Tackling obesity through weight loss is a form of harm reduction

Health Care, Heart Care Foundation of India Comments Off

About 5% to 10% weight reduction can delay the onset of diabetes

New Delhi, 11th February 2019: Studies indicate that the risk of Type II diabetes rises with increasing body weight. Those who are obese are 3 to 7 times more likely to acquire this condition than those with a normal weight. The risk increases by 20 times in people with a body mass index (BMI) greater than 35 kg/m2. According to statistics, a modest weight loss of even 5% to 10% in six months is enough to delay or prevent the onset of diabetes and other obesity-related illnesses.

Losing weight to counter obesity and maintaining the ideal weight are all steps towards harm reduction. The first-ever conference on harm reduction that was held on 30th January 2019, organized by HCFI and IJCP, discussed this and more. It highlighted the need for a balanced diet in maintaining the ideal weight according to one’s body type.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “When we gain weight, we must acquire more strength and when we lose weight, we must lose the strength. This is a fundamental medical principle. If we gain weight and feel week, it is a disease and when we lose weight and gain strength, we are recovering from the disease. One is not supposed to gain more than 5kg of weight after the age of 20 years. Any weight gain after that will only be due to accumulation of fat which leads to insulin resistance. Insulin resistance does not allow food to convert into energy. In the state of insulin resistance, whatever you eat, it is converted into fat. As it is not converted into energy and you feel week. When you reduce insulin resistance by drugs or walking the metabolism becomes normal and whatever you eat gets converted into energy and you start gaining strength.”

Cutting back on calories from sugary drinks – by only one serving per day – can account for nearly two–and–a–half pounds of lost weight over 18 months. The body can self-regulate its intake of solid food. However, the same does not apply for what we drink. The body does not adjust to liquid calories, so over time, it leads to weight gain.

Adding further, Dr Annop Misra Sr Consultant Diabetologist said, “It is not important to achieve an ideal weight. The medical aim is to reduce weight to prevent onset of diabetes in obesity. Any weight reduction is better than no weight reduction. Even 1 kg of weight loss is good for harm reduction.”

Some tips and recommendations.

  • Limit the intake of complex carbohydrates as they tend to increase blood sugar levels and the production of insulin. In those with insulin resistance, this surge can lead to further weight gain. Get your blood glucose levels monitored at regular intervals.
  • Exercise every day. Aim at getting about 30 to 45 minutes of physical activity every day, five times a week.
  • Do not consume refined sugar in any form as this can get absorbed into the blood stream more easily and cause further complications.
  • Reduce stress through activities such as meditation and yoga.

Some never events are non-reimbursible: Who should bear the cost of their treatment?

Health Care Comments Off

Never events are events, such as surgery performed on the wrong patient or wrong site surgery, which should never happen in a healthcare setting. They are defined as adverse events that are serious, largely preventable, and of concern to both the public and health care providers for the purpose of public accountability.

Ken Kizer, MD, former CEO of the National Quality Forum (NQF) first coined the term never event in 2001. The list of never events has been revised over the years and there are now 29 “serious reportable events” that have been grouped into 7 categories:

  1. Surgical or procedural events
  2. Product or device events
  3. Patient protection events
  4. Care management events
  5. Environmental events
  6. Radiologic events
  7. Criminal events

Never events illustrate the quality of patient care. They adversely affect patient morbidity and mortality. They increase the cost of treatment due to prolonged hospitalization not only for the patient and also cause loss of revenue to the hospital.

Catheter-associated urinary tract infection (CAUTI), a nosocomial or hospital-acquired infection (HAI) is one such never event. They are often drug-resistant infections and so difficult to treat.

Who bears the cost of treatment of never events?

Some never events may be categorized as non-reimbursible events.

Mediclaim may not pay, CGHS may not pay.

The CGHS has issued a clarification in 2013 regarding admissible and non-admissible items under it.

“…However, if the beneficiary has to stay in the hospital for his/her recovery for a period more than the period covered in package rate, in exceptional cases, supported by relevant medical records and certified as such by hospital, the additional reimbursement shall be limited to accommodation charges as per entitlement, investigations charges at approved rates and doctor visit charges (not more than 2 visits per day per visit by specialists/consultants) and cost of medicines for additional stay.

No additional charge on account of extended period of stay shall be allowed if that extension is due to infection on the consequences of surgical procedure or due to improper proceed …”

Medicare in US has adopted the non-reimbursement policy for certain never events – defined as “non-reimbursable serious hospital-acquired conditions” – in order to motivate hospitals to accelerate improvement of patient safety by implementation of standardized protocols (Patient Saf Surg. 2009 Dec 31;3:26). These include:

  • Catheter-associated urinary tract infection (CAUTI)
  • Vascular catheter-associated infection
  • Surgical site infection following coronary artery bypass graft (CABG) – mediastinitis
  • Surgical site infection following bariatric surgery (laparoscopic gastric bypass, gastroenterostomy, laparoscopic gastric restrictive surgery)
  • Surgical site infection following orthopedic procedures (spine, neck, shoulder, elbow)
  • Deep vein thrombosis (DVT)/pulmonary embolism (PE) in total knee replacement and hip replacement

CAUTI rates are indicative of the infection control policy as well as antibiotic policy of the particular hospital.

The patient may not pay for the cost of the treatment of these events as these are largely preventable events.

Hence, the onus of treating this HAI lies on the hospital. And, they are also required to bear the cost of such preventable events.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA