It is often said that if all you have is a hammer, every problem looks like a nail. Physicians and patients can sometimes get caught up in ‘hammering’ out a cure. Too often, root causes like diet, exercise and weight reduction are still being sidelined.
A 2014 Kenya Demographic and Health Survey (by Kenya National Bureau of Statistics, Ministry of Health and Kenya Medical Research Institute) offers some insights.
It revealed that healthcare workers are quick to prescribe medicinal treatments without offering advice on lifestyle changes such as smoking cessation, weight reduction or alcohol moderation.
The fact is that unless we act, the prevalence of type 2 diabetes, hypertension and the devastating complications associated with the conditions like heart diseases, stroke, visual problems, kidney diseases and loss of vital body organs will be on the rise.
A 2017 study published in Jama Network Journal of Internal Medicine indicates that nearly one half of all cardiometabolic deaths (referring to death from heart disease, stroke, and type 2 diabetes) are associated with suboptimal intake of vegetables, fruits, nuts, seeds, whole meal grains and omega-3 fatty acids.
Traditionally, doctors have been trained to focus more on diagnosing and treating diseases. Matters relating to nutrition are often left to dieticians and nutritionists and in such scenarios, it is hard to see risk factors of diseases as integral components of the management process.
But the reality is that lifestyle factors play a very significant role in health and disease and all patients need to hear this from their doctors first hand to see it as important.
For example, on matters weight management, I always say that when energy expenditure exceeds energy intake, weight is lost and the reverse is true — you basically are what you eat.
Globally, adequate nutrition education is lacking at medical schools. For example, a 2015 study published in Journal of Biomedical Education on the state of nutrition in US medical schools revealed that more than 71 per cent did not meet the recommended goal of providing at least 25 hours of nutrition education to medical students, which is lower than the recommended instructional targets.
According to the WHO statistics, 15 per cent of Kenyans are dangerously inactive with the Ministry of Health lacking a physical activity programme or guidelines, while the medical training institutions do not have adequate amount of training time on non-medicinal management of non-communicable diseases and preventive counselling.
Another challenge is that sometimes what we eat is dictated by one’s religious and cultural beliefs or economic status. A study in the Ethnicity and Health Journal Volume 4 of 2014 concluded that there is a general perception that ‘eating healthfully’ means giving up part of one’s cultural heritage and trying to conform to the dominant culture.
Barriers to eating a healthful diet also included no sense of urgency, the social and cultural symbolism of certain foods, the poor taste of ‘healthy’ foods, the expense of ‘healthy’ foods, and lack of information.
Feed the Future Kenyan Chapter of 2015 stated that 58.5 per cent of the Kenyan population in the Northern parts live in poverty and therefore lack access to a balanced nutritional supply.
Segments of the population that potentially could be motivated to make dietary changes included women, men with health problems, young adults, the elderly, and those diagnosed with severe, life-threatening diseases. In some religions, consumption of certain plant and animal products is considered a taboo.
Another problem is that a lot of information found on the Internet can be misleading and sometimes patients go to the clinic with unrealistic expectations.
To lose weight and keep off diseases such as diabetes, hypertension, other heart diseases and their complications, patients often go for diets that are either too restrictive or unbalanced.
They may also consume those that cause rapid weight loss, which leads to weight regain after some time due to resetting of the resting metabolism to very low levels to counter the change in weight, a phenomenal called ‘metabolic adaptation.’
There are health benefits associated with weight loss, and at the time of diagnosis, everyone with type 2 diabetes should be told this.
Weight loss of between five and 10 per cent improves diabetes control, reduces the need for medications and improves associated symptoms of urinary stress incontinence and joint pain.
Above 10 per cent weight loss, there is chance to reverse type 2 diabetes and the need for medication.
There is ample evidence on benefits of lifestyle changes in managing chronic diseases and patients have a right to hear from their doctor that a holistic approach works better.
The writer is the MTIBA Medical Claims Assessor, CarePay Limited. CarePay Ltd created M-Tiba with Safaricom and PharmAccess Group.