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PT and the Greater Good

The Obesity Fight

Published March 12, 2013 11:44 AM by Dean Metz
By now, many people have heard about New York City Mayor Michael Bloomberg's attempt to combat obesity by limiting the size of soft drinks containing sugar. There has been both an aggressive ad campaign and a new ban on beverages over 16 ounces. He has quite a few professional voices backing these decisions. Today, though, a state Supreme Court judge overturned this new law, saying the mayor reached beyond his authority in an "arbitrary and capricious" way.  

Obesity is a growing problem in developed western nations. It also has huge potential financial implications on healthcare as the incidence of diabetes skyrockets. This is not to mention the probable growth of osteoarthritis and cardiac disease from being overweight. People will argue that it's their choice and their right to get fat from soda should they choose to. Well, that impacts Medicare and Medicaid utilization, as well as rising premiums for private insurance. Do people really have the right to increase others' costs for their own selfish behavior?

Wellness and prevention of arthritis, cardiac disease and diabetes can certainly fall under the scope of physical therapy patient education. What should the professional role be in this situation? Do you educate overweight patients, regardless of presentation, on the risks of being overweight or the options available in food choices?

This public health issue isn't going away anytime soon. Should government take steps like those Mr. Bloomberg has attempted to protect the entire public from those who make poor choices, or do we allow a level of personal freedom that could eventually impact all of our health costs?

What about the impact on the factory workers, distributors, shop keepers, advertising agencies and bottlers if these bans go into place? Will this action to protect the population actually hurt the economy and localities that depend on producing soda to make a living?

Nanny state or anarchy, we seem to be the ones paying in the end.

7 comments

Umm -  please forgive my typos, I'm better at writing than typing.  Guess I'll head back to DRF . . .

M.L. Black April 11, 2013 10:06 PM

It almost seems the obesity epidemic in North America is deliberate.  Example:  Why is HFCS legal (in the USA of course, not other countries?0  And included in diets for diabetics IN THE HOSPITAL SETTING?  

There is a book titled "Good Calories, Bad Calories" by Gary Taubes that researches nutritional research itself.  Makes it hard for me to fault all but the obviously excessive trash-food adherents.  I want to cry sometimes when I hear an overweight person who I KNOW is trying, and who I KNOW is religiously counting caloriers and omitting fats, and yet is constantly hungry and not losing weight . . . the disbelieving, depressed, bewildered tone . . . and the person is doing everything EXACTLY as told.  

Monsanto, et al should fund the Obesity Centers located around the USA, but I doubt that any incentives to healthy living will ever be profitible to those who matter.

M.L., P.T. April 11, 2013 9:59 PM
AL

Rosemary, Wow! What a difficult system to have to work within! You are between the proverbial rock and hard place. The only option you have seems to be to refer to other licensed providers who have this within their scope of practice.

Why don't people go after the unlicensed providers? How can one impact upon those people if they have no license? Literally they have nothing to loose.

Once again our fragmented health 'system' seems to protect the interests of provider groups rather than the consumers/patients. Thanks for your story.

Dean Metz April 1, 2013 11:55 AM

I live in North Carolina. I am a PT who also has additional education in bodywork and nutrition. My original goal in getting this additional education was to have a wellness practice, educating folks about their bio-terrain and how important it is to work from the spiritual and cellular level out. Currently, in NC, someone has added a specific clause to the PT practice act that specifically prohibits PTs from educating about nutrition. We have an extremely aggressive RD/MD/RN faction who have aggressively gone after people for 'illegally teaching nutrition' and 'practicing medicine without a license. Chiropractors so far have gotten around this. I have a lot of wisdom, but am legally prevented from sharing it. What's ironic is that there are plenty of unlicensed people selling 'nutrition' and no one seems to be going after them. Aside from going back to school to 'learn' from a system that doesn't work, ie promoting the SAD (Standard American Diet), and promoting a pyramid fabricated by the beef, dairy, and grain industries, what else can I do?

Rosemary Lucas, PT April 1, 2013 8:56 AM
Charlotte NC

Dean,

Good topic for discussion. I have to admit, unlike your other posts, this is one time I haven't taken the time to follow the links, so forgive me if I hit on something in my diatribe that's already covered in a link.

This is one issue where achieving best practice seems elusive.

No, those who care for themselves shouldn't be punished for the poor choices of others. Yet, policing personal choices is a slippery slope. America was founded on freedom. If freedom ceases to exist, so does America.

It seems there has to be a better way of attacking this than micromanaging America's dietary choices. But for those who want to go that route, removing the Big Gulp is really like kicking a 200 year old oak tree and expecting it to fall down. Laughable. Let's get out the chain saw. The truth is, if fast food restaurants weren't in existence, many of our modern day food ills would disappear. So, if we're really concerned with American's health, let's close all of the fast food restaurants, starting with McDonald's.

Jason makes two excellent points. First, a portion of our coronary health is genetic. Examples of this are everywhere. The picture of health keels over dead from heart failure. A morbidly obese person is the picture of coronary health. Both are senseless. But it happens. So, if we choose to alter our health plans and provide a sliding scale coverage/premium based on our health care choices, as has been discussed in previous posts on this site, the fact that health care has a significant genetic component means that no matter what decision you make, someone can cry foul play. Someone on one end of the court or the other will be treated unfairly. That is unavoidable. Whatever decision we make, that will have to be an acceptable casualty.

Second, those who are underweight represent a growing health concern. I guess to be fair, that one is a bit tougher. I mean, how do we legislate making someone eat more or keep down what they eat? Now THAT would be ridiculous, right?

What about the impact of alcoholism and tobacco use? If the idea is to minimize the impact on others' costs, then shouldn't we be looking at all of the big players? I don't see anyone trying to remove alcohol or tobacco from the shelves. I'm still trying to figure out how addictive drugs with no medicinal value are still legal, but marijuana is such an issue - or opiates for that matter.

Yes, I realize I'm teetering on the edge here. But that's sorta the whole point, isn't it?

Janey Goude March 22, 2013 12:27 AM
Lexington SC

An interesting editorial on the subject. The responses to it are even more interesting!

http://opinionator.blogs.nytimes.com/2013/03/19/banning-the-big-gulp-ban/?ref=opinion

Dean Metz March 20, 2013 12:58 PM

Dean,

Great topic

Glad you mentioned those who may be out of a job when and if a ban goes into effect.  It is those families that will be impacted by a ban the most.   I would agree that some products are not the best for people but if I refill my 16 oz soda five times the point of banning large sodas is moot.  

Measuring obesity is difficult, according to the BMI I am overweight (I like to think its mostly muscle) so should I not lift my weights to drop pounds because according to a chart I am overweight?  Are we profiling patients by size to determine their weight? Then there are those who are at their "ideal weight" and they die of heart attacks just as easily as those that are overweight.  Sometimes genetics can be a major factor in a persons health.

How often are PT's educating patients that are underweight? This can be unhealthy as well.    

Jason Marketti March 16, 2013 7:23 PM

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    Dean Metz
    Occupation: Staff Development Specialist
    Setting: New York, NY – Newcastle Upon Tyne, Great Britain
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