1. Short form of Research will submit full copy upon
request.
Health Care and Humanity
The conflict between Health Care
And
Health Care Providers
For the professional in the Health Care profession there is an
important conflict confronting the health care provider. One
Conflict confronting a health care provider is a problematic
condition that he or she observes during a patient’s visit. The
condition observed is not within the physician’s expertise yet the
physician can clearly see a condition that needs attention.
In some cases, the physician will make a referral and in other
cases, more so than not, they will not address the issue. . It is a
dilemma for the physician to address this apparent condition.
A specific scenario is a cardiovascular doctor presented with a
new client. The client is a woman 35- 40 years of age for a heart
infraction. The nurse practitioner has seen the patient and the
history data recorded. The patient weighs 235 pounds upon seeing
the physician. The patient is 5’5” tall the physician checks the
patient and reviews her chart. He does all the necessary approaches
to check the heart and the patients’ blood pressure.
The doctor releases the patient and tells her to return in three
months. Upon returning the patient weighed in and gained 5
pounds. The question to ask is, should the physician address the
patient as to her obesity or should he just say, “I see you gained
some weight.”
The skirting of the issues is the condition I wish to address in this
paper especially to the point that as health care providers we need
to be come more than active in the fight against obesity we need
to speak out not only to our patients but to the community we
serve .

2. I am sure many of you will say let’s confront the issue. Good!
Now this bring about a certain condition which physicians may
not be aware of and that is the intervention motif( Cause and
Affect ) which is not just directly dealing with the patient’s
condition but dealing with the totality of the patient i.e. family and
the socioeconomic ,cultural and environmental conditions the
patient is living under.
In dealing with the patient it is important to understand these
conditions and more so the Humanity of the patient which the
professional must deal with the (Cause and Affect) upon the patient
and the condition they are living in.
It is this part of society, which shuns the empathic part of society
rather it, confronts the apathy that society projects upon those who
are different physically and culturally. Do we in the health care
system work in apathy or do we move beyond this dropping the in
humanitarian part of society and go beyond and see the needs of
the patient in a more empathic approach using an empirical design
which not only sees but acts upon the condition.
Being polite to the patient and speaking gently about the obesity
is an acceptable approach because physicians are concern that they
would have legal actions against them. However, if the empirical
approach to intervention is that area most physicians vacate
because of not only the time involved in intervention but also the
fact that they see it a not cost effective.
(1) Conflict and Resolution 2001 by John Trojian, PH.D. abd
Self-Published
Referring back to a former comment of causality, which is a part of
(Cause and Affect). It is at this juncture that intervention comes
into play which I will speak to throughout this paper using the term
(Co-Operative Medicine.)
Intervention is addressing the problematic condition which can
bring understanding into the Humanity of Health Care.
Intervention comes outside the patient’s individual care and that it
is the Totality of the patient’s care (Co-operative Medicine) with
the understanding of the historical background of the patient. By
the term Totality I am referring to the intervention of the problem
and beyond the patient’s visiting the Physician.

3. It extends into the patient’s life style and conditions afore
mentioned. The historical data is not just on a form sheet they have
filled out “Any heart problems, any diabetes, T.B. etc. All these
questions are veneers to the totality of the person. More
particularly it must deal with the patient’s family and the extended
family. The intervention or Co-operative medicine approach is the
extension of the physician’s care of the patient.
In recent studies in the field of Gastroenterology at the 73rd
annual Science Meeting it was revealed that many patients do not
accurately perceive their child as overweight or at risk for Adult
Obesity
(2) Gastroenterology at the 73rd annual Science Meeting
In the Journal Public Health Nursing reveals that there is an
increased risk for midlife obesity. Obesity continues to increase for
women in the U. S. Particularly among African –Americans and
Mexican – Americans Women between the ages of 35 – 44. There
are approximately 3.3million whites and 575,000 Mexican-
Americans who are Obese. (
Obesity
**********************************************
I would like to speak to a point, which in our society has become
an issue, which is a national problem to the point that corporations
and individuals have made millions of dollars on the obesity factor.
Corporations have developed food chains that promote this
condition, and other corporations have increased their business by
developing programs for weight lost. Many conditions, both
medical and sociological, cause the problem of obesity. If one
looks at reasons and excludes medical, we then need ask ourselves
if it is because of the person’s lack of self-respect, low self-esteem;
or is it based upon other issues within the person’s life.
Obesity is not just an eating disorder; it is also based upon, in
many cases, self-esteem. However, it must first be determined
whether there is a medical problem within the family’s history,
such as diabetes or other medical conditions, which can contribute
to obesity. In order to help the person or family, it is important for
the psychotherapist to work closely with the physician.

4. (3) For more information go to November Daily
Science Jan. 14th
. 2009
Case in Point Conflict in Peer Pressure
Part #1
When it comes to young people being obese, it will cause many
social issues in their lives, especially at school with their peers.
Parents need be aware of their child’s appearance. If a parent finds
that their child is not exercising, or that they binge on snack foods
and do not eat properly, then it is important for them to seek
medical help to discover the cause of the obesity. Watching the
child’s weight is a good practice for the parents to become
concerned about the child’s health. More importantly, the parents
need to look at themselves first and check their weight.
Take a woman who finds herself overweight. Does she dress to
look fashionable? Does she have a good sexual relationship with
her husband? There are many issues with obesity. When the
therapist faces a client with this condition, it is more important at
first to address the issues that have caused her obesity. Many of
these problems are due to historical family background, i.e.
medical, socio-economics, and the psychological conditions of the
client.
One case in point that I have had, as a therapist, is a woman came
in to my office weighing 210 pounds. She was about five feet,
eight inches tall, with a very attractive facial feature. She was very
concerned about her sexual relationship with her husband. I asked
her was she always over weight. She said no. She started to gain
weight when she was about twelve or thirteen years old. I went
into her family background to find out if her parents were alive and
living together, and if she had other siblings. I also asked her if she
had any medical conditions that may contribute to her overweight.
She said no, but that her father was an alcoholic, and her mother
never fought back with her husband. She always bowed down to
him. I hated that, and I always told her to fight back, but she would
say your father supports us, so just let it be.

5. It wasn’t until several more sessions that my client told me friends
of her father abused her when she was about twelve. It was at that
time that she started to gain weight. It was obvious that the weight
problem was to ward off her father’s friends. However, this issue
carried into her marriage.
Her past also hampered her sexual relationship. Working through
these issues with her and disclosing my past, which I spoke of
previously, helped her open up and feel more relaxed during the
sessions.
Case in Point Resolution
Part #2
We worked together for more than six months, and during that
time, she started to lose weight. I made a deal with her and asked
her to work on more weight lose by reducing her food intake at
night and eating only two regular meals a day for five months.
After which she was to return for more sessions. My client came in
after several months with a weight loss of some sixty pounds. She
now weighed a hundred and fifty pounds, and she looked like a
new woman. She sat down in a more posed way, her dress was
new, and fashionable, and said, “How do you like this new me? I
tell you, I feel great and my husband said whatever you did, that I
should tell you thank you.” I told her to thank her husband, but it
wasn’t me who lost the weight. I was not the one who confronted
the issues it was she.
We ended our sessions, and she asked if she could come back if
she needed help in other areas. I agreed and told her if she wanted
to tell her husband about her past, it would really help their
marriage as long as he understood that it wasn’t her fault, but the
parents who were at fault. She said she told him, and said if I ever
wanted to confront my father, he would be right with me.
This report extracted from Science Daily, March 5, 2008, with
some paraphrasing.
In the Science Daily of March 15, 2008, a study showed that girls
with attention deficit, hyperactivity disorder stand a substantially
great risk of developing eating disorders in adolescence than girls
with ADHD, a new study found.

6. “Adolescence girls with ADHD have been found to have body
dissatisfaction, and tend to go on repeated binges eating, and purge
themselves that are common in bulimia nervosa,” said University
of Virginia psychologist Amori Yee Mikami, who led the study.
Reports have it at that 5% of girls and three times more boys have
ADHA than girls. These children have aggressive behavior and
restlessness and become irritably. With this understanding and the
knowledge of ADHD, it is imperative for parents and schools to
become more aware of this disorder and develop better
understanding of these students. The understanding brings about
more than concerns, it demands action and programs that will help
the student with self-esteem and self-awareness, wherein they can
help themselves overcome intimidations, and slanderous remarks
from important fact that parents need to know about causes of
obesity.
Alcoholism
In the area of alcoholism, there are many who feel that AA is the
end all to helping people with alcoholism. I must confess I do not
feel that this condition is treatable just by attending sessions with
other alcoholic and saying, “I am Henry, and I am an alcoholic.” It
is true that admitting to the fact that one has a condition, but what
is more important to understand is what caused this condition. I am
sure you have heard people say, “I drink to get away from my
problems. I can’t stand my job, so I drink to calm me down. I
enjoy drinking and I can control it, so what’s the problem.” When
listening to these lame excuses, these are the real reasons for those
with alcoholism to be in therapy. The issues seen are the cause on
the surface for drinking, or it may be the job or whatever. These
are not the underlying issues, which brings the person to where
they are in life.
Resolutions within Obesity and Alcoholism
Part#3 Understanding
Within the framework of alcoholism and obesity, the therapist
needs to understand the inner feelings of the client; in order to
understand this inner feeling, the therapist needs to approach the
condition through Gestalt therapy, wherein the client can develop
an understanding of his or her inner feelings and are able to
express them openly.

7. When the client can express these feelings openly and understand
how these feelings have affected him or her, then a rebirth begins,
and the confrontation of the conflict is addressed.
There is without doubt problems psychotherapists are confronted
with, and that is, that not all of society will enter therapy. Yet, how
often I am told by people who I meet, hearing that I practiced
psychotherapy; they immediately say, “Boy, I could use you or this
place could use you.” Our society talks about needing help, but so
often it does nothing to get help from the professional. The
question is, is it because when a person enters therapy, they are
marked as having a mental condition, or is it that they see
themselves as having a condition they do not want to address? I
have mentioned, it is important for the therapist to enter therapy
once a year with a colleague who can help sort out certain
problems the therapist may have with his cases or within his or her
personal life. It would be nice to have our society enter therapy,
however, this is not reality, but what is reality is that we need to
enter into areas of concern within our communities to help make
them a better place to live. Visiting our schools and churches,
giving lectures on specific subjects that one finds is plaguing our
communities is away to accomplish this concern. The therapist
then can help bring about a rebirth within the community.
The community that develops a rebirth has seen the problems
within the community and has acted upon the conditions that
existed, and the community eventually will see a new community
with new realizations that help develop a better economy within
the community, which eventually help individuals and the total
society to achieve a rebirth.
Interpersonal and Intrapersonal
Relationships
In the area of interpersonal and intrapersonal, (Intrapersonal
relationship that is dealing with one’s own personality within his or
her own concept of self) Example: A person stands before a mirror,
and looking at himself or herself, says, “I see you seeing me seeing
you.” We need to go back to transactional analysis to understand
this concept. It is within this area that we can understand more
clearly the differences and the importance of these two areas.

8. Relationship begins from the moment we enter into this world. It is
not only how we interact with others or our environment, it is also
how we are interacted upon what develops in our interpersonal
relationship with family and friend.
Resolution to Conflict in Birth, Infant’s Growth, and
Libido Development
From the time of conception we have a growing Libido and
develop Conflict and Resolutions within Interpersonal and
Intrapersonal relationships. These relationships developed from the
time our mother takes us into her life. When a mother nurses her
child, the sucking of the child upon the mother’s breast is the first
sexual encounter a child has; although unknown to the child it
grows with every interpersonal interaction it has in life. Thus, our
growth, and how others, and we perceive us depends upon how we
receive the messages and instructions from the beginning of our
arrival on this earth.
How we relate outwardly to outsiders is a much different way than
we do with family members. We often want others to see us the
way we want them to see us because we want acceptance from
them.
5
Conflict within Self and Its Resolution
Part #1
It may be that we do not feel acceptance from the family, however,
this may not be the case. It may be due to some conflict in
personality, or it may be the way in which we have had
interpersonal relationships communicated to us, telling us we’re
not good enough, thus, we search for acceptance and belonging.
Although this condition may not have been explicit, we interact
with people and ourselves in the condition. Interpersonal
relationships developed from birth have brought upon each of us
certain conditions, which we may know or not know consciously.

9. I mentioned how when I went into therapy with my psychiatrist
before I entered my profession as a psychotherapist, and he
brought out how I looked in an iconic way as a gorilla, and he had
me stand upon a chair and beat my chest.
It was through this experience that I found how the interpersonal
relationship with my father created this attitude. Not only was it
the interpersonal relationship, but the intrapersonal relationship I
had within myself that surface. I will comment on this
interpersonal relationship later in this material.
In looking back at a case aforementioned, where the client came
into my office about marriage and ended up talking about his
homosexual relationship with a friend it was here again, the
intrapersonal relationship he had with his wife was one personality,
and within himself, he had a struggle with his interpersonal being.
The intrapersonal relationships we develop are often struggling
with the personality within the intra. The problems our client
brings to us are those struggles based more so on the past, through
the development of the interpersonal being. What has been seeded
in our lives is what grows forth, and only when new soil and
nurturing has taken place can the plant that has grown become a
more productive plant and produce more seeds and a better and
stronger offspring. The intrapersonal being we have within us
gives us a better understanding of our life as it is today.
Intrapersonal with the External Personality
When confronted with conflict, it is the intrapersonal relationship
we have within that causes the anger, the denial, the addiction, the
obesity; and so as we develop a better understanding of self, we
then can see deeper within and help with a rebirth in our
interpersonal being.
Too often, we have transference of anger, of refutation; which says
it is not true; it is someone else’s problem. All that is wrapped up
in the person’s denial is the intra and escaping from the reality that
they need to admit to the cause and effect, and recognize that once
they have conquered the intra, then the interpersonal being can
move forward. Rebirth of acceptance of self is thus creating a new
and healthier being.

10. We so often transfer our problems unto others, yet we know that if
A affects B, then A plus B affects C, which in turn creates an
ongoing causation of problems never to be resolved. Thorndike’s
Theory, 1904 Cause and Affect
Looking at transactional analysis specifically, at the one up man
game, it is the basis of our daily lives. Example: Seeing a friend
who is really just an acquaintance, you say good morning and he or
she returns the favor saying, good morning, and you both walk
away. You happen to meet this person during coffee break and you
say, “Hell of a day.”
They return a message, “Hell of a day, and so much rain, hope it
stops before I go home.”
They leave and return to their work place. You are going home and
on the elevator, there he is again. You say, “How was your day?”
His response, “Mine was exhausting. Say, how about lunch
sometime.”
The door opens and you walk out first and leave without any more
conversation. The one up man is complete, you are the winner, and
the one up man conquered the situation. Eric Berne developed this
transactional analysis.
In the interpersonal relationship within this situation, the up man
does not make a commitment, and the intrapersonal being is
walking away saying, “I really didn’t mean what I said to him. I
don’t want lunch with him.” Being true to oneself is one thing,
however; being truthful to others is so much more difficult. Biting
off ones tongue is the general rule because of consequences, which
we have learned from our first years on this earth. We relate to
consequences, which have proven harmful to us in our lives. Do
not talk back; be good, watch your step; mommy’s good boy, he
never does anything wrong; does he! Our sculptured image created
by our parents that have planted the seeds and cultivated our
garden. We are the fruits of their labor, and so we grow weak,
strong, hateful, obese, addicted, and often withdrawn from the
world around us. Our interpersonal relationship is weak, and our
intrapersonal being is in an abyss, never really feeling the true self
and the aspirations of the inner being.

11. The development of intrapersonal skills is the groundwork for a
more rounded life style, which increases the individual’s
opportunities. This transactional analysis involvement is the basis
for the development of a mature individual. Knowing how to
communicate with others, hearing what they have to say, and
understanding the message is the most important part of
interpersonal relationship. Not understanding the message is part
of the conflicts in marriage.
Listening to the partner and knowing how that person feels helps
we understand that there is something within the communications
that tells a different message than that which you are hearing. What
someone speaks is what that person means. What we hear is how
we listen to the message. When the partners ask each other, ‘Is this
what you mean?’ or ‘I’m hearing you say this’; these are the keys
to understanding and to better communications.
(3a. Thorndike’s Cause and Affect, 1904 Empirical Study on Cause
and Effect
It is the beginning of a stronger interpersonal relationship with the
significant other.
The development of one’s intrapersonal abilities is that program
which is a product for growth during our early stages of life. A
dominating parent controls the individual and develops a
withdrawn personality. It develops a person that seldom takes
control of situations. He seldom speaks up, and very seldom gains
a position of authority. How our parents helped us grow into
adulthood is the foundation of our personality. In order to make a
change in this area, one must be able to understand its beginning,
and then work towards the development of a new being that allows
the intrapersonal being to emerge as a new and stronger being with
a more outward interpersonal personality. It is this being that will
overcome the past and develop a rebirth; that has control over his
life, and being able to relate to others in a more meaningful
relationship with his significant other or with others within his life.
In this section, I will speak about resolution and conflict as that
part of one’s life which will, and does, relate to others in how they
see us and respond to us.

12. What we have developed into is what we are. This development is,
as aforementioned, the groundwork our parents, who have tilled
and sowed the seeds of the being to be. I am sure some readers will
say, “How come I turned out okay and my brother is a bum; an
addict; a lousy father?
The part of the cause and effect you are now saying you were
treated the same, and he even got more than you did. You say your
mother always said, “Your brother needs whatever.”
Like Father Like Son
Like Mother like Daughter
As these word are closely associated with parents who are
alcoholic so it is with parents who are Obese. In a research by
Early BIRD DIABETES a study has shown in the July 13th
International Journal of obesity indicated that girls whose mothers
classified as clinically obese are significantly more likely to
struggle with overweight problems in childhood with similar
relationship between Father and Son.
Although the condition was different between mother and son
Child who are obese tend to carry this condition into adulthood.
His intervention applies (Co- operative medicine) which will
develop a more serious and intents historical data base of the
patient and his or her family in extension.
How do these investigations relate to the patient of the
Cardiovascular Physician or to any other field of medicine? The
patient is only (A) part of the problematic condition which is the
bases in Cause and Affect that relates to the historical background
of the patient and his or her Totality
(Extended family)
This brings the Humanity of Health Care into its right
perspective. It is the way Health Care providers can lower the cost
of Health Care and achieve a better and more effective program
with in society and within the physicians practice.
If we say the physician has the obligation to confront the patient
and society with these issues then we begin to fulfill our obligation
to Society, no, to Humanity as aforementioned on an earlier page.
It is the oath which we have taken to care for those in need.

13. This caring is not just the hundreds of patients one sees rather it is
Society, Humanity we need to see as those in need especially those
who are those that are casted aside and forgotten in the health Care
System.
The severity of obesity within the last 20 years has risen to
epidemic proportions and yet society looks the other way in an
Apathetic manner.
Society is a term we easily use because it does not include the,
you and me which it leaves out. It is a collective word just as if we
say a group of people then the (You) is not included, although you
may have been in the group. It is your desire for recognition as an
individual. To serve the patient is not Society served it is
Humanity, the individual, l who allows you the privilege to touch
him or her and to view his or her body in an exclusive manner that
only a very select group of individuals may do.
The multitude of society looks at obesity and comments
negatively on it not showing the Humanity it needs to help those in
need.
American Children are overweight and one fifth is obese. Dr.
Geeths Raghuveer of Sick Children’s Hospital in Kansas City said
this is a wakeup call for all physicians to take notices and to
respond to this growing problem with in our Society. The high
cholesterol count in young children and the many signs of danger
using an Ultra Sound to measure the thickness of the wall of major
neck artery almost all had abnormal cholesterol and many were
obese. It would be well to read this article. Newspaper November.
(3) . Atlantic City Press Newspaper November 12, 2009. (3)
Atlantic City Press, November 12th, 2009
If Humanity is society and we live in this society unrestricted from
openly speaking our thoughts concerning our feelings or thoughts
then what is our obligation to ourselves as,
a part of this humanity and the ultimate society itself?
The question is “Do we seek a healthier Society, a better Health
Care System and a richer and more meaning concern about our
patients or are we concern on how we are seen by Society in
general displaying apathy towards our fellow being?

14. That is, just continue, doing the same old approach and never look
to improve our outreach into society. I assure you, I do not see this
attitude very much within our community, yet it exists. We see new
hospital going up and new practices opening yet none of these
announce that they are starting a new intervention (co-operative
medicine) practice.
ADHD
The portion of this research was extracted from the March 5th
,
2008 study which shows
that girls with attention deficit, hyperactivity disorder, stand a
substantially great risk of developing eating disorders in
adolescence than girls with ADHD, a new study found.
The conciseness of society and the portion of that society that
serves humanity must be more aware of the problems children in
our society face. Especially do we need to be more cognitive of the
problems school social workers face and the need to work closer
with these professional.
“Adolescence girls with ADHD have been found to have body
dissatisfaction, and tend to go on repeated binges eating, and purge
themselves that are common in bulimia nervosa,” which has
become a problem more pronounced in the last several years than
it has in the last twenty years.
In the fashion industry young women who work in this fashion
Industry present the ADHD problem more often than was reported
fifteen years ago.
About 5% of girls and three times more boys than girls are ADHD
subjects. These children have aggressive behavior and restlessness
and become irritable.
ADHD is a condition related to obesity and a mental and physical
disorder is more within boys having ADHD more than girls, and
that girls are frequently undiagnosed with this disorder. Although
this disorder is not directly about obesity, yet the condition
contributes to the development of obesity. Knowing this, it is an
important fact for parents and physician as well as Social workers
to become more aware of what contributes to Obesity. (4) (5)
(6)

15. Science Daily report March 5th
, 2008 (5) Daily Science
March 15th
2008 University of Virginia Amori Yee Mikami
Questions to address
1. Can intervention lower the cost of Health Care?
2. . Can intervention lower the morality rate?
3. Will the Government intervene by developing programs that
will lower the cost of invention with in insurance coverage?
( not a Socialized Program)
4. Will the government tell the insurance companies they most
include intervention within their insurance coverage?
5. Is it imperative for Health Care workers to include
intervention within their practices?
6. How does the insurance Industry keep the cost of Health
Care Higher when it does not promote Intervention (Co-
operative Medicine)?
7. Would clients want an intervention program that would
involve their extended family?
Family members brought into the patients’ health Care visits.
If the above questions are of impertinence to patients then it
would seem that intervention (co-operative Medicine) would be a
practice the patient would except from their Health Care provider
I understand that at times there are circumstances that this type of
practice would not be acceptable when the patient does not their
confidentiality open to some members of the extended family.
In continuation of the report on page 8, it is important to
understand the significance of this epidemic (obesity) it is not just
for the physician s it is and must be a concern for those in our
school system that are involved on an everyday bases
The school nutritionist must become aware of the special
conditions of the student but more so the general condition of the
student body. It is the counselors who also must recognize the
needs of that student who show signs of overweight or obesity. (5)
The educators who have involvement with our nation’s children
during the day account for more time with a child then most
parents spend with their children at home. Because of this
involvement it is apparent that these educators need a more
cognitive awareness of the health conditions of our children.

16. The question is, Can educators under our present system be
personally involved with our children without jeopardizing
themselves and be punished for their intervention. Can a teacher
become a catalyst for a student when they see a student gaining
weight and seeing a student who is obese and has withdrawn from
social activities?
There are great opportunities for our teachers to play an important
role in decreasing this epidemic and help decrease the morality rate
within our nation.
As professional health Care workers develop a new and more
meaningful system to help our youth become more intelligent
concerning their physical and emotional wellbeing, as well as their
psychological outlook about themselves, it is evident that they will
become healthier individuals and better parents with a deeper
understanding and concern about their children and their health
conditions .The quicker our nation becomes aware of the need to
change the quicker our nation will begin to lower the mortality rate
in our nation and lower the health care cost within our nation.
(4) Atlantic City Press Newspaper March 5th, 2008
10
When this takes hold we then will see Obesity become less and the
inter and intra relationships our children have with others,
developing a great Self- Esteem and a great self-awareness as
adults, thus their peer relationship will become more involved and
they will have developed better group dynamics as mature adults.
According to some investigations young people who are
overweight or obese generally associate with those groups that are
less involved in the “in Group” and are less popular. They
seemingly retreat from socializing with those students who are in
the “in group.”
Peer pressure is a factor that parents need to be aware of as their
child growing into the age of puberty their involvement with other
children will show if they are advancing in socialization or if they
are withdrawing from society. Patents need to become aware of
certain factors: Does the child become active in sports or in some
after school activities?

17. Do they socialize with inter sexual partners girl and boys. Do they
express their feeling openly? All these involvements are points that
will indicate how their peers and how the child feels about how he
or she is seen by others and themselves.
Condition that relate to the epidemic of Obesity
1. Genetics 2. Environment. 3. Cultural 4. Scio-Economics. 5.
Psychosocial.
6. Parental Guidance. 7. Educational System.
As our nation and the world confront the epidemic of Obesity
physicians, nutritionist, and other health care providers need to
become more aware of the conditions that are attributing to this
epidemic. If Obesity is not confronted then this condition which
attributes to a great number of moralities among those who are
obese will cost our nation’s health care system more tax money
and will continue to deprive our young people a healthier life style.
The rate of obesity among African-American, Mexican-
Americans as stated before is not only a detriment to this group but
too their children especially the young girls.
The more services examine this phenomenon the better the health
care system in our nation will be able to address the epidemic of
obesity. We need to become aware of the fact that there is a lack of
intervention in the above areas especially in the school systems of
our nation no less the area of parenting. There is lack of
intervention by general practitioners, and more so with
cardiovascular physicians and internal medicine physicians in
dealing with this epidemic.
I will speak to a condition which is an important part of the lack
of intervention among a specific group of physicians and that is
those physicians themselves who are overweight or obese. I
recognize that fact that this is a subject that will not be acceptable
by some professional however; these physicians are of the
epidemic class and need help as well as the general population.

18. Counseling in Obesity
Knowing that it is an important intervention with our patients who
are either overweight or obese and that are professional health care
providers we need take the first step in confronting our patients
concerning this condition. Now comes the problem: How does a
physician who is overweight or obese prepared to counsel his or
her patient if they themselves fall within these two classes. It is
like an Alcoholic telling another man who is an alcoholic he or she
should stop drinking because it is killing him. The fact that many
professionals lack continual training in the area of counseling thus
they lacks the ability to develop a good intervention program.
There is another reason and that is either embarrassment due to
one’s own weight condition or the lack of self –esteem which
covers up their professional position because one has a doctorate
does not change the persons’ self-esteem or self-awareness. It has
only given him or her more insight into a specific area of
knowledge The area of intervention is not only necessary to
confronting this epidemic it will also decrease the morality rate in
our nation. Physicians realize what the consequences are in
overweight and obesity yet for those physicians who fall into the
category needing intervention.
With this statement made concerning intervention and the
physicians who needs this help, the questions are now open for
discussion. (a) Can intervention help lower the morality rate?
(b) Will intervention lower the cost of health Care? (c.) Does this
open the acceptance of Co-operative medicine? (d) How will
insurance providers accept Co-operative medicine within the
practices of physicians with specific expertise?
There is another area that will be a stumbling block to intervention
and that is with intervention in the area of obesity. The low socio-
economic groups especially within the African – American and
Mexican- American and White American women will be the group
mostly ignored by the insurance groups due to the fact that they are
not insured.
In speaking with many physicians on casual bases I asked them
what their thoughts were on intervention (Co-operative medicine).
Most agreed that it was a good idea however, not one of them have
co-operative medical partnerships, nor do they offer interventional

19. services
Setting Counseling for Pregnant Mothers
Most women who find that they are pregnant are willing to stop
certain activities that will harm their fetus. The idea that they
would continue to drink alcoholic beverages or to smoke tobacco
products is a no, no for they understand the danger these things
have upon the growth of their newly expected child.
One of the most important counseling sessions a physician should
have with their patient who becomes pregnant is to start them out
on a weight conscious routine. Helping their patient recognize that
what they do during pregnancy is what will occur after their
pregnancy.
Starting pregnancy at healthy weight is very important according
to Dr. Vani Dandolu M.D. at Temple University
In a recent analysis, Dandolu and colleagues found that obesity,
increasingly common in pregnant women, raises the risks to
mother and baby. Overweight and obese pregnant women are at
higher risk of C-Section, and less likely to breastfeed, while their
children are at higher risk of high birth weight and childhood
obesity. Specifically, over half of the overweight and obese women
gained excessive weight during pregnancy. Further over half of the
obese women had a C-section, almost twice the rates of women
who were normal BMI (body mass index) before pregnancy.
The researchers offer the following recommendations:
Body mass index should be measured as part of vital signs at
routine annual check-ups and all women of child bearing age
should be counseled to achieve and maintain optimal BMI.
Preconception counseling programs should include education
regarding the poor maternal and perinatal outcomes among the
obese and overweight.
(4a) Sci. Daily July 14th, 2007 (4b) Temple University of
Medicine and Hospital, appears in American Journal of
Perinatology, 2007 May; 24(5):291-8.
Women with high BMI planning a pregnancy should be counseled

20. to participate in intensive nutrition programs aimed to achieve
optimum BMI prior to conception.
Encouraging breastfeeding can partially help to decrease childhood
obesity and also help mother to return quickly to pre-pregnancy
weight.
In the May 2007 issue of the American Journal of Perinatology,
Dandolu and colleagues analyzed 7660 women using the New
Jersey state Pregnancy Risk Assessment Monitoring System
database: 18 percent of mothers were obese, 13 percent were
overweight, and 16 percent were underweight. Black non-Hispanic
mothers were more likely to be obese and overweight than white
non-Hispanic mothers. U.S.-born mothers were more likely to be
obese and overweight than foreign-born mothers were. And older
women who'd previously given birth were more likely to be obese
than younger women who had not. The study is among the first to
show a correlation between high pre-pregnancy weight, excessive
pregnancy weight gain and post-partum consequences.
Within this data it is apparent that the obese factor in American
women is greater than worldwide pregnancies. With such data it is
apparent that the fact that the epidemic of obesity within our nation
is at an alarming rate. If we are to combat this condition we then
must start with education not just in schools (colleges and J.
colleges), but in community affairs informing the public of these
conditions that affect our population.
The outcome of overweight or obesity at the pregnancy stage of
life is not just a nine months experience. It is a condition that will
continue thereafter not just with the mother, it also continues on
with the child especially with the female child more so than the
make child.
In a study from the Universite’ de Montréal and the Douglas Metal
Health University Institute published in the Journal of Eating
Disorders showed that 10 to 15 percent of women have and
maladaptive eating behavior attitude. This study shed new light on
women who binge and who have or show signs of anorexic
behavior.
This study shows that a proportion of female population displays
maladaptive eating patterns. Exercise was a base line within this
study.

21. (5a.) Science Daily report Dec. 20th
, 2009 Disorder Eating may
Effect 10 to 15 percent of Women.
Patient’s Expectations
If the above questions are of an important factor in patient care
then it would seem that intervention would be a practice that
physician’s patient would expect from their doctors.
This epidemic is not just a concern for the physician it is a must
concern for those professional aforementioned. Yet more so to
those who are in direct contact with our nation’s children every day
Teachers. The opportunity for the educational system in our county
to help decrease the morality rate of our nation is in their hands
more so than the physician who may see a patient once every three
month or even six months.
There is another grouping which I believe has an even greater
responsibility to the reduction of overweight and obesity within
our nation and they are the parents.
This brings up a proposal which may not set well with society
however if the reader will listen to the writers thoughts before
rejecting it we may have a way to help decrease obesity with in our
nation at a quicker rate
Child Abuse
Many counties have agencies that protect young people and
families. They protect them from abusive parents who at time may
even kill the children. When society hears about these parents the
cry out how awful those parent are how can anyone do such a
horrible thing to young children?
If the agencies who have legal rights to take children from their
homes to protect them then why not take those children who are at
risk of death earlier than they should be because of their parents
allowing them to become obese.
If the parents are overweight or obese as stated previously the
children are at greater risk to become obese in adulthood.
A research at the Stafford University School of Medicine and the
Lucile Packard Children’s Hospital dealing with lower-income
children studied an anti-obesity program to prevent obesity for
low-income children who were primarily girls from the African

22. –American grouping produced beneficial changes in Cholesterol,
diabetes risk and depressive symptoms but had little effect on
youths’ weight in a trial conducted by these two groups. The
research group set up certain activities i.e. culturally tailored dance
Low-income groups however they did find that girls of high risk
subgroups from single parent households and those who watch a
lot of T.V. They also noted that the large –scale randomized trial
produced other important benefits. It lowered participants’ total
cholesterol and LDL cholesterol levels, reduced the onset of high
insulin levels and reduced symptoms of depression
Further in the research Dr. Thomas Robinson, MD. Professor of
pediatrics and of medicine noted almost 85% of families stayed in
the study at least two years Dr. Robinson noted that it is important
that people do not become discouraged from doing research
because it is very difficult to develop a research among those in the
low-income grouping.
This research went on to develop dance classes and cultural
dances from Africa another group received health educational
classes. This research was more than about obesity. The research
was to help the children learn about their cultural background
which developed pride and self-awareness of the historical
relationship to other people. The fact that these groups became
involved in community activities also helps develop self –esteem.
(6) Daily Science report Nov. 1, 2010
Suggested reading on girls at Risk for Cardiovascular Disease read
Jan. 9, 2007 Daily Science report Results from the NHLBI Growth
and Health Study of more than 2300 girls.
It showed that girls as young as 9 years of age who are overweight
are at increased risk for short-term and long term problems that
will occur due to overweight and Obesity.
Nov. 19th
, 2010 Science Daily reported on Childhood Obesity
linked to increased Risk of Adult Cardiovascular and Metabolic
Disorders.(7)
Note 6- Stafford University School of Medicine Dr. Thomas
Robinson, M.D. Nov. 1, 2010
Daily Science Report. (7) Daily Science Report Jan. 9th
, 2007
Overweight Girls at Risk for Cardiovascular Disease Nov. 19th
2010 Childhood Obesity link to increase for adult Cardiovascular
Disorders.

23. Treatments
If we are to take a greater interest in stopping obesity in our
nation then it is important to recognize that parents and the
extended family is part of the problem. We have discussed this
earlier however there is more to the extended family it is the
community as we discussed before. In a recent research dealing
with parents entering programs for overweight and obesity it was
found that parent entering these programs for parent only showed
that parent-only treatments for childhood obesity work equally as
well as plans that include parents and children. Parents are the
most significant people in a child’s environment serving as the
first and most important teachers in the child’s life therefore if the
parents are willing to enter treatment to learn how to decrease the
obesity or overweight of their child then the child will see that the
significant other is there for them. The research conducted by Kerri
N. Boutelle, PH.D. Associate professor at
U C San Diego and Rady Children’s Hospital, San Diego
addressed this approach of parents –only group and equally viable
method for overweight loos.. (June 15th
, 2010
Within the group dynamics it is important to understand the
group’s reason for its existence. It is also important to understand
that even though the group may have a mindset the mind-set is still
different on the individual bases. As the individuals state their
reasons for being in the group it is also important to understand
that there is other underlying conditions that affect the individual
within the group. An example: One individual who is in the group
has stated that they are obese and want to lose weight. Yet their try
and find little results. They with draw from others and continue to
destroy themselves. What if someone had abused the person who is
in therapy and this condition is not part of the therapeutic data? Is
this not another reason within the group dynamics?
If a parent enters a treatment group because of their child being
overweight or obsesses is it important to find out what the parents’
issues are as well?

24. (8) Science Daily summary report Oct. 25th, 2010 also see (9)
Helping Children loss weight: Group Treatment may help Children
Achieve Healthier weights. (June 15th, 2010
In the many cases I have had over the years dealing with child
abuse it was important to separate the parents from the child in
order to understand the conditions within the home environment.
So it is within the ground dynamic the counselor must understand
the conditions of each individual within the group and then address
these conditions separately then when the patient allows the group
to intervene and help to discuss the issues confronting the
individual which may in turn bring out others within the group to
speak to conditions that have not been addressed before.

25. Ca. Sci. Daily Report Oct.
25th. 2010 Helping Children Sci. Daily June 15th, 2010
If our social network is to truly work then it is up to the agencies
within our communities to become more aware of child abuse and
the cause and affect it can have on the child not just the emotional
but the physical conditions, overweight and obesity.
As previously commented on, the patients visit to the
physician and what occurs from the first visit and beyond. The
historical inventory of the patient is more than a road map to the
physical makeup of the patient. The questionnaires filled out are
without a doubt an important aspect to look at in the patient’s
genealogy and that is the FTO gene, identifying the most important
aspect of the obese patient. Understanding the condition of the
patient is not just within the scope of the physician’s expertise but
beyond using the intervention (co-operative medicine) approach.
How often don’t we find patients who seeing physicians lack the
intervention in the areas of obesity? We know obesity and diabetes
and heart infractions are in relationship to each other as it is with
food intake increasing longer stays in the hospital, gastrointestinal
conditions. Knowing these conditions relate to obesity it should be
important to act upon this condition using intervention or co-
operative medicine which intern will cost the cost of health care.
Emity Sonestedt, member of Marjus Orlio-Medunders research
group at Lund University Diabetes Center states, “The critical
factor is what you eat.” The FTO Gene (Fat mass and obesity
associated) is common in general population. She states that 17%
of the general population has a double copy of the FTO gene
meaning the individual has inherited it from both parents. She
states that another 40% have a single copy of the FTO gene.
I am sure you are asking what is he talking about by bring this out
in the statement Beyond the Physician’s visit The reason is that
when the patient entered the physicians service and the patient is
obese then this area of FTO needs be investigated. The intervention
of the physician in the care of his patient goes beyond his expertise
it encapsulates others who have expertise in areas that will help the
physician care for his patient in a fuller and more co-operative
way.

26. Health care providers have known for years that over eating
caused weight gain. The question arises “What causes one person
to eat more than another. Science has become aware that the FTO
gene found in that part of the brain that regulates appetite and
satiety, and the risk variant connected to an increase energy intake,
especially in the form of fat.
The risk factor of becoming obese is 2.5 times higher for those
who have a double copy of the best known risk gene for
overweight and diet neutralizes the harmful effect of the FTO gene.
(10) Marjus Orlio –Medunders Research Group at Lund
University Diabetes Center. Dr. Emity Sonestedt June 15th
.
2010 conference on FTO
(11) ML Medical College of Georgia (2009 September 12th
.)
Children with Fatter midsections at Increased Risk for
Cardiovascular Disease, Study Finds

27. Midsections At Increased Risk for Cardiovascular Disease, Study
Finds Sci. Daily. Retrieved Sept. 13th
, 2009, see pg2.
Eating Habits High Risk
When the eating habits are under examination in high risk
patients or subjects the subjects eat a higher amount of intake
foods (Fats) Consumption.
Sonestedt states: (those who had a diet where less than 41 % of the
energy consumed came from fat. Obesity was not more common,
in spite of inherited risk.”)
The FTO acts in the (Hypothalamus) the part of the brain that
regulates appetite and satiety, thus it has a connection to the high
intake of energy especially in the form of fat.
This brings about the question “Is the gene the culprit that fools
the eater and encourages more intakes of food, therefore
consuming more, and gain weight.
Now let us consider for a moment the question: How many
cardiovascular physicians examine this glue or for that matter how
many physicians consider this FTO gene in their diagnostics?
The problem lies in the two or more areas: One the intervention of
investigative medicine, which is according to the (politicians) to
expensive. However, if one would stop and examine the cost
factors of preventive medicine over against the cost of those who
present a greater risk for heart infractions, stroke, diabetes, E.D.
and many more conditions that occur due to obesity then we may
say prevention is worth its weight in life saving medicine.

28. Right Perspective on Health Care
This brings the Humanity of health Care to the forefront into a
new perspective. It is the way Health care providers can lower the
cost of Health Care and achieve a better and more proficient
program with in our society and within the physician’s practice.
If we say physicians have the obligation to confront the patient
and society with these issues of FTO and other life threating
diseases then we begin to fulfill our obligation to society and to our
oath we have taken as professionals in the Health Care Industry.
Taking on the intervention motif maybe more than the physician is
willing to accept for his practice. However, one needs ask himself
opt herself: What is my obligation to my patient and am I willing
to go the extra mile to serve my patient in not just in a
humanitarian manner but in the totality of professionalism which
maybe more than I am use to doing and Society willing to accept.
The problem we as Health Care Providers have is how do we help
bring attention to a problem which is an epidemic in nature? How
do we develop better and more efficient Health Care for humanity
and how do we do a better job in providing a better life style for
our patients and their family? A recent article stating that one third
of the American Children are obese. Dr. Geetha Raghuveer of Sick
Children’s Hospital in Kansas City said this is a wakeup call for all
Physicians to take notice and to respond to this growing problem
within Society. The high cholesterol count in young children and
the early signs of damage noticed using Ultra Sound to measure
the thickness of the wall of major neck artery almost all had
abnormal cholesterol and many were obese.
Research in Obesity has taken many different approaches and each
of them has revealed that it is not just research nor new approaches
to effectively combat obesity in our young children nor in adults
rather it is for each of us to consciously endeavor to find the proper
approach to eliminate obesity within the populist around the world
as that epidemic that has taken thousands of lives.

29. Although obesity is a silent killer seen every day is society we
causally allow it to wonder about through society as if it were an
acceptable condition that those affected by this condition are
normal individuals seen by those with overweight or obesity are
looked upon by some in a scant manner.
Research brings to light the cause and effect of obesity within our
society yet most healthcare professionals do little within their
practice to confront their patients who have the condition of
overweight or obesity. In a recent visit to have an MRI a health
care professional mentioned that she knew very few professional
that would confront the problem due to the fact that they are afraid
they will have to go to court if the bring up the fact that their
patient is obese. If this were the case it may be up to the insurance
companies to state that a physician most takes this condition into
account when they first see their patient of if their patient poses an
obese problem under his or her care. For the healthcare
professional to step outside their expertise is asking them to do
more in the area of preventive medicine .The intervention of
preventive medicine according to insurance companies is to raise
the cost of healthcare in our country. If we agree with this attitude
then we are blinded by corporate America persecution by their
controls rather than accepting the fact that preventive medicine is
cost effective and will contribute to a long longevity of our
patient’s life when professionals take the extra step and intervene
in this patient’s life that brings about heart attaches ,diabetic
symptoms , gastro intestinal problems E.D. and other conditions
such as social rejection, psychological problems, depression and
many more side effects.

30. Health Care Providers and Obesity
________________________________________
The question presented is, Can an Obese Health
Care professional address his or her patient on the
subject of Obesity if they themselves are obese.
In a research concerning Interns, trainees and senior doctors who
have been in practice for a number of years and who are either
overweight or obese and who have intervention with their patients
regarding counseling in the area of overweight or obesity it has
shown that many of the doctors are inadequate in the area of
counseling if not lacking the proper background to counsel no less
to be an example to their patients when they themselves are
overweight or obese. These may seem like harsh remarks however,
if we are going to confront obesity as a healthcare provider then it
is our responsibility to become leaders by example.
As you may recall my comment s concerning a cardiovascular
physician who spoke to me concerning a friend whose child is
overweight and he did not want to confront the friend concerning
this problem because he did not want to hurt the friends feelings
about their child’s weight problem.
The next reason for this avoidance was he did not want to mix his
professional life with his personal life.
The question now is raised is twofold. One: Do we as professionals
always remain professional when it comes to dealing with people?
The second part of the question is: At what point as a professional
do we put aside our professional life and become just an individual
(just ordinary Joe) If you see a problem; a man drowning and you
are in a row boat and have a life jacket do you throw it to him or
do you row away Is this apathy and is it not justifiable approach to
warn someone of the condition that we know is a health hazard.
How many times do we not say to someone “Stop smoking?” We
speak out about this addiction and yet we are closed mouth when it
comes to a condition that kills thousands every year.

31. The term politeness used in society as that human action of
civilization however I believe we need to put politeness aside when
it comes to saving lives.
Just think of words that correlate to harshness are, frankness,
outspoken, rudeness, unconsidered, rash, uncouth. Yet we can use
these words when it pleases us to speak out to something we feel is
obnoxious. You say killing someone is inconsiderate of human life.
Well think about not tell someone they are obese and need to see
someone to help them with their disease.
How polite should we be when we know a condition is going to
kill a person especially if we did not react to that condition
immediately? The reaction is spontaneous when we know someone
need help we will quickly use mouth to mouth resuscitation or we
would use a cardiac defibrillator to save a life. Oh that’s different. I
guess so because we do not see obesity as a killer in the general
sense of the word killer. No it is just one of the most death causing
diseases we have in our world today, but don’t speak out just sit
and watch our children die a slow death. It is my contention that
we cannot be closed mouth on this subject, not if we are truly
concerned about our fellow man. As healthcare providers we need
to be in the forefront of this condition not in a monetary manner
rather in a humanitarian approach with professionalism so our
patients will understand our desire to keep them health and live a
better and more productive life.
(9) University of Temple, Dr. Vani Dandolu Daily Science July
14th
, 2007 Obesity with pregnancy fund obesity increasingly
common among pregnant women
Important factor is that those who were obese had C Sections.
(10) Childhood obesity a risk for premature deaths in young
Children New England Journal of Medicine Assist Professor Paul
Franks of Umea University in Sweden

32. Obesity and Counseling
___________________________________
_
With an over amount of people within the U.S. who are
overweight or obese there is within the Healthcare professionals a
lack of understanding and ability by many physicians to enter into
counseling their patients on the subject of overweight or obesity.
It is not for the lack of intelligence rather the lack of knowledge
within the subject of dietary understanding. Nutritionist is educated
in food values and had attended school for their profession.
Therefore, it is not for a cardiovascular physician to know this
subject rather it is for the two professionals to work together
joining forces to increase the health of their patients. Again the old
adage is COST FACTOR; if we are conservatives then we will say
it is too expensive, if we were liberals then we would say we do
not have enough. However if we are truly concerned humanitarians
then we would say, bring it on we will find a way to decrease the
death toll of our young and bring better healthcare to our people
and the world.
Doctor Elizabeth Jackson an assistant professor of internal
medicine at the University of Mental Health System states, “An
emphasis on health diet and exercise counseling is an important
part of medical education for physicians of all levels.”
This is more than true even for those doctors in the Health Science
field, who are not directly in contact with their patients in the
course of psychotherapy. Thus the question asked is, how can those
professionals gain the ability to counsel their patients who are
overweight or obese?
I don’t believe they need to learn how to instruct their patients in
better life styles what they need to do is develop team approach
with those who have been educated in the area of nutrition and
who understand the field of nutrition as in overweight and obesity.
(11) More weight equals longer Hospital confinement Sociologist

33. Jan.1, 2009 Ken Ferrao, Ph.D. Purdue University in West
Lafayette, Ind.
For it is in this area that I believe one need to have proficiency in
dietary evaluation. I am sure the readers will be saying this means
more out of the pocket money, time, office space, and staffing. All
this is true, true, true and not true and not true. This can be
accomplished by renting space and developing a client list through
the physicians’ practice there by assisting the patient and
developing a more practical approach to the condition of
overweight and obesity. In this way the patient sees their physician
as one who is knowledgeable in the area and more empathetic to
the patient’s condition. There can be a billing by the nutritionist for
his or her service. This dual role can also be stretch into a physical
therapist having space in helping the patient develop a new and
healthier life style through exercise. This dual intervention makes
even more than dual it is a triad which becomes a greater in the life
of the patient. Intervention
Heart Doctors Don't Follow Guidelines for Treating
Patients; Pre-operative Statins Reduce Deaths
(12) Science Daily (May 27, 2008) — A Europe-wide survey has
revealed significant differences between doctors in the way they
treat patients with heart failure, with many physicians failing to
give the best care to their patients despite the existence of
recommended guidelines.
Confidences in Physician
What gives the patient confidence in a Physician? Is it that he or
she has a nice personality? Is it that the physician has a nice
looking office and staff that is very friendly?
Is it that the Physician dresses very well? I am sure these
statements help the patient make a choice about going or not going
to see the physician.
There may be another reason and that is that the Physician attended
to the patient in ER and then became the patient’s physician only
by accident. Now that the patient has hired the physician to work
for him or she does the patient question the physician as to his or
her approach to medicine or prescriptions prescribed for a
condition?

34. Confidence is gained through a willingness to do the very best to
ensure the patients’ health is the number one reason the physician
has accepted the patient into his or her practice.
I didn’t mention in the beginning of this section that the Physician
is obese. I didn’t mention that the physician dies not dress in a suit.
I didn’t mention that the physician has an accent and is not from
this country. The question now is does the patient stay with the
physician or not? These questions are supercilious when it came to
saving the patient’s life is the old adage true you get what you see
or is it you get what you pay for. The bottom line is patients are
human and doctors are human and we all make judgments whether
they are right or wrong. The foot note on physicians following the
guidelines for the care of patients with heart infractions is an
important comment because it tells us that the best way to know
your doctor is to ask questions and to challenge the physician he or
she is not a deity and they do not want to be if they were or want to
be they would not be of this world.
Obesity for a physician is a problematic condition which they need
to fix because they do not show that they care for themselves then
how can the care for others. I know some of you will say how can I
be so blunt and it is not true. I may be wrong but first let us
examine it from the psychoanalytical aspect. What is obesity? Is it
a self-destruction.? If one would examine this condition through
this aspect then we would have to look at the gestalt, the sum, and
whole as to the parts of this condition. If is due to a physical
condition that is one thing but if it is because the person does not
truly work on reduction of weight then it is plan neglect. So what
do you think about my statement now? I would never say the
physician who is over weight is not a good or great professional
but I would say to him as I have YOU ARE TOO Heavy, LOSE
weight for your own health sake.

35. Training and Exercise
We spoke of trainers or attending physicians who lack the
confidence in their ability to change patient’s behavior even when
it is apparent that when the weight loss can and has alleviated
overweight and obesity related to physician’s conditions i.e.
Diabetes, E.D., Cancer, hypertension, gastrointestinal track
conditions.
As doctors develop their own exercise program and develop the
ability to counsel his or her patients in the area of Obesity or
overweightness then there develops a more cogent acceptance of
the physician’s ability to work with their doctor on weight loss.
The trust factor is increased and the patient sees the physician in a
more realistic manner as an expert in the health care field. Their
life style changes and so does their life style of the patient.
The one and most neglected person in the healthcare field is the
doctor who spends little time caring for himself or herself. The
question is why. Is it self confidence in his or her life as a doctor
with the ability to understand medical conditions or is it not having
enough time for self.
In the overall ability of interns, trainees and attending physician’s
reports state that attending physicians took better care of
themselves over trainees and internes due to their schedules and
reportedly felt inadequate to counsel clients regarding healthy
lifestyle habits. However, those internes and trainees who
exercised and developed a personal training program increased
their level s of ability to counsel their patients in developing a
better and healthier life style.
The Treatment of Obesity.
There are more programs and diet pills on the market for those
who are overweight or obese however, there is also many
precautions attacked to these programs and diet pills. First, does
the FDA approve them? What are the side effects and do I need to
see my physician before I start to take these pills. Is OK to take
pills for weight lose if they are not FDA approved and the sales
program on T.V. says that hundreds of people have lost weight
using their pills.

36. The ironic thing about all of these is the precautions attached to
these programs or pills. “Before using” If you are on medication
consults your physician.
As afore mentioned those physicians who are not trained in
nutrition ,dieting, counseling methodologies what would be the
reason for their patients to go to them asking whether or not a
dieting program is right for them. The answer is to make sure the
program will not interfere with any medication the patient is using.
The treatment of obesity with drugs or dietary supplement
programs can be very effective at times however, they are only
effective on a short term bases.
The maintaining of long term success is usually very poor.
In a research presented in the research on Metabolism says a new
study helps to explain how leptin, a hormone produced by fat
tissues influences that motivation to eat.
Research in the Sci. Daily news report on Sept. 14th
, 2009 Food
habits are more important than most Important Obesity risk Gene.
This means that the critical factor is what you eat. At least in the
case of FTO gene, the most important obesity gene identifies so far
“Say Emily Sonestedt, member of Marju Orho-Melanders research
group at Lund University Diabetes Center. She also is the main
author of a study that is under publication rights in the American
Journal of Clinical Nutrition. Stating that several studies show that
exercise diminishes the effect of risk gene…”
The findings show that subjects with higher plasma leptin and
lower ghrelin levels before dieting were more prone to regain
weight lost after dieting and that these hormones levels could
proposed as biomarkers for predicting obesity treatment outcomes.
Within this research the question proposed and which opens the
contradiction if not the questioning a for mentioned research on
FTO and how it acts upon the hypothalamus part of the brain that
regulates and satiety, thus it has been connected to the higher
intake of energy, (fat) especially.
If this research is valid then the question for continued longevity
weight loss is apparently part of the FTO than to the ghrelin, and
leptin and insulin concentration s before, during, and after dieting.
If the FTO is the culprit that masks the control by telling the
subject you are not full due to the FTO copy while another subject
says he or she is full and stops eating. Question is the FTO gene
the gene that brings about obesity or overweight condition we are
trying to prevent.

37. If those with higher plasma leptin and lower ghrelin levels before
dieting were more prone to regaining weight lost after dieting and
that these hormones levels can predict obesity outcome treatments
then how does this investigation of plasma leptins and lower
ghrelin levels control the FTO gene to bring about a favorable
weight loss and remain a loss without the intervention of the FTO
gene whether single or copy with the subject biological makeup.?
Dr. Ana Crujeiras Ph.D. of Compeji Hospitalaris University de
Santiago, Spain
August 6th Metabolism, printed in the Sci. Daily August 7th 2009.
Those subjects who are satiety due to the FTO double copy need
the intervention of preventive medical treatment.
According to recent reports from the World Health Organization,
about 1 Billion people worldwide are overweight or obese, with
most of these in the developed world. In the United states, for
example it was found that approximately 66% percent of all adults
20 years of age or older were overweight or obese.
That is almost 4 out of every 5 American men ages 40 to 59 were
overweight, according to the 2006 study published the week of
Oct. 27th
, 2008.
This statistic was from an Examination Survey by the National
Health and Nutrition Association
The target was ghrelin which can be modesty effective against
obesity, weight loss or gain can be effected by ghrelin which is
released by the body to encourage eating (FTO) during periods of
caloric restriction (dieting).
In human studies ghrelin levels rise before meals and fall
afterwards which is consistent with the hormone’s role in hunger
and eating initiative.2006 study published the week of Oct. 27th,
2008.
This statistic was from an Examination Survey by the National
Health and Nutrition Association.
(12) Sci. Daily Aug. 7th, 2009. Dr. Ana Crujeiras PH.D. Of
Compeji Hospitalaris University de Santiago, Spain. Study on

38. Metabolism and Hormones (13) Sci. Daily Sept. 14th, 2009. Study
on Food Habits and FTO gene. Also American Journal of Clinical
Nutrition. Exercise diminishes the effects of risk gene...
When food deprivation is used ghrelin levels are increased
however, when an intake of glucose load ,insulin and somatostatin
it is decreased which is a signaling of the hormone when ghrelin
or its receptor are lacking storage less of their consumed food and
are deficient for ghrelin thus the subject is resistant to diet –
induced obesity.
Given the complex nature of obesity, any antibody based strategy
would most likely used in combination with the other
Innunoterceptlutic approaches against ghrelin.
(13) For a more in-depth study on this subject read the author of
study Catalytic Antibody Degeneration of Ghrelin, Alexander V.

39. Mayorov of the Scripps Research Institute and the Skaggs Institute
for Chemical Biology, Oct. 28th
, 2008.
Overweight & Obesity.
**************************************
In reading many articles on overweight and Obesity I have
discovered that scientist have discovered many reasons and causes
in the field of overweight and Obesity. Some of the reasons are
part of the report upon the neurological conditions with many
factors for the increase of fat (energy) intake such as FTO gene or
ghrelin gene and many more numerological aspects to increase
weight gain or obesity.
Reports show that emotional difficulties cause a higher risk for
children to become obese as adults. Stress within the life of
youngster may cause if not cause obesity or overweight. Stress is
not precluded from adults who are confronted with difficulties
within their life style which contrite to overweight and obesity.
This condition relates to remarks mentioned concerning physicians
counseling their patients which would indicate the referral of the
patient to a healthcare provider in the field of Psychotherapy.
It is reported that the Emotional Difficulties caused within Higher
Risk subject such as Children may become Obese in adulthood
over the next 20 years.
(14) Scripps Research Institute and the Skaggs Institute for
Chemical Biology Oct. 28th, 2008.
Study on Catalytic Antibody Degeneration of Ghrelin
(14a) Scripps Research Institute and the Skaggs Institute for
Chemical Biology Oct. 28th, 2008.

40. Study on Catalytic Antibody Degeneration of Ghrelin
They found girls were more affected than boys were.
It is a suggestion that early intervention could help improve their
chances with long term physical health.
Andrew Termouth ,David Collier and Barbara Maugham from
MRC Social, Genetic and Developmental Psychiatry Center at the
Institute of Psychiatry ,King’s College London, Eng. Having
studied 6,500 members of the 1970 Brt. Birth cohort Study as
10years olds, who were under assessment for emotional problems,
self-perceptions and BMI, and who reported on their BMI at age
30. Reports have it that children with lower self-esteem, those who
felt less in control of their lives and those who worried often were
more likely to gain weight over the next 20 years.
As aforementioned concerning preventive approach to the care of
healthcare professionals’ patients it is intervention which is an
important approach to the reduction of many physical conditions
that may arise due to overweight or obesity. As an educator I have
observed many students who are of low self-esteem generally they
are either overweight or obese and their relationships with other
students are due to several factors: (a) they are academically more
advanced thus they help those who are connected to them. (b) They
associate with others who are much thinner than they are. (c)
Many overweight or obese students have similar partners. (d)
Their future long term partner is overweight or obese and their off-
springs generally follow in the same physical condition.
The Author Andrew Termouth and his colleagues suggest that
early intervention for children suffering low-self-esteem, anxiety,
or other emotional challenges could help improve their chances of
long term physical health. The author of the above article
concludes, “Given the growth problem with childhood obesity in
many Western societies, these findings are particularly important.
On a larger scale they may offer hope in the battle to control the
current obesity epidemic.

41. It is not without say that in my report I has alluded to this
intervention several time and insist that co-operative medicine is
more than a scheme to produce more income for the physician it is
an intervention for the wellbeing of our patients in the Healthcare
professions.
With such a conclusion it is apparent that the introduction of
psychological counseling as well as course developing for greater
self-awareness and self-self –esteem may help those with
emotional problems overcome the low self-esteem and help
recognize those young children who are having problems in
parents-child relationships.
Within this research the authors have not identified those children
with physical abuse in their background by their father or mother
no less any other relative in the family unit. (Extended family)
It is my experience that children of abuse carry these abusing
events into adulthood as the author himself testified earlier within
this writing.
As for abused children becoming overweight or obese it can be
said that a good portion of these abused children having low –self-
esteem can carry this abuse into obesity having less regard for
oneself and caring less about the outcome of appearance not
having a good feeling within.
(14) In Science Daily Sept.14th
, 2009 a previous research has
shown that low self-esteem and emotional problems are found in
people who are over-weight or obese –But which influences
which? Research published today in the open access Journal BMC
Medicine shed light on this issue showing that children with
emotional difficulties are at higher risk for obesity in adult life *
(15) Science Daily Sept. 14th
, 2009. Andrew Termouth, David
Collier, and Associates from the MRC Social Genetic and

42. Development Psychiatry Center at Kings College , London
,England
Obesity and the Educational System
The United States a world power for many years has helped bring
peace to improvised people, those people under dictators. However
over the past two decades reports say that the United States is not a
world power when it comes to education. Our nation lacks in
mathematics, reading, reading comprehension, and sciences.
Looking at those nations where dictators rule we find that those
children are far more astute in math, science the two basic areas
that help develop the nation. If we are to overcome this problem
then we need to begin a greater evaluation of our educational
system and its facilitators -“No Child left behind.” was Pres. G.
Bush’s slogan. However
Does this mean a child who does not understand the math or
science of that grade group should move on to the next class? The
question is an impending one knowing some of those pupils will
not comprehend that subject does that mean we put them in a
higher level just to be compassionate or do we develop special
classes for these students .in order to help them within the subject
they are failing.
Problems that may arise are: (a) is it the subject that is causing the
problem? Or do we say it is some emotional condition. (b) Is it
something with in the pupil’s life style that is the deterrent? Which
is causing the pupil to fail? There are several factors to consider,
Psychological, or Physical. The bases upon which the following
may occur (1) physical abuse occurs (2) psychological abuse as to
when it occurs? (3) Obesity, overweight and physical deformity is
factors to consider.
A child physically and emotionally under abuse and who is
psychologically abused and is put into the following scenario:
Every time the family takes a trip the father driving his 1937 car
dives past sings along to highway advertising Gillette shaving
cream. These sing have slogans on the and the father asks the boy
to read them when the boy does not read or see the sign in time is
hit across the head by the father, Question do you think the child
will have a reading problem? This is a true case and the child did
have a reading problem.

43. He remained in his present grade twice. This was due to the fact
that the boy did not read out loud or read very well.
One reason was after many years the school system found the boy
to be Dyslexic and after entering college a professor took him
under his wing and helped him in a remedial reading lab.
The boy finally started to read and enjoy the subject and improved
in his studies enough to enter a doctorate program in
Psychotherapy.
The psychological problems of abuse are more times unnoticed
and often time neglected.
Our educational system needs to reevaluate its approach in dealing
with students who are not up to par. It needs s to find the cause and
effect that hamper the child and fix the problem even if mean
taking to away from the family.
Two questions; did the student start to read better because of the
Professors intervention through the reading lab? Or did the student
begin to read better because he gains self-worth and a better
understanding of his own being?
Although the above scenario seems out of context it is well within
the problematic conditioning on many students who have
personality disorders as well as physical problems. I am not
relating this comment towards physically handicap people rather I
am looking at the psychical conditions of those children abused by
parents who allow their children to become obese or over weight
and do nothing to help the child overcome this condition. The
following statement may cause some people to have their hair
raised on the back of their necks however; it is a question that is
open for discussion and for scrutiny.
This question is directly for specific agencies which deal directly
with children meaning school systems, Child Welfare agencies,
Healthcare providers, and government agencies assigned to the
task of protecting our children within this society. The question
;should society meaning those agencies aforementioned have the
right and enforce the right to withdraw children from parents who
have allowed their child or children to become obese or over-
weight to a point where their health may be in jeopardy and their
interpersonal structure is scared due to this neglect of the parents?

44. Society cries out against physical abuse of children and expounds
the modo “Love thy Children.” If society is truly concerned about
the welfare of their children’s physical protection how it is that
society closes its eye to the most abusive condition placed upon
our children which is overweight and obesity. This causes many
more deaths of our children and those children who have grown
into adulthood and suffer from diabetes, heart infractions, and
gastrological conditions. All these conditions are apparently due to
the neglect of parents who leave their children to become obese
and overweight as they themselves are as adults. This is the
physical abuse that I am speaking about, that abuse parent’s
continual forester when they neglect to bring their children to
health professional that can help.
As we look deeper in this problem there arises many questions and
many objections to this epidemic. There is no serum to cure this
illness nor is there that magical bullet that will cure and arrest this
damming condition which plagues our society. The question is how
we do as society approach such an epidemic problem within not
only our society but also the world at large. To answer this
question would take more time than this book will allow however,
it is a question for you as a reader or as a professional to examine
and to research and possible do something about it within in your
profession or within your society at large.
The next question which will stir up voices of discontent as well
as political patriotism is has caused a great deal of objections to
Universal Health Care or Socialized medicine.
Under the Obama administration proponents to this program have
come basically from the one side of the aisle. As a professional
who has worked under the Socialized Medicine agenda I had not
found any deficits.
It is the conservatives within our political system that puts up
barriers preventing the progress of such a program, the comments
by conservative groups oppose the government’s involvement into
the health care field.
If we would step back and take off the blinders then those who
oppose government’s involvement into Health Care would see that
Government has been in the Health Care business for decades.
Medicare, not to forget Social Security although citizens put some
monies into this program there is a growing need for more
socialized medicine in our country.

45. Just for a moment look at the European nations that have a Health
Care Government sponsored program. The question is Should
Government involved itself in the Health Care profession within
our nation. Should government dictate to the American people
what type of insurance they should carry, should government
dictate that everyone must have health insurance? Universal Health
Care is not as a communistic approach to dictate to its citizen what
they should or should not have.
This is such an ignorant statement do to the fact that we already
have this system in place for many years as aforementioned.
The new breed of politics that has risen within our nation after the
Bushian area has put a cough hold on our government and has
brought about a conservative group that will do anything to
curtail the advancement of a Universal Health Care program within
our nation stating it will cost too much.
If those who oppose this type of program then I would ask them to
look at our health Care for the indigents or those families whose
income is such that they cannot afford a Health Care program.
Does not the hospital have signs which state, “If you do not have
coverage and cannot afford medical treatment you may not be
turned down?” These people get the care they need. Eventually all
citizens of our nation pays for this service to those less fortunate
which is a human right to be cared for if one does not have the
means.
There are those opponents who have said that those who cannot
afford Health Care “It’s too bad, let them get a job or find a better
job. Question, what if these citizens do not have the ability or the
education to advance into a better position should we say No to
them?
This attitude is not what we of this nation believe within the core
of our nation, that is not what we have fought for regardless of
who we Are or what ethnic background we come from we are all
one as a nation. There is no more Sothern’s or Northerner's .We are
a united people, I hope that this is still true for our nation.
Our nation has a social System and we have had it since the early
thirties when Franklin D. Roosevelt introduces Social Security.
Ask those of the conservatives group, who reject social system,
what their parents would have done without Social Security? For
many Senior Citizen of our nation who are on Medicare and whom
are on Social Security if asked what and where they would be
without these services we would hear on the streets.

46. If these people were not under these systems then our hospital
would be flooded with seniors knocking on their doors for help.
What would this cost our nation and could we hold our heads up in
front of the world while other nations do so much more for their
senior citizens.
With this said and done the question still remains do we bring
those responsible f or abuse on children to an accountability and
charge them with abuse. Now the uproar but first let me say. If we
continue to allow those children to stay overweight and not receive
health care because the family cannot afford it should we allow the
children eventually to die? The problem is encyclical first the
parents who are children of someone then the children of these
children are parents of children and so on. This epidemic of obesity
need to stop therefore society must intervene or it will grow to epic
proportions, which is not that far away.
The next question is When these children are confront with heart
infractions, diabetes, gastrointestinal problems are we to pay for
these conditions because we allowed their parents to abuse these
children by continual feeding them into obesity. By the term feed I
am speaking in two manners of concern: (one) physical, (two)
Psychological. These two manners of concern are the confrontation
our Health Care Providers see as a road block on how do they
support an interventional program and how do they summit codes
that will allow them to bill for their services once they have treated
their patient?
As we look at the problem of intervention in the Health Care
Profession one wonders what if the label on obesity were not
obesity but Polio, T.B. Malaria and many other conditions we have
had intervention on would we be so hesitant to do something about
it?
Having spoken on the need to confront obesity as an abuse upon
children by parents there has been a significant attempt to help
quell this condition as reported by Science daily research new and
that is through the research studies led by researchers at the
University of California, San Diego School of Medicine indicating
that parents –only treatment for childhood obesity works equally as
well as plans that include children and parents, while at the same
time more cost effective and potentially easier for families.

47. The opportunity for parents to address this issue of obesity within
their family structure is an important step in quelling the abuse on
children through obesity.
The researchers show that parents only groups were not inferior in
terms of child weight loss, parent weight loss and child physical
activities,” said these conditions were not taken into account.
The fact that parents brought into weight loss treatment is
significant approach in weight loss for children of parents who are
over-weight or obese and enter into treatment for this condition of
weight loss. The apparent and most obvious reason is the parents
become a role model. It is during this session that parents begin to
recognize the significance of their weight loss as a deterrent to
obesity within their children. It is transference affect in that
parents’ seeing a significant loss of weight brings about a new
relationship that the parents did not have with their parents and as
an encyclical relationship as mentioned earlier in this paper A
affect B and B affect C thus Thorndike’s Cause and Affect law is in
affect
Parents are the most significant other in the child’s life. The parent
represents the child a way of life which is acceptable, good, bad, or
indifferent.
We know that parents are the significant force in the achievement
of weight-loss in the family environment.
When parents are taught and treated in a weight-loss program it
brings about an acceptance and understanding that their
encouragement to losing weight through exercise and nutrition
which develop a way of life for the parents. This will encourage
the children to see as a way of life with in the family environment.
(16) Boutelle PH.D. Associate professor of pediatrics and Rady
Children’s Hospital, San Diego, California

48. According to a new study from the John Hopkins’s University’s
Bloomberg School of public Health research looking at 30 years’
worth of studies a found kid’s diets have become far different from
their parents’ and they appear less healthy.
The negative message corporations contribute to the obesity
epidemic among young people is essentially through their
advertisements. The percentage of Children from age 2 -19 equally
w7 percent of the population of our nation according to the federal
center for Disease Control and Prevention are at risk for heart
disease and Diabetes and are much more likely to be obese in
adulthood. The encyclical problem is that which is from parent to
child and from adult child who becomes a parent who then
transmits this obese condition. With this as a known condition
society still takes a back sit to the problem of obesity and over-
weigh
As we approach this issue it is more important for each of us as
health care providers to ask ourselves the question what do I do to
confront this issue within my practice, Am I a good example for
my patients. Or should I be asking myself, am I really concerned
about the condition that many of my patients have. Do we step
outside our expertise in order to help our patients achieve a better
life style with intervention in their health Care program? We
cannot turn a blind eye to this epidemic which is plaguing our
society. Is this condition of obesity and over-weigh in our society a
wakeup call to the health care provider or is a slap on the wrist to
say wake up people and see the sickness that many of your patients
have and you do little to address this condition by intervention
using thus professional who can offer your patients the needed help
to overcome this sickness.
The Cliché’ is not good enough “Better late than never. Never put
off what you can do today for tomorrow may never come.”
The need for greater interdisciplinary cooperation with patients’
care is more than a need it is a demanding call for physicians and
psychotherapist, Social Worker, Dietitians and Nutritionist to
answer the call and work on wiping out this epidemic of obesity.

49. All this will produce is a more proficient practice and a better
Health Care system with society. Research shows that within the
above disciplines they have indicated that the source of obesity is
not a causation of one specific gene or environmental conditioning
rather it is a combination of these areas that contribute to obesity.
Neurological
In the area of neurological studies at many research institutions
state that the brain holds triggers for many causes of higher
metabolic rate on fasting –The FTO ,Ghrelin antibody,
hypothalamus are for the most parts the catalytic level even with
a limited amount can alter the effective level of feeding.
(16) Worm Institute of Research and Medicine (WIRM) at Scripps
Research suggest that only “Validate antibody –based therapeutics,
but strongly suggest that catalytic anti-ghrelin antibodies might
help patients reach and maintain their weight loss goals.”
This study is under “Fight Obesity ‘with new antibody that
degrades appetite Stimulant; Ghrelin (Grell-in)
The intervention of such findings indicates that the
interdisciplinary concept can and should be regular co-operative
approach to modern health care practices.
To emphasize the immediacy of co-operative health care system
based upon intervention for prevention of obesity and over –weight
see Daily Science News article by the World Health Organization
stating about 1 billion people worldwide are either over –weight
or obese.

50. Emotional Factors
Within this concept of though it is apparent that the human factor
is involved which bring about the Emotional Factor in FTO as well
as that of the persons outlook on eating (feeding).
In conflict and Resolution the author spoke on the child abuse
both physical and psychological these two areas are without a
doubt areas physicians need closer monitoring. In a recent
investigation conducted by the assemble of pediatrics Dr. Cook
suggested that physicians need to be more cognitive of the sings of
abuse on children. It seem to me that this monitoring goes beyond
the physician’s office, it must first start within society by education
and then by educators within the school system to take a deeper
interest in monitoring these child and sweep this condition into a
corner for someone else to discover.
The emotional difficulties of children ass to the high risk factor for
adult obesity, this condition was presented earlier in this paper
under “Ternouth ,David Collier and Barbara Maughan of the MRC
Society ,Genetic and Development Psychiatry Center at Kings
College, London ,England. Foot note (15) pg.38
The fact that abuse children have a low self-esteem contributes to
obesity in the later life was found to produce adults with great BMI
increases contributing obesity (See Children with emotional
Difficulties RT Higher Risk for Adults Obesity Daily Science
News Sept. 14th, 2009.
The finding which the above research discusses is based upon the
factor that those children who have or had low self-esteem at the
earlier age gained considerable amount of weight and that from the
age of 10 a children within the research group of 6,500 of the 1970
British Birth Cohort Study who had been assessed as having
emotional problems self-prescriptions and BMI, and who reported
on their BMI again at age 30. It also shows that those who fell
within this mark would gain more weight over the next 20 years.
The fact that this research suggest that children with high anxiety
levels having early intervention for Childhood emotional problems
which may cause obesity in later life ,there is one absurdity that
anxiety plays a role along with other factors such as parents whose
BMI ,diet and exercise.

51. This intervention into early childhood obesity showing the anxiety
of the subject is high will cause weight gain and low-self- esteem.
However this intervention will add longer physical health and
improve as well as promote a better social interaction which in turn
promotes more positive relations to self and others within their life.
The author of the research suggest that intervention is not just in
the physiological rather it is an avenue which needs extend into
the social structure of society i.e. school systems where in courses
of learning self-esteem are promoted also looking at the emotional
aspect of learning. As afore mentioned in this paper regarding
psychological abuse.
Emotional Factor
The emotional factor which the above research suggested as a
possible and positive finding particularly “Given growing problem
with childhood obesity in many Western Societies, these findings
show that they may offer hope in the battle to control the current
obesity epidemic.” not only need we continue to investigate any
and all abuses, we need to understand the signs of abuse first and
fore most.
If the contributing factor for obesity is the lack of self- esteem
during childhood then it is an important factor for pediatricians to
consider when dealing with patents from early age on often parents
attend visits with their children when in the examining room thus
the opportunity for the physician to ask questions pertaining to
parent-child relationship is limited or unavailable. This approach
may seem a little extreme yet I have found in some many cases
where a child is seemingly
abused when I recommended that I speak to the child allow I find
there is less hesitation for the child to open up a little quicker
however, not right away.
In one specific case a young female of the age thirteen accused
her step father of having sex with her. The child openly accused
in front of the step-father, that he committed this act; who
emphatically denied the accusation. It was at that time I informed
the provincial government of Canada according to my legal
appointment as a psychotherapist of the Ontario, Canadian
government.