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April, 2011

Help Your Patients by Helping Yourself

By Mark Sanna, DC, ACRB Level II, FICC

As healthcare providers, we are expected to model the behaviors we promote. Doctors who do not engage in healthy behaviors are less likely to counsel patients regarding their importance--and their patients are less likely to take the message seriously.

According to the American College of Sports Medicine, when doctors have adequate knowledge about the health benefits and counseling aspects of physical activity, they have higher levels of physical activity themselves and are more likely to include physical activity recommendations in their practice. While the majority of chiropractors report frequently discussing nutrition and diet, physical fitness, changing unhealthy behaviors, and disease prevention with their patients--do we listen to our own advice? You may find the results of a recent survey surprising.1

NonSmokers But Overweight

Decade after decade, tobacco use has topped the list as the number one cause of death in our nation. Smoking-related deaths total 440,000 each year. On an optimistic note, ninety five percent of the chiropractors surveyed say they are non-smokers. This is positive compared with the approximately twenty percent of the U.S. population that smokes. It is also evidence that chiropractors have been on the forefront of aligning with the message about the dangers of smoking.

That's the good news.

But, while chiropractors have embraced the public health initiative against smoking, we have been slower to take up the cause of obesity. And obsesity, resulting from a lack of exercise and poor dietary choices, is about to overtake tobacco as the number one killer of Americans.

Objective measurement is the gold standard of an outcome-based health care paradigm. Objective documentation must also become our standard for prevention and wellness services. The objective measurement that is the most widely accepted and referenced to determine a person's state of "wellness" is Body Mass Index (BMI). BMI is a ratio between weight and height: BMI = Weight [in pounds] x 703 / (Height [in inches])2. Research shows that an individual with a BMI of 25 – 29.9 is considered overweight. Approximately sixty six percent of Americans fall into this category.

According to the survey, Body Mass Index calculations showed that only twenty five percent of chiropractors have normal weight, with sixty eight percent being overweight, and twenty seven percent obese. We need to try harder to become the picture of health for both ourselves and our patients. If we want to have a positive influence on our community, we need to set the standard for wellness and prevention, and live the advice we give our patients.

If your BMI is high, you have an increased risk of developing many chronic diseases including hypertension, cardiovascular disease, dyslipidemia, adult-onset diabetes and osteoarthritis, to mention but a few. In order to position ourselves as the providers of preventative care for the significant causes of death and disease described above, we should include BMI measurement as part of every chiropractic evaluation. Make the measurement of BMI on every patient's first visit standard procedure in your practice. If you are considering adopting an Electronic Health Record (EHR) for your practice, recording BMI is a mandatory component necessary to achieve "meaningful use" of your EHR and to qualify for the federal government's $44,000 incentive for conversion.

But how willing are you to check your patients' BMI when you are yourself overweight? And don't think you're patients won't notice. They will.

Getting It Under Control

The American Heart Association recommends thirty minutes of moderate intensity cardiovascular activity on a daily basis. However, twelve percent of chiropractors report no cardiovascular activity at all and almost half engage in cardiovascular exercise only one to two days a week. In the area of exercise, we need to raise our game.

Poor dietary habits are the second component behind the rise of obesity. How healthy are chiropractors' nutritional habits? The majority of chiropractors report regularly taking vitamins or supplements. However, almost two-thirds consume two servings or less of whole grains a day, despite the fact that the consumption of whole grains is associated with lower rates of premature mortality. Instead of the recommended five to nine daily servings of fruits and vegetables, more than half of chiropractors report consuming only four servings or less.

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