Criticism of obese individuals is the last socially acceptable form of prejudice in the United States, according to an article in the American Thoracic Society journal on the management of obesity. One study showed that 63 percent of family practice physicians attributed obesity to a lack of will power, and more than one-third described their obese patients as "lazy." Overweight and obesity are very serious problems in the U.S. A recent Centers for Disease Control and Prevention report indicated that 65 percent of all Americans are either overweight or obese. The number of obese Americans has more than doubled in the last 20 years. As studies have shown, the problem can lead to type 2 diabetes, hypertension, cardiovascular disease, and sleep apnea, among other illnesses. The article's expert author points out that, when they visit a physician, few patients consider weight to be their main problem. He advises doctors to listen carefully to the problem that the patient wants to discuss. Also, he advises that physicians provide the same care to obese patients as to non-obese. While encouraging the patient to lose weight, they should be sure to treat their other conditions. In addition, the doctor should never provide medical care at the expense of the patient's self-esteem. Although pharmacotherapy for weight loss in the past has been fraught with inappropriate practices, two drugs, Sibutramine and Orlistat, have been approved by the U.S. Food and Drug Administration for use with patients with high body mass index of 30 or more (27 with other related problems). In dozens of randomized clinical trials, these two drugs have been shown to be safe and effective in properly selected patients, producing weight loss of from 8 to 10 percent over 2 years. After outlining specific guidelines that physicians can offer to patients to help them improve their behavior necessary for effective weight loss, the author points out that one of the best services a physician can provide to an obese patient is to remind them their self worth is not measured on the scale; it is independent of body weight. The article appears in the first issue for August 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
THE FIRST EVIDENCE OF "CHIMERISM" IN THE HUMAN LUNG
Based on results of studies with the tissues of two of three patients, investigators have provided the first evidence of chimerism in the human lung after human stem cell transplantation. The researchers found significant rates of epithelial (2.5 to 8 percent) and endothelial (37.5 to 42.5 percent) cell chimerism in lung tissue samples from two out of three patients who had undergone either lung biopsy or autopsy. They noted that the localization of donor-derived cells or chimerism had recently been shown to occur in the cells of mice after hematopoietic stem cell transplantation or infusion of cultured marrow. The authors said that the team's results suggest that significant chimerism of the human lung may follow hematopoietic stem cell transplantation and that adult human stem cells could potentially play a therapeutic role in the treatment of the damaged lung. Donor-derived epithelial and endothelial cells were predominately found in the alveoli, although donor-derived epithelial cells were also found in the bronchial lining. (The bronchioles are the smaller airways with dozens of bubble-shaped, air-filled cavities at their end called alveoli.) The study appears in the first issue for August of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
FIRST SARCOIDOSIS PATIENT QUALITY-OF-LIFE OUTCOME MEASURE DEVELOPED
Researchers have developed the first validated outcome measure, the Sarcoidosis Health Questionnaire, to determine health-related quality of life in patients with this disease. They created the questionnaire in the hope that it could improve communication between clinicians and patients by facilitating discussion about issues not usually discussed, such as depression, or easily measured, such as pain or fatigue. (In sarcoidosis, a disease that develops most often between 20 and 40, patients suffer from abnormal collections of inflammatory cells called granulomas that can occur in the lung, liver, lymph nodes, eyes, spleen, and other organs. The disease is more common in northern Europeans and American black persons. Its cause is unknown and there is no cure, but it is rarely fatal. The lung is the organ that can be affected the most by the disease.) The Sarcoidosis Health Questionnaire was arranged in three domains based on the development teams' belief in their importance to patients. The areas are: Daily Functioning (13 items); Physical Functioning (6 items); and Emotional Functioning (10 items). The items, written at a sixth grade reading level, are scored using responses ranging from 1 ("all the time") to 7 ("none of the time"). During the developmental phase of the test, patients identified common problems, including low energy level (84 percent), worrying about sarcoidosis worsening (83 percent), having the sensation of breathing uncomfortably (79 percent), and feeling bodily pain (79 percent). The authors point out that the Sarcoidosis Health Questionnaire requires only about 10 minutes to complete, appears more sensitive than other health-related quality-of-life questionnaires to sarcoidosis organ system involvement, and contains only items patients felt were needed. The research article appears in the first issue for August 2003 of the American Thoracic Society's peer-reviewed American Journal of Respiratory and Critical Care Medicine.
For the complete text of these articles, please see the American Thoracic Society Online Web Site at http://www.atsjournals.org. For either contact information or to request a complimentary journalist subscription to ATS journals online, or if you would like to add your name to the Society's twice monthly journal news e-mail list, contact Cathy Carlomagno at 212-315-6442, or by e-mail at ccarlomagno@thoracic.org.
Journal
American Journal of Respiratory and Critical Care Medicine