As you probably know, in mid-June the American Medical Association adopted new policy that recognizes obesity as a disease. The controversial move generated much discussion and speculation in social and news media among medical and allied health providers, obese people, the general public and—of course—fitness professionals. IDEA Answers came alive with conversation the day of the announcement, and our Facebook Fan Page erupted in a flurry of posts, both pro and con, when we asked what you thought about the decision.
It’s a complex issue. The proclamation essentially means that one-third of U.S. adults and 17% of American children are sick and require a range of medical interventions.
Part of the AMA brouhaha is the reversal of a recommendation from the AMA’s own Council on Science and Public Health, which, after studying the issue at length, advised against the “disease” designation, saying that even a definition of what constitutes a disease is lacking. Central to the council’s con argument was the use of body mass index as the yardstick to define obesity. A BMI of 30 or more brands a person as obese; however, as you’ve seen in your own client base, many people who exceed the 30 BMI marker are still healthy—and many below it have metabolic issues.
“A sensitive and clinically practical diagnostic indicator of obesity remains elusive,” says the council’s report. “Obesity, measured by BMI, is clearly associated with a number of adverse health outcomes, with greater consistency across populations at the highest BMI levels. However, given the existing limitations of BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes. The disease label is likely to improve health outcomes for some individuals, but may worsen outcomes for others.”
Finally, how this may impact our dire national healthcare spending situation is a mystery. Some experts think it will reduce costs, while others see it further ballooning the mounting chronic-disease burden and rising healthcare expenses tied to obesity—estimated in 2009 by the Centers for Disease Control and Prevention at a staggering $147 billion a year.
One thing is certain: Insurers (and therefore all who pay into health insurance programs) will likely end up footing the bill for obesity interventions. But is that really anything new? Haven’t we been absorbing the financial blow of obesity for many years now? We feel the crucial question is, will physicians respond by prescribing pharmaceutical measures (obesity prevention pills) or by writing Rxs for physical activity and a diet of whole foods? This remains to be seen, but it’s where we see fitness professionals getting more involved.
Our advice: Assume that medical reimbursement for your services is not going to happen (or is very far in the future), but operate more aggressively knowing you may be looking at the ripest, lowest-hanging fruit you have ever been offered. This is a major opportunity to connect and collaborate with local physicians who need your expertise to lead their patients—the once unreachable deconditioned population—toward health. This clientele has been elusive for fitness professionals because very few obese people will venture on their own to seek your services. When exercise is mandated by a physician’s prescription, however, the potential upside is enormous.
Doctors study a wide berth of impressive topics during medical school and residency, but disease prevention through exercise and whole-food interventions are not emphasized. Your expertise fully complements a physician’s assets to give the patient-client a complete care model. Obesity resolution and prevention are on MDs’ collective radar now that their own association has branded this condition a disease.
So dig a little deeper into your networking, sales and marketing tool chest to build a plan that will make you a relevant, respected and top-of-mind partner in a physician’s successful patient outcomes. Commit to connecting with at least one physician or pediatrician in your network this month. Take him or her out for lunch or coffee and find out how you can help to improve the care continuum.
Also, if you wish to establish solid physician referrals, assess your skill set for working with obese and deconditioned populations and see where there are gaps you need to fill. Actively pursue more education or a new certification that will serve you well from a credibility standpoint.
Yours in good health,
Kathie & Peter Davis