How to use weight management to tip the scale in your favor

It’s a fact: Americans are fat, and getting fatter. If you have any doubts, consider data gathered through the Centers for Disease Control and Prevention’s (CDC) annual Behavioral Risk Factor Surveillance System (BRFSS):

• In 1990, among states participating in the BRFSS, 10 states had a prevalence of obesity less than 10 percent, and no states had a prevalence equal to or greater than 15 percent.

• By 1998, no state had a prevalence less than 10 percent, seven states had a prevalence of obesity between 20 percent and 24 percent, and no state had a prevalence equal to or greater than 25 percent.

• In 2006, only four states had a prevalence of obesity less than 20 percent, while 22 states had a prevalence equal to or greater than 25 percent, and two of these states — Mississippi and West Virginia — had a prevalence of obesity equal to or greater than 30 percent.

Weight management is a growing problem and Americans themselves realize this — which is why they spend $55 billion a year on dieting programs, according to Marketdata Enterprises (www.marketdataconsulting.com), an independent market-research publisher. The company’s analysts project a 6 percent average annual growth for the total U.S. weight-loss market to $68.7 billion by 2010. That’s a lot of money to get rid of excess pounds.

It is well known that being overweight is a health risk that can lead to diabetes, heart disease, and obstructive sleep apnea. While these conditions concern chiropractors, obesity hits even closer to home when it comes to their ability to help patients with musculoskeletal problems.

Chiropractic Economics talked with several practitioners who provide successful weight-management programs, as well as providers of weight-management systems. (See sidebar, “Meet our experts.”) They discussed a number of different issues concerning chiropractic and weight management.

OBESITY, PAIN, AND CHIROPRACTIC

Pain and obesity are linked, says Beth L. Speckman, DC, of ProActive Wellness Center. “A patient’s weight and size affect the adjustment and recovery,” she says. “Often the low-back, knee, and other pain are caused by the weight of the patient. If the patient could lose 20 pounds or more, the pain would probably go away.”

Weight affects the body’s ability to hold an adjustment, says Jeffrey A. Cartwright, DC, a practicing chiropractor and president of NovoLife LLC. He observes, “Weight is a huge hurdle to cross when adjusting a patient. Today, the average spine and corresponding muscles are marbled with fat, and I believe this is why we have to adjust more frequently.”Obesity also affects the practitioner’s ability to adjust well, says John Lefand Jr., DC, of Satilla Spine Center. “A patient’s weight can affect the techniques used, patient outcomes, and the patient’s ability to complete active rehabilitation.”

CHIROPRACTIC’S ROLE

The experts all agree that chiropractic can — and should — take a lead in weight management.

At a basic level, chiropractors can lessen the patient’s pain so exercise is possible, says John H. Maher, DCCN, of BioPharma Scientific. “They can also screen for underlying metabolic and cardiovascular disorders, advise dietary changes, or offer a referral if they don’t have a nutrition background,” he adds.

“As a natural healthcare provider, DCs are well positioned to be community experts on wellness and be able to address much more than just back pain,” says Mary Beth Larsen, DC, of Standard Process. “The average person doesn’t know how to eat well, and most need help finding an appropriate exercise program.

“Our role should be to outline a healthy, primarily whole-food diet, an appropriate exercise program, lifestyle modifications for stress management, and supplements to support the body’s systems that may be depleted. We can be the experts!”

Cartwright adds, “If we claim to be holistic practitioners, then we should address the whole body. In fact, I would like us to claim wellness by claiming ourselves as ‘whole-istic’ practitioners. We should address toxins and thoughts.”

Speckman proposes that DCs be educators and problem solvers. “We should be honest with patients and educate them on the effect of their weight on the body. But, in addition to pointing out the problem, we need to offer them a solution, too.”

GETTING STARTED

Honesty is one thing; getting people to manage their weight is another. Where do you start?

All of the experts say the starting point is with the patient. But, unfortunately, not all patients are ready. “It’s not about identifying patients who would benefit, because a large percentage would,” says James Bogash, DC, of Life Care Chiropractic. “Rather, it’s about who is ready to make the lifestyle changes needed.”
For patients who are ready, the experts all agree the best starting place is a comprehensive evaluation to measure overall health. This gives a baseline against which to form health goals and measure progress.

“This evaluation should include weight, body-fat measurement, and resting metabolic rate, if available,” says Larsen. “Organ systems need to be evaluated, including digestion, elimination, endocrine, and cardiovascular functions. Likewise, liver function and toxicity levels need to be assessed in order to determine if there is a need for a purification program — which is almost always the case in today’s world.”

Cartwright agrees about purification. He says, “Maybe we should change the label ‘weight management’ to ‘toxin management.’ One of the body’s best defenses for toxins comes from buffering them with fat and water. Weight management needs to address these toxins in two ways — where the toxins come from and how we
can rid ourselves of them. Cleansing is the best way.”

Speckman also starts her overweight patients with a good evaluation, then a cleansing program. “The body’s organs and digestion need to be reset,” she says. “And the patient has to get out of the carb-addiction cycle.”
Bogash, who conducts weight-management classes instead of individual counseling, addresses detoxification at a later point with his patients. He says, “There is no point detoxing someone who has poor lifestyle habits.

Our last class covers detoxification. By that point, participants are much better aware of other factors. And proper lifestyle changes automatically improve liver and gut function.”

WHAT ABOUT A PROGRAM?

One reason the weight-management industry is so lucrative is because people “yo-yo” diet. Dieting, in the vernacular used by lay people — cutting calories — doesn’t work.

“People focus on cutting calories,” says nutritionist Shari Lieberman, PhD. “They often cut their calorie intake in half. This causes a great deal of muscle loss rather than fat, although some fat is lost. And it can slow the metabolism by 10 percent. When they go off the diet, they gain the weight back as body fat, and may even add 5 percent more.”

Instead of focusing solely on calorie-cutting, the experts say patients should have a solid weight-management program that focuses on lifestyle change and nutrition-dense foods. As Lieberman puts it: Cleanse your mind and body, control the food you eat, take appropriate supplements, and exercise.

“A program must include either nutrition, lifestyle change, or exercise,” says Larsen. “Ideally, it would be a combination of all three. For many people to make such drastic change, it’s too difficult and they quit. Some can make drastic changes immediately; others can be encouraged to cut down on soda and alcohol, then cut out any white flour and white sugar products.”

“A weight-management program should include evaluation, cleansing (at least the liver), developing an individualized eating plan, and an individualized exercise schedule,” advises Speckman.

Education is key, says Cartwright. “You need to educate patients on nutrient-dense foods. This is most effectively done in a class setting, such as an in-office workshop. This is also a perfect time to ask them to bring guests who care about their health to form a support group.”

Part of the education process, recommends Lieberman, should focus on low-glycemic foods. According to Lieberman, high-glycemic foods are those that raise glucose and insulin levels too quickly. Not all carbo­hydrates are bad, she emphasizes. “When you consume high-glycemic-index foods, you throw a metabolic switch that signals the body to store body fat. This has nothing to do with calories. A rapid rise in blood sugar, followed by a rapid rise in insulin, are the culprits. This event also causes inflammation, high-blood lipids, and a host of other health issues.”
Whatever program you advise, however, needs to be simple. “All suggestions and alternatives need to be easy to comply with,” says Maher.

ADDING MISSING NUTRIENTS

Depending upon the program you recommend to your patients, you may want to include supplements. Some supplements, in fact, may help with weight loss, such as gymnema to help suppress sugar cravings, says Larsen. “Also, a purification program that includes nutrient-dense whole-food shakes and supplemental food and herb products to support detox­ification may also be beneficial in helping a patient lose weight initially.”

Bogash does not advocate supplements that supposedly speed up weight loss. “Many are only minimally effective,” he says. “Some meal replacements may speed up the initial process, but the process of wellness does not mean taking these for life. That aside, the basics — multivitamins and essential fatty acids, for instance — should be part of the program.”

Cartwright recommends using supplementation as an insurance policy. “Supplements should never be used to replace a nutrient-dense diet. We should use them as agents that can assist the body in ridding toxins. They are also necessary to help people get their systems working better. I like the adage, ‘Let your food be your medicine, and your medicine be your food.’”

FINAL ADVICE

The experts we talked with work successfully in weight management. Here is what they advise to those who would like to enlarge their practices to help lead patients to a healthier lifestyle:

• Speckman: “Try it on yourself first. You have to be your own best testimony.”

• Lefand: “Provide products you use. Encourage your staff to get involved and take advantage of all the programs offered. That helps with patient support, not just from the doctor, but from the trusted staff.”

• Larsen: “People need to hear this type of advice from health and wellness experts, and DCs need to be those experts.”

• Bogash: “Discussing lifestyle issues with patients takes a strong background and extra time. In a busy practice, doing this one-on-one may not be possible. I’ve found teaching a class in a group setting can be very cost-effective.”

• Cartwright: “Obesity is a symptom, and symptoms need to be corrected, not masked. Patients want to lose weight. They want answers and information. They want their health. Take advantage of the current health trend. Get a good understanding of cleanses, and use them. Walk the talk, and lead by example.”

Linda Segall is editor-in-chief of Chiropractic Economics. She can be reached at lsegall@chiroeco.com.

-When patients have weight-management questions, be prepared to answer them. Go to “Why can’t I lose weight? How to answer your patients’ dieting questions” at www.ChiroEco.com/answers.

-Calculate BMI. Go to www.ChiroEco.com/bmicalculator.

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