Durban – South Africa is now ranked as the third most obese nation in the world.
Approximately 80% of obese adults are likely to have metabolic syndrome. Frighteningly, about 40% of normal weight adults may also have, or be at risk of, metabolic syndrome.
Dr Peter Hill of Met-S Care, a specialist in metabolic syndrome, says it is not a single disease. Rather, it is a cluster of conditions that includes, among others, increased blood pressure, high blood sugar levels, excess body fat around the waist and abnormal cholesterol and blood fat levels.
It is diagnosed when three or more lifestyle-related chronic conditions or disorders are found together, which increases the risk of heart disease, strokes and diabetes.
“Not enough emphasis is being placed on metabolic syndrome,” says Hill. “This is particularly concerning, particularly when you look at the alarming rise over the past 10 years in the burden of disease, specifically non-communicable diseases like hypertension, diabetes, asthma, depression, cancer, Alzheimer’s dementia and coronary artery disease and stroke.”
What is even more concerning is the rise in the number of medical scheme beneficiaries who have multiple chronic conditions. According to the findings of a report by The Council for Medical Schemes on the prevalence of chronic diseases in the population covered by medical schemes in South Africa, the number of medical scheme beneficiaries who were diagnosed and treated for multiple CDL (Chronic Disease Listing) conditions increased by more than 25% in 2013 (2012 compared to 2013), with the number of beneficiaries with four or more CDL conditions increasing by about 78%.
According to the report, this will have a negative impact on the risk profiles of medical schemes, particularly as the upward trend in diagnosis and treatment of many chronic conditions on the CDL continued in 2013.
“The deterioration in risk profiles is a concern for most medical schemes as this small percentage of beneficiaries are, in some cases, driving as much as 30% of the total costs,” says Hill.
He says the underlying and unifying metabolic dysfunction of metabolic syndrome appears to be insulin-resistance, which leads to an imbalance in fat metabolism.
Over time, this metabolic dysfunction may lead to the development of obesity, as well as to playing a major role in the development of the other serious chronic diseases mentioned previously.
“This means that controlling and normalising insulin is key to improving metabolic syndrome health outcomes,” says Hill.
One of the most effective ways to combat this pandemic is through self-care and not purely medical care.
“While medical care is important, self-care decisions about taking or not taking medicines, what to eat, how much exercise to get, what tests to do, keeping doctor appointments etc are all decisions almost always made by the person with the chronic disease and not by their healthcare providers.”
The empowerment approach to chronic disease care has resulted in a shift from provider-centred care to more patient-centred models that acknowledge the primary role of patients in providing their own care: problem solving, informed decision-making and self-efficacy.
Hill uses the example of a Type 2 diabetes patient. The patient is likely to see their doctor four times a year for a check-up, to have some blood tests done and to renew a prescription for chronic medication.
“Assuming there were no complications and our patient’s Type 2 diabetes was well controlled, then this would mean our patient would get two hours (four 30-minute consultations) of medical care in a year. There are 8 760 hours in a year, so medical care accounts for only 0.02% of the care taken in managing this disorder. The remaining 99.98% of the time is all about self-care.”
Authors of the well-accepted Chronic Care Model state that of all the elements that influence patient health outcomes across almost all chronic diseases, none has greater influence or is more important to patient health outcomes than self-care.
“We need to empower patients to be actively involved in their care rather than being treated as passive recipients. On the correct programme, patients will be in a position to identify disease-related needs, set health-related goals, discuss and agree on a treatment strategy, implement the interventions and monitor the outcomes.”
The Mercury