Editor's Note: This is part two of a six-part series about creating a wellness and fitness center from the perspective of an existing medical office or fitness facility. In the coming months, be sure to read the continuing articles on case management, documentation, reimbursement and legal structure. 
In the last article, I stated that "human beings will only duplicate those behaviors for which they are continually reinforced." How true it is! Yet, I see fitness and health professionals performing assessments at the initiation of care and, literally, never re-evaluating. The nonverbal communication sent here is that either the treatment wasn't really effective or that the assessments were meaningless to begin with. Either way, it breeds apathy and distrust in the client and is a big reason for the staggering attrition rates found in most fitness clubs and health care facilities. Conversely, assessments as benchmarks of success are the most powerful compliance tool available to practitioners.
How Assessment Promotion Can Help Business
            Take a lesson from the drug companies. Seventeen years ago when Pfizer introduced Lipitor, they did so on the heels of theFramingham study, which showed increased risk of cardiovascular disease (CVD) associated with high cholesterol levels. Their clinical trials on Lipitor had already shown a definitive result of lowered cholesterol before they launched the drug. They did not, however, launch a campaign directly for their drug, but instead launched a campaign for the public to have their cholesterol checked, knowing full well that a predictable percentage of the population would indeed test positive for high cholesterol and that the drug, marketed to doctors as "the cure" would then be prescribed.
            Predictably, a segment of the population tested positive for high cholesterol and were prescribed Lipitor, and subsequent reassessment in eight to 12 weeks was scheduled to confirm the drug was working. Low and behold, cholesterol levels were lower. Pfizer even provided a little wallet-sized card to record subsequent test results predictably showing a steady reduction of and then stability of your cholesterol levels, reinforcing the perceived positive result.
            Today, Lipitor is the number one selling drug in the world despite its well-publicized and potentially life-threatening side effects. Clients who take Lipitor will defend its use when challenged stating; "It works and I've got the little card in my wallet to prove it!" Alas, this is a hard argument to win.
How to Deal with Reassessment Failures
            I believe that one reason some facilities don't regularly reassess is because they are unsure of how to deal with the potential of unfavorable findings. Let me share an experience I had with a client a few years ago. Jackie was a 52-year-old female with some hormone issues and a major weight issue. At 275 pounds, Jackie was tired, unmotivated, stressed out and generally depressed, even though she was taking anti-depressants. Her initial body composition and fluid analysis found that she had 53% body fat, her extra-cellular fluid was abnormally high and her blood sugar was dangerously low. In short, she was catabolic and, for all practical purposes, a diabetic.
            After three weeks of sporadic effort, Jackie looked worse, her body composition was worse, she felt terrible, had not completed any of the diet-activity reports I had given her and had not completed her nutrition assessment. Immediately, she questioned me as to why she wasn't getting the results we had predicted.
            I asked Jackie directly what her perception of my role was in this process and in turn how she saw her role. "You're supposed to fix me," she said. I explained, "The difference between what we were offering here can be summed up as the difference between medical care and health care. I would define medical care as 'what a highly trained specialist can do for you, or to you' whether it be performing a surgery, manipulation, exercise and rehabilitation or writing a prescription. Health care, conversely, would be defined as 'what you must learn to do for yourself.' The principles here around diet, stress, blood sugar management, hormone regulation and their link to weight management and fatigue are truly 'health care' and as such, mean that when applied, they always work. There is nothing that I can do to 'fix' you in this instance, I can only coach you as to the principles at work here and show you a better way to access more of your healing potential. When you take responsibility for your actions the results will follow, and not until." And my words helped.
            Jackie had an epiphany. She finally "got it." She started to cry and told me that she appreciated my honesty and that she now realized that it was up to her to get better. From that day on, Jackie was the model of compliance and anxiously awaited her next re-evaluation date like a kid waiting for Christmas. Her results were proportionate. At Jackie's one-year evaluation, she had lost 81 pounds, her body fat was 35%, her blood sugar was normal and she was off her anti-depressant medication and feeling great. In the final analysis, it was all about her taking responsibility for her actions aided by the objective feedback of the assessments.
Fixing the Tools
                        Our society expects failure when it comes to improving our diet and lifestyle because we have been conditioned for failure by previous experiences. In the majority of these failures, it is the "system" which we have engaged that is flawed, not our physiology. As such, the dieter that engages a diet and exercise program where the only metrics being measured are weight and body composition will likely be disappointed and join the "society of the apathetic" because these tools aren't likely to show the expected positive results at the first reassessment. This is not because they aren't valid tools for assessment, but because they aren't sensitive enough to demonstrate the real shift in metabolism that occurs early on in an effective fitness and nutrition program.
                        Metrics like phase angle and a shift in fluid distribution from extracellular to intracellular that indicates movement into an anabolic state will be seen long before results like weight loss manifest and is a much more valid indicator of health and vitality than body composition or weight loss.
                        In my estimation, assessment can be your most powerful tool or most potent adversary depending on the technology you choose and the way you position and interpret its findings.
                     Look for Dr. Perryman's article on case management in the March issue.


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