Obese Not the Only Ones Lacking Definition! by Rick Howard, M.Ed., CSCS, *D, USAW
It is no wonder we can’t solve the obesity epidemic, we can’t even agree on definitions surrounding the issue to know which way to go. Consider the recent decision by the American Medical Association to recognize obesity as a disease. Two challenges to the decision are:
- How do we define disease?, and
- How do we define obesity?
Is obesity a disease? A syndrome? A condition? A disorder? Surprisingly, there is no universally accepted definition of disease which guides us in achieving health outcomes.
- Will the one third of the population considered obese now be encouraged to utilize and possibly be reimbursed for preventative services?
- Will they rely on more medicine and expensive procedures?
How will we ultimately define obesity so that a large piece of the trillions of dollars in health care costs, reimbursement, and other passive costs that are dependent on the definition go to prevention (health care) and not medication and procedures (sick care)?
- Will an integrated definition of obesity which considers lifestyle factors help people take personal responsibility for their health and assist others in their community?
- Will the measure of obesity, body mass index (BMI), be accepted universally despite its limitations (which led the advisory group tasked with reporting on whether obesity should be a disease to say no, because of the issues with BMI)?
- Will obesity in the context of other wellness factors be considered when seeking a shared definition?
- Will obesity being classified as a disease impact other elements (social, psychological, etc.) of wellness for those affected?
Take a quick look at coincidental rising health care costs. In 2014, as the Affordable Care Act is implemented, it is predicted that 22 million fewer uninsured people will help drive costs up by 7.9% (2.1 percentage points higher than in the absence of reform). And, many of the newly uninsured will be younger and relatively healthier than currently insured individuals, so spending is predicted to increase on prescription drugs and physician and clinical services more so than acute care.
Do you sense what I am sensing? By proclaiming obesity a disease, insurers will be forced to cover a new growth industry — obesity medications and surgeries. While some remain hopeful that making obesity a disease will influence physicians to counsel their patients toward healthy lifestyle changes, including proper nutrition and physical activity, according to an excellent blog by Dr. Allison Bowersock, “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.”
So, how are we going to get exercise included in mainstream medicine? How do we make headway to get insurers, physicians, and lay people to recognize the benefit potential of proactive prescriptive wellness over reactive treatments? Current insurance reimbursement does not cover exercise prescription, although physical activity is the fourth primary risk factor for chronic disease, children that do not get proper exercise as youngsters are less motivated to be active adults, and even relatively small lifestyle improvements in adulthood, including exercise, carry significant health benefits.
To spread the word and begin a national movement toward taking seriously the benefits of exercise, friends and colleagues have coined the term exercise deficit disorder. Questions that need to be addressed include:
- Why isn’t physical inactivity treated with the same vigor as smoking?
- How do we engage children and adolescents in fun and developmentally-appropriate physical activity?
- How do we ensure that quality physical education and quality instruction in sports and physical activity is available to every child?
- What is the role of the medical community in combating obesity and physical inactivity?
The next question, therefore, is how will we educate the masses about the powerful benefits of physical activity? Many believe that school is the answer. After all, school is where the vast majority of our children go from age 5 through 18. At school, they can be exposed to physical activity throughout the day, quality physical education every day, and health information to help make positive choices. Uh-oh! More problems with definitions…
- Is any bodily movement that uses energy enough for engaging young children in activities for a lifetime?
- What defines quality physical education—is it fitness test scores? Lifetime fitness activities (who decides these?)?
- Is health and physical education considered a highly valued subject in school? Do educators and administrators recognize the value of physical activity on not only health and well-being but on self-esteem, attendance and behavior, and academic outcomes?
But consider that, even if students received physical education for the recommended 30 minutes per day in elementary school (150 minutes/week), and half of the time spent in PE should be moderate-to-vigorous physical activity, we still have two issues to resolve:
- We are still short 30-45 minutes of physical activity each day. Can this be filled with recess and activity breaks every day? What happens if students do not receive PE every day and/or all year?
- Who is leading physical education and physical activity? In many states, the classroom teacher in a self-contained classroom (the students do not change classes for subjects)”teaches” PE. This is the most critical age for learning motor skills, health fitness and skills fitness, and we rely often on teachers with little, if any, experience in this area. Would we do this for fundamental concepts in reading or math?
The decision to include obesity as a disease raises more questions than it provides answers. Even some of the answers available to us are wrought with lack of clear, consistent definitions.
Clearly, Cross-sector collaboration is considered necessary for building healthier communities. But we need to set clear definitions, roles, and qualifications for each partner in order to best achieve health outcomes. It is time for everyone involved in the health and well-being profession to work together to improve physical activity levels, reduce obesity levels, promote health literacy and physical literacy, and let’s get our definitions in line to fill the talent pool!