Another Reason to Fight Obesity: Cognitive Decline

One of the major issues we face as physicians, and family physicians in particular, is how to motivate our patients to do the right thing.  As the saying goes, you can lead a horse to water, but you can't make him drink.  Likewise, we only have so much power to inform & cajole our patient.  Sure, they're more likely to take a pain pill if they're hurting or an antibiotic if they're running a fever.

But how do you motivate someone regarding relatively silent diseases like diabetes (high sugars), hypertension (high blood pressure) and hyperlipidemia (high cholesterol).  When it comes to our health, most of us are more adolescent in our thinking.  Oh, it won't happen to me, that only happens to the other guy.  That's where motivation by carrot is less persuasive than by stick, but by then, it's too late.  The patient has already had the heart attack, stroke or amputation.  So we're back to the wake up call.

Well, in an observational study published yesterday in Neurology, the authors concluded that both obesity and metabolic derangements, separately as well as together, were linked to greater cognitive decline.  The latter was defined as two or more of 1) high triglycerides or use of cholesterol lowering medications 2) high blood pressure or use or blood pressure lowering medications 3) high glucose or use of diabetes medications and/or 4) low HDL cholesterol.

Overweight & obesity was defined as usual by body mass index.  Four different cognitives tests, each measuring different domains, were administered at baseline and then twice more, 5 years apart.  The authors followed 6,401 participants, of whom almost 3 out 4 were men 39-63yo.  Almost one out of 3 had at least two metabolic abnormalities.  2 out of 5 were overweight while 1 out of 10 were obese.

The authors noted that in the obese participants, cognitive decline was noted in both metabolically normal and abnormal patients over 10 years.  For those w/metabolic abnormalities, cognitive decline was noted first in the obese.  Bottom line, both obesity & metabolic abnormalities were separately linked to cognitive decline.  But more important, those participants w/both obesity & metabolic abnormalities were noted to have the greatest cognitive decline.

PS  I'm posting from the Summerlin Hospital ER where I'm hanging out with a patient.  Thank goodness they have a free WiFi!

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