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Medscape
14-07-2025
- Health
- Medscape
An Elusive PCOS Diagnosis Could Explain Obesity Issues
As a teenager, Ali Chappell, PhD, CEO and founder of Lilli Health, hid food in her room. She said that while she had plenty of access to meals and snacks, she never felt satisfied. Chappell felt shame at the amount of food she consumed. 'I felt very out of control around certain types of food. The minute I woke up in the morning, it was, what was I going to eat and how much was I going to get to eat,' Chappell, now 38 years, said. 'I remember waking up in the middle of the night to go run on the treadmill because I was gaining weight and gaining weight and gaining weight.' She had a number of hormonal symptoms during the same time: Chappell battled acne that required treatment with Accutane twice while she was in high school; she only came off the drug because as a 15-year-old, her cholesterol 'got way out of control.' Ali Chappell, PhD It would be years before a doctor at her college said her symptoms, including disordered eating, very well could be polycystic ovary syndrome (PCOS). Before that, however, Chappell said she had wild mood swings during her teenage years, with her mom describing her as 'an absolute mood disaster.' Also, Chappell didn't get her period until she was 16 years — or at least, that's what she thought. She struggled for years with extremely infrequent periods, often getting her menses only once every 12 months or so. 'My mom was concerned I wasn't having a period and took me to the family doctor — we didn't have a gynecologist in our small town. The doctor ordered an ultrasound, and I just remember them saying, oh, you have a lot of cysts on your ovaries, but that's okay, it's normal,' Chappell recalled. 'I had another two or three ultrasounds (between) ages 16-21, and they kept saying I had cysts on my ovaries, but it's okay.' Chappell's disordered eating continued to worsen as she completed her undergraduate studies in nutrition at Texas A&M University, College Station, Texas. Finally, the summer before she turned 22 years, she went to the university hospital to get a prescription for contraceptives. The doctor there ordered bloodwork, which revealed that Chappell's thyroid was underactive, and her testosterone was high; she also ordered an ultrasound. At the conclusion of the tests, the doctor brought all of Chappell's symptoms together under one name, one she'd never heard before. 'She said, 'You've got a lot of cysts on your ovaries, you're not having a period, you're having acne. All of this lines up to be PCOS,'' Chappell said. 'So that was it. She said, 'You're going to need to watch your weight, and I'm going to put you on these birth control pills so we can get you a cycle started.' She gave me a pamphlet about polycystic ovary syndrome. I'd never heard of it. And that was the end of that.' Chappell was sent on her way with a lot of questions. As a nutrition major, and as someone who'd had an unhealthy relationship with food all her life, her thoughts immediately turned to a potential relationship between PCOS and diet — what could watching her weight possibly have to do with her ovaries? That question would define her scholarly career and her life's work. PCOS is a hormonal disorder that affects women of reproductive age. It's characterized by a combination of symptoms, including all of those Chappell experienced: irregular or absent menstrual periods, higher-than-normal levels of androgens, and often, but not always, the development of many small fluid-filled sacs on the ovaries — though cysts don't have to be present. This hormonal imbalance can lead to additional symptoms such as excess hair growth, acne, weight gain, and thinning hair, and can also cause infertility. While the exact cause isn't fully understood, factors like genetics, insulin resistance, and low-grade inflammation are thought to play a role, and if left unmanaged, PCOS can increase the risk for long-term health issues like type 2 diabetes and heart disease. World Health Organization statistics show that PCOS affects as many as 1 in 8 women worldwide, but that up to 70% of women affected by this disorder may never receive a diagnosis. Additionally, Katherine Schafer, PhD, MEd, a licensed clinical psychologist and assistant professor at Vanderbilt University Medical Center in Nashville, Tennessee, said that the type of disordered eating Chappell experienced is common in women with PCOS. 'The best scientific research that we have shows that PCOS and disordered eating are closely linked,' she said. A recent meta-analysis showed that women who had PCOS were more likely than healthy controls to have disordered eating and meet criteria for eating disorders, including bulimia nervosa. 'In fact, when we look at the women who had PCOS, up to 12% of them met criteria for bulimia nervosa in their lifetime, which was much higher than in the general population, where we see only 3% of women meeting criteria for bulimia nervosa in their lifetime. 'This link between disordered eating and PCOS might be driven through hormones and neurotransmitters and create a self-amplifying cycle between eating pathology and PCOS symptoms,' Schafer said. Women who have PCOS often have disturbances in their levels of hormones and neurotransmitters including serotonin, leptin, and cortisol, which may leave them susceptible to developing eating disorders, which in turn might intensify and exacerbate hormonal disturbances, she said. Katherine Schafer, PhD, MEd Upon receiving the diagnosis of PCOS, Chappell vowed to get educated. She quickly found that all her research led her in one direction. 'I went to PubMed and I downloaded and printed out every single article that I could find that was about PCOS. Everything kept going back to one single point, and that was insulin,' she said. 'By that point, the only thing I'd learned about insulin was that you gave it to diabetics to lower their blood sugar. Never once (in school) did I learn anything about insulin resistance or what that meant.' Chappell earned both her master's and doctorate degrees at Texas Tech University, Lubbock, Texas. She arrived at grad school on a mission — she wanted to research the connection between insulin and PCOS in a clinical setting. Before she even started her master's degree, Chappell had already written a 100-page proposal outlining this research. Chappell said that as she completed that degree, her PhD advisor suggested she try to get the funding for her own research and pointed her in the direction of The Laura W. Bush Institute for Women's Health. 'She said 'This is something they would love. You just have to find a fertility specialist who's willing to work with you so that they put a little bit more credibility to what you're doing,'' Chappell said. 'I think I'd already put in the grant application before I'd even finished my master's.' Chappell's advisors at Texas Tech were impressed with her thoroughness and tenacity. 'Ali was very knowledgeable about PCOS and enthusiastic about how her (low-insulin) nutritional approach had worked for her,' said Mallory Boylan, PhD, RD, LD, a member of the research faculty at Texas Tech's Center of Excellence in Obesity and Cardiometabolic Research. 'She had reviewed literature that related to the topic and found very little that directly related to her research topic. She worked tirelessly to find a clinician who would collaborate with her so she could get a grant for the research.' In 2011, The Laura W. Bush Foundation made a grant to Chappell in the amount of $25,000 to perform her doctoral research. Chappell's 8-week dissertation study 'Effect of a Low Insulinemic Diet on Clinical, Biochemical, and Metabolic Outcomes in Women with PCOS, enlisted 24 women with polycystic ovary syndrome.' Prior to the study, they discontinued insulin sensitizers, oral contraceptives, and cyclic progesterone. Ten of the participants underwent testing using a metabolic cart to analyze fasting and after-meal energy expenditure, respiratory exchange ratio, and macronutrient oxidation after consuming a high-saturated fat shake. The participants were placed on a low insulinemic diet, instructed to eat as much as they cared for of the following foods: lean animal protein; non-starchy vegetables; fruits, including fatty fruits; and nuts, seeds, and oils. Participants older than 21 years were allowed one 6-ounce glass of red wine per night, and all subjects were allowed up to 1 ounce of prepared or fresh, full-fat cheese each day. The diet excluded all grains, beans, and pulses; all dairy products except cheese and butter; and all forms of sugar and sweeteners because of their insulinotropic properties, although sugar substitutes were allowed. The individuals in the study were not advised to count calories or carbohydrates, and they were encouraged to eat until they were satisfied, but not to overeat. They were instructed to continue their normal exercise routine for the duration of the study. The study's participants realized significant improvements. They saw marked reductions in weight, BMI, fat mass, and waist/hip circumference, alongside significantly lower fasting and 2-hour insulin, triglycerides, very low-density lipoprotein, and testosterone levels — with all the changes showing very high statistical significance ( P <.0001 for most). The diet also dramatically shifted metabolism toward increased fat oxidation and led to significant improvements in binge eating behaviors and overall quality of life. Chappell said one critical component of the low insulinemic lifestyle is that it is not about calories. She emphasized that individuals who adopt this way of eating can eat to satiety, and that just as in the clinical studies she has performed, it is about eating as many of the nontriggering foods as possible, while staying away from those that are insulinotropic. She said it is an approach that differs greatly from the traditional approach some clinicians take, telling patients with PCOS that they should lose weight. Sometimes the treatment for PCOS can actually precipitate disordered eating, as clinicians underestimate underlying causes of the disease. 'Many patients with PCOS are advised that their condition is related to their weight and the treatment is weight loss which for some individuals may actually precipitate the onset of an eating disorder,' Elizabeth Wassenaar, MD, DFAPA, CEDS-S, regional medical director with Eating Recovery Center and Pathlight Mood & Anxiety in Denver. 'This is problematic for many reasons; it reinforces diet culture and disordered eating and distracts from understanding weight neutral interventions.' Kim Hopkins, PhD, WHNP-BC Chappell has been an investigator on nine published studies, five of which are specifically in the area of PCOS. She continues the research to this day — now, with the purpose of providing products and services to benefit other women with PCOS via her Galveston, Texas-based company, Lilli Health. Through Lilli, Chappell realized a very important moment in her personal and business lives recently: She made her first research grant in the company's name. 'I have so many plans for research studies in many different areas. That's where I want to go,' she said. 'I just started the first Lilli Health Research grant and I gave a grant award to an investigator at the University of Texas Medical Branch at Galveston. I felt like I'd made the full circle, now I can actually give back to the research. We're in a time when women's health research is dwindling, and getting to be the funder, to be able to give back, is amazing.' Kim Hopkins, PhD, WHNP-BC, a PCOS specialist who practices out of PCOS Paragon Health Services & Consulting in Waldorf, Maryland, said it's long overdue that the clinical community has the opportunity to move beyond one-size-fits-all advice for PCOS. 'Understanding that PCOS exists along a spectrum, has multiple varying symptoms, and impacts overweight, normal weight and lean persons (is important),' she said. 'The only way we're truly going to improve symptoms and long-term outcomes is by addressing the root cause, and that means making insulin-lowering strategies the foundation of treatment. I'm proud to see Lilli Health working behind the scenes to finally bring insulin-lowering strategies to the forefront of PCOS care where it belongs.'
Forbes
03-07-2025
- Health
- Forbes
Can Primary Care Survive Burnout, Bureaucracy, And A Broken System?
The fading art of the family doctor—will tradition survive the future of healthcare? Remember the primary care physician of yore? The doctor out of a Norman Rockwell illustration who knew you, your parents, your children, who was your trusted confidant, who you turned to for every sore throat and annual physical. Today, that relationship feels like a quaint relic, replaced by rushed visits, rotating clinicians, and an endless amount of paperwork. Today, this backbone of healthcare is facing a hard reboot. Burnout, bureaucratic bloat, and disruptive market forces are testing its resilience. But is this the end of the family doctor — or the birth of a reimagined model? The Perfect Storm: A Specialty Under Siege The numbers paint a dire picture. The shortage of physicians is being driven by an aging population and by aging physicians themselves — over a third of PCPs are over 55 — while fewer than 30% of residents plan to enter traditional primary care, with most opting for better-paying specialty roles. A new AAMC study projects a shortfall of 37,800 to 124,000 physicians by 2034, with primary care physicians (PCPs) bearing the brunt. Compounding the crisis: only 85 PCPs exist per 100,000 Americans, a ratio woefully inadequate for an aging, chronically ill population. What's more, if you are one of the 50 million Americans who reside in rural areas, only 9% of the nation's physicians practice in these communities. The culprit? There are a few. A system that puts paperwork over patients. PCPs spend two hours on paperwork for each hour of direct patient time. This includes time treadmilling on administrative tasks and EHR (Electronic Health Records) event logs and prior authorizations. Add stagnant reimbursements and median student debt exceeding $200,000, and the primary care exodus becomes both understandable and inevitable. The Reinvention Game Plan Fortunately, necessity is the mother of invention. Across the country, new thinking is rewriting the rules: Technology at the Bedside New tools promise to offload burdens and personalize care. Under recent Medicare rule changes, physicians can bill for remote patient monitoring and virtual check-ins, opening revenue streams and supporting proactive outreach. Why Retail Clinics Can't Fill the Gap Big players like CVS and Walmart promised disruption and primary care for everyone with much-touted retail clinics, but many have closed amid disappointing patient engagement. Consumers consider retail health as transactional — a quick fix for a sore throat, perhaps not as long of a wait as urgent care, but not for managing chronic disease or complex care plans. Without the deep, long-term relationships that PCPs cultivate, outcomes suffer, and trust Can Patients Do About All This? While the system evolves, patients also play a crucial role in preserving and improving primary care. The stakes are high: studies show that patients with a consistent primary care relationship have better health outcomes, lower costs, and fewer hospitalizations. 'As a family physician, I've seen firsthand how having a trusted primary care doctor can truly change the course of someone's life,' says Sarah C. Nosal, MD, FAAFP, President-Elect of the American Academy of Family Physicians (AAFP). 'When patients have a usual source of care—someone who knows their health history, understands their goals, and can guide their health journey—they're more likely to stay on top of preventive care, manage chronic conditions, and avoid unnecessary hospital visits. Family medicine is about connection, continuity, and ultimately, better health and longer lives.' Here's how you can advocate for your health and your doctor: 6. Understand Your Insurance • Learn what preventive services (e.g., vaccines, screenings) are fully covered under your plan to avoid surprise bills. The future of family doctors hinges on both systemic reform and everyday choices. While clinicians and policymakers wrestle with large-scale solutions, patients wield surprising power—by demanding continuity, leveraging technology thoughtfully, and investing in relationships with their PCPs. These small acts compound into transformative change: preserving the human core of primary care while embracing innovation. The result? Better health outcomes today, and a blueprint for a system where the future of family doctors isn't just secure, but sustainable.
CTV News
17-06-2025
- Health
- CTV News
New medical clinic, 10 doctors coming to Langford
The Goldstream Medical Clinic is expected to open early next year. A medical clinic is opening in downtown Langford with plans to give thousands of people access to a family doctor. The Goldstream Medical Clinic is expected to open early next year. During an in camera meeting last week, city council unanimously approved $1.7 million to supply medical equipment and build out the space on Bryn Maur Road off Goldstream Avenue. 'Langford has committed the immediate funding to move this critical project forward because residents cannot wait any longer for a doctor,' Mayor Scott Goodmanson said at a press conference Monday morning. Goodmanson noted health care is not a municipal responsibility, so he hopes the province will kick in some cash to help cover the cost of outfitting the clinic. The South Island Primary Care Society, a non-profit, will own and operate the clinic. 'We take on all the administrative burdens, so our physicians in our spaces can give their undivided attention to patient care,' said Alyssa Andres, the charity's executive director. The society plans to recruit 10 doctors to work at the clinic. Five physicians are already on board, including Dr. Tunde Omisore, who moved to Vancouver Island from the United Kingdom five months ago. 'There are so many patients who are unattached – so many people in the community who do not have a doctor,' he said. Langford estimates 27,000 people on the West Shore are without a family doctor. It believes the new clinic will give 12,500 people access to a physician. Those patients will be pulled from B.C.'s Health Connect Registry, Andres said. 'It's a really important opportunity if you're someone who doesn't have a family doctor to make sure you're registered on the B.C. Health Registry,' she said.
CTV News
02-06-2025
- General
- CTV News
CTV National News: Canadians turn to AI for medical diagnoses
Watch As many Canadians don't have family doctors, some are turning to AI however the technology can be inaccurate at times. John Vennavally-Rao reports.
CBC
28-05-2025
- General
- CBC
'Seeking a Physician': 96 and doctorless, N.S. senior turns to the classifieds
The unusual advertisement in the Friday morning newspaper caught the eyes of many Nova Scotians. It tells the story of a 96-year-old woman who is "of sound mind and body" for her age, and who doesn't want to be "a burden to the healthcare system." Her biggest concern? She doesn't have a family doctor. "I am apparently somewhere in the 80,000's in the physician waiting list, and so time is increasingly of the essence," the ad reads. Dorothy Lamont wrote that ad, using the title "Seeking a Physician" — a last-ditch effort to take matters into her own hands after three years without a family doctor. "I really didn't know what else to do," Lamont told CBC News in an interview at her home in downtown Dartmouth, N.S. "I should have a doctor. You know, at 96 years old, there's sure to be problems. But I have no one to turn to." Lamont said in the past nine years, she has had five doctors, all of whom retired or left the city. This has left her with a virtual doctor that she says just isn't cutting it. "It doesn't make sense to me," she said. "And I'm sure there are many other seniors in the same situation as I am." Though Lamont's tactic of advertising for a doctor is unique, her story isn't. An estimated 6.5 million Canadians don't have a family doctor. According to a recent Health Canada report, Canada needs nearly 23,000 additional family physicians to address the shortage. In Nova Scotia, Premier Tim Houston has campaigned on fixing health care and is aiming to slash the list of people waiting for a family doctor or nurse practitioner. The list has been shrinking, after it reached a peak of about 160,000 last June. Still, 91,474 people — or about 8.6 per cent of the province's population — were on the Need a Family Practice Registry as of May 1. "I think for all folks that are dealing with complex health concerns or for the average person in Nova Scotia, we want to connect as many people as possible as quickly as possible to care," Bethany McCormick, Nova Scotia Health's vice-president of operations for the northern zone, said in an interview Tuesday. 'At 96, I think you deserve a bit better' Lamont, a retired Grade 4 teacher, loves spending time outside tending to her tulips and large vegetable garden. She calls herself a "busy person" who used to be an avid reader before her eyesight deteriorated. She has lived in Nova Scotia all her life, and says she remembers decades ago when doctors made house calls, and it seemed like most people had access to primary medical care. Her son, Stewart Lamont, is also without a family doctor. He said his mother had a health scare last year and he spent hours with her in the emergency department. When she was eventually discharged, there was no followup because she had no doctor to send the file to. He said his mother isn't angry with the government and isn't trying to be political. What she is doing is standing up for herself and other seniors in similar situations. "We respect our seniors, we try to look after them. At 96, I think you deserve a bit better," he said. "I'm just proud of her that … she is still willing to make a public statement." The provincial Department of Health and Wellness declined an interview request for Health Minister Michelle Thompson, and directed the request to the Nova Scotia health authority. McCormick, from Nova Scotia Health, said she can't discuss Lamont's case due to patient confidentiality, but she urges anyone without a doctor to make sure their information is up to date on the registry, because the list is triaged. Patients on the registry fill out a health questionnaire and a health complexity score is created for them. "It tells us about their type of concerns and people that have chronic conditions or more complex health-care needs, maybe a new emerging issue," McCormick said. "We do use that as a way to think about who needs continuous care and connection to a family practice sooner." McCormick said she has never heard of someone putting an ad in the paper looking for a doctor. "I think that person is trying to advocate for their health-care needs, which I think is important." A surprise call Stewart Lamont said he received a call from a Nova Scotia Health employee on Friday afternoon, after the advertisement ran in the newspaper, saying his mother's information wasn't filled out properly on the registry and would now be added. They called back Monday morning and said they were working to find her a doctor. Then Monday afternoon, a Dartmouth medical clinic called and said a new doctor moving to the province to take over from one of her former physicians who retired years ago can take her on as a patient in the next few months. CBC News contacted the clinic, who said the doctor is on vacation and unavailable to comment. Dorothy Lamont said she is optimistic, but is left with one thought. "I would like all our seniors to be able to have a doctor to go to, not just me because I put the ad in."
