Much has been written in both the lay press and the medical literature about the health consequences of obesity and inactivity. Despite the attention that this public health dilemma has received, almost two-thirds of Americans are overweight (body mass index [BMI], calculated as weight in kilograms divided by height in meters squared, between 25 and 29.9) or obese (BMI ≥30).
Between 1986 and 2000, the percentage of people with a BMI of 40 or higher quadrupled. Looking at the generation ahead offers some alarming statistics as well. Childhood obesity has tripled during the past generation, and almost 20% of youths aged 12 to 19 years are overweight. More than 70% of Americans do not achieve the recommended amount of physical activity to obtain health benefits.
The consequences of obesity on morbidity, mortality, and quality of life are well documented and noteworthy. Adults with a BMI higher than 30 have a 200% to 300% higher mortality rate than normal-weight adults. Hypertension and cardiovascular disease, cancer, type 2 diabetes, and musculoskeletal problems such as osteoarthritis are just a few of the diagnoses associated with obesity and inactivity.
Obesity and inactivity also have far-ranging economic consequences for businesses and for the US economy. The cost to business of obesity-related health care issues totaled $15.4 billion in 2002, a figure that does not include considerable costs associated with lost productivity and absenteeism.
One large study found that employees with an elevated BMI (>25) had medical costs that were on average more than 50% higher than those of normal-weight employees. Additionally, obese employees are nearly 75% more likely to experience high rates of absenteeism than are normal-weight employees.
Nationwide, medical spending on obesity-related conditions was estimated to have reached $147 billion per year in 2008, which is almost 10% of all medical spending. When combined with type 2 diabetes, the impact of obesity on the health care economy is estimated to be $259 billion.
As codirector of the Sports Medicine Center at Mayo Clinic, Edward R. Laskowski, M.D., a specialist in physical medicine and rehabilitation, is often surprised that many in the lay public and also health care professionals are unaware of the magnitude of the obesity and inactivity epidemic. "One of the most common responses that I hear when I present these data is 'I knew it was bad, but I didn't realize it was this bad,'" says Dr. Laskowski. "The good news is that the effects of obesity and inactivity are reversible and that physiatrists have the tools to effectively treat this population."
Consistent activity has been shown to offer multiple therapeutic benefits, including shorter hospital stays, fewer physician visits and less medication use.
In many cases, physical therapists, athletic trainers, coaches, physical education teachers, and other fitness specialists provide counseling for healthy adult fitness enthusiasts engaged in physical activity for weight control and cardiovascular and musculoskeletal fitness. But like medicine, exercise has an appropriate dosage, indication, contraindication, and adverse effect profile.
Acknowledging that no one really owns the treatment of obesity and that no single intervention provides answers for all patients, Dr. Laskowski envisions a unique role for physiatrists in tackling this problem. "Physiatrists have the specific qualifications and skills to provide accurate, research-based exercise prescriptions for a broad range of people, including healthy individuals, those with obesity-related joint complications, and inactive individuals without impairments who need to begin an activity program to optimize cardiovascular and musculoskeletal fitness," says Dr. Laskowski.
Physiatrists can also provide guidance in proper technique for strength training, stability and flexibility exercises, and aerobic conditioning. "These are all essential elements in developing an effective exercise prescription that prevents injury," says Dr. Laskowski. "And because physiatrists treat patients with musculoskeletal and medical problems that impair movement, we have learned to prescribe exercise in a way that is gradually progressive and unique to each individual."
At Mayo Clinic, physiatrists play a role in the clinic's own workforce LiveWell program, which promotes regular physical activity and other healthy lifestyle choices. This program utilizes Mayo Clinic's on-site resources such as:
Patients who are not part of the Mayo workforce can see Mayo Clinic physiatrists and physical therapists for evaluation and treatment of an array of obesity-related conditions.
As with other parts of their practice, Mayo physiatrists work closely with other specialists, including endocrinologists, orthopedic and bariatric surgeons, psychologists, and physical and occupational therapists. "We evaluate and treat musculoskeletal conditions that impair activity and function, and we use various modalities for diagnosis and treatment, including ultrasound-guided corticosteroid injections," explains Dr. Laskowski. Mayo physiatrists can also assist in the treatment of patients preparing for bariatric surgery.
According to Mayo Clinic physical therapist Mary K. Wehde, Mayo Clinic providers also address the physical, mental, and social triad that plays an important role in wellness. "In the past, therapists tended to treat a patient's medical condition, such as lack of motion or weakness. We know now that to prevent further problems, we must also help patients manage issues in their lives that affect their overall well-being and their ability to participate in exercise programs and to lead more active lives," says Ms. Wehde.