Should Doctors Be More Proactive in Advising Patients to Exercise?
IDEA member Kim Ruby, a Los Angeles–based personal fitness trainer and yoga instructor, works with many overweight and obese clients who also have various health concerns. While some of her clients are referred by physicians and dietitians with whom she has built professional relationships, many learn about her by word of mouth, not through their doctors. Ruby has often been shocked at how few physicians recommend exercise as a preventive measure.
“When I call doctors’ offices to let them know about my services, I rarely make it past the receptionist,” Ruby says. “They say they are not interested because it is not covered by health insurance and therefore not something they will even consider. It’s an ongoing frustration that prescribing exercise isn’t a priority.”
The health consequences of obesity are well documented. In 1998, the American Heart Association (AHA) reclassified obesity as a “major, modifiable risk factor for coronary heart disease.” In its call to action, the AHA recognized that even modest weight reductions of 5%–10% of body weight can decrease blood pressure and total blood cholesterol, improve glucose tolerance in diabetic patients and reduce the severity of obstructive sleep apnea. The organization urged healthcare providers to take a more proactive role in helping to prevent obesity by educating the public and providing strategies to treat obesity. However, studies indicate that physicians aren’t heeding this call to action.
Only 42% of the 12,835 obese participants in a study published in the October 27, 1999, issue of the Journal of the American Medical Association were advised by their doctors to lose weight. A national survey in the July 2000 Archives of Family Medicine found that during doctors’ visits by obese patients, exercise was recommended on only 33% of occasions. “This is a critical issue in the healthcare profession,” says Omer Abid, MD, a researcher at the Centers for Disease Control and Prevention’s division of nutrition and physical activity. “We need to ask why doctors aren’t advising their patients to lose weight. Obesity is a serious condition that warrants preventive action.”
In its own call to action, the Archives of Internal Medicine released a report in February that outlined recommendations for its subscribers. According to the journal, a simple consultation requires only a few minutes and will “facilitate more effective intervention related to obesity.” As reported on CBSNews.com, the recommendations include the following:
- Assess body mass index and waist measurements and discuss patients’ activity levels at every visit.
- Tell overweight patients about the dangers of obesity, which include an increased risk of heart disease and diabetes.
- Congratulate patients who are not overweight.
- Counsel overweight patients to reduce their daily food intake by 500–1,000 calories and get more exercise, with a goal of losing up to 2 pounds a week.
- Write a prescription for exercise—for example, “Take a brisk walk at least 5 days a week.”
- Advise sedentary patients to incorporate more activity into their daily routines by using stairs instead of elevators, walking during lunch breaks or getting off the bus or subway a stop early and walking home.
- Suggest wearing a pedometer, which can help motivate some people to walk more.
- Recommend strength training to help raise metabolism.
Many of these recommendations support methods that fitness professionals already advocate. The key, according to Ruby, is to create relationships that will lead to professional referrals. “It’s not easy, and it does take a lot of leg work, but it’s worth it,” she says.
Ruby points out that many doctors don’t refer patients to personal trainers because they are not considered qualified. “This is a problem we need to work on from the inside. Personal trainers need more than just a basic certification if they want to gain the necessary knowledge and experience. Only then can we earn doctors’ respect.”
Still, Ruby feels so strongly about doctors prescribing exercise that she has recently decided to go to medical school herself. “If I can get the prerequisites in time, I’m hoping to apply by next summer,” she says. “I want to become a doctor who teaches patients about prevention and mind-body health. I really do believe that exercise is great medicine.”