Wellness Endocrinology

This opinion piece introduces a novel concept termed as “wellness endocrinology”. Wellness endocrinology can be defined as the discipline which utilizes knowledge of endocrine physiology and pharmacology to ensure optimal biopsychosocial health for the population at large. The authors describe the rationale, scope, spectrum and utility of the framework, and call for a wellness-based or salutogenic projection of endocrinology.

Health and Endocrinology

Health, as defined by the World Health Organization, is a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity.¹ This definition highlights three domains of health: physical, mental and social. All these aspects of health are influenced by, and reflected in, the function of various organ systems of the body.

Perhaps the most important organs are the endocrine glands. Most glands weigh just a few milligrams or grams, and secrete hormones in concentrations of nanograms or micrograms but are able to have an impact throughout the body. Endocrinology has been viewed as an esoteric specialty, which focuses more upon biochemical or hormonal assays for screening, diagnosis and monitoring. Nothing, however, can be further from the truth. Endocrinology is a dynamic subject which seeks to attain and maintain optimal hormonal and metabolic health in the community.

Community Endocrinology

Community endocrinology may be defined as a specialty which involves the assessment of the endocrine and metabolic health needs of a population. This involves planning and administering community-based, community-oriented promotive, preventive and curative public health services to meet those needs and maintain optimal endocrine and metabolic health.² The spectrum of community endocrinology includes management of endocrine transition at various phases of life, lifestyle management of chronic endocrine and metabolic diseases, food fortification, environmental health and attention to minority groups with specific endocrine needs.

The Gap Between the Public and Endocrinology

From personal observation we feel there is, however, a communication disconnect between the general public and endocrinologists. Endocrinology is unique in that it has relevance at all levels of health care, ranging from primary to tertiary. However, endocrine training is considered a specialty of medicine in most countries.³ Therefore, other healthcare professionals and patients in the community are unable to appreciate the utility of endocrinology in achieving a comprehensive state of health.

Being a chronic care specialty, endocrinology lends itself to “longitudinal”, long-term evaluation and follow up, rather than “cross sectional”, acute intervention practised by many other disciplines. This characteristic reinforces the role of endocrinology in creating lifelong health.

To highlight the strengths of endocrinology and to bridge the communication gap within, we propose the concept of “wellness endocrinology”.

Wellness Endocrinology

We propose that “wellness endocrinology” is a discipline in which knowledge of endocrine physiology and pharmacology is utilized to ensure optimal biopsychosocial health for the population at large. Wellness endocrinology includes diagnostic, clinical and public health aspects of endocrine medicine. The subject covers all age groups and genders, and takes a proactive, preventative approach to endocrine health. Some domains of wellness endocrinology are listed in Table 1.

Table 1: Domains of Wellness Endocrinology

• Endocrine transitions during different phases of life
  • neonatal, infancy and childhood
  • puberty and adolescence
  • conception
  • menopause and andropause
  • old age
  • end-of-life care
• Environmental challenges
  • extremes of temperature
  • pollution
  • limited resource availability
• Professional challenges
  • sportspersons
  • night shift working
• Social challenges
  • stress
  • sociocultural and religious practices
  • living arrangements
• Nutritional challenges
  • exposure to unhealthy foods
  • lack of healthy foods
• Specific genders
  • male, female, transgender

Scope of Wellness Endocrinology

Wellness endocrinology takes a “salutogenic”, or health-oriented, attitude to life.⁴ The practice of wellness endocrinology is not limited to just endocrinology specialists; rather, it is a concept that must be owned and followed by all healthcare providers. It is important, however, to note that the basis of wellness endocrinology is a “knowledge of endocrine physiology and pharmacology”. This makes it imperative for endocrinologists to be involved as team members in the prevention and care of all endocrine and metabolism-related disorders.The aim of wellness endocrinology is to ensure optimal biopsychosocial health. This alludes to a comprehensive definition of health and the relevance of endocrinology in achieving this. This phrase suggests that mental and social healthcare providers can benefit from endocrine expertise while planning therapy. “The population at large”, included in our definition, implies that wellness endocrinology is useful for every person, irrespective of health status.It is also noteworthy that wellness endocrinology includes “diagnostic, clinical and public health”. This implies that endocrine opinion must be sought while suggesting appropriate investigative, therapeutic and public health interventions related to this field. The endocrinologist serves as the bulwark of quaternary prevention and helps avoid unnecessary, potentially harmful tests and treatments.⁵ The endocrinologist also acts as a useful partner in quinary prevention by tackling misinformation and misconceptions related to their field, as well as promoting the right information.⁶ The rubric of wellness endocrinology addresses all age groups and genders. This reinforces the need for paediatricians, gynaecologists, urologists and geriatricians to collaborate with endocrinologists to achieve optimal results in their patients. The term “all genders” highlights the role of endocrinology in assessing and managing transgender and other non-binary genders.⁷ The focus on “proactive, preventative approach” underlines the basic philosophy of endocrinology, and specifically of wellness endocrinology. This is to utilize all available evidence-based knowledge and expertise in a proactive manner to promote health and prevent ill health.

Impact of Wellness Endocrinology

There is great distrust between the medical profession and the public. The “3I” approach (interaction, information, involvement) has been suggested as a means of bridging this trust deficit.⁸ The construct of wellness endocrinology is a useful way of facilitating this endeavour. Wellness endocrinology is a health-oriented field, which shares scientific information in a simple, person-friendly manner, and encourages involvement of all stakeholders. It helps demystify endocrinology and at the same time encourages seeking and acceptance of appropriate endocrine services. Wellness endocrinology helps apply endocrine services to primary healthcare delivery, without deflecting resources from their role in secondary and tertiary health.

Summary

Wellness endocrinology is a discipline which promotes optimal biopsychosocial health for all, utilizing available knowledge of endocrine physiology and pharmacology. It seeks to serve everyone of all age groups, gender and backgrounds. Wellness endocrinology creates a proactive, teamwork-based, community-oriented face of endocrinology. Thus, it facilitates the endeavour of endocrinologists to ensure optimal endocrine and metabolic health for the community that they serve.

References

1. World Health Organization. Official Records of the World Health Organization. New York: United Nations, World Health Organization: 1948;100–9. Available at: https://apps.who.int/iris/bitstream/handle/10665/85573/Official_record2_eng.pdf;jsessionid=7E8EBFA6F76A6E91E381CDFDF87A14D6?sequence=1 (accessed 1 March 2021).
2. Kalra S, Kumar A, Aswathy S, Shriraam V. Community endocrinology. Indian J Endocrinol Metab. 2015;19:695–7.
3. Bajaj S, Ghosh S, Kalra S. Endocrinology training in India. Indian J Endocrinol Metab. 2015;19:448–50.
4. Lindström B, Eriksson M. Salutogenesis. J Epidemiol Community Health. 2005;59:440–2.
5. Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Policy Manag. 2015;4:61–4.
6. Kalra S, Kumar A. Quinary prevention: Defined and conceptualized. J Pak Med Assoc. 2019;69:1765–6.
7. T’Sjoen G, Arcelus J, Gooren L, et al. Endocrinology of transgender medicine. Endocr Rev. 2019;40:97–117.
8. Kalra S, Unnikrishnan AG, Baruah MP. Interaction, information, involvement (the 3I strategy): Rebuilding trust in the medical profession. . Indian J Endocrinol Metab. 2017;21:268–70.

Disclosure: Sanjay Kalra and Madhur Verma have no financial or non-financial conflicts of interest to declare in relation to this article.

Support: No funding was received in the publication of this article. Editorial assistance was provided by Touch Medical Media.

Published: 4 March 2021