On Obesity Worldwide

The prevalence of obesity continues to increase worldwide. Reports indicate that in 2005, 1.6 billion individuals over the age of 15 were overweight, and at least 400 million were obese. Projected figures indicate that this will continue to increase, and that by 2015, 2.3 billion adults will be overweight, and more than 700 million will be obese. Though data from the Centers for Disease Control and Prevention (CDC) indicate that obesity rates among Americans have peaked, World Health Organization (WHO) statistics point to increasing obesity rates in both the developed and developing world.

Abnormal or excessive accumulation of body fat often indicates that an individual is “overweight” or “obese.” The body mass index (BMI) - the weight of an individual in kilograms divided by the square of their height in meters – provides a crude measure to determine into which category an individual falls. According to the WHO, a person with a BMI between 25 and 30 is generally considered overweight, and over 30 is generally defined as obese. Overweight and/or obese individuals are more susceptible to many serious health complications. Excess body weight has been shown to increase the risk of ischemic stroke by 22 percent in overweight individuals, and 64 percent in obese individuals. The Mayo Clinic reports that obesity can cause a number of additional health complications, including high blood pressure, heart disease, osteoarthritis, and type 2 diabetes. Reports also indicate that “in the U.S…. [an estimated] seven types of cancer…are weight related [and] just under 20 percent could be prevented through people being a healthy weight.”

Obesity is commonly thought of as a condition of the developed world. However, a 2007 surveyThe WHO notes that the “increased consumption of more energy-dense nutrient-poor foods…[and] reduced physical activity” have led to increased obesity rates worldwide. According to experts, people around the globe are being introduced to more “Western” lifestyles which often include an influx in the supply of unhealthy choices, reduction in exercise, and higher-stress occupations.

While this shift affects individuals worldwide, they are somewhat magnified in the United States where in the past 30 years, the number of obese adults has doubled, reaching nearly 34 percent, and the number of obese children has tripled to 17 percent. A study from the University of Michigan Health System shows that more Americans are becoming overweight or obese at a younger age and carrying the extra weight for longer than previous generations. According to research from Oxford University, the life expectancy of moderately obese individuals is reduced by about three years, and severely obese individuals’ life expectancy is reduced by 10 years. While obesity can be attributed to poor dietary selections or a lack of physical activity, research from the University of Texas Medical Branch at Galveston shows that a tendency towards obesity can be detected in infants as young as 6 months of age, and many of these infants are likely to continue to carry extra weight as they mature. To identify a means of overcoming obesity, researchers have continued to try to locate a genetic cause and help to improve treatment options. Findings from a indicate that the Chinese studyfat mass and obesity-associated gene (FTO) may be strongly linked to the predisposition for some individuals to gain weight more rapidly than others.

While there may be both genetic and behavioral causes for obesity, it can be prevented. Recent studies indicate that in teenagers who carry the FTO gene, physical activity can help to mitigate its effects. By gaining an understanding of the causes of obesity and preventative measures that can be taken, it may be possible to reduce its likelihood and detrimental effects.

Find out more about a recent study on medical care for obese patients

Check out the iCons in Medicine blog on Obesity and Nutrition or Join in on the iCons in Medicine Forums to discuss this and other public health topics found that the South Pacific island of Nauru was the nation with the highest percentage of overweight people – 94.5 percent of its population. Other small nations including the Federated States of Micronesia, Cook Islands, Niue, and Tonga were noted among the nations with over 90 percent of the population overweight or obese.

Tuberculosis Worldwide

Tuberculosis kills more than 1.7 million people around the world each year, and this figure is growing as over-crowded conditions in poverty stricken areas can elevate transmission rates. The World Health Organization’s (WHO) recently published report, entitled “Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 Global Report on Surveillance and Response” outlines the prevalence of the disease and its potential global impact. In it, data from 114 countries around the world are examined to determine the extent of this “serious threat to global health.”



Mycobacterium tuberculosis, the organism that causes tuberculosis (TB), is an airborne bacteria exclusive to humans and can be transmitted through close personal contact, particularly coughing. According to the United States Centers for Disease Control and Prevention (CDC), the bacteria usually affect the lungs of an individual, but can also impact the kidneys, spine and brain. Nikoloz Sadradze, International Committee of the Red Cross (ICRC) medical delegate, explains that more than two billion people – approximately one in three – carry the microbes that cause TB, but only one in ten will actually experience symptoms. Effective treatment of TB depends on daily doses of courses of medication lasting six to eight months. Tuberculosis infection is defined as multidrug-resistant (MDR-TB) if it cannot be eradicated by the antibiotics commonly used to treat tuberculosis: isoniazid and rifampicin. It is classed as extensively drug-resistant (XDR-TB) if it is also resistant to fluoroquinolone antibiotics and the injectable drugs amikacin, kanamycin, and capreomycin. If an individual contracts a MDR-TB or XDR-TB strain, a combination of oral medications, injections, and other treatment may be required for 24 to 36 months or longer. Costs associated with treating MDR-TB are, on average, 10 times more than “standard” TB. The WHO reports that 60 percent of individuals who contract of TB have been cured.

The WHO also reports that drug-resistant forms of TB killed approximately 150,000 people in 2008, and that 50 percent of all cases of MDR and XDR-TB occurred in India and China. Further, 57 countries have had at least one case of XDR-TB since September 2009, according the WHO report. Programs to combat the spread of tuberculosis have been established by the WHO in 30 countries around the world, primarily those that are impacted most by the disease. Reports from the CDC indicate that reported TB cases in the United States are at an all time low, but that there were a total of 108 reported cases of MDR-TB in the U.S. in 2008. According to the WHO there were approximately 440,000 reported cases of MDR-TB worldwide in 2008. Many cases of MDR and XDR-TB are due to individuals lacking access to necessary medical attention and drug treatments. In addition to a lack of available treatment, reports indicate that only an estimated seven percent of patients with MDR-TB are diagnosed.

In regions where access to medical care and treatment may be limited, telemedicine can be used to improve the rate of diagnosis and treatment outcomes. Programs like iCons in Medicine allow healthcare providers in remote and medically underserved areas to connect with physicians who can provide knowledge and guidance for recognizing and treating tuberculosis.

Physicians Using Social Media

Individuals and organizations have embraced the use of social media as a way to quickly and easily create and disseminate information, ideas, and experiences, using low-cost, web-based technology. Doctors and others in the healthcare industry have been among those utilizing these new tools, but this use is not undertaken without some concern regarding matters of patient privacy and the blurring the lines between physicians’ public and private personas.

Robert L. Coffield and Joanne E. Joiner report that to date there are at least 540 hospitals in the United States using social media tools to communicate to a general audience. This figure includes 247 YouTube channels, 316 Facebook pages, 419 Twitter accounts, and 67 blogs, and these numbers continue to grow. Further research indicates that though nine out of ten U.S. hospitals are utilizing social media in some way, only one third have a formal social networking plan in place.

Twitter, which has an estimated 6 million monthly visitors, was ranked by Neilson.com in March 2008 as the fastest-growing site in the Member Communities category for the previous month. Among the physicians using social media, particularly Twitter, to connect with patients and colleagues, are a number of “celebrity doctors,” some of whom have more than 75,000 followers. In addition to these practicing physicians, social media and social networking websites are particularly popular among medical students, residents, and interns.

Researchers from the University of Florida’s colleges of Education and Medicine 2008 conducted a survey of the Facebook profiles of medical students and residents. Over 800 medical students’ names were searched on Facebook, and 44 percent of them were found to have profiles. Of these 362, only 37 percent had restricted the level of access to information contained on their profile by altering privacy settings. Additionally, a recent survey of medical school deans indicates that medical students have been found to frequently post inappropriate material on social networking websites.The findings, published in the Journal of the American Medical Association, show that 60 percent of the 80 deans who responded to the survey knew of incidents of unprofessional conduct, and 13 percent admitted to incidents that violated patient privacy.

David H. Brendel, MD, PhD, chair of McLean Hospital’s Institutional Review Board, has similar concerns for medical students’ disregard for protecting patient privacy when posting information on social networking websites. In Dr. Brendel’s case, this concern extends also to practicing physicians using Facebook and other sites, and he advises the following four guidelines for doctors when using online networking websites:

1. Address a patient’s online invitation immediately and in person to avoid damaging the therapeutic relationship.
2. Do not include information obtained through social networking websites to a patient’s medical record without their consent.
3. Use discretion when posting personal information online.
4. Understand the privacy policies available on social networking websites and use them to limit access to personal information.

Some healthcare providers chose to connect with patients not only through social networking websites, but also to exchange emails. Results of a 2009 study by Manhattan Research indicate that experts in “Physicians in 2012: The Outlook on Health Information Technology,”five specialties are most likely to contact their patients via email or online messaging: dermatology, medical oncology, neurology, endrocrinology, and infectious disease. indicated that five percent of approximately 9,000 U.S. adults who participated had send or received an email from a doctor, and 49 percent wanted to do so in the future. Additional data from Manhattan Research included in a report entitled

Many physicians are still reluctant to employ the use of email or social media to connect with patients because of privacy risks, despite the potential for beneficial physician and patient interaction. According to Robert L. Coffield and Joanne E. Joiner, even physician-to-physician contact through social networking websites can be problematic if the individuals involved are not careful to ensure that patient information and identifiers are not shared. To prevent some of these issues, telemedicine programs are sometimes utilized. Telemedicine is defined by Merriam-Webster’s dictionary as “the practice of medicine when the doctor and patient are widely separated using two-way voice and visual communication (as by satellite or computer).” It has grown since its first inception to include not only physician-to-patient contact, but also physician-to-physician Unlike standard, “public” social networking websites, iCons in Medicine is medical social networking and telemedicine website which allows doctors to request and send teleconsultations on difficult cases. To ensure patient privacy, iCons in Medicine relies on secure connections and one-on-one sharing of patient data.

Physicians who would like to provide or request teleconsultations can register online to take part in the program. Non-physician individuals with an interest in healthcare can also sign up to participate in the iCons in Medicine network as General Members.

Healthcare Following Chile's Earthquake

While aid organizations continue to support relief efforts in Haiti, some attention has now been diverted by the 8.8-magnitute earthquake which struck Chile on February 27, 2010. As with Haiti’s tragedy, many organizations are accepting donations to benefit relief efforts in Chile via text message, and individuals have banded together on Twitter and Facebook to request help locating loved ones, provide updates, and share information.

Experts, including Sergio Barrientos, science chief of the Seismology Institute of the University of Chile, indicate that this quake was 50 times bigger than the one that killed thousands and destroyed much of Haiti’s infrastructure on January 12, 2010. Richard Gross, a geophysicist at NASA’s Jet Propulsion Laboratory, indicated that the force of the quake was in fact so strong that it affected the Earth’s figure axis (the axis about which the Earth’s mass is balanced) and caused the length of the day to be shortened by 1.26 microseconds. Compared to Haiti’s relatively shallow earthquake which occurred just 8.1 miles below the surface of the earth, the depth of Chile’s recent quake was 21.7 miles. This increased depth, which allowed some of the quake’s energy to disperse, and Chile’s strict building codes lessened the earthquake’s potential to cause more serious damage.

According to the National Emergency Office, 795 individuals have died as a result of the earthquake, and the 40-foot tsunami and 131 aftershocks of magnitude 5 or greater that have followed. Chilean President, Dr. Michelle Bachelet stated that it is likely that two million people were affected in some way by the recent earthquake. Many lost family and friends, and an estimated 500,000 homes sustained considerable damage, according to reports from the Chilean Red Cross.

Efforts for locate and rescue survivors are ongoing, and it is expected that, as seen in Haiti, medical and rehabilitative care will be needed by many. Information regarding the number of individuals injured or displaced by the earthquake and the aftershocks and tsunami that followed is not yet available. Though current counts of individuals killed or injured are substantially lower than following Haiti’s earthquake, these figures are expected to rise as reports indicate that as many as 500 individuals are still missing in Constitución alone. In addition to the earthquake itself, which hit most strongly in six central regions of Chile, substantial loss of life and damage to infrastructure is due to the subsequent tidal wave which submerged fishing towns on the coast of south-central Chile. More than 20 boats were swept ashore in the port of Talcahuano, and rescue workers have located over 300 bodies in Constitución. Access to drinking water, food, electricity, and other supplies to many towns in these costal areas, including Bio Bio and Concepcion, have been disturbed, leading to tension and looting in some areas.

Amid civil unrest in areas with destroyed highways and collapsed bridges, the spread of diseasedelivery of healthcare is also a concern. According to UN Humanitarian spokeswoman Elisabeth Byrs, Chile’s government has identified its emergency needs as temporary bridges, field hospitals, satellite telephones, electric generators, damage assessment teams, water purification systems, field kitchens, and dialysis centers. While reports indicate that the health network in northern Chile is operating normally, in the south access to heath services has been disrupted by the collapse of six hospitals and damage to two others. To provide some assistance, the United Nations will be sending 45 satellite phones to Chile for officials coordinating relief efforts, and is prepared to send 30 tons of food and other aid. U. S. Secretary of State Hillary Clinton has indicated that the United States will offer “not only solidarity but specific supplies” to help Chile recover. Aid from the U.S. will include 62 satellite phones, eight water purification systems, and a mobile field hospital with surgical capability. Argentina has already sent medical supplies including three tent hospitals, water processing equipment, medications, and satellite telephones to Chile. Other nations including Canada, which has pledged $2 million to support relief efforts, and Singapore, which will supply $50,000, have also offered contributions. In addition to the need for facilities and supplies, the Pan American Health Organization (PAHO)/WHO noted a shortage of healthcare personnel and has assembled an emergency response team of 80 trained specialists.

As the outpouring of support for Chile begins, governmental agencies, non-governmental organizations, aid organizations, and individuals face the daunting task of coordinating their relief efforts and some areas are still awaiting support. It remains unclear how many individuals have been affected by the earthquake, both directly and indirectly, but it is of great import that they get the care and assistance they need.

Find out about how the iCons in Medicine teleconsultation program can help following natural disasters and what iCons in Medicine and the Center for International Rehabilitation are doing to ensure the provision of rehabilitation services in Haiti. and the

Call for Mobility Aid Donated Goods for Haiti Relief

iCons in Medicine, under the auspices of its parent company the Center for International Rehabilitation, is seeking donations of Mobility Aids to support ongoing rehabilitation relief efforts in Haiti.

Needed items include Adult and Pediatric Crutches, Walkers, and Wheelchairs

Details on Criteria for Mobility Aid Donation

Mobility aid donations can be made by individuals, as well as bulk product donations by manufacturers and distributors. Monetary donations for purchase of mobility aids may also be made. For complete instructions, please click the appropriate link below:

There are a number of other ways you can help provide support to medical and rehabilitation efforts through iCons in Medicine.

Autism Spectrum Disorders

Debates regarding recent changes to the guidelines for diagnosis of Asperger syndrome, often considered a high-functioning form of autism which inhibits the ability to interact socially and causes repetitive behaviors, are ongoing. According to the Centers for Disease Control and Prevention (CDC), one in 110 children have an Autism Spectrum Disorder (ASD). Time Magazine reports that researchers at the University of Leicester, working with the NHS Information Center found that roughly 1 in 100 adults exhibit an ASD. Though the exact cause for these conditions is not known, the rate at which they are occurring is increasing. The Centers for Disease Control and Prevention indicate that autism and related disorders are more common than previously thought, though it is unclear if this increase is due to an improved ability to diagnose.

A developmental disorder that appears in the first three years of a child’s life, autism affects the brain’s development of social and communication skills. One in every 110 8-year-old children, and one of every 70 boys, in the United States has been diagnosed with autism. The CDC indicates that; per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and International Classification of Diseases, Tenth Revision; “criteria have identified ASD rates ranging from 2.0 to 12.0 per 1,000 children” worldwide. Individuals with autism may repeat body movements, have difficulty communicating, and avoid social interaction, including physical contact. Findings from a study of mice with Fragile X Syndrome, a condition that is often linked to autism, indicate that delayed development in the sensory cortex of the brain may be the cause of autistic individuals’ aversion to touch. Dr. Gina Gómez de la Cuesta, from the National Autistic Society, notes that “Autism is common in people with fragile X syndrome, however there are many other causes of autism, most of which are not yet fully understood.”

Efforts to identify causes, treatments, and prevention measures for the disorder are ongoing. Some advocates maintain that diets removing gluten (found in wheat, barley, and rye) and casein (found in dairy) alleviate some of the symptoms of autism, however there has not been any scientific documentation of the success of these restricted diets. A now-discredited study published in the Lancet in 1998 indicated a link between autism and the measles, mumps, and rubella vaccine frequently administered in early childhood. According to experts, the frequency with which autism symptoms become more apparent at two years of age when receiving these vaccinations, is coincidental, as childhood vaccines do not cause the disorder.

New research indicates that babies born prior to the 26th week of pregnancy, are at a higher risk of developing autism. A recent study showed eight percent of 219 children born in this timeframe, met the criteria for an ASD at the age of 11. A comparison group of 153 children born full-term were also included in the study, none of whom exhibited signs of autism or other ASDs. The age of both parents has also been linked to a child’s likelihood of developing an ASD. Data collected from 4.9 million births in the 1990s in California indicated that compared with women in their mid- to late-20s, women giving birth after 40 had a 50 percent increase in the risk of having an autistic child. The father’s age was also found to impact the likelihood of having a child with autism, but only in the case of men over 40 having children with women under 30.

Recent research indicates a correlation between a deficiency in oxytocin, a hormone that makes women more maternal and men less shy, and autism or Asperger syndrome. In a study of 13 adults with high-functioning autism or Asperger syndrome, use of a nasal spray containing oxytocin was found to improve scores on a test involving recognition of faces. This type of medical intervention could provide an additional treatment option for children and adults with ASDs who are currently involved in behavioral interventions. Though often expensive, structured behavioral interventions and early intervention programs have been found to improve the language skills of children with ASDs, sometimes increasing the IQ of children as many as 18 points. Direct medical and non-medical costs for an individual with an extreme case can total as much as $72,000 per year. Medications, clinical visits, and occupational and speech therapy, as well as special education, camps, and child care are just some of the expenditures of parents of children with autism. As individuals with autism grow into adulthood, these costs continue, as caregivers and specialized programs may be needed.

There is still no known direct cause for autism and other ASDs. These conditions can put an emotional and economic strain on families, and can lead many parents to blame themselves for their children’s condition. With improved diagnostic tools and earlier diagnoses, children with autism can receive early intervention treatments and education to improve their outcomes.

Discuss this and other topics in the iCons in Medicine Forums

Amputation and Prosthesis in Haiti

As government agencies and non-governmental organizations flood Haiti to relief support, many are finding a lack of even the most basic medical equipment and supplies. Even before January 12^th, Haiti’s healthcare system was unable to fully support the needs of the Haitian population which included 800,000 individuals with disabilities, and life-saving medications were in short supply but high demand. While outbreaks of tuberculosis, HIV, and cholera are the current major public health concerns, insuring the provision of rehabilitation services to the estimated 200,000 (some reports indicate 250,000) individuals who have undergone amputations as a result of the earthquake are especially pressing. This figure includes not only the 2-3,000 individuals who have had amputations of major bones as well as the thousands more who have fingers or toes amputated (per personal correspondence with Al Ingersoll, CP; Healing Hands for Haiti).



Without proper medical equipment and often in unsterile conditions, physicians providing care in Haiti since the earthquake struck have had to amputate the limbs of individuals who otherwise would die. The social stigma attached to individuals with disabilities in Haiti and other developing nations has led some Haitians to leave gangrene infections untreated, as they would rather die that face the prospect of living without an arm or leg. In addition to possible infection at wound sites, individuals who have suffered “crush injuries” or rhabdomyolysis are at risk developing kidney failure when the crushed muscle ruptures. Studies indicate that between four and 33 percent of patients with rhabdomyolysis develop kidney failure, but amputation of the affected limb has the potential to save the patient’s life. In order to perform these amputations, CNN reports that some surgeons have had to use “civil war medicine” – amputating limbs with saws and other instruments, often without anesthesia. Some estimates indicate that as many as 95 percent of Haitians who suffered crushing injuries in the earthquake will undergo amputation.

Haiti’s hospitals sustained considerable damage and what remains of the Haitian healthcare system has been overwhelmed by the demand of those in need of medical services. To fill this gap, clinics run both by local hospital staff and international aid organizations have been setup in tents outside the devastated buildings. Reports indicate that surgeons at University Hospital, Port-au-Prince’s largest hospital, performed approximately 225 amputations within the first few days following the earthquake. Though statistics are not available yet for the number of new amputees, Mirta Roses, director of the Pan American Health Organization, has indicated that some hospitals have reported performing as many as 30 amputation surgeries per day. Limitations of space, medical personnel, and other resources have forced many makeshift Haitian surgical wards to discharge individuals after amputations are completed, overloading what remains intact of Haiti’s fragile hospital system with patients in need of post-operative care. To assist further assist these individuals, organizations like Healing Hands for Haiti, Handicapped International, and Doctors Without Borders are making efforts to provide surgical and post-operative care following amputation. Additionally, Global Relief Technologies has introduced a system that allows for critical information about patients to be collected and uploaded to a PDA so that this information can be shared with other aid organizations to ensure high-quality care for all amputees.

In addition to the importance of post-operative care, individuals who have undergone amputation are in need of prostheses, but the devices commonly used in the developed world may not be best suited for use in Haiti. An average prosthesis can cost between $4,000 to $6,000 and in the United States a new amputee could expect to undergo a minimum of four fittings a year for the life of the prosthesis to ensure that the device is comfortable – in Haiti this is simply outside the realm of possibilities. Low-cost, high-quality devices developed by non-profit organizations, including the Center for International Rehabilitation (CIR) and Legs for All may be applicable for use in Haiti. Developed specifically for use in areas with limited resources, the Center for International Rehabilitation’s CIR Casting System could allow for the rapid fitting of Haitian amputees. Unlike traditional plaster-based prosthetic fabrication methods, the CIR Casting System uses a fabric bag filled with polystyrene beads and allows for the fabrication of prostheses in a fast, simple, and low-cost manner. A final prosthesis can be fabricated in less than two hours during a single clinical visit, compared with at least two clinical visits using traditional plaster-based methods. In addition to the development of this innovative fabrication method, the CIR conducts blended distance learning initiatives that combine online training with hands-on workshops to familiarize local technicians with the fabrication method. Since 2008, following trainings in Thailand and India, over 2,500 individuals have been fitted using the system and it has been widely accepted in these regions. However, as Jeffrey Bigelow, resident neurologist at Yale University who completed a survey of the needs of Haitian amputees for Healing Hands for Haiti in 2004, notes, it is important to recognize that even when using this type of appropriate technology, “devices need to be skillfully made or they’re just too painful to wear.”

Dr. Steven R. Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at NYU Langone Medical Center, noted that even in the best of circumstances, when an amputation site can be properly cared for, it can take four to six months for a traumatic amputation to heal completely. Even before they can be fitted, many of Haiti’s new amputees will require counseling to come to terms with their new lives as a part of Haiti’s generation of amputees.

Specialty physicians who wish to offer teleconsultation support to disaster-relief workers in Haiti, Health professionals who wish to provide volunteer support on the ground in Haiti, and U.S. healthcare institutions that are willing to provide services to victims of the earthquake who are airlifted to this country for urgent medical or rehabilitation care can register through iCons in Medicine.

Find out more about The Center for International Rehabilitation and the CIR’s innovative prosthetic technologies