Recent headlines and research have suggested that both childhood and adult overweight/obesity rates have reached a critical point with respect to their influence on health, and risk for future illness, and subsequent expense to the already spiralling costs to the health-care system. The next generation may be the first that does not outlive its parents if morbidity and mortality estimates are accurate.1 Many within the health-care system have previously recognized this phenomenon but, for too long, most health-care professionals have ignored this silent killer.2
Creeping obesity has been a known and accepted development associated with aging. Consider that a modest one-to-two pound increase annually from the age of 20 manifests as a 20-40-pound weight gain by the age of 40! The alarming trend here though, is the rate of obesity in children and adolescents. What was previously a relatively stable prevalence of less than 10 per cent of this population is approaching 40 per cent – a trend that has accelerated over the past 15 to 20 years.3 Is it our diet, our activity levels, our predisposition with everything electronic and/or automated? The simple answer is “yes” to all of the above. We have shifted our diets from predominantly whole foods to food products while insisting that children 0.7 kilometers or more from their schools get bused. We program our kids into regulated, supervised – and limited – physical activities, but allow unlimited television and computer time. While this may be an oversimplification of the problem, it is the crux of what is happening with today’s younger population.
WHY BE CONCERNED ABOUT OBESITY?
Rehabilitation researchers and clinicians alike have listed obesity as a risk factor for cardiovascular disease for many years now. Obesity has a negative impact on cardiovascular health and is associated with elevated cholesterol and blood pressure levels. Additionally chronic conditions including osteoarthritis and rheumatoid arthritis, asthma and Type 2 diabetes are only a few of the increasingly ubiquitous disease states costing ever-increasing amounts to our already overburdened health-are system.4,5,6 Estimates suggest close to 50 per cent of the North American population may be at risk for Type 2 diabetes – the ominous metabolic syndrome or syndrome X – primary causes of which include obesity and poor lipid profiles.
THE ROLES OF MOTION, MEALS AND MEDS
Physical activity and balanced nutrition have been shown conclusively to reduce each of these risk factors and improve the state of all of these conditions.7,8,9,10 More importantly, physical activity, when maintained from a young age throughout adulthood, can prevent most of these risk factors and physical deteriorations from ever developing in the first place.11
High blood pressure and high cholesterol are not diseases but rather symptoms of underlying pathology usually secondary to obesity and/or poor lipid profiles that progress to become risk factors for cardiovascular disease. While medications may lower the absolute values of these factors the associated adverse reactions can be extreme.12,13 There is mounting evidence to suggest that in the absence of other risk factors, the pharmaceutical treatment of any one of these conditions exposes an otherwise healthy patient to a myriad of adverse reactions including irreversible muscle damage and even death.14,15
Indeed, even as the parameters for these risk factors have been progressively broadened; hat is, lowered to include an ever-expanding patient base, the incidence of obesity, cardiovascular disease and degenerative conditions continues to rise16.
Evidence abounds to support increased physical activity and better nutrition – or even a return to levels we routinely experienced more than 30 years ago.17, 18, 19
A PLACE WHERE DCs SHOULD BE
All health-care practitioners but particularly chiropractors can, and should, be taking a leadership role in the education of our patients, and the public at large, regarding the benefits of physical activity and adequate nutrition. 20 At a time when governments are looking at cost effectiveness and the essential nature of various health professions, chiropractors could be positioning themselves as the prevailing experts in this scientifically supported, effective, conservative and preventive approach to many of these chronic conditions.21 Indeed it completely complements the chiropractic philosophy and science initiated and developed over the past 100 years or so. Our colleges should develop more educational units with a greater emphasis on physical activity and increased hours on nutritional science so new graduates are better equipped and qualified to be leaders in this field. Our professional bodies need to be actively lobbying the educational systems, governments at all levels and the media. We should take a leadership role in this and drive it to where it needs to be. If we do not lead, we will be forced to sit back and watch while others lay claim to it.
Regular physical activity
Regular physical activity offers an effective solution for lowering the risk factors associated with cardiovascular disease, and can reduce the signs and symptoms of many musculoskeletal conditions including various types of arthritis and osteoporosis. When introduced at a young age – i.e., daily in the schools – it would provide a preventive approach to these same risks and conditions.22 This would result in a positive change of lifestyle for many and would be inexpensive but extremely beneficial for virtually the entire population.
Health-care costs would be reduced – the British Heart foundation reports that a five per cent reduction of the sedentary population could realize more than 200 million dollars saved in health-care costs and more than 120 lives saved.23 Pharmaceutical dependence – and influence – could be reduced for all but the extremely ill, and the health and well-being of the majority would be increased.
Interestingly the terms “conservative” and “preventive” are also oft used in the description of chiropractic philosophy and its holistic approach to health care.
So, if not us, then who?
1. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J, Hayflick L, Butler RN, Allison DB, and Ludwig DS, “A Potential Decline in Life Expectancy in the United States in the 21st Century,” New England Journal of Medicine, 352:11, pp. 1138-1145
2. Dr. William Dietz, Director of Nutrition and Physical Activity Centers for Disease Control and Prevention, Atlanta, GA
3. Canadian Community Health survey: Obesity among children and adults –
4. Northwestern University (2006, January 12). Obesity In Middle Age Raises Heart Disease, Diabetes Risk In Older Age. ScienceDaily.
5. Després JP, Lemieux I. Abdominal obesity and metabolic syndrome. Nature. 2006;444:881-887
6. Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med. 2006;119:812-819
7. Boule, N.G., Bouchard, C., and Tremblay, A. 2005. Physical fitness and the metabolic syndrome in adults from the Quebec Family Study. Can. J. Appl. Physiol. 30: 140–156.
8. Physical activity and the metabolic syndrome in Canada. Susan E. Brien and Peter T. Katzmarzyk Appl. Physiol. Nutr. Metab. 31: 40–47 (2006)
9. Is the association between dietary fat intake and insulin resistance modified by physical activity? Metabolism 2001 Oct; 50(10):1186-92 Harding AH, Williams DE, Hennings SH, Mitchell J, Wareham NJ
10. The Effect of Metformin and Intensive Lifestyle Intervention on the Metabolic Syndrome: The Diabetes Prevention Program Randomized Trial.” April 2005 Annals of Internal Medicine (volume 142, pages 611-619). T.J. Orchard, M. Temprosa, R. Goldberg, S. Haffner, R. Ratner, S. Marcovina, S. Fowler
11. Pediatric Exercise Medicine, Oded Bar-Or, Thomas Rowland 2004: 117- 131 publisher Human Kinetics
12. Cohen, JS, Adverse drug effects, compliance, and the initial doses of antihypertensive drugs recommended by the Joint National Committee vs. the Physicians’ desk reference, Archives of Internal Medicine, 2001: 161:880-85
13. American Heart Association (2005, May 24). Side Effects Of Cholesterol-lowering Drugs. ScienceDaily.
15. Willcox SM, Himmelstein DU, Woolhandler S. Inappropriate drug prescribing for the community-dwelling elderly. Journal of the American Medical Association Jul 27, 1994; 272: 292 – 296
16. Patel P, Zed PJ. Drug-related visits to the emergency department: How big is the problem?. Pharmacotherapy Jul 2002; 22: 915 - 923
17. Cardiovascular disease, World Health Organization http://www.who.int/topics/cardiovascular_diseases/en/
18. Physical activity, nutrition and health, PACE Canada, http://www.pace-canada.org/physact.htm
19. Healthy living, Health Canada, http://www.hc-sc.gc.ca/hl-vs/physactiv/
20. Commission on the Future of Health Care in Canada 2002, Roy Romanow, recommendations 22,23
21. U.S. Department of Health and Human Services. Physical activity and health: a report of the Surgeon General. Washington DC: Department of Health and Human Services, Centers for Disease Control and Prevention, 1996
22. World Health Organization (2005). Preventing chronic diseases: a vital investment. Geneva: WHO
23. Economic costs of physical inactivity, British Heart Foundation
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