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Everyday Fitness

with Pamela Peeke, MD, MPH, FACP

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Wednesday, May 9, 2012

Medicate with Movement: An Rx for America

By Pamela Peeke, MD, MPH

I had the pleasure of speaking this week at the CDC’s Weight of the Nation conference in Washington, D.C., a meeting that brought together national experts on virtually every aspect of America’s obesity epidemic. This conference was a great reminder of the value of cooperation rather than confrontation in addressing such an urgent public health challenge. It was a forum for everyone in the field to share insights, find opportunities to collaborate and seek answers together. I was able to meet with other physicians, politicians, nutritionists, nurses, mental health experts, educators, insurers, and others from the public and private sectors. The bigger the tent, I say, the better.

My talk focused on the need for health care providers (doctors, nurses, and allied workers) to actively engage their patients and consumers in discussions about the importance of physical activity. We’re literally writing prescriptions for walks rather than pills and potions. The panel, “Systems Change: Enhancing the Obesity Chronic Care Model” had me sitting next to Dr. Keith Bachman from Kaiser Permanente and Dr. Madelyn Fernstrom from the University of Pittsburgh, both of whom have incorporated physical activity as a vital sign in patient charting and monitoring.

What I heard from my fellow panelists reminded me of something I once heard my good friend Dr. Robert Sallis say that summarized my own thinking. Dr. Sallis, a family practitioner at Kaiser Permanente Los Angeles and founder of the American College of Sports Medicine’s Exercise is Medicine campaign, asked: “What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients?”

Heck yes! The prescription is simple: regular physical activity.

All too often, conversations about obesity are driven by the latest theory, whether it’s the best new fad diet, the worst ingredient of the month, or the newest pill. While we can debate all day long about these provocative theories, I am guided by the science. And there is plenty of evidence-based science supporting the benefits of regular physical activity.

Getting up and assuming the vertical more often reduces mortality and the risk of recurrent breast cancer by about 50% and colon cancer by more than 60%. It reduces the risk of developing Alzheimer’s disease by about 40%, lowers the incidence of heart disease and high blood pressure by 40% and reduces the risk of stroke by 27%. And type 2 diabetes? Physical activity lowers the risk of developing it by 58%. Plus you drop weight and feel great. A royal win-win-win.

But the key question is how to get physicians, nurses, and other providers to prescribe physical activity just as they now prescribe medical drugs.

Part of the answer, at least, has been the creation of Exercise is Medicine, a global initiative by the American College of Sports Medicine and the American Medical Association. The goal of Exercise is Medicine is to make physical activity a standard part of disease prevention.

We’ve made a lot of progress in shifting America’s medical treatment paradigm, but much more needs to be done. We’ve conducted research showing 65% of patients would be more interested in exercising to stay healthy if their doctor told them to. This is especially true if the medical care provider is walking the talk and sharing what a great experience it is. We’ve educated policymakers and advocated with the White House, congressional leaders and others to encourage healthcare providers to offer exercise prescriptions to all their patients.

Meanwhile, Kaiser Permanente is demonstrating what all this looks like in practice. In Los Angeles, Kaiser is pioneering an effort to integrate exercise as a vital sign in patients’ electronic medical record, measured alongside blood pressure, weight, pulse and BMI. Preliminary results show that by doing so, the provider has to open the discussion about activity and this discourse can lead to change on the part of the patient.

None of this work would be possible without powerful public and private sector partnerships because obesity is too big a problem for any one organization to solve alone. Many have joined this important effort including the U.S. Surgeon General, the President’s Council on Physical Fitness and Sports, the American College of Preventive Medicine, to name just a few. Private industry sector partners who provide funding and services include The Coca-Cola Company, NBA FIT, the YMCA, and many others.

So what’s next? As I told those attending Weight of the Nation, the next step is to get Medicare, Medicaid, and private insurers to reimburse health care professionals for counseling patients on physical activity. Public debate has focused a lot over the last few years on investing in preventive care. Physical activity and nutrition counseling are low-hanging fruit, a relatively small investment in reducing the $150 billion annual cost attributed to sedentary living, about 12% of the U.S. healthcare budget.

The Weight of the Nation conference, along with an upcoming HBO documentary series set to air May 14 and 15, will go a long way toward calling attention to obesity. And the timing couldn’t be better with the recent publication of a report in the American Journal of Preventive Medicine predicting that by the year 2030, 42% of Americans will be obese and 11% will be severely obese. This is a call to arms for all sectors — public and private — to actively team together to create solutions for this complex problem.

Posted by: Pamela Peeke, MD at 9:06 am

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