The cheapest prescription that’s most beneficial to patients

I see nearly 100 patients a week.  Of these, easily 35% are overweight and 15-20% are obese with a BMI greater than 30.  I live in New Orleans, Louisiana, which along with Mississippi has the highest rate of hypertension, diabetes mellitus, arthritis, and other diseases commonly associated with obesity.  There are many explanations for the obesity academic in America but certainly poor nutrition and lack of exercise are at the top of the list.  As health care providers, we are in a position to promote to our patients healthy life style habits including regular exercise.

When I am providing urology care to a male patient who is obese, I will have the following discussion:

If I could offer you a pill that would increase your muscles, increase your strength, improve the strength of your bones, decrease your cholesterol, decrease your risk of diabetes, lower your blood pressure, decrease blood coagulation and risk of stroke and heart disease, improve coronary blood blow, decrease your risk of prostate and colon cancer, decrease your risk of depression, improve your mood, provide you with more energy, decrease your joint pain, prevent your risk of arthritis, improve your balance, improve your endurance, increase your libido or sex drive and make your penis 1 to 1.5 inches longer, would you take the pill?  Oh, and one more thing, it is approved by your insurance company and the cost is negligible.

Oh, it’s not available as a pill; it’s exercise!

(Of course, this discussion is modified for a female patient and I focus on treatment and prevention of urinary incontinence.)

After the patient acknowledges that he needs to be more physically active, I write him a prescription for 30 minutes of exercise 4 days a week.  I provide him with a list of gyms and clubs to join as well as addresses of parks and recreational facilities in the area.  If he is interested in going on a diet I give him the names and telephone numbers of several credible local nutritionists.  I also note his current weight from his vital signs and ask him to commit to a 10-pound weight loss in 3 to 4 weeks.  He signs the commitment, which is then entered into his electronic medical record.  I have found that constant monitoring is necessary to achieve results. Patients need positive reinforcement and support from their caregivers.

Let us not forget that exercise is the easiest and cheapest medicine available to everyone.

Suggestions for exercise are available to nearly every patient in every community.  They include walking, power walking, running, cycling, rowing, swimming, and elliptical exercise.  I encourage patients to measure exercise in minutes not in distance.

The surgeon general’s report on physical activity concluded that the percent of time Americans spend in physical activity decreased as their age increased.  Lower levels of activity were strongly related to weight gain.  Patient surveys showed that 2/3 of patients would be interested in exercise prescription from their doctor.  Exercise prescriptions in older adults should be of lower intensity, but go beyond minimal recommendations.  Incorporating resistance, flexibility and balancing exercises are very helpful in keeping fitness levels and preventing falls.

Bottom line:  Obesity is healthcare epidemic in the United States.  Physicians are in a unique position to promote weight loss and a healthy life style for our patients.  For the most part we can do more than we have done in the past.

Neil Baum is a urologist at Touro Infirmary, New Orleans, LA, and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MDor on Facebook and Twitter.

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  • Patient Kit

    You would think this would fall into the realm of stuff everybody already knows — exercise good; healthy weight good. But I just read recently that most obese and overweight kids don’t even realize that they are obese or overweight — 81% of obese/overweight boys and 71% of obese/overweight girls think they are about the right weight. That’s pretty mind-blowing when I think about how it was for overweight kids when I was growing up. I’m not advocating meanness, but kids knew they were overweight.

    That said, whenever I tell a new doc that I swim laps 5x a week (often a mile), they rarely pat me on the head and praise me. ;-) My exercise routine mostly seems to be outside doctors’ radar of interests.

    • SarahJ89

      My doctor, any doctor, over the years has displayed a stunning lack of interest in the ups and downs of my weight. I have no idea why they bother to weigh me. It seems so knee jerk. At one point I lost 70 pounds and kept it off for years. Prior to that I gained that 70 in a year and a half. Neither situation was noticed or commented upon. Which is fine, since I feel I’m responsible for my weight. But puzzling, given the near obsession with weight in our culture and in reading medically oriented articles written by and about medical professionals.

      I totally agree with the author. Exercise is the berries. I’m currently lamenting the onset of autumn because it means the end of swimming where I live. Pools are few and far between, plus.. they’re pools.

    • Lisa

      My experience is a bit different than yours; my doctors encourage me to exercise. My oncologist says it is the second most important thing I can do to prevent a recurrence and my orthopedic surgeon also encourages me to exercise. He also reminds me, every time he sees me, that weighing less is easier on the joints – real and artificial. My pcp knows I like to hike and encouraged me to get my second hip replacement sooner rather than later, when I told him that I was finding hiking difficult.

    • querywoman

      When I tell most of my docs that, after my first pneumonia, that I got a daily asthma inhaler and use it, and now can walk a half mile to a mile for errands at least 3 times a week instead of using the bus, they are quite pleased.
      The most important thing to me is that it’s what I like to do. I can do it on my time and not have to wait for a bus.

    • guest

      My internist and GYN both nag me, in quite a judgmental way, to exercise more (I probably get vigorous exercise about twice a week, which I think is a lot for a physician who is a single mom to three kids). On the other hand, when my weight dropped to 98 pounds one year as a result of some very significant stress, no one said a word or expressed even a little bit of concern. I agree with Sarah that I wonder why they bother to weigh us.

  • Becky

    Exactly where do you find the time to have this discussion? How long is a typical appointment?

  • Suzi Q 38

    One doctor (I don’t remember which one) said that a lot of her visits with patients did not require a physician with an MD.

    They are overweight, so they need to talk to a dietitian.
    A dietitian would be more useful.

  • querywoman

    Exercise is cheap and excellent. I’ve done yoga, which can be simplified down for anyone. There at least used to be a man teaching yoga in California, Charles Van Dyke, who was over 600 lbs.
    But most people cannot follow a diet!

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