Editor's Note: This year, Dr. Lehman's column focuses on the ethical responsibility of chiropractors to pursue prevention and wellness care. This article discusses weight maintenance as a necessary element of that duty.
During my earlier years in practice, I first became aware of the obesity problem in New Mexico because of an offer to star in a movie. The Albuquerque school system contracted with a local physician / film maker to create a documentary movie that described the obesity problems facing Albuquerque's youth. The local physician provided the talent search, and worked as the producer and director of the movie.
He interviewed my wife (a chiropractor with a degree in nutrition) and me. At the time, I was practicing chiropractic and acupuncture. Using auriculotherapy, I treated patients for smoking addictions and appetite suppression. Hence, the doctor / film producer was interested in having both of us in the movie because we could explain the value of our alternative weight-loss therapies. "The Rolly Polly Blues" was quite good and was shown to Albuquerque Public Schools' elementary students for more than 10 years.
We Can't Ignore the Facts
Today, obesity in America is problematic. According to data from the National Health and Nutrition Examination Survey (NHANES), 2013-2014:1-4
Eckel suggests heredity explains 30-70 percent of cases of obesity. Yet diets high in fat and calories are a major cause of obesity and enlarged waistlines with excess baggage in America. A lack of physical exercise compounds the obesity problem in America.5
The World Health Organization, the U.S. Dept. of Health and Human Services, and other authorities recommend that for good health, adults should get the equivalent of two-and-a-half hours of moderate-to-vigorous physical activity each week. Children should get even more: at least one hour a day.
There's been some debate among researchers, however, about just how much activity people need each day to maintain a healthy weight or to help with weight loss, and the most recent studies suggest a total of two-and-a-half hours a week is simply not enough.6-9
A population-based, cross-sectional study of men revealed that high-intensity LBP and/or disability was associated with increased levels of obesity, particularly in those with an emotional disorder. The authors claim that this data provides evidence to support a biopsychosocial interaction between emotional disorders and obesity with low back pain.10
It makes one wonder how a chiropractic clinician can manage such a patient without a dietician, nutritionist and a behavioral health specialist also on board.
You Can't Do It Alone
So, how does the chiropractic clinician manage the obese patient complaining of severe, low back pain because of an on-the-job injury, which has been disabling for the past 12 months? Is it our ethical responsibility to advise the patient to change their high-fat diet, lose weight, exercise regularly and provide counseling? What would you do to help this type of patient?
I am familiar with chiropractors who attempt to be a "jack of all trades" and tackle this complicated patient situation without assistance from other providers. In fact, many years ago, chiropractors did not have a choice because the AMA prevented medical doctors from working with chiropractors.
Today, the health care scene is different. Chiropractic clinicians practicing patient-centered care have an ethical responsibility to recognize the health issues facing their patients and address them through coordination of care. No longer is it ethical to claim that chiropractic is separate and distinct, or that chiropractors are only responsible for the detection and correction of subluxations. Now is the time to become a member of a coordinated care team to help tackle the obesity epidemic.
For the past seven years, I have served as a chiropractic specialist within a primary care team. The team includes primary care providers (MD, DO, APRN and PA), behavioral health clinicians, nurses (RN), podiatrists and chiropractic clinicians (neuromusculoskeletal medicine specialists). Each team member understands their role on the team, which is to provide high-quality, patient-centered and evidence-based health care.
Create a Team to Fight Obesity
Private-practice chiropractors concerned with obesity and disease prevention might consider developing relationships with other providers and establishing new locations to meet people and potential patients. Create your own "coordinated care team." For instance, if you work out at a gym or fitness club, I suspect other health care providers are members. Why not meet with the management and offer to develop a team of providers who could offer advice to club members? Here are a few other suggestions for your consideration:
Resources to Get You Started
Don't let the "rolly polly blues" get you or your patients down; call for help from your coordinated care team members and help make a difference. For more resources and ideas to get you started, see the sidebar in this article.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
