Editor's Note: This year, Dr. Lehman's column focuses on the ethical responsibility of chiropractors to pursue prevention and wellness care. This article discusses weight maintenance as a necessary element of that duty.
During my earlier years in practice, I first became aware of the obesity problem in New Mexico because of an offer to star in a movie. The Albuquerque school system contracted with a local physician / film maker to create a documentary movie that described the obesity problems facing Albuquerque's youth. The local physician provided the talent search, and worked as the producer and director of the movie.
We Can't Ignore the Facts
Today, obesity in America is problematic. According to data from the National Health and Nutrition Examination Survey (NHANES), 2013-2014:1-4
- More than one in three adults are overweight.
- More than two of three adults are overweight or obese.
- More than one in three adults are obese.
- About one in 13 adults are extremely obese.
- About one in six children and adolescents ages 2 to 19 are obese.
Eckel suggests heredity explains 30-70 percent of cases of obesity. Yet diets high in fat and calories are a major cause of obesity and enlarged waistlines with excess baggage in America. A lack of physical exercise compounds the obesity problem in America.5
The World Health Organization, the U.S. Dept. of Health and Human Services, and other authorities recommend that for good health, adults should get the equivalent of two-and-a-half hours of moderate-to-vigorous physical activity each week. Children should get even more: at least one hour a day.
There's been some debate among researchers, however, about just how much activity people need each day to maintain a healthy weight or to help with weight loss, and the most recent studies suggest a total of two-and-a-half hours a week is simply not enough.6-9
A population-based, cross-sectional study of men revealed that high-intensity LBP and/or disability was associated with increased levels of obesity, particularly in those with an emotional disorder. The authors claim that this data provides evidence to support a biopsychosocial interaction between emotional disorders and obesity with low back pain.10
It makes one wonder how a chiropractic clinician can manage such a patient without a dietician, nutritionist and a behavioral health specialist also on board.
You Can't Do It Alone
So, how does the chiropractic clinician manage the obese patient complaining of severe, low back pain because of an on-the-job injury, which has been disabling for the past 12 months? Is it our ethical responsibility to advise the patient to change their high-fat diet, lose weight, exercise regularly and provide counseling? What would you do to help this type of patient?
I am familiar with chiropractors who attempt to be a "jack of all trades" and tackle this complicated patient situation without assistance from other providers. In fact, many years ago, chiropractors did not have a choice because the AMA prevented medical doctors from working with chiropractors.
Today, the health care scene is different. Chiropractic clinicians practicing patient-centered care have an ethical responsibility to recognize the health issues facing their patients and address them through coordination of care. No longer is it ethical to claim that chiropractic is separate and distinct, or that chiropractors are only responsible for the detection and correction of subluxations. Now is the time to become a member of a coordinated care team to help tackle the obesity epidemic.
For the past seven years, I have served as a chiropractic specialist within a primary care team. The team includes primary care providers (MD, DO, APRN and PA), behavioral health clinicians, nurses (RN), podiatrists and chiropractic clinicians (neuromusculoskeletal medicine specialists). Each team member understands their role on the team, which is to provide high-quality, patient-centered and evidence-based health care.
Create a Team to Fight Obesity
Private-practice chiropractors concerned with obesity and disease prevention might consider developing relationships with other providers and establishing new locations to meet people and potential patients. Create your own "coordinated care team." For instance, if you work out at a gym or fitness club, I suspect other health care providers are members. Why not meet with the management and offer to develop a team of providers who could offer advice to club members? Here are a few other suggestions for your consideration:
- Arrange to visit with fitness club management and offer to provide lectures.
- Research health providers in your area who deal with weight control.
- Offer to provide lectures at stores that sell weight-loss supplements, vitamins and minerals.
- Develop relationships with physicians, nutritionists and mental health providers who deal with obesity.
Resources to Get You Started
- Weight Control: National Center for Complementary and Integrative Health Click Here
- Biological Factors and Weight Loss Methods: National Institutes of Health Click Here
- Ease of Weight Loss Influenced by Individual Biology: NIH Click Here
- Weight Management Program for adults at UCSF Medical Center Click Here
- Could a Holistic Nutritionist Help You Lose Weight? Click Here
- Weight Watchers. Says one review: "This is one of the best known weight-loss programs around. The reason it's successful is that it's often viewed as one of the easier programs to follow, helping you to change the way you think about and behave around food."
- You might want to become familiar with bariatric surgical specialists in your area for any morbidly obese patients who are unable to follow your recommendations and are endangering their lives. For example, here is a bariatric center in Connecticut: Click Here
Don't let the "rolly polly blues" get you or your patients down; call for help from your coordinated care team members and help make a difference. For more resources and ideas to get you started, see the sidebar in this article.
References
- Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA, 2016;315(21):2284-2291.
- Ogden C, Carroll MD, Lawman HG, et al. Trends in obesity among children and adolescents in the United States, 1988- 1994 through 2013-2014. JAMA, 2016; 315(21):2292-2299.
- Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight, obesity, and extreme obesity among adults aged 20 and over: United States, 1960-1962 through 2011-2014. National Center for Health Statistics Data, Health E-Stats, July 2016.
- Fryar CD, Carroll MD, Ogden CL. Prevalence of overweight and obesity among children and adolescents aged 2-19 years: United States, 1963–1965 through 2013–2014. National Center for Health Statistics Data, Health E-Stats, July 2016.
- Eckel RH. Obesity and heart disease: a statement for healthcare professionals from the Nutrition Committee, American Heart Disease. Circulation, 1997;96:3248-3250.
- World Health Organization: Global Recommendations on Physical Activity for Health, 2011.
- U.S. Dept. of Health and Human Services: Physical Activity Guidelines for Americans, 2008.
- Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 2007;116:1081-93.
- Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep, 1985;100:126-31.
- Chou L, Brady S, Urquhart M, et al. The association between obesity and low back pain and disability is affected by mood disorders. Medicine, 2016 Apr;95(15): e3367.
Click here for previous articles by James Lehman, DC, MBA, DIANM.