The Obesity Epidemic and Physical Therapy Practice
Health care costs will unquestionably increase during the next 30 years, as a result of baby boomers “coming of age” and accessing Medicare benefits. The economic and social impact of the future growth of US health care expenditures for the elderly will be significant. Obesity will impact costs since an obese 65-year-old individual entering the Medicare program requires immediate and higher health-care expenditures than normal-weight individuals.
An obese 45-year old person surviving to age 65 has significantly higher average lifetime Medicare costs of $163,000 compared to $117,000 for a normal-weight 45-year-old surviving to age 65. Additionally, as obesity and resulting health effects occur in younger individuals, costs to the healthcare system will be earlier and for longer than in past years when obesity developed at older ages. The reality of these costs are substantiated by recent estimates of national healthcare expenditures for children related to obesity: $14.1 billion in additional prescription drug, emergency room, and outpatient costs annually.
Many obesity-related chronic diseases affect the health-related quality of life of obese individuals. When obese individuals are assessed using the health assessment short form (SF-36), they typically exhibit low scores on the physical aspects of assessment involving functioning. Physical functioning is most commonly affected by orthopedic problems that impede joint mobility and interfere with gait and other activities of daily living (such as climbing steps, lifting groceries, and getting into and out of the bathtub). Researchers have found a positive association with the body mass index (BMI) and knee osteoarthritis (OA); specifically knee, hip, and back pain. A study comparing obese/non-obese individuals demonstrated a 13-fold increase in the incidence of knee osteoarthritis (OA) among the heaviest subjects. Studies have also demonstrated that hip-joint replacement at younger ages is positively associated with body weight and hip contact stress.
In contrast, research shows that obese individuals who lose a modest amount of weight (0 to 9.9% weight loss) have improved SF-36 scores in the area of psychosocial functioning, physical functioning, and general health at 2 years, demonstrating a dose response improvement with increasing weight loss. Other research describes overweight people with radiological evidence of knee (OA) who, upon losing 10 to 12 pounds on average, reported a 30% improvement in knee pain and experienced 24% improvement in their ability to perform daily activities; including the ability to walk upstairs more quickly and easily than those subjects who did not lose weight.
Physical therapists are in a position in which they can positively impact the obesity epidemic. The American Physical Therapy Association (APTA) recognizes that physical therapists are uniquely qualified to assume leadership positions in efforts to prevent injury and disability, and fully supports the positive roles that physical therapists and physical therapist assistants play in the promotion of healthy lifestyles, wellness, and injury prevention. APTA holds as ethically binding the principle that PTs “shall endeavor to address the health needs of society.” The APTA envisions that by 2020 consumers “will have direct access to physical therapists in all environments for patient/client management, prevention, and wellness services.” These statements made by the APTA leaves no other option but for physical therapists to assume an active role integrating all aspects of disease prevention, health promotion and wellness into practice.
Future articles will be designed to demonstrate how physical therapists can effectively integrate health promotion and wellness into their practice.