"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Thursday, May 17, 2012

Obesity and Physical Therapy

I don't talk a lot about diet with my physical therapy patients.

I probably should because Body Mass Index - your weight in kilograms divided by your height in meters, squared - is an important predictor of future disablement and death.

However, I don't talk much about diet for one simple reason - I am not qualified to give anyone advice on their food consumption.

Oh, it's not that I don't have the knowledge or experience. Its just that I have no discipline.

I never met a cookie that I didn't like.

Which, I think, is most American's problem - especially those who struggle with obesity.

In The Mathematics of Obesity, MIT-trained physicist Carson C. Chow dishes out his theory of why Americans began gaining weight in the 1970's and have only recently began to cut back.
"Beginning in the 1970s, there was a change in national agricultural policy.  
Instead of the government paying farmers not to engage in full production, as was the practice, they were encouraged to grow as much food as they could.  
At the same time, technological changes and the “green revolution” made our farms much more productive.  
The price of food plummeted, while the number of calories available to the average American grew by about 1,000 a day.  
Well, what do people do when there is extra food around? They eat it! 
...the model shows that increase in food more than explains the increase in weight."
I like Chow's approach to explaining obesity - he doesn't blame individuals. Its not lack of willpower, or a sweet tooth, or "big bones".

Further, Chow's analysis dispells much of the contradictory psuedo-science of WHERE your calories come from - carbs, proteins, fats - its all calories.

However, the answer to obesity will have to come from individuals. And their healthcare providers. The individuals will have to change their eating behavior. Patients will have to control their food intake.

And, physical therpists can help them.

There is an interesting BMI Simulator based on Chow's work at The National Institute of Diabetes and Digestive and Kidney Diseases that is probably too complex for most people.

Bottom line, we'll probably all need help getting our impulses under control. For me, that means fewer cookies (pause, while I brush the crumbs off of my keyboard).

As Chow explained in his New York Times interview,
"It’s so easy for someone to go out and eat 6,000 calories a day.  
There’s no magic bullet on this. You simply have to cut calories and be vigilant for the rest of your life."

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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