom

Reference

Reynolds, W. (2000). Do nurses and other professional helpers normally display much empathy. Journal      of Advanced Nursing, 31(1): 226-34

Hayashi.DNP710.First Blog

First Blog: Lichen Sclerosis

        The article I would like to share with everyone is on “Lichen Sclerosis (LS)”.  According to the authors “few health care providers are knowledgeable about LS and those who are often focus on women’s sexual functioning with little consideration of impact on participation and overall quality of life” (Wehbe-Alamah, Kornblau, Haderer, & Erickson, 2012, p. 504).  LS not only affects women but men and children as well.  It is amazing that even a 6 month old child can be affected by this horrible chronic disease.  Often when a child is diagnosed with the condition it can be mistaken for child abuse due to signs of vulva soreness and anal fissures.  Also the women with LS suffer from tremendous psychological effects like depression, despair, guilt, worry, and embarrassment. 

        Women with LS in this study used the Internet (e.g. blog) to express their frustration, seek help, encourage each other, support each other, and basically meet their social needs regarding similar experiences.   The women jointly agreed that health care providers should listen, be empathetic to their needs, and most of all assist them in finding a cure.  Unfortunately at this time there is no cure for LS but they can be offered symptom relief, which is clobetasol propionate 0.05% applied once or twice daily for three to six months.
        It is evident that women with LS are silent no more regarding this chronic disease.  As Nurse Practitioners (NPs) it is truly our ethical and moral responsibility to hear their voices and serve as their advocates.  One way we can become more knowledgeable is to familiarize ourselves with the LS guidelines that can be retrieved from:
(http://inquestsoft.com/wordpress/wp-content/uploads/2012/06/BADLSGuidelines.pdf).  Another way we can assist these patients is by becoming familiar with literature pertaining to LS regarding timely diagnosis, emotional support, and care. 
        As NPs we can move into a new frontier and utilize social media like blogs, Twitter, Face book and other sites in order to improve patient outcomes relating to LS.  Finally, “these expanding opportunities through current and future social media networks provide NPs, in their varied roles as clinicians, educators, researchers, and policy makers, with the tools needed to address the social injustices associated with LS” (Wehbe-Alamah, Kornblau, Haderer, & Erickson, 2012, p. 504).

Reference:

Wehbe-Allamah, H., Kornblau, B. L., Haderer, J., & Erickson, J. (2012).  Silent no more!  The

        lived experiences of women with lichen sclerosis.  Journal of the American Academy of

       Nurse Practitioners 24, 499-505.  doi: 10.1111/j.1745-7599.2012.00715.x 

 

Saying hello

My name is Thomas Stoneking. I am a proud RN at John C. Lincoln hospital where my passion is tending to my patients, especially the elderly. I have been a nurse for about five years and was motivated to continue my education. I am currently in the BSN-DNP program at ASU specializing in Adult/Gero. I will graduate in May and make my mark in society.

Representing mental health!

Hello! I'm Monique and I'm the psychiatric-mental health nurse practitioner of the group. I am passionate about mental health and am so glad I discovered my niche after years of trying on different types of specialties and applying to numerous psychology-related programs. I am currently doing my residency at a student health center. I am also conducting my doctoral research study using cognitive-behavioral therapy (CBT) with anxious children.
Outside of school, my life is filled to the brim with my husband (also a doctoral student at ASU) and my charming and energetic 3-year-old son. Other passions include writing (including blogging here), exercising outside (biking, swimming, hiking), yoga (just started Bikram--yikes!), and maintaining close relationships with family and friends back home in California.
I am excited about this new adventure into professional blogging and collaborating with others outside of mental health.

 

Thanks for visiting our NP blog!

 

Hi, I'm Becky Girard. I graduated with my BSN from the University of Michigan in 2007. Since then I have been working as a cardiac nurse specializing in the care of patients with heart failure. I am currently a family nurse practitioner student in the Doctor of Nursing Practice program at Arizona State University. I will be graduating in the Spring of 2013. My interests are in cardiology and dermatology.

Hi everyone I have been practicing as a Women's Health Nurse Practitioner for the last fourteen years.  My previous career was an ICU nurse for 15 years.  Currently I am in the DNP program and really enjoying the program.  The best part of it is learning from each other.  Look forward to blogging with all of you.  Sylvia Hayashi, WHNP 

Welcome to the ASU Nurse Practitioner to Nurse Practitioner Blog!

Hello, my name is Amanda Fong. I am currently a women's health nurse practitioner student in the Doctor of Nursing Practice program at Arizona State University. I am working on a postpartum depression evidence-based practice DNP project.  I will be graduating May 2013 and could not be more excited. In the mean time, I am working as a hospice triage registered nurse.