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Tuesday, June 25, 2013
I have almost 30 pages of peer-reviewed journals listed in the back of my doctoral dissertation if you wish to view them. Or you can trust me that the information I’m about to share is valid. I would recommend the latter for the sake of not reading yourself to sleep.
I was first interested in researching doctors’ knowledge of an exercise prescription after hearing a friend’s account of an office visit to her primary care physician. After about a 10-minute screening, she was written several prescriptions to help manage her newly diagnosed hypertension and high cholesterol. I asked if the doctor inquired about her eating or exercise habits, or even what she did for a living. No, no and no.
This exchange is common. Evidence suggests doctors do not have adequate time to discuss weight management with their patients and do not have adequate training to do so. Many doctors report a lack of confidence in providing exercise recommendations for patients unless they have experience with a regular exercise program.
Research has also illuminated a significant degree of obesity bias in health care settings. Doctors, medical students and residents, nurses, dentists, dieticians, personal trainers and undergraduate exercise science students have been shown to demonstrate bias toward obese patients. Many health care providers feel obese patients are lazy and unmotivated; others simply lack empathy for the weight loss struggles many obese patients undergo.
I predict the decision by the American Medical Association to define obesity as a disease will place pressure on doctors to pay greater attention to obesity as a label. I fear this may lead to greater emphasis on surgical and pharmaceutical interventions rather than physical activity and healthy eating. This is not a fault of the doctors per se but of our current reimbursement structure, in which doctors are paid a considerable amount of money to surgically implant a stint rather than spend an additional 15 minutes discussing ways in which dietary changes may help manage the comorbidities associated with heart disease. The tides are beginning to turn in the reimbursement structure, but we are still far from the scenario in which preventive medicine takes precedence over acute treatment.
In addition, medical school curricula are tightly restricted in both time and pressure to cover a significant amount of material in a relatively short amount of time, so there is little wiggle room for additional didactic programming. Some schools, like the New York University School of Medicine (where my doctoral dissertation work originated) and the University of South Carolina School of Medicine are finding unique ways to weave components of weight management principles into their existing curricula.
Other schools, like Ohio State School of Medicine, require all undergraduate medical students to take the “Exercise is Medicine” course. With administrative support and financial resources to support it, this Exercise is Medicine movement is helping guide medical schools and other higher education institutions toward improved training for future healthcare providers.
The Exercise is Medicine movement is supported by a highly motivated network of health and fitness professionals, so “we” get it, and we are all in. We agree that obesity is a health crisis worth the connotations associated with words like “disease” and “epidemic.”
Although a movement of these proportions will require broad changes supporting healthy lifestyles, especially at the local and state levels, it will require a village mentality to successfully implement a change. Villages are comprised of people, and you as a person are empowered to create positive change right where you live, labor, learn, lay and pray. If we all did our part to improve the lives of ourselves and those around us, we may have a shot at chipping away from the rapidly escalating obesity rates in this country. Your doctor may (and should) be part of your village, but only one part; the most important part of that village is you, and your contributions today will have a direct impact on your health and those around you. You don’t need a Ph.D. to know that and act on it.
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