Philadelphia Medicine Fall 2021 - 21

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conditions, trauma is a huge factor and contributing factor. It has
always been, but I am seeing it even more evident and more common
now. And as we see the rate of COVID-19 rise again, violence
and crime, particularly in Philadelphia and other urban cities in
the country, there's a direct correlation to that. Studies have shown
that trauma has a direct correlation with weight gain and obesity.
Trauma actually changes our DNA. It changes our genetic structures
to make us more prone to obesity and conditions related to obesity.
What are the origins of trauma as seen among your
patients?
Dr. Gadegbeku: On any given day, any given patient question
I could have - we'll say even a 60- or 70-year-old patient who has
experienced loss of any of their friends and support systems - is
related either to old age, but more commonly, the way that people
experience sudden death among family and friends. There are middle-aged
patients who are distressed by the loss of family members,
particularly young family members, whether it's a mother who lost
their son, or someone lost their nephew to violence, to being murdered.
It is not uncommon these days that a patient will come in having
a hard time because they recently lost their young family member
due to homicide. Also, suicide. I don't know how many people know
this, but Pediatrics published a study last year that documented
how suicide attempts among black adolescents increased by 73%,
while attempts among white youth decreased during the 19912017
period. We have a suicide epidemic in black families! This is
definitely something we need to talk more about and that we need
to address as a community.
I have younger patients, particularly women in their maybe
late 20s or early 30s, who are just having a hard time with having
their kids at home, with the home schooling and virtual learning
and trying to manage their household while trying to support their
children's education. And so, there's just so much mental health
distress that I see right now, and that can lead to, again, unhealthier
habits where they're stress-eating, where people aren't eating well
and they're not having regular meals. It can be related to financial
challenges, trying to decide between their child's tuition and food,
or medication, not taking medications. Or it can be related to just
not taking care of themselves, because they're trying to take care of
their homes, household, children, older family members and parents.
There's a lot of middle-aged patients that are either trying to keep
their parents safe, and keep their parents healthy, or being caregivers,
which is extremely challenging and can be extremely stressful,
especially when you're in the middle and you're trying to manage
up with your parents and down with your children. That is actually
one very common scenario and situation that I see in many such
patients. And they're tired, and really not sleeping, either because
working so much, or there's, again, anxieties and pressures affecting
sleep. We know that studies have shown that poor sleep has a direct
correlation with weight gain and obesity.
And so, those are just some of the examples of what I see day-to-day
with my patients, related to stress, trauma, mental health and their
chronic conditions. And even people just not taking, again, their
medicines for their chronic conditions, their diabetes. They're eating
things that they know are unhealthy and are not able to exercise.
During COVID-19, it is especially important to get outside and
not be inside all day, but for many residents, they do not feel safe to
spend time outdoors in their neighborhood. Sidewalks may not be
available or they may have inadequate lighting: all of those things
that directly and indirectly affect your lifestyle and ultimately your
risk for being overweight and obese.
Dr. Rao, what are steps families and policymakers can
take to mitigate this?
Dr. Rao: The underlying issues here are extremely complex and
require getting many different players and stakeholders to the table. In
large metropolitan cities like Philadelphia, we need to invest in areas
that we, as physicians or health systems, traditionally think about.
We need to relook at the Farm Bill and how it impacts our
communities, we need to interface differently with supermarkets,
and we need to involve day care and schools, so we start obesity
prevention initiatives as early as possible.
As physicians, we have a very powerful voice when advocating
for the public's health. We need to use this locally and at the state
level so more investments are made in prevention. We need to have
community residents, education leaders, faith leaders, the business
community and others join us in this effort.
Community coalitions and public-private partnerships are
so important. Through Cities Changing Diabetes as well as the
Healthy Food Challenge, a global idea competition to transform
local food systems, I am witnessing the great collaboration of major
institutions in our city, such as Temple University College of Public
Health, Temple Health, The Food Trust, Esperanza College, Jefferson
Health, the Advocacy Institute of the Health Promotion Council and
others. Step by step these partners are creating new initiatives, new
partnerships to address obesity and diabetes at the neighborhood
level in Philadelphia.
I truly believe that positive behavior change must happen at the
family and neighborhood levels. That is where the greatest promise
for success is. *
For more information about Cities
Changing Diabetes - Philadelphia, visit
https://www.citieschangingdiabetes.com/
network/philadelphia.html.
Klaus Krøyer Madsen, MPH with Cities
Changing Diabetes - Philadelphia.
Fall 2021 : Philadelphia Medicine 21
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Philadelphia Medicine Fall 2021

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