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Sept. 20 2006 12:00 AM

           With health care costs increasing and obesity and related illnesses on the rise, what are fitness professionals doing to help our nation's health? Likewise, what are health care professionals doing to help their patients? More importantly, how can these two groups of professionals work together to prepare for the obesity epidemic and decrease rising health care costs?

            Not a day goes by in which Americans are not made aware of how exercise and nutrition can impact their health, including longevity and quality of life. We've all heard the statistics; two-thirds of Americans are overweight or obese. Obesity-related diseases cause as many as 300,000 preventable deaths per year. According to the National Institute of Health, only one-third of people who are morbidly obese at the age of 30 will live to see their 60th birthday. Statistics show that there are more obese people in the US than there are cigarette smokers and drug users combined. Health care costs attributable to obesity are estimated to be $117 billion a year. As a consequence, health insurance premiums were up 13.9% from last year.


The Physician's Role

            The cure for the present problem seems straightforward: weight-management programs in medical offices, insurance billing codes for clients to see dietitians and health club reimbursements by insurance companies. Sound easy? The problem is that there is no published peer-reviewed data supporting or proving that these types of health interventions are effective in preventing obesity. Additionally, there are structural hurdles that inhibit implementation of these progressive health care reforms. For instance, traditional medical facilities are not equipped to help patients with their fitness needs. Some physicians and nurses do not want to address obesity-related issues because they do not have the training to advise patients about the benefits of physical activity and nutrition. According to an Archives of Internal Medicine survey, only 38% of physicians polled participated in vigorous exercise; half of the surveyed physicians exercise; and the majority of these respondents recognized that they do not exercise enough. Medical school curriculum is inadequate. Nutrition courses are usually optional. Exercise physiology is not offered at most programs. Cathy Farrell, registered dietitian at the East Bank Club in Chicago, Illinois, says, "Several years ago, I had a client, with severe kidney disease and he was losing weight fast. Nobody could figure out why, so when we assessed his diet, we found that he was on a high-protein diet that his doctor prescribed. It is ridiculous." Farrell continues, "It is like me telling my clients to go diversify their portfolios because I've heard about it on TV."

            Health care professionals do not believe that they have the time or the money to hire dietitians or certified personal trainers in their offices. Obese patients are reluctant to go to a health club to seek the help they desperately need. Prevention programs are where the answer lies, but the oversight of these programs is dependent upon the collaboration of fitness professionals, health educators and medical intervention. Barry Broutman, founder of Chicago Personal Training, states, "First and foremost, understanding what patients need is crucial to improving their health. Right now, society usually picks one avenue to go through when it comes to treating health aliments and these patients only get one point of view from that health care professional. There is not enough communication between doctors and trainers."


Complementary and Alternative Medical Centers

            Some facilities are beginning to use roundtable discussions to help treat their patients as a mechanism for all the professionals involved to be aware of the treatments their patients are receiving. The Universal Health Institute in Chicago (UHI) does just this. UHI offers a unique combination of traditional and alternative health care options such as chiropractic, kinesiology, holistic medicine, nutrition, rehabilitation, Pilates-based exercise, physical and massage therapy, acupuncture and craniosacral therapy. The options offered are sometimes effective and more affordable than medications or surgery. Further, because each doctor or therapist meets daily with the other members of the practice to discuss their patients' progress, all patients receive personal attention. Dr. Nathan Conroy, a chiropractor at UHI states, "Complementary and Alternative Medicine (CAM) providers continually promote fitness as a solid staple of a healthy body. Many of those involved in fitness professionally visit with CAM providers and vice versa, so it makes a happy marriage between the two." More studies are being published about health care costs savings yielded from the use of CAM and fitness. According to the Archives of Internal Medicine, "CAM has been proven time and time again to reduce health care costs to those who pursue it, especially chiropractic. The studies are highly impressive and only gaining more momentum." According to Dr. Conroy, "More scientific studies accredit CAM as a viable way to prevent disease. As insurance companies begin to cover these services, more people will believe in these methods. These methods need to be viewed as mainstream alternatives."


Corporate Wellness Programs

            To curb many escalating health care costs, companies are increasingly implementing corporate wellness and fitness programs to improve the health of their employees and to consequently increase the bottom line. In 1999, 86%, (up 25% from 1996), of companies that employ more than 50 employees have some sort of wellness and fitness program. Today, that percentage is up to 93%. The companies that have implemented these programs are reaping the benefits of lowered health care costs, reduced absenteeism, greater productivity and increased employee morale all of which yield a positive return on investments.

            Corporate wellness programs vary in scope and cost. Based on its financial status, demographics and employee health risks for disease and lifestyle choices/habits, a company can choose one of many options. Common alternatives include hiring a full-time staff dedicated to employee wellness, offering on-site health screenings and/or hiring a speaker to educate its employees. This is an opportunity that any company cannot afford to overlook, as healthier and happier employees have a positive impact on the company's bottom line.

            Numerous studies show that for every dollar spent on a preventative health program, companies can save up to six dollars in insurance costs. Studies done by the University of Michigan and Johnson & Johnson show that employers can save:


  • $1,100 per year for every employee who quits smoking;


  • $269 a year for every employee who goes from being

                 sedentary to physically active;


  • $1,200 a year on employees who reduce their cholesterol

                 levels from 240 mg to 190 mg; and


  • $177 a year for each employee who goes from being obese

                (more than 30 pounds overweight) to a healthy weight.

                Based on these results, implementation of wellness programs will result in decreased health care costs and workers' compensation costs.

                Providing on-site health screenings is another way to save on medical claims. While companies have found that early detection may cost them approximately $15,000 in surgical costs, the health care costs for acute disease averages $40,000 per incident. Johnson & Johnson found that it spends about $4.5 million every year on health risk appraisals programs, but without them, its medical bills would be at least $13 million higher. This is a savings of about $8.5 million!


    Medical-Based Fitness Centers

                Medical Fitness Centers (MFC) provide the win-win situation for health care and fitness. They collaborate with physical and massage therapists, cardiac rehab, personal trainers, dietitians medical doctors and create the ultimate medically supervised fitness center. A survey published in April 2004 by the Medical Fitness Association found that there are 715 medical fitness and wellness facilities in the United States, Canada and Japan, up from 550 in the year 2000. Statistics show the number of MFCs is expected to reach 1,150 by 2010, and from 2000 to 2003, the total health care investment of MFCs was $1 billion. This growth is attributable to society's increased longevity. Medical-based fitness centers are on the right path to having everyone work together to help their communities. Sick and injured people are motivated by the fit and healthy, and the healthy are motivated by the sick and injured. Everyone just wants to be healthy and stay healthy.


    The Bottom Line

                Fitness professionals are continuing to seek respect and acceptance from health care professionals. Although more and more health clubs are crossing over and offering services such as physical therapy, chiropractic, massage therapy and in-house dietetics, the services are not being used to their maximum potential. This is causing a revenue problem for health clubs, so we find ourselves in a no-win situation. Since health clubs are tapping into medical and alternative services, it is the perfect opportunity for fitness professionals to take the initiative and offer their services to surrounding businesses for corporate wellness programs. Additionally, fitness professionals can help the dilemma by collaborating with area hospitals to educate the staff on how to better serve patients through health prevention and rehabilitation programs. The goal is to not put anyone out of business, but we really need to start thinking about how we treat patients for diseases and illnesses. In order for us to help reduce obesity and age-related disorders and health care costs, while enhancing emotional and mental well-being, we all need to work together to invest in preventative medicine.


                Look for Jasmine Jafferali's next article on stress management in April.



    "The Ultimate 20th Century Cost Benefit Analysis and Report," University of Michigan Health Management Resource Center. March 2000.

    "Prescribing Exercise: Is Your Physician's Head in the Game?"by Thomas J. Beckman. Archives of Internal Medicine, 2004; 164:2066-2067.


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