David C. Radford, DC, MS
Obesity is a chronic disease that involves three simultaneously occurring interactions. These include a genetic predisposition that is estimated to contribute to about 30% of the problem. The other 70% includes the individual’s behavior and environment. Let us break this complex interplay down into these individual components and think about how, as employers, we can help reduce the incidence of this epidemic affecting more than a third of our nation, and driving our cost for healthcare into the unsustainable range. We know that smoking and tobacco costs our nation about $2 billion a year in lost time, decreased productivity, and cost of illness. Obesity is far more expensive, costing American business an estimated $13 billion dollars a year in lost time decreased productivity, and cost of illness, and the cost to our nation is approaching $300 billion. While obesity now affects more than a third of the entire US population, more than 50 percent of the injured workers with low back pain are obese.
Advancements in human genetics and human genome-wide association approach have isolated 20 genes that are associated with obesity and type 2 diabetes. Alone, these genes only have a modest effect, but if we couple genetics with a poor diet and a sedentary lifestyle, we have the prescription that has led to our current healthcare disaster. Obesity results when body fat accumulates over time as a result of a chronic energy imbalance (calories consumed exceed calories expended). Obesity is a major health hazard in our nation and it is associated with several relatively common diseases such as Metabolic syndrome, leading to insulin resistance and Type 2 diabetes, hypertension, heart disease, Vitamin D deficiency, osteoarthritis of the lower extremities, gallbladder disease, and gout as well as several types of cancer. In women these cancers include endometrial, cervical, ovarian, breast, and colorectal. In men, obesity increases the incidence of prostate and colorectal cancers. In both men and women obesity contributes to sleep apnea, morning headaches, daytime sleepiness, and decreased productivity.
Integrative medicine and cooperation between different types of healthcare providers is required to provide a solution. Patients need cost effective conservative primary care, using evidenced based methods for weight loss coupled with preventive medicine. Physicians, nurses, and dieticians need to work one on one to encourage patients to move towards a healthier life style. Treating obesity is a process that requires making lifestyle changes.
As a physician treating obesity and working to prevent chronic illness today, I have witnessed rapid and spectacular advances in medical research in the fields of biochemistry, physiology, biophysics and genomic medicine. We know the cause and cost of obesity and its consequences are not just taxing our resources, the increased incidence of obesity and its related problems are rapidly bankrupting our nation’s healthcare programs under Medicare and Medicaid. Obesity is driving the costs for private insurance through the roof. Physicians fees are not to blame. It is the high cost of managing the co-morbidities associated with obesity, which fuels the development of chronic diseases by the systemic inflammation that is caused by morbidity.
How do we get Employers and Employees to Address Obesity?
The question is how do we get employers and employees to buy into addressing obesity? There are preventable contributors of a chronic illness like obesity, and making changes to address obesity will lower our healthcare costs. What will motivate the person to lose weight? I like to use the BMI (body mass index) to start the discussion. Obesity is defined as a BMI greater than 30. I use serum biomarkers (objective laboratory tests) to monitor progress. These lab tests are covered by health insurance. Sitting with a patient and reviewing these results allow goals to be set and progress can be tracked. Seeing improvement in an objective measurement and positive feedback reinforce the goal.
Developing interest can be particularly difficult for those living in poverty. As they face a far greater and more challenging environment. Access to a variety of fresh foods can be challenging, and payment vouchers for food often lead to bad nutritional choices. Returning to grassroots education at the community level through public health clinics will help. It is important that all county, state, and our federal government address this epidemic of obesity, as well as the Type 2 diabetes and Vitamin D deficiency. As these are related problems that increased the morbidity of obesity, and we all pay for this epidemic through higher taxation.
For the employed, the incentive that seems to hold great promise is a financial benefit for buying into preventive medicine. A financial incentive to lower the employee’s contribution to their insurance premium cost is a good starting point. Patient’s using a health savings account and having a higher deductible learn that some of the burden of care is their personal responsibility to themselves and their families.
An onsite exercise area or a negotiated group discount to local area health clubs will encourage greater activity. Group instruction to teach healthy eating pays off quickly, and employees may need some guidance to learn how to live a lifestyle that normalizes weight. The weight loss process starts by reducing the refined carbohydrates in the diet. These calories from simple starches, sugar, and high fructose corn syrup pack on the pounds. Eating plenty of fruits, vegetables, nuts, seeds, fresh and dried herbs and spices create a strong anti-inflammatory response in the body. The extra pounds of fat in obesity drive inflammation, good bacteria in the gut counteract this process, so that eating fermented foods that contain healthy live bacteria like yogurt and kefir are very beneficial. I have found patients with lactose intolerance, gluten intolerance, constipation, IBS or irritable bowel syndrome, yeast infections, allergies and even asthma benefit from a probiotic if they lack the good bacteria in the gut.
Finally, we all need to make sure that we are getting enough vitamin D. Teaching our employees how to eat sensibly can be the first step in reducing our employees healthcare costs.
Dr. Radford is in private practice. He is a third generation Doctor of Chiropractic Medicine. He earned a Master’s Degree in Advanced Clinical Practice and he provides conservative primary care. He has treated work related injuries for more than 30 years. Dr. Radford has found that treating the co-morbidities that often accompany injured workers like obesity, medication overuse, and addiction lead to a more complete recovery. He was a founding member of the Cleveland Orthopaedic and Spine Hospital, Cleveland, Ohio. Contact for more information at [email protected] or phone: (440)-248-8888.
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