65 Of course there is a genetic component to obesity and metabolic efficiency, which was an advantage during evolution when food sources were inconstant.66 However, in recent times this has turned into a handicap. Obesity, therefore, is inherited but not inevitable, and cannot occur unless there is a permissive “obesogenic” environment.67 The effects of social networks on the sociotype have been described for obesity,68 and recent research

has shown the benefits of moving house on the prevalence of diabetes and obesity.69 This would not seem to be a universally available Inhibitors,research,lifescience,medical option, and the mechanisms are not clear, though presumably they involve changes in life-style influenced by the new neighborhood. THE SOCIOTYPE OF DIABESITY AND CHRONIC ILLNESS: Inhibitors,research,lifescience,medical PATIENT SELF-MANAGEMENT Table 2 lists aspects of the sociotype in the three domains—in addition to the factors detailed in Table 1—that are required for coping with chronic disease, using diabesity as an example. The sociotypic map will change during the course of an illness. For instance, the response to a relapse following cancer therapy or in multiple sclerosis will not be the same as that at the initial diagnosis. And in a diabetic patient, the need for dialysis Inhibitors,research,lifescience,medical or an amputation will produce a different sociotypic response than that for commencing injections of insulin. Table 2 Additional factors in the three domains of the sociotype that

relate specifically to chronic disease management as in diabesity. The key factors integral to the management of diabesity are a change in diet and life-style,70 and encouraging self-management,71,72 using a combination of techniques of which motivational interviewing by health professionals is one example.73 Inhibitors,research,lifescience,medical Further, investments need to be made in strengthening competencies of the health team and implementation of new care models for a multidimensional approach to patient management. This involves new relationships with the case manager, hospital specialists, and carers. Self-management also means that patients

have the confidence Inhibitors,research,lifescience,medical to follow their prescribed therapy, to avoid health deterioration, and to preserve function.74,75 It is hypothesized that the sociotype is essential for the ability to the succeed in the three self-management tasks of: (1) medical management, (2) role management, and (3) emotional management. For diabetes patients, the first task involves the skills needed in leading a healthy life-style and following correctly the medication regimen. In addition, the patient has to deal with the possible side-effects of the treatment as well as disease progression (macro- and micro-angiopathy). Role management Quisinostat cost refers to the managing of relationships that change or come under pressure during the course of the chronic illness. The third task of emotional management refers to the skills patients need to cope with emotional states or challenges associated with their illness.