Many politicians are well aware of the political loyalties of older people, but they still need to meet them with a greeting. When engaging in small talk with an older person, especially a woman, any politician worth their salt knows not to begin by talking about their husband or sons, because that diminishes the risk of losing a vote.
Experienced politicians often begin by asking if their counterpart is having back problems, since it is a good icebreaker that often gets them talking, making it easier to move on to the main issue. As humans have evolved from quadrupeds walking on all fours to walking upright, more stress has been put on our backs, and as we get older and suffer from bone disease, back pain becomes a common problem.
In this age of computers and smartphones, we see people with their heads bent over their screens everywhere. People are working long hours in front of their computer monitors and screens, having fun, socializing. Soon, the conversation opener will be to ask about neck or shoulder pain.
The world is also moving toward a global obesity epidemic, which would give doctors yet another greeting: “How are your knees holding up?”
Over the past several decades, obesity has increased sharply in the US, the UK and Australia. In Taiwan, it is most obvious in Taitung and Hualien counties, followed by the agricultural counties in western Taiwan.
In 1990, obesity in the US states with the highest obesity rates stood at about 15 percent. Today, two-thirds of adults and one-third of children in the US are overweight or obese. In Taiwan, half of all adults in Taitung County are obese, quickly catching up to the US.
The obesity trend is affecting the population of pregnant women as well. Data from 10 years ago show that 40 percent of all pregnant women in the US were obese. In 1999, one in 10 pregnant women weighed more than 113kg and one in 20 weighed more than 136kg.
Obesity continues to increase, and obstetrics has now added the category “extreme obesity,” where the BMI value exceeds 50 or the woman weighs more than 140kg in the 20th week of pregnancy.
According to a study published in Australia last year, there were 370 extremely obese pregnant women during the first 10 months of 2010, or 0.21 percent. Of these women, 96 percent used public hospital services, 23.8 percent were smokers and 36 percent were socially disadvantaged.
They all suffered from a higher proportion of obstetric and medical complications and 51 percent gave birth via caesarean section and 6 percent required care in intensive care units. A larger proportion of their babies were big babies — weighing more than 4.5kg — that had to be transferred to a hospital or an intensive care unit.
Obesity is a sensitive issue, and most physicians will not tell their patients that they are obese. In 2011, a study published in one of the American Medical Association’s publications showed that only 45 percent of overweight patients — someone with a BMI above 25 — and 66 percent of obese patients — with a BMI above 30 — had been told by their physician that they were too heavy.
It is worth noting that patients who are told by their physician that they weigh too much are more likely to try to lose weight.
There are many reasons physicians do not tell their patients that they are obese. For example, the consultation period is too short, the physician does not have sufficient training, or could be afraid of offending the patient, which could result in a report being filed by an angry patient. Another reason could be that the physician’s income would suffer if a patient did not return.
In reality, telling a patient the truth is part of a physician’s code of ethics. It is necessary for the medical profession to remove any taboos and talk frankly about obesity. While it is true that physicians must be sensitive and avoid being subjective, patients must also avoid being overly defensive. After all, our own health and the health of our children depends on facing realities.
Taiwan’s formal pregnancy checkups are not suitable for obese or extremely obese women. A better team is needed when it comes to providing information about body weight, exercise and nutrition control and testing for and treatment of high blood pressure and diabetes.
This is because it can be difficult to find the pulse on an obese patient, intubation can be difficult and extra staff are required to move such patients on and off the operating table. Hospital beds, operating tables, equipment and instrument straps could be too narrow or too small. Automated lifts and larger hospital beds and gurneys are required, as well as the creation and training of specialized teams.
Policymakers must not be satisfied with simply greeting patients, they must understand the seriousness of the obesity trend and increase the investment in staff, equipment and facilities.
Chiang Sheng is an attending physician in the Department of Obstetrics and Gynecology at Mackay Memorial Hospital.
Translated by Perry Svensson
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