Chronic Disease Management
The Chronic Disease Management GP services enables you Doctor to plan and coordinate your health care. If you have a chronic disease your GP might think you require a multidisciplinary, team-based care approach from a GP and at least two other health or care providers.
A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions, mental health issues and stroke.
Patients who have a chronic medical condition and complex care needs and are being managed under a GP Management Plan and/or Team Care Arrangements are also eligible for Medicare rebates for certain allied health services with referral from their GP.
Speak with your GP at BAMS today about how a Chronic Disease Management plan might help you with the long term planning for your health.
What Is a Chronic Disease
Chronic diseases are conditions that tend to be long-lasting and persistent in their symptoms or development such as some cancers, heart disease, and type 2 diabetes.
Chronic diseases are major diseases which may require ongoing medication but most chronic diseases are preventable for most people through healthy lifestyle choices. Evidence shows that improving diet and being more physically active can help prevent or delay the onset of some chronic diseases.
AM I AT RISK OF GETTING A CHRONIC DISEASE?
By adulthood the effects of exposure to modifiable lifestyle risk factors such as tobacco, physical inactivity and obesity may manifest as chronic diseases. It has been estimated that the risk factors of overweight and obesity, physical inactivity and low fruit and vegetable consumption account for 16.2% of Australia’s burden of disease.
Many Australians increase their risk of developing a chronic disease through unhealthy behaviours that can be prevented: •in 2007-08, the proportion of adults who exercised sufficiently to obtain benefits to their health was 37%
- 3 in 5 adults (61%) and 1 in 4 children (25%) were either overweight or obese
- just over half (51%) of the population aged 15 years and over consumed two or more serves of fruit per day, while 1 in 11 (9%) consumed five or more serves of vegetables .
Chronic diseases are more prevalent in some population groups, particularly Indigenous Australians. It also should be noted that lifestyle based chronic diseases such as type 2 diabetes are now being diagnosed in children and teenagers.
Evidence has shown that positive changes in some lifestyle behaviours can prevent or delay the onset of chronic disease.
AREN’T CHRONIC DISEASES INEVITABLE FOR OLDER PEOPLE?
Chronic disease is not inevitable for older people. Some chronic diseases can run in families but how you live your life now can influence whether you develop a disease in later life. There are simple measures you can take to decrease your risk of chronic disease and other health problems, and it is never too late.
I AM STILL YOUNG SO WHY CHANGE NOW?
The way you live your life now, even when you’re young, will impact on your future health. Evidence shows that improving your diet and being more physically active can help prevent or delay the onset of some chronic diseases. Also you will find that the changes you make to your diet and physical activity now can greatly increase your energy, help you sleep better and reduce the risk of depression.
WEIGHT AND WAIST MEASUREMENTS:
WHAT IS A HEALTHY WEIGHT?
Is there an ideal weight we should all try to achieve? The answer is NO! There’s no ideal weight that suits everybody. Each person is different and their healthy weight will be determined by different factors. There are two methods that can be used to check if you are in the healthy weight range – the Body Mass Index (BMI) and measurement of your waist circumference.
WHAT IS OVERWEIGHT?
Overweight is a condition of excess weight that normally results from a sustained energy imbalance. Energy imbalance occurs when dietary energy intake is more then energy expenditure over a period of time i.e. you’re consuming more energy then you are burning off. A combination of body mass index (BMI) and waist circumference is recommended for the clinical measurement of overweight and obesity.
WHAT ARE THE HEALTH CONSEQUENCES OF BEING OVERWEIGHT?
The health problems and consequences of being overweight and obese are many and varied, including musculo-skeletal problems, cardiovascular disease, some cancers, sleep apnoea, type 2 diabetes, and hypertension. Many of these are often preventable though a healthy and active lifestyle. Having excess fat that coats your organs is a risk to your health. . This is called visceral or intra-abdominal fat. It is not yet clear on what the exact cause is which links intra-abdominal fat with chronic disease, but what is clear is that even a small deposit of this fat increases the risk of serious health problems.
WHY IS WAIST MEASUREMENT IMPORTANT?
A waist measurement of greater than 94cm for men or 80cm for women is an indicator of internal fat deposits, which can coat the heart, kidneys, liver and pancreas, and increase the risk of chronic disease. Waist circumference should only be used for adults to check the risk of developing a chronic disease. Measurements that indicate increased risks for children and teenagers have not been developed.
For most people a waist measurement of greater than 94cm for men or 80cm for women is an indicator of internal fat deposits, which can coat the heart, kidneys, liver and pancreas, and increase the risk of chronic disease.
Waist measurements should only be used for adults to check their risk of developing a chronic disease. Measurements that indicate increased risks for children and young people have not yet been developed.
The waist measurements above are recommended for Caucasian men and Caucasian and Asian women. Recommended waist measurements are yet to be determined for all ethnic groups. It is believed that they may be lower for Asian men than for Caucasian men and are likely to be higher for Pacific Islanders and African Americans (men and women). The limited data currently available indicates that the risk factors in Aboriginal populations appear to be similar to those in Asian populations; and the risk factors in Torres Strait Islander populations appear to be similar to those found in Pacific Islander populations.
HOW DOES MY HEIGHT AFFECT THE WAIST MEASUREMENT GUIDELINES?
For most people. no matter how tall you are, if your waist measurement is more than 80cm for women and 94cm for men you are at an increased risk of some lifestyle related chronic diseases e.g Type 2 diabetes, cardiovascular disease and some cancers.
Current clinical evidence indicates waist measurement is an accepted indicator of risk.
WHAT EVIDENCE SUPPORTS THE WAIST MEASUREMENTS?
The recommended waist measurements used in the Measure Up campaign are based on findings by the World Health Organization (WHO) and the National Health and Medical Research Council (NHMRC).
The current Australian Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults were issued by the NHMRC in 2013. The NHMRC is Australia’s peak body for health research and advice, and the Guidelines were developed by an expert panel after a comprehensive assessment of the current scientific evidence.
I CONSIDER MYSELF TO BE HEALTHY AND ACTIVE, YET MY WAIST MEASUREMENT IS IN THE RISK RANGE. IS THIS A PROBLEM?
It is not possible to give individual tailored clinical advice as every individual situation is different. However based on current clinical evidence (see above), waist circumference measurement is an accepted indicator of risk. The measures for increased risk of 80cm and above for women and 94cm and above for men have been taken from these Guidelines.
While waist circumference is a simple and obvious indicator of potential risk, health risk is not solely linked to waist circumference. Smoking, physical inactivity, blood pressure and blood cholesterol, lack of sleep and many other factors all play an important role. Some individuals will naturally carry small deposits of subcutaneous fat around their abdomen even though they follow an appropriate lifestyle.
If you exercise regularly and eat well, don’t smoke or drink excessively and generally live a healthy life then a slightly elevated waist circumference should not cause you to worry. It is important to note that all efforts to increase physical activity and improve diet will help reduce risk and have an individual health benefit. We encourage you to continue your efforts.
WHAT IS BODY MASS INDEX (BMI)?
BMI is an acceptable approximation of total body fat at the population level and can be used to estimate the risk of diseases in most people.
The use of BMI is a convenient way for you (an adult) to assess whether your weight is in the healthy range. Your BMI is calculated by dividing weight in kilograms by height in metres squared. For example, a woman 1.67m in height and weighing 65kg would have a BMI of 23.3 which falls within the healthy weight range. Overweight is measured as 25 or more with obesity determined as 30 or more.
There are exceptions to this rule, which means a BMI figure may not be accurate.
BMI calculations can overestimate the amount of body fat for:
- Body builders or weight lifters
- Some high performance athletes or highly active defence personnel
- Pregnant women.
BMI calculations can underestimate the amount of body fat for:
- The elderly
- People with a physical disability who are unable to walk and may have muscle wasting.
BMI is also not an accurate indicator for people with eating disorders like anorexia nervosa or people with extreme obesity.
Therefore the BMI is not the best measure of fatness or health risk. Increasingly experts believe that the type of fat and where it is on your body may be more important than BMI – and that your waist circumference is really the figure that you should pay attention to. Even if your BMI is normal, if you have a waist measurement above 94cm for men and 80cm for women you may be at risk of serious chronic disease.
It is important to remember, however, that even though your BMI can tell you if you are overweight, your waist measurement is a better guide to your risk of chronic disease. Even if your BMI is normal, fat around the waist can put you at risk.
WHY DOESN’T THIS CAMPAIGN USE THE BMI?
BMI does not distinguish between weight attributable to fat and weight attributable to muscle. It can also over estimate the amount of body fat for pregnant women and under estimate the amount of body fat for the elderly. The BMI should be interpreted with caution when assessing an individual’s body weight.