Why Some DCs Don't Address Their Patients' Unhealthy Weight
Dennis Barley, DC, CCSP
With close to 75 percent of the U.S. population overweight or obese, the health consequences not only affect quantity of life, but also quality; not to mention the cost burden on our health care system and its subscribers. So, why aren't some chiropractors addressing patients' unhealthy weight? Let's look at some of the reasons and how to overcome them for the benefit of your patients and practice.
Eye-Opening Data on Metabolic Health
Recent research found that only 12.2 percent of the population maintains optimal metabolic health. Poor metabolic health leaves people more vulnerable to developing type 2 diabetes, cardiovascular disease and other serious health issues.
The study presents the most updated U.S. data on metabolic health, defined as having optimal levels of five factors: blood glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and waist circumference, without the need for medications.
For the study, researchers examined National Health and Nutrition Examination Survey data from 8,721 people in the U.S. between 2009 and 2016 to determine how many adults are at low versus high risk for chronic disease. Data revealed that only 12.2 percent of American adults are metabolically healthy, which means only 27.3 million adults are meeting recommended targets for cardiovascular risk-factor management, according to researchers."1
As I have seen in my 37 years of practice, the disease of obesity can literally be the foundation for almost all other disease. The comorbidities related to unhealthy weight are many and varied: cardiovascular diseases, diabetes, stroke, high blood pressure, dementia and Alzheimer's, sleep apnea, PCOS and fertility problems, ED, hyperlipidemia, other metabolic disorders and even some cancers.2
Reasons for Non-Engagement
Evidence indicates that health care providers are often not speaking to their patients about obesity. Providers perceive multifactorial barriers that influence their level of engagement. Dr. Scott Kahan, from the Mayo Clinic, has cited that a lack of knowledge of nutrition, a lack of time in a patient's appointment visit, and the fear of reprisal online from the patient, leads to this suboptimal obesity intervention.
This lack of provider–patient engagement can adversely affect the diagnosis and management of obesity and the ultimate health of the patient. Barriers perceived by HCPs and patients influence their level of engagement.3
Communication Barriers
What if I get a bad online review? What do I say? What can I say? These are some of the many questions chiropractors may have as they approach the tender subject of weight with their patients. What has worked for me is first getting permission to speak openly to the patient about how their weight may be affecting their health.
"Mrs. Jones, is it OK if we speak today about how your weight may be having an effect your health?" As a chiropractor, taking care of a patient's overall health is what we've been entrusted with; not just neuromusculoskeletal health, but also metabolic health. BMI, albeit not the perfect indicator of unhealthy weight, is a vital sign, and indeed a vital sign that must be addressed. The Affordable Care Act says HCPs must perform vitals and BMI is such a vital. As chiropractors, we must step outside our box of comfort and make a stand for our patients' overall health.
The Time Factor
Besides the above-mentioned communication barrier in all health care provider circles, having the time to discuss weight may be an issue, too. With insurers coming down hard on reimbursement, it seems that working harder and faster is how we keep up with the ever-thinning profit margins, especially post-COVID, where supply is short and demand high, thus skyrocketing supply costs.
If you've ever had the willing patient wanting to discuss their weight with you, then you know that conversation can take time. So, setting up a system whereby your CA can do most of the interaction would be a real plus. Time is at a premium for the busy practitioner, and it may be another reason why adding something like weight loss to the practice might be avoided.
Partial Meal Replacements: To Use or Not to Use?
In the chiropractic community, I find many times that what the patient consumes while on a diet is of big concern for the chiropractor. What the DC must assess for the patient, and not themselves, is the cost to the patient of continued unhealthy weight versus the gain of using a product that may not be optimal in our minds, but health beneficial in the long run.
Partial meal replacements or PMRs, as opposed to a protocol utilizing just whole foods, is often what stops the doctor moving forward, mostly because those PMRs may contain artificial as well as natural ingredients. When I was first introduced to a protocol I have now used in my office for the past 13 years, this was my hangup, too. As it was explained to me, these PMRs, along with the wholesome fibrous vegetables, micronutrients, probiotics and healthy fats and adequate proteins, provide a structured, easy-to-use, easy-to-store, easy-to-cook and easy-to-travel-with tool to help my patients lose weight safely, effectively and conveniently.
As I saw it, this protocol was a great tool to a) start the conversation about unhealthy weight; and b) have a profound effect on my patients' metabolic health!
Far Better Than the Alternatives
So, many times I witness a chiropractor turn a PMR box around, read the ingredients and put their stop sign up. Let me suggest that the next time your initial thought is to thumb your nose at a weight-loss plan utilizing something that goes against what you deem is important, realize that most of your concerns are probably not your patient's. Ask yourself, What's worse, the comorbidities and the medications the patient is taking for those comorbidities, or the ingredients in the PMRs that are a short-term tool to take them over the bridge from insulin resistance and ill-health, to improved metabolic healththat could potentially last a lifetime?
Food for thought the next time you scrutinize the ingredients on a weight-loss food or other product. After all, think about what's in the diabetes or blood pressure medications they are already taking, because of the chips and soda they've been consuming for the past 30 years.
Cause, Correction, Maintenance
What's the best diet? One that works for the patient in front of you. Let's face it, our patients are insulin resistant and highly inflamed. To get to the cause of those issues, we must address diet or get to the cause. After we've addressed and corrected this metabolic insulin resistance, we must maintain that correction by returning that patient to a healthy, metabolically flexible diet that includes more and more whole foods. Cause, correction and maintenance – sound familiar?
I believe that to help your patients beyond the worst pandemic to afflict humanity, obesity, we should use a protocol based in science, backed by research and overseen by a health care provider – and who better than a chiropractor?
References
"Only 12 Percent of American Adults Are Metabolically Healthy, Carolina Study Finds." University of North Carolina (UNC) Gillings School of Global Public Health, Nov. 28, 2018.
Health Risks of Overweight and Obesity. National Institute of Diabetes and Digestive and Kidney Diseases.
Kahan S. Practical strategies for engaging individuals with obesity in primary care. Mayo Clin Proc, 2018 Mar;93(3):351-359.
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