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Raising the Bar in Rehab

Michigan and Childhood Obesity

Published September 29, 2011 5:10 PM by

News came out recently about a new initiative in Michigan for state-wide tracking of pediatric BMI (body-mass index) values. The rationale behind the new policy is that physicians will see the data and be more likely to discuss healthy weight and lifestyles with the patients and the children's parents. The only lacking part of the policy is that physicians are not required to educate their patients and families about obesity, nor does it give the physicians more time during an appointment to review the data with the patient and family. Other noteworthy news this week also surfaced that Michelle Obama is teaming with Olive Garden and Red Lobster (the Darden restaurant group) to reduce fat, sodium and calories in their meals. Obama also hopes to make milk the default drink with kid's meals, unless the guest specifically requests a soda-pop drink. 

I don't have kids, so I don't know how hard it is to find time for children to exercise and eat healthy meals. But, I know it's hard for myself to do those things during a busy week... I just need to make it a priority. And it should be a priority. Discussing obesity during an appointment with a primary care physician should be the highest priority, policy or no policy. I think tracking the BMI values is a great start; and physician improvement of those values over the course of a year should be considered with performance reviews and raises. Outcomes are key, and children need to be healthy. 

If health care providers could focus efforts on reducing obesity in the patients they serve, the amount of other preventable injuries could be diminished significantly. Patients who are obese are more likely to need hip and knee replacements due to the increased impact force on those joints, diabetic-related neuropathies, and muscle atrophy and weakness. I think part of the problem is a lack of responsibility and advocacy for these overweight patients - very few health care providers will address the lifestyle changes needed. In South Florida, a group of physicians (OB-GYNs) have recently refused to treat obese patients due to the increased risk of being sued and the risk of additional complications during pregnancy and delivery. 

As physical therapists, we may be able to help our patients live better by addressing the root of the problem instead of focusing on the knee range of motion or other specific interventions. We can implement a beginning exercise program and recommend our patients to meet with a dietician. We are just as accountable as any other provider. 

What about you? How are you helping the obesity epidemic in our nation, both for children and adults? How do you find time to help your children stay healthy?


I echo Jason's concern about BMI in children.  With my own children I saw a variation in their chubbiness and it had to do with their growth spurts.  I had a doctor speak to me in front of my child about her size.  I told the doctor I was confident it was part of her growth phase.  I explained that she got plenty of exercise and she had healthy eating habits:  she'd choose a yogurt or cheese over cookies and she left food on her plate when she was done eating.  The emphasis needs to be on healthy behavior.  With the media and fashion industry feeding our kids a steady diet of anorexic models, the last thing our kids need is something else to tell them they are too fat.  While fat is an ultimate outcome of healthy choices, especially in children it is often just a phase of growth spurt.  My child was in a chubby phase, but came out of it at a completely normal weight.

You and Dean touched on an interesting topic, which is isolatory evaluation practices.  I went in for an evaluation for a potential disc problem.  The symptom he had on his little referral form was altered sensation at the ankle.  He didn't even want to talk about motor symptoms in the same leg!  Tunnel vision.  I remember in school being cautioned to evaluate the whole patient, not just the primary complaint on the referral.  Unfortunately, oftentimes if we treat patients only for their complaint, we are only putting on a bandaid.  We have to see the big picture to really effect a longlasting change.  But I also remember how hard that can be with a high caseload.  Something I think most healthcare professionals could do better at.

Janey Goude October 3, 2011 11:39 PM

We are health professionals with a vast array of knowledge and expertise on the human body. Your observations about the effects of obesity on weight bearing joints is evidence of that. We must start being holistic providers looking at comprehensive assessments and not just a knee or a joint. It is our duty to educate our patients on the risks of obesity (or whatever risk factor they may have) and if we lack the full range of abilities to address the issue, we need to get them to someone who does have that skill set.

Our roles do not begin and end with full range of motion and normal strength, we need to start looking at every aspect of the patient.

Dean Metz October 1, 2011 1:02 PM

Arnold Schwarzenegger, when he was in top form, would be classified with a BMI of 30.2 - obese.  I have a BMI of 35.4 and I am not obese either (look at my facebook pictures).  

Not sure if we want to go around and label children with the BMI when it is not a reliable way to measure for obesity.  

I agree with education on diet and eating habits and I definitely agree therapists should at least mention eating patterns to the patients who want to get stronger and recover faster.  

Jason Marketti October 1, 2011 12:43 PM

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