Fitness as Pharmacy
An accomplished orthopedic surgeon, Gregory Degnan, MD, serves as medical director of ACAC Fitness & Wellness Centers, home to 38,000 members throughout Pennsylvania and Virginia. Since a rare medical condition sidelined Degnan’s surgical career, he has worked to map out the ACAC physician-referred exercise program and has advocated for the unification of the healthcare and fitness industries. An avid exerciser, Degnan attended Wesleyan University and Eastern Virginia Medical School in Norfolk. Certified by the American Board of Orthopaedic Surgery, he specialized in hand and microvascular surgery.
ACE: How do you see the obesity epidemic affecting our society, either in your capacity as a medical professional or in your work in the fitness industry?
Gregory Degnan: As a medical professional, I see the impact of obesity in four major areas: our economy, our health care, our social interactions and our future. The economic impact of obesity in this country is absolutely staggering and goes far beyond the obvious direct costs. According to the Journal of Health Economics, obesity and related diseases cost the healthcare system alone more than $190 billion annually. In my opinion, this burden is the single greatest preventable stress on a badly overtaxed system.
From a healthcare perspective, obesity is now second only to tobacco use as the leading cause of preventable death in the United States. Health conditions related to obesity include diabetes, hypertension, heart disease, stroke, hypercholesterolemia, asthma, sleep apnea, gallstones, kidney stones, infertility and at least 11 types of cancer. Many of these (and their secondary effects on the organ systems) are reversible, but many are not. Moreover, obesity-related death is generally a long, slow and costly process.
Socially, weight discrimination is, in many circles, as prevalent as race, religion or sexual-orientation discrimination. Numerous studies have documented weight-based stereotypes that overweight and obese people are lazy, weak willed, unsuccessful, unintelligent, and lacking in self-discipline and willpower. These attitudes give way to social stigma, prejudice and discrimination against the obese in many settings and facets of their lives, including healthcare facilities, workplaces, educational institutions, the media and even interpersonal relationships.
When it comes to future generations, the behavior our generation has adopted is no doubt affecting our children. One study published in the Journal of Pediatric Psychology revealed that the risk of adult obesity doubled for children raised by obese parents. Young children are now suffering from insulin resistance, and teenagers are experiencing heart disease.
ACE: How does a focus on achieving wellness instead of weight loss help those impacted by overweight or obesity to experience long-term success?
Gregory Degnan: I think the difference between a focus on weight loss and a focus on wellness is the difference between success and failure long term. When the primary goal is weight loss, I believe two things happen: (1) dieting often predicates gimmicks or rapid weight loss, and (2) dramatic calorie deprivation or limited food choices are often the focus. Plans that leave people feeling deprived are not sustainable. Only the combination of sensible eating and exercise will provide the cardiovascular benefits, improved HDL and LDL ratios, and decrease in inflammation that contribute to better cardiac health. Additionally, I believe the overall sense of well-being and increased energy that come with good eating habits and exercise help people embrace good lifestyle choices in the long run.
ACE: In what ways do you feel the healthcare and fitness industries should work more collaboratively?
Gregory Degnan: The integration of the fitness industry into health care is my ultimate goal and, in my opinion, the only way that this country will truly move into preventive care. We have historically considered early detection (i.e., colonoscopies, mammograms, etc.) as preventive care, but that is early detection—not prevention. True prevention for the top medical issues in this coun-
try requires a focus on lifestyle choices, including proper nutrition, weight control, smoking prevention, and exercise as a habit.
The healthcare industry is not set up to provide these services. The medical-school curriculum does not typically include formal training in exercise prescription and nutrition education. Healthcare facilities are not qualified, for the most part, to provide fitness services. As healthcare professionals have come to realize they need to prescribe better life-styles for their patients, they have also come to realize no “pharmacies” exist to fill those prescriptions. We, the fitness industry, can be the “pharmacies” that provide the necessary first line of preventive health care.
ACE: What misconceptions—if any— do you believe healthcare providers hold about fitness professionals, and how do you believe our industry can overcome those misconceptions?
Gregory Degnan: I believe that historically the healthcare industry has viewed fitness professionals as “ex jocks,” or enthusiasts who have chosen fitness as a way to make a living. Medical professionals have not viewed them as being particularly well trained in the management or
prevention of disease; they’ve seen them as people who make fit people fitter. The world of health care is judged and governed by certification, licensure and continuing education. If we are to integrate successfully into this world, we must collectively step up our level of training, education and certification. We must also be willing to demonstrate efforts in meaningful continuing education.
ACE: What advice would you give to professionals from either health care or fitness who may be having trouble engaging with their overweight or obese clients?
Gregory Degnan: I believe there is no easy solution to approaching people struggling with their weight. They have obviously made poor choices to get to that point and are almost universally defensive or in denial. I believe the best approach is to be direct but empathetic. Be honest about the difficulties, but also be honest and enthusiastic about the rewards. Very few people who are overweight or obese are truly happy with the results of their choices and, if given the opportunity (if it was easy), almost all would take the magic pill or have the magic surgery. They are, therefore, open at some level to the need for change and intervention. The key is honesty, both about the rewards and about the difficulties in achieving them.