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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