Summary
Comprehensive data collection, reporting, and monitoring of metrics are essential to improve the quality of healthcare and patients’ safety. The treatment of severe mental disorders in people with obesity preceded or induced by therapy is a complex clinical problem of modern psychiatry. Unfortunately, many effective psychotropic drugs contribute to increased body weight, which often forces patients to resort to surgical correction. This problem affects various aspects of the patient’s life and the environment and can indirectly affect patient safety, quality of medical care, and costs.
The Connection between Obesity and Depression
The co-occurrence of obesity and depression severely impacts the health and well-being of people, leading to the development of other comorbidities. Researches underline the constant and significant increase of an alarming 76% between 1997 and 2012 (Chauvet-Gelinier et al., 2019). A depressive state is a disease that affects a single specific sick person and is a significant burden on modern society since it is spreading more and more widely in the world, bringing enormous damage to the health of the population.
Patient’s Safety
During the study, it was found that depression does not directly have a severe impact on the safety of patients and their families. However, it is worth noting that patients with obesity accompanied by depression have developed anxiety, which is expressed in constant worry for their health. Such a constant stressful state can end with compulsive overeating or, conversely, starvation, decreasing physical activity, and shortening sleep (Tomiyama, 2019). Constant nervous tension, negative emotions, and fear in conditions of an abundance of food directly contribute to obesity, which is associated with a large number of other serious diseases, such as depression.
Only a few of the studied patients went to emergency care, but no one was hospitalized. However, in the US, hospital admissions increase consistently with higher body mass index categories (Nørtoft et al., 2018). Often, patients with critical cases of obesity or depression go to the hospital when independent treatment no longer brings positive results. Patients turned to emergency care with problems related to the heart or blood pressure.
The Assistance for the Problem
All over the world, the assistance provided to patients at the initial admission by a doctor is often insufficient. For adequate weight loss, an integrated approach of various specialists is necessary, and repeated active patient consultation by the attending physician and a psychologist or psychotherapist is necessary. First of all, antidepressants are prescribed for the treatment of depression, which are the first and foremost drugs for drug relief. Most patients are limited to one maximum of two medications to treat depressive disorders that have occurred with obesity.
Specialists and Medication
It is necessary to involve many specialists in managing patients with such a pathology, such as a cardiologist, gastroenterologist, surgeon, nutritionist, and specialists in preventive medicine, but first of all, therapists. The only drug that has received the unquestioning approval of the US Food and Drug Administration (FDA) is orlistat (Suleiman et al., 2020). Another common drug for the treatment of obesity, which patients take, is the drug of central action, sibutramine. Thus, it can be concluded that the number of medications needed to solve this problem is relatively small but individual for each patient. In addition, it is necessary to take into account the side effects and contraindications when taking several drugs at once.
Medical Insurance
The United States of America has a developed insurance system, which is recognized as one of the best in the world. To reduce the costs of citizens, the United States pays for the treatment and purchase of medicines necessary to combat obesity under the Medicare program. However, Medicaid expansion was associated with a significant reduction in the proportion of adults with depression who lacked health insurance (Fry & Sommers, 2018). Nevertheless, Medicaid also provides coverage for medications for depression.
Side Effects of Medications
The side effects of sibutramine are due to its significant effect on the central nervous system. As a rule, they pass on their own or noticeably weaken during the first month of treatment. Nevertheless, in addition to the general undesirable effects, sibutramine can provoke more severe complications: eating disorders, increased risk of myocardial infarction, psychological disorders associated with abrupt withdrawal of the drug or increased anxiety, and depression. These side effects are often combined with the uncontrolled taking of drugs against the background of possible contraindications. Only a doctor can determine the potential danger of drugs and prescribe them to a specific patient, considering the clinical need.
Adverse reactions when taking orlistat, as a rule, are observed from the gastrointestinal tract and are due to its pharmacological effect. Following a low-fat diet reduces the likelihood of such reactions. Pharmacological drugs of the group of antidepressants have similar mechanisms of action, respectively, and their side effects are similar. Among them may be dry mouth, sedation, drowsiness, increased intraocular pressure, or confusion up to delirium with optical hallucinations. In addition to medical treatment, many patients visit various specialists, such as psychotherapists for depression and a therapist, nutritionists, or surgeons for obesity. In most states, insurance covers from 50 to 80% of the cost of visiting a psychotherapist. The same applies to the treatment of excess weight. Every resident who has insurance can visit the doctor he needs.
Healthcare Costs
Obesity and its associated diseases significantly increase the costs of the health system. Revels et al. point out that “studies have shown that obesity is associated with a 36 percent increase in both inpatient and outpatient spending and a 77 percent increase in medications” (2017, p. 200). Furthermore, depression was associated with higher costs in all age groups and as comorbidity (König et al., 2020). Thus, obesity with concomitant depression is an essential problem of modern society, which should be paid more attention to.
The Effect of the Problem
During my experience during the first two practicum hours, I met with a patient suffering from obesity co-occurring with depression. They were interviewed about the impact of these two diseases on their lifestyle, their relationship with others, and ways to combat patients with obesity and depression. Despite the fact that most studies included people who took psychotropic drugs, there are many reports of weight loss in patients with newly diagnosed mental disorders and in the absence of drug correction.
In the article Layered stigma? the authors raise the topic of society’s attitude to these diseases. The diseases were described as stigmatized conditions and associated with negative attitudes and discrimination (Luck-Sikorski et al., 2018). It is also noted that people suffering from obesity and depression face more significant stigma and worse health consequences. Moreover, depression among obese people is more common in conditions where obesity is less common and, therefore, obesity represents a more significant deviation from bodily norms and is condemned. From this study, I learned that it had been documented in the past that the stigma of being overweight can be an obstacle to access to medical care and, in particular, to preventive services and cancer screenings.
Stigmatization
The obstacle that I encountered during the presentation of the problem to patients was just stigmatization. Patients were reluctant to speak out about their psychological state and how obesity affected their lives; some even showed aggression. Despite this, all patients agreed on the relevance and significance of the problem. The skill that I used was the effort not to succumb to provocations. An aggressive patient waits for the doctor to respond to the provocation by entering into a verbal altercation. It is important to remember that a medical specialist is more decisive in medical matters, and by entering into an exchange of verbal shots, you will become equal with the patient. Furthermore, creating a sense of urgency based on data or policy requirements helped. I would do differently if the patient’s dissatisfaction is justified, it is better to agree with it immediately.
Management Skills during Interactions
A conflict-free dialogue or collaboration with the patient is an effective way to get the necessary information from the patient. Its strategy is determined by the goals of transmitting information or exchanging it. In this case, it is vital to carefully monitor that a conflict-free dialogue with informative strategic goals does not develop into a conflict dialogue, the strategy of which is entirely different. However, medical specialists should not forget that they are the leader in the dialogue. Therefore, it is necessary to take leadership tactics when conducting a conversation.
References
Chauvet-Gelinier, J. C., Roussot, A., Cottenet, J., Brindisi, M. C., Petit, J. M., Bonin, B., Vergès, B., & Quantin, C. (2019). Depression and obesity, data from a national administrative database study: geographic evidence for an epidemiological overlap. PLoS One, 14(1). Web.
König, H., König, H. H., & Konnopka, A. (2020). The excess costs of depression: a systematic review and meta-analysis. Epidemiology and psychiatric sciences, 29. Web.
Luck-Sikorski, C., Schomerus, G., Jochum, T., & Riedel-Heller, S. G. (2018). Layered stigma? Co-occurring depression and obesity in the public eye. Journal of psychosomatic research, 106, 29-33. Web.
Nørtoft, E., Chubb, B., & Borglykke, A. (2018). Obesity and healthcare resource utilization: comparative results from the UK and the USA. Obesity Science & practice, 4(1), 41-45. Web.
Revels, S., Kumar, S. A., & Ben-Assuli, O. (2017). Predicting obesity rate and obesity-related healthcare costs using data analytics. Health policy and technology, 6(2), 198-207. Web.
Suleiman, J. B., Nna, V. U., Zakaria, Z., Othman, Z. A., Bakar, A. B. A., & Mohamed, M. (2020). Obesity-induced testicular oxidative stress, inflammation and apoptosis: Protective and therapeutic effects of orlistat. Reproductive Toxicology, 95, 113-122. Web.
Tomiyama, A. J. (2019). Stress and obesity. Annual review of psychology, 70, 703-718. Web.