Australian Family Physician August 2006 - Weight
Vol 35, (8) 561 - 656
The theme for the August issue of AFP is weight.
This month's articles include dieting, weight loss medication,
management of obesity, cholesterol and belonephobia.
A weighty issue
Jenni Parsons
This issue of Australian Family Physician examines the management of overweight and obesity - a public
health problem of expanding proportions. According to the 2004-2005 National Health Survey, the proportion of adults classified as overweight or obese increased over the past 10 years.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners.
BMI of Australian general practice patients
Lisa Valenti, Janice Charles, Helena Britt
The BEACH program, a continuous national study of general practice activity in Australia, gathers height and weight details of patients at 40% of recorded encounters, enabling their body mass index to be calculated.
If not dieting, now what?
Rick Kausman, Terrill Bruere
Helping patients to achieve and maintain their most healthy weight is a common challenge. Giving a 'one size fits all' set of instructions to patients who are over their most healthy weight does not help.
Weight loss medications - Where do they fit in?
John B Dixon
Obesity is a chronic disease requiring a similar long term approach to management as that of other chronic conditions.
The science behind weight loss diets - A brief review
Peter Clifton
Controversy surrounds both the Atkins diet and moderate carbohydrate, high protein diets.
Management of obesity - The role of surgery
Wendy Brown, John B Dixon, Paul O Brien
Obesity is rapidly becoming Australia's biggest health care issue.
Individualising weight loss prescription - A management tool for clinicians
Garry Egger, Suzanne Pearson, Sebely Pal
Obesity is a global epidemic and a growing cause of comorbidities seen by clinicians. Yet apart from recent guidelines developed by the National Health and Medical Research Council there are few clinical tools available to tackle this problem.
Cholesterol - Frequently asked questions
Patrick J Phillips, George Phillipov
The cholesterol was a bit high (7.1 mmol/L) but the patient wasn't fasting. Does this matter? Not fasting has little effect on low density lipoprotein cholesterol (LDL-C) but can have some effect on high density lipoprotein cholesterol (HDL-C) and a dramatic effect on triglyceride (TG).
The role of physiotherapy in weight control
Jan Smith
I can't exercise; my knee hurts; my back aches; I've got diabetes. How many times have you heard the long list of excuses from patients who are told they need to lose weight?
Dysplastic melanocytic naevus syndrome
Anthony Dixon
Case history: Mr BS, 55 years of age, presented with numerous naevi in 2001. His history included a 0.85 mm thickness Clarke 3 malignant melanoma excised from his scalp at 50 years of age.
Complementary medicines and weight management
Marc Cohen
This is the sixth of a series or articles looking at the available evidence for complementary medicine relating to the theme topic in Australian Family Physician.
Dengue fever and dengue haemorrhagic fever - A diagnostic challenge
Sanjaya Senanayake
The number of cases of dengue fever in returning travellers is increasing worldwide. In Australia, two mosquito vectors exist and the Aedes aegypti mosquito has already been responsible for local transmission within Queensland. For these reasons, general practitioners need to be able to recognise dengue fever and its complications: dengue
haemorrhagic fever (DHF) and dengue shock syndrome. Infections can vary from severe to asymptomatic.
Acne - Natural history, facts and myths
Greg Goodman
This article describes the epidemiology and natural history of acne and discusses the common aetiological myths and beliefs surrounding acne. Acne is a polymorphic disease with noninflammatory and inflammatory aspects and a wide spectrum of severity.
Australia’s Vietnam veterans - A review
Hedley Peach
Vietnam veterans' war experiences have adversely affected their own mental health and that of one in 3 partners and one in 4-6 of their dependents, many of whom are reluctant to seek help.
Belonephobia - A fear of needles
Louisa Yim
Belonephobia is an unreasonable and altered response due to the fear of needles. It affects up to 10% of the population and has implications for treatment and follow up, especially in the paediatric setting (see Case study).
Evidence based answers - Is salmeterol safe in asthma?
Geoffrey Spurling, Jenny Doust
Case history:
SW, 21 years of age, presented for a prescription for her salbutamol puffer. She had a long history of chronic persistent asthma usually exacerbated by upper respiratory tract infections
(URTIs). These exacerbations had occasionally landed her in hospital but never in intensive care.
More than just a headache
Jerzy K Pawlak, TJ Kroczak
Case history:
Celine, aged 44 years, developed recurrent headaches about 7 months ago. She was found to have an elevated blood pressure at that time and this was treated. However, her headaches got worse and a few months ago, her family started noticing weakness on her left side with facial asymmetry and dragging of her leg.
Clinical challenge
Steve Trumble
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue. Answers to this clinical challenge will be published next month, and are available immediately following successful completion online.
‘Wrongful life’ claims
Sara Bird
On 9 May 2006, the High Court of Australia dismissed 'wrongful life' claims brought on behalf of two patients. One of the cases involved the alleged negligent failure by a general practitioner to diagnose prenatal rubella and to advise the mother of the risks to the fetus associated with rubella. This article outlines the case and discusses the nature of 'wrongful life' and 'wrongful birth' claims.
Interpreting and understanding meta-analysis graphs - A practical guide
Karin Ried
Ideally, clinical decision making ought to be based on the latest evidence available. However, to keep abreast with the continuously increasing number of publications in health research, a primary health care professional would need to read an insurmountable number of articles every day covered in more than 13 million references and over 4800 biomedical and health journals in Medline alone.
Balint groups - An Australian perspective
Marion Lustig
Balint groups are an important, internationally established method of training general practitioners in the psychological aspects of their work. Small groups of GPs meet regularly with a trained leader to discuss clinical material from their
practices, with a focus on the doctor-patient relationship. This article explains the Balint group model and its benefits
and describes what is known about Balint groups in Australia, including avenues for Balint group experience available to Australian GPs.
Book reviews
Vicki Kotsirilos, Delma Mullins
Reviewed this month are Integrative Medicine by David Rakel and Outline of Palliative Medicine, 4th edition by Victor Chan and Ruth McConigley.
When symptoms of disease overlap with symptoms of depression
Grace K Ellis, Julie A Robinson, Gregory B Crawford
The diagnosis of depression is often dependent on somatic symptoms which overlap with the symptoms of many medical illnesses.
Initiating a PDSA cycle - Improving management of diabetes in rural WA
Cynthia Porter, Belynda Wheatland, Marisa Gilles, Charlie Greenfield, Ann Larson
Diabetes affects 1 million Australians and is the seventh leading cause of death in Australia. General practitioners play an important role in the management of diabetes, especially in rural areas where there is limited access to specialist providers and services.
Assessing whiplash recovery - The Whiplash Disability Questionnaire
Robert Ferrari, Anthony Russell, Allan J Kelly
General practitioners often need to track outcomes of whiplash patients, and a disability questionnaire may be useful.
The fate of papers rejected by Australian Family Physician
Rachel Green, Chris Del Mar
Research papers submitted to Australian Family Physician (AFP) are accepted or rejected on the judgment of the research editor with advice from expert reviewers. Rejection can be outright (eg. when research is 'fatally flawed') or, more often, conditional (when authors are invited to respond to criticisms). Sometimes authors fail to resubmit. The fate of both groups of papers is unknown, as are the reasons for failing to resubmit.