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DIABETES AND
OBESITY

Conclusion
Physicians and their clinical col-
leagues are challenged by the
multi-factorial nature of weight
management and diabetic control.
With limited time, decreasing re-
imbursements, and support, build-
ing the optimal team to manage
the full spectrum of diabetes care
can be daunting. Physician soci-
eties, payers, and professional
groups must work together to
identify, build, and support the
creation of multidisciplinary
teams needed to manage the
sive disorders. Partnering with behavioral health specialists may
emerging best practices which are then needed to manage the
help primary care and subspecialty physicians to overcome the
complex relationships of behavioral health and food.
complexity of psychosocial trauma, depression, and distress. The
AdA website contains additional resources for physicians on find-
Edward Dick, MD, is a Board Certified Family Physician. He currently
ing trained behavioral health specialists and other resources to ad-
serves as Senior Vice President of Integrated Health for Methodist Health-
dress diabetic distress and other behavioral challenges.
care Ministries (MHM).
Food Insecurity References:

Further complicating the challenges of adequate behavioral https://www.acesconnection.com/
health approaches to diabetes and obesity is the role that social de- American diabetes Association (2018). Standards of Care 2018.
terminants of health play in their management. lacking the re- diabetes care, 41(1), supplement 1, S1-155.
sources to purchase, store, and prepare healthy foods contributes http://care.diabetesjournals.org/content/41/Supplement_1
to poor food choices and complicates weight and glycemic control. Anda, R. F., Felitti, v. J., bremner, J. d., Walker, J. d., Whitfield,
Shalowitz and colleagues showed that lacking adequate appropriate C., Perry, b. d., dube, S. R., … Giles, W. H. (2005). The enduring
effects of abuse and related adverse experiences in childhood. A
food (food insecurity) leads to hospitalizations, emergency room
convergence of evidence from neurobiology and epidemiology.
utilization, and other diabetic complications. Food Insecurity can European archives of psychiatry and clinical neuroscience, 256(3),
be screened using a validated two-question item called the “Hunger 174-86.
vital Sign.” The Hunger vital Sign can be done by itself or as part Aw, W., & Fukuda, S. (2017). Understanding the role of the gut
of a larger social determinant screening such at the PRAPARE tool ecosystem in diabetes mellitus. Journal of diabetes investigation,
from the National Association of Community Health Centers 9(1), 5-12.
(NACHC). In a New England Journal Catalyst presentation, the https://catalyst.nejm.org/prescribing-fresh-food-farmacy/
Geisinger Clinic described the power of addressing food security http://www.nachc.org/research-and-data/prapare/
in the management of diabetes. Geisinger showed that screening https://nppcaces.org/
and addressing food security resulted in a 40 percent reduction in https://safoodbank.org/
the risk of death or serious complications, a 2.1 percentage point Shalowitz, M. U., Eng, J. S., McKinney, C. O., Krohn, J., lapin,
drop in HgbA1C, and an 80 percent reduction in costs. The San b., Wang, C. H., & Nodine, E. (2017). Food security is related to
adult type 2 diabetes control over time in a United States safety
Antonio Food bank helps with food insecurity screening in the
net primary care clinic population. Nutrition & diabetes, 7(5),
clinical setting and resources to help address it. e277. doi:10.1038/nutd.2017.18

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