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Health Maximization Creates New Paradigm
For nearly 30 years, the prevalence of obesity and being overweight has increased sharply for both adults and children. Data from two NHANES surveys show that among adults aged 20-74 years, the prevalence of obesity increased from 15.0% (in the 1976-1980 survey) to 32.9% (in the 2003-2004 survey).
These increasing rates raise major concern because of their implications for Americans’ health. Although one of the national health objectives for the year 2010 is to reduce the prevalence of obesity among adults to less than 15%, current data indicate that the situation is worsening rather than improving.1 In my surgical practice, I realized years ago that many of the disease processes could be prevented for which I was treating patients. I recognized the dire need for obesity-intervention and prevention, a component of healthcare that was missing in Central Florida. In 2005, 60.7 percent of Florida adults were overweight (37.9%) or obese (22.8%). According to a recent study, obesity-related medical expenditures for adults in Florida total more than $3.9 billion, with over half of the costs being financed by Medicare and Medicaid.1 By telling our patients to “eat healthy and exercise,” without further education, assessment or diligent follow-up, we were setting them up for failure. It became abundantly clear to me that the patient and the physician, together, have to take responsibility in finding a solution that works for both parties involved — achieved weight management/health maximization for the patient and improved patient outcomes for the physician. And the primary care physicians can’t address this problem with their patients alone. These physicians have huge workloads and their reimbursements are tight – so it was important to me as a specialist that I partner with them to afford better results for their patients. More than four years ago, I opened the Campisi Health Centers, now a part of Dr. P. Phillips Hospital. At Campisi Health Centers we’ve combined key physiological assessments with a team of affiliate healthcare providers to bring modern obesity intervention and medically based wellness to the community at large. By utilizing assessment results for body composition (measured by the BOD POD®), VO2max, RMR (resting metabolic rate) and RQ (respiratory quotient), we are able to personalize a patient’s plan by the specific assessment for success rather than generalizing it. Although people commonly make reference to being “overweight,” having excess body weight and excess body fat are two completely different things. Only by accurately measuring body composition can one learn the amount of fat and lean tissue that makes up his/her weight. Using the BOD POD® method of measuring body composition provides excellent tracking. The BOD POD® method is based on the same whole-body measurement principal as hydrostatic weighing, but uses patented air-displacement technology instead of water. Testing is highly accurate (less than 2% error rate), non-invasive, suitable for all types of populations and provides a complete analysis in about five minutes. Ideal body fat percentages acceptable for good health over age 18 are 13-20% for men and 23-30% women.2 VO2max is the maximum volume of oxygen that a body can consume during intense, whole-body exercise while breathing air at sea level. This volume is expressed as a rate, either liter per minute (L/min) or milliliters per kg bodyweight per minute (ml/Kg/min). Because oxygen consumption is linearly related to energy expenditure, when we measure oxygen consumption, we are indirectly measuring an individual’s maximal capacity to do work aerobically. When we perform VO2max tests on untrained persons, we often see that they stop at a time point in the test when the VO2max seems to still be on the way up. They just do not have the aerobic capacity in their working muscles and become fatigued locally prior to fully exploiting their cardiovascular capacity. In contrast, when we test athletes, they will usually show a nice flattening of VO2 despite increasing intensity towards the end of the test. The ratio of oxygen consumption (VO2) to carbon dioxide production (VCO2) is called the respiratory quotient (RQ). The range of respiratory coefficients for organisms in metabolic balance usually ranges from 1.0 (representing the value expected for pure carbohydrate oxidation) to ~0.7 (the value expected for pure fat oxidation). A mixed diet of fat and carbohydrates results in an average value between these numbers. By understanding that the largest percentage of fat as fuel is utilized at a RQ of ~0.7, the correlating heart rate during the VO2max test is the level at which aerobic exercise is prescribed. Resting metabolic rate (RMR) measurement is easier than ever by measuring oxygen consumption (VO2) by a means of a 10- to 15-minute breath test. As RMR represents about 75% to 80% of daily caloric needs, it is key in the development/ prescription of an effective nutrition and exercise regimen. Through our Centers’ team approach, we have effectively been able to positively impact many of the lives of our varied clients — from the morbidly obese to elite athletes to the elderly. Through a moderate-aggressive and monitored nutrition and fitness prescription, our patients lose between 1-2 pounds every two weeks. Our patients have full-access to me as supervising physician, along with the Centers’ registered dietitians, exercise physiologists and personal trainers, a medical concierge, a mental health specialist, spiritual advisor and a management group giving support on their journey to health maximization. And, we keep their primary physician up-to-date on all results and patient status.
May 2008 Click here for a PDF of this article Tags:NoneBookmark:
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