Most of us have tried to lose weight during our lifetimes. Most of us have succeeded in doing so, only to regain the weight lost, plus a few extra pounds. This conundrum is no different for our patients. The majority of them have perhaps managed to lose hundreds of pounds over the course of their lives—demonstrating that they can be successful in this regard—but invariably fail in keeping off that lost weight over time. In fact, according to the National Institutes of Health, 98% of us who lose weight gain it back within 5 years, and 90% of those regain more than they lost originally.

Alongside this dilemma of fluctuating weight is the challenge of maintaining a healthful condition from an orthopedic standpoint. Most PTs focus their practice on treating people suffering from musculoskeletal issues. As it turns out, a great number of these issues could be avoided, prevented, or more successfully rehabilitated without the added physical burden of 20 or more extra pounds.

As caregivers, it is our responsibility to provide guidance and professional assistance to our clientele with an interest in reclaiming their health. To be sure, managing our weight as individuals can be a vexing problem since, as we get older, our bodies endure physiological changes that complicate such efforts. But our background knowledge and training, and experience as practitioners—as you will learn from the following discussion—positions PTs favorably to really help people make lasting change.

PTS SHOULD BE INTERESTED IN WEIGHT MANAGEMENT

Today, it is common knowledge that two thirds of the adult population in the United States are overweight or obese. Consensus estimates indicate that, based on current trends, 90% of us will meet this description within two generations. The problem is pandemic.

There are reams of evidence indicating the cost to the community at large resultant from these demographics. It has been often estimated that the diseases concomitant with obesity cost the health care system more than $100 billion annually. And that's based on more than 35% obesity rates, plus another 30% who are overweight. When those numbers double over the coming generations, the increase will likely reveal itself as exponential, not linear, revealing annual costs well over $200 billion.

To illustrate that there are also hidden costs, here's an anecdotal story. I recall a specific conversation shared with a hospital administrator over background construction noise, only to have him explain the ruckus: "We are widening doorways and buying larger beds in some of our patient rooms in order to fit larger patients." This phenomenon is not isolated and is unaccounted for in the $100 billion figure cited above. More than 7,500 hospitals nationwide will collectively be spending billions to manage the demands attributable to increases in oversized patients.

Together, US adults spend more than $46 billion annually combating their weight and individually are spending as much as $7,000 or more per year to participate in name brand, food-product-based rituals.¹ However, they are not finding relief from these traditional channels. In fact, independent studies have revealed suboptimal outcomes from self-help or major commercial weight-loss programs.²

With less than stellar results from usual options, an increasing number of people are employing surgical procedures to bypass or reduce stomach size, or both, for weight loss. However, most bariatric surgeons follow the 1991 guidelines set by the National Institutes of Health that candidate patients have a BMI of greater than 40 (roughly 100 pounds overweight for men, 80 pounds for women). This population represents around 5% of the total. Alternatively, candidate patients may suffer a BMI from 35 to 40, plus at least two serious obesity-related health issues such as severe sleep apnea, type 2 diabetes, or heart disease. And many surgeons also require the patient to lose 5% to 15% of their weight prior to surgery.

While these procedures can produce favorable results for some, there are also very real risks associated with this approach. For instance, one study shows a threefold higher rate of mortality for male patients over the age of 55 undergoing gastric bypass surgery compared with younger males.³ It is also expensive. Estimates are from $30,000 to $40,000 for the average procedure, escalating to $70,000 or more depending on complications. Surgery is not the answer for everyone and, despite its increasing popularity, still serves only a small market segment.

The market for weight-management services is very large and is increasing rapidly while demonstrably longing for a tenable solution. Should PTs get involved? Their intellectual assets, capital infrastructure, and desire to employ cash-based business initiatives to regain control over revenue streams suggest they should seriously consider it.

PTS CAN BE PART OF THE SOLUTION

Many PTs would acknowledge an interest in engaging in a new practice area that can help two thirds of the population. That is a market category too large to ignore. However, they would quickly point out that new program efforts capitalize on their time. It takes countless hours in research, orchestration, negotiating vendor relationships, training staff—the list goes on.

Due to these and other complexities associated with starting a new treatment initiative focused on weight management, many PTs might pause prior to jumping in. There is an alternative. Just as you wouldn't design and build your own treadmill and figure out how best to use it in your clinic, or self-instruct and implement ergonomics, lymphedema, or orthotics specialties, there's no point in designing and building your own weight-management program when a solution already exists. Let's consider brief introductions to businesses that are employing a successful approach that is currently available from Smart Metabolism.

IF IT WORKS IN TOPEKA...

Rebound Physical Therapy of Topeka, Kan, has been implementing the Smart Metabolism-based solution in its Smart Exercise Weight Management and Wellness Program for a couple of years and is facilitating highly favorable patient outcomes. While contemplating how best to leverage its skills and resources, it learned that the tool kit provided by Smart Metabolism included device hardware, computer software, and training, along with additional tools to allow for the establishment of what Smart Metabolism refers to as the "metabolic fingerprint" for its patients.

For its program, the metabolic fingerprint is at the center of the wellness baseline determined at patient intake. It is this specific piece of information that sets the program apart as it reveals patient stasis regarding his or her body's capacity and efficiency with burning fuel. Output data also includes a maximum fat-burning heart rate range and a number of other biomarkers that position the team at Rebound to devise treatment plans specific to the individualized physiologies of its patients.

You cannot change what you cannot measure. With these tools employed, Rebound PT is helping people to change their weight and generally improve their health by virtue of having access to hard, scientific data. And the information is generated in real time, making it easier to keep the patient engaged during the intake process.

A major additional benefit of collecting hard data on the patients is that it holds them accountable. The way the program is designed, patients are tested every 3 months, and they know the resulting data is not going to lie about their measured physiological changes: Either they have been compliant, or they have not. No guesswork.

For companies that offer bariatric patient equipment, visit our Online Buyer's Guide.

Patients at Rebound PT and other clinics delivering the Smart Metabolism solution are paying cash for the service before treatment is delivered and are doing so quite willingly. Recall that adults are spending more than $46 billion each year trying to lose weight and that many of them do so incrementally with food-product-based offerings to the tune of $7,000 per year or more. Conversely, enrolling in a program at a professional caregivers clinic that offers supervised, medically managed workouts built around the actual physiological data drawn expressly from the patient represents a high-value proposition.

In fact, Rebound PT reported that, during one recent period when it measured this data, more than 40% of the patients it consulted with about its program enrolled in new services at its clinic and paid cash up front to do so. Testimony from two Rebound PT patients speaks to their perception of value:

Patient A, age 48: "At my 3-month test, I have had outstanding results. I have lowered my blood pressure from 140/92 to 120/70, lowered all my blood lipids, and lowered my blood sugar from 100 to 86. I have more energy, more endurance for activity, and improved strength. I also lowered my body fat to 18.4% and lost 20.8 pounds. I feel wonderful and cannot believe I have achieved such great results in only 3 months."

Patient B: "I had to go to the doctor last week and was down 21 pounds from my last regular check. I have also noticed big differences. For example, tying my shoes is so much easier. I'm not out of breath and completely uncomfortable attempting such an easy task. My eating habits are also much improved, and I am also paying attention to portion sizes and what foods I'm putting in my body. Thanks for the push and encouragement."

With access to good data like a metabolic fingerprint, patients are ready to take action in reclaiming their own health. With guidance and support from medically trained caregivers like PTs, they are bound to find success.

WEIGHT LOSS IS NOT THE WHOLE STORY

Sentiments like these reflect meaningful results. And measurable patient outcomes anticipated for its specific population compelled Siteman Cancer Center at Barnes-Jewish St Peters Hospital to get involved. This nationally recognized cancer treatment facility is affiliated with Washington University School of Medicine in St Louis and elected to add Smart Metabolism's program to its menu of treatment services.

It is extending the argument into the realm of breast cancer since the literature strongly suggests that weight gain after breast cancer leads to increased risk of recurrence. Sharon Lee, manager of the Siteman Cancer Center at Barnes-Jewish St Peters Hospital, offers that, "When we learned about the overlap in Smart Metabolism's offerings and our intentions, it was an easy choice for us."

The below chart aggregates data from patients enrolled at a number of additional clinics and shows what degree of improvements in patient health across a number of biomarkers are enabled by the implementation of this type of program. Clearly, these outcomes reinforce why PTs should engage in this practice area, especially using a predesigned program:

There are simple, known facts regarding weight loss: Create an energy imbalance of 500 kCal per day, and you'll lose about 1 pound per week over a managed period. This is great information if you know how many calories your body actually burns. That's what the Smart Metabolism solution provides: a window to the body's efficiency.

Without a doubt, Daryl Menke, PT, of Rebound PT, explains, "This information is super valuable in helping patients to understand how their body operates and reacts to both exercise and food, calories out and calories in." In devising this program, Rebound PT goes on to describe how Smart Metabolism determined to coalesce the dialogue around obesity into a comprehensive strategy, one that could be readily offered to the community at large and that relies on tested, documented science and the expertise of professional caregivers to deliver.

PTs' intellectual training, background medical knowledge, expertise in exercise physiology, and existing clinic equipment and staff offer a natural fit. Add to that its treating patients at a teachable moment—they come to the clinic post-trauma, seeking rehabilitation. During the PTs' conversations concerning the patients immediate suffering, PTs have every opportunity to open a dialogue regarding the patients' general health.

Invariably, patients are open to discussing their overall health, since physicians are often unavailable to deeply address their concerns. PTs can work together with their patients to devise a treatment plan that keeps them in the clinic longer, offering PTs a greater opportunity for higher revenue and lasting health changes for their clientele. Which encapsulates why many PTs entered this business in the first place: to help people live healthier lives.

REFERENCES

1. Hoffman L, Rose L. Costly Calories. Forbes. January 3, 2006
2. Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss programs in the United States, Ann Intern Med. 2005;142:56–66
3. Livingston EH, Huerta S, Arthur D, Lee S, DeShields S, Heber D. Male gender is a predictor of morbidity and age a predictor of mortality for patients undergoing gastric bypass surgery. Ann Surg. 2002 November. 236:576–582.

Mark Fiebig, cofounder, president, and CEO of Smart Metabolism Inc, Bellevue, Wash, has spent his 22-year career analyzing, starting, and running businesses. Neil Chasan, PT, MMT, is cofounder and vice president of Smart Metabolism Inc. Chasan graduated from the University of Washington in 1982 and is a sports-oriented, manual physical therapist with a private practice in Bellevue, Wash. For more than 4 years, Chasan has had success in his clinic with treating weight-loss patients using the Smart Metabolism tools and methodology. Fiebig can be reached at . Chasan can be reached at . For more information on Smart Metabolism, visit www.smartmetabolism.com.