The Obesity Epidemic and Physical Therapy Practice

In Fitness and Physical Therapy, Physical Therapy Articles by Jeff Gilliam, PT, PhD, OCSLeave a Comment

Health care costs will unquestionably increase during the next 30 years, as a result of baby boomers “coming of age” and accessing Medicare benefits. The economic and social impact of the future growth of US health care expenditures for the elderly will be significant. Obesity will impact costs since an obese 65-year-old individual entering the Medicare program requires immediate and higher health-care expenditures than normal-weight individuals.

An obese 45-year old person surviving to age 65 has significantly higher average lifetime Medicare costs of $163,000 compared to $117,000 for a normal-weight 45-year-old surviving to age 65. Additionally, as obesity and resulting health effects occur in younger individuals, costs to the healthcare system will be earlier and for longer than in past years when obesity developed at older ages. The reality of these costs are substantiated by recent estimates of national healthcare expenditures for children related to obesity: $14.1 billion in additional prescription drug, emergency room, and outpatient costs annually.

Many obesity-related chronic diseases affect the health-related quality of life of obese individuals. When obese individuals are assessed using the health assessment short form (SF-36), they typically exhibit low scores on the physical aspects of assessment involving functioning. Physical functioning is most commonly affected by orthopedic problems, that impede joint mobility and interfere with gait and other activities of daily living (such as climbing steps, lifting groceries, and getting into and out of the bathtub). Researchers have found a positive association with the body mass index (BMI) and knee osteoarthritis (OA); specifically knee, hip, and back pain. A study comparing obese/non-obese individuals demonstrated a 13-fold increase in the incidence of knee osteoarthritis (OA) among the heaviest subjects. Studies have also demonstrated that hip-joint replacement at younger ages is positively associated with body weight and hip contact stress.

In contrast, research shows that obese individuals who lose a modest amount of weight (0 to 9.9% weight loss) have improved SF-36 scores in the area of psychosocial functioning, physical functioning, and general health at 2 years, demonstrating a dose response improvement with increasing weight loss. Other research describes overweight people with radiological evidence of knee (OA) who, upon losing 10 to 12 pounds on average, reported a 30% improvement in knee pain and experienced 24% improvement in their ability to perform daily activities; including the ability to walk up stairs more quickly and easily than those subjects who did not lose weight.

Physical therapists are in a position in which they can positively impact the obesity epidemic. The American Physical Therapy Association (APTA) recognizes that physical therapists are uniquely qualified to assume leadership positions in efforts to prevent injury and disability, and fully supports the positive roles that physical therapists and physical therapist assistants play in the promotion of healthy lifestyles, wellness, and injury prevention. APTA holds as ethically binding the principle that PTs “shall endeavor to address the health needs of society.” The APTA envisions that by 2020 consumers “will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services.” These statements made by the APTA leaves no other option but for physical therapists to assume an active role integrating all aspects of disease prevention, health promotion and wellness into practice.

Future articles will be designed to demonstrate how physical therapists can affectively integrate health promotion and wellness into their practice.

References:

Andersen, R. E., Crespo, C. J., Bartlett, S. J., Bathon, J. M., & Fontaine, K. R. (2003). Relationship between body weight gain and significant knee, hip, and back pain in older Americans. Obesity Research, 11(10), 1159-1162.

Cai, L., Lubitz, J., Flegal, K. M., & Pamuk, E. R., (2010). The predicted effects of chronic obesity in middle age on medicare costs and mortality. Medical Care, 48(6), 510-517.

Christensen, R., Astrup, A., & Bliddal, H. (2005). Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage. 13(1), 20-7.

Coggon, D., Reading, I., Croft, P., McLaren, M., Barrett, D., & Cooper, C. (2001). Knee osteoarthritis and obesity. International Journal of Obesity and Related Metabolic Disorders, 25(5), 622-627.

Doll, H. A., Petersen, S. E., & Stewart-Brown, S. L. (2000).  Obesity and physical and emotional well-being:  associations between body mass index, chronic illness, and the physical and mental components of the SF-36 questionnaire.  Obesity Research, 8(2), 160-170.

Felson, D. T., Anderson, J. J., Naimark, A., Walker, A. M., & Meenan, R. F.(1988). Obesity and knee osteoarthritis.The Framingham Study. Annals of Internal Medicine, 109(1), 18-24.

Field, A. E., Coakley, E. H., Must, A., Spadano, M. A., & Laird, N. (2001). Impact of overweight on the risk of developing common chronic diseases during a 10-year period. Archives of Internal Medicine, 161, 1581-1586.

Finkelstein, E. A., Trogdon, J. G., Brown, D. S., Allaire, B. T., Dellea, P. S., & Kamal-Bahl, S. J. (2008). The lifetime medical cost burden of overweight and obesity: implications for obesity prevention.  Obesity, 16(8), 1843-1848.

Gelber, A. C., Hochberg, M. C., Mead, L.A., Wang, N.Y., Wigley, F.M., & Klag, M. J. (1999).Body mass index in young men and the risk of subsequent knee and hip osteoarthritis. American Journal of Medicine, 107(6), 542-8.

Messier, S. P., Loeser, R. F., Miller, G. D., Morgan, T. M., Rejeski, W. J., Sevick,         M. A., …Williamson, J.D. (2004). Exercise and dietary weight loss in overweight   and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis Rheumatism, 50(5), 1501-1510

Oliveria, S. A., Felson, D. T., Cirillo, P. A., Reed, J. I., & Walker, A. M. (1999). Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee. Epidemiology, 10(2), 161-166.

Recnik, G., Kralj-Iglic, V., Iglic, A., et al. (2009). The role of obesity , biomechanical constitution of the pelvis and contact joint stress in the progression of hip osteoarthritis. Osteoarthritis Cartilage, 17(7), 879-882.

Rice, D. P., & Fineman, N. (2004). Economic implications of increased longevity in the United States. Annuals of Review in Public Health. 25, 457-473.

Trasande, L., & Chatterjee, S. (2009). The impact of obesity on health service utilization and costs in childhood. Obesity, 17(9), 1749-1754. 

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Jeff Gilliam, PT, PhD, OCS
Jeff Gilliam PT PhD, OCS: is a weight loss specialist, who has studied extensively in the areas of health behavior, exercise physiology and nutritional biochemistry at the University of Florida. Jeff has taught a course at the University of Florida called ’Research Applications to Obesity and Weight Loss’. He has also taught courses for the DPT program at UF in Health Promotion and Wellness’ and ‘Evidence Based Practice III’. He has presented on a national level on topics related to diseases related to obesity and changing behavior to facilitate a healthy lifestyle. His PhD research was in the area of effective behavioral interventions for obesity and its associated diseases. He is founder of Physicians’ Choice for Weight Loss, a successful lifestyle/weight loss program, which can be found in over 50 clinics in the eastern US. He currently is clinical director of ReQuest Physical Therapy (Gainesville, Florida) and incorporates his lifestyle/weight loss program into his patients’ physical therapy to help them achieve their healthiest body weight. Jeff Gilliam is an Orthopedic Certified Specialist through the American Board of Physical Therapy Specialties

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