Serving the Underserved

obesityOf all the health care problems endemic to the U.S., possibly none is more serious than the current obesity crisis. Nationwide, more than 93 million individuals are estimated to be obese, and the epidemic is predicted to expand by approximately 30 percent within the next half-decade.

Despite the various threats posed by these emerging trends, many experts and critics observe that this population has largely been ignored, both by

mainstream medicine and by the chiropractic community. And Minnesota-based D.C. Marcia Krueger can be counted among the growing group of health care professionals voicing this perspective.

“These patients continue to be misunderstood and underserved, and very few of my colleagues pursue patients who are obese,” says Krueger, who often works with obese people. “As chiropractors, we should promote health, wellness, balance and an active lifestyle, regardless of a person’s size.”

Where’s the Compassion?

As an active member of the Obesity Action Coalition (OAC)—an organization dedicated to empowering those affected by obesity through education, advocacy and support at national and state levels—Krueger has made it her mission to educate, support and advise her patients about the challenges of being obese. However, she says, these efforts are hampered by the bias, stigma and even outright discrimination experienced by obese patients.

“In fact, negative perceptions of the obese exist throughout all aspects of our daily life,” says Krueger. “There’s weight bias and stigma in employment, in school and even in health care settings.”

In particular, she says her obese patients often report negative attitudes about their weight from physicians, nurses, mental health professionals and dietitians; not to mention that some have described embarrassing situations involving inappropriately sized medical equipment, gowns and exam tables. “This makes these individuals reluctant to seek the preventive care and services they may need,” Krueger adds.

As a point of reference, she recalls a patient who went to visit her family’s OB/GYN to see what other factors may be contributing to weight gain. After trying all of the weight-loss tricks like eating better food, eating less, moving more, drinking more water, etc., this patient was still struggling to lose weight.

“The doctor, as my patient described, assumed she was totally noncompliant, despite the story of her weight-loss efforts,” she says. “He assumed her weight plateau and inability to lose weight were because she wasn’t trying and told her that she needed to be working out and burning a surplus of 1,500 calories a day by biking and running. The most frustrating piece was that there were no suggestions for increased activity that fell somewhere between the perceived sitting around laziness and 1,500-calorie-burning runs.”

Confronting the Stigma

Clearly then, many people might argue that addressing the current U.S. obesity epidemic surpasses simply educating patients about weight management practices. Instead, Krueger suggests, a more comprehensive approach would involve directly confronting stigmas like the ones her patients have encountered.

“As DCs, I believe it’s absolutely within our realm of care to provide situation-appropriate solutions when discussing increased movement and exercise,” she says. “In the case of a 500-lb. patient, his medical doctors told him to simply ‘get [his] tennis shoes on and start walking,’ but neglected to clarify distance, length of time or how many days a week. They also didn’t take into account the pain he’d experience from fractures in his fifth metatarsals because of the excess weight.”

The definition of “increased movement” for this patient, Krueger suggests, could mean taking the stairs instead of the elevator or parking his vehicle at the end of the parking lot. “For a doctor, it would have been extremely inappropriate to suggest that he start a running regiment or lift weights at the gym,” she adds.

Rather, Krueger believes health care professionals should discuss what types of shoes to wear and which types of clothing will prevent chafing and blisters. “The overall goal of including the patient in an exercise plan is to address the areas in which the patient can make small choices to move more each day,” she says, “and this ultimately leads to more compliance and better results.”

A Unique Advantage

Experts like Michael Failla, a DC who’s written extensively on the subject, seem to agree with this point. In his work, Failla has suggested that such an approach could help achieve a wider recognition that factors such as age, gender, genetics, environment, physical activity, psychology, illness and medication can all play pivotal roles in causing a person to become obese. “While the obesity epidemic does affect millions of Americans,” he says, “there’s no easy ‘one-size-fits-all’ solution.”

Regardless of the cause, other obesity-related health issues—like diabetes and heart disease—can subsequently develop and become a threat to a patient’s overall well-being. As more and more obese patients seek relief from their pain and turn to Chiropractic, though, DCs will have more opportunities than most health care professionals to assist these people.

“When it comes to helping patients with their long-term weight-loss solutions, chiropractors have a unique advantage: we often see patients on a routine basis, anywhere from a few times per month up to a few times per week in some cases,” Failla says. “Due to the nature of these appointments, chiropractors have a great opportunity to meet with their patients on a regular basis to track their individual weight-loss and exercise programs.”

Because of this increased contact with their patients, Failla observes, chiropractors can track changes in their patients’ physical activity. This relationship also gives them increased leverage in making necessary adjustments to specific weight-loss agendas, along with more opportunities to address concerns and offer encouragement.

Addressing the Epidemic

Across the nation, an increasing number of DCs are beginning to diversify their practices by integrating additional services into the wellness programs they offer patients. And, Failla says, this isn’t being done merely for arbitrary reasons.

“When you consider that 8 percent of the U.S. adult population seeks out chiropractic care in any given year, while 63 percent of the population is seeking a weight-loss solution,” he explains, “it becomes clear that the opportunity to help more patients by addressing weight loss is considerable.”

Many practices, for instance, have begun holding yoga and Pilates classes for improving flexibility and promoting fitness for patients. “These are just a few of the ways that chiropractors are diversifying their services as they help their patients overcome their battle with obesity,” he adds.

According to Krueger, specialized equipment can help as well. Different tables, for instance, can be used to better support obese patients. “I’d suggest a bench table,” she says. “These tables are typically wider and more stable (check for weight limitations) to support a person of large size. Because of past experiences, some of my patients have a fear of falling off (or breaking) my adjustment table. With reassurance that my table will support them, adjusting becomes easier.”

By contrast, Krueger says, mechanical (HyLo) tables aren’t a good choice for obese patients. She attributes this to the fact that these tables are very narrow and—while they may be able to lower the patient into a horizontal state—HyLo tables might not be able to return the patient to a standing position.

“Drop tables may be easier for the doctor to use,” she explains, “but I haven’t found one capable of supporting individual segments of the pelvis, lumbar and thoracic areas of a patient weighing more than 350 pounds. It’s also important to be aware of the possibility of pinching excess fat between the drop pieces.”

She says DCs should also be aware that an obese patient’s physical limitations (such as inability to bend at the waist or knee) might make side posture adjusting difficult. Adaptations in positioning and line of drive may be necessary to deliver an adjustment to these patients.

Changing the Future

Overall, it appears DCs are faced with an excellent opportunity to help this widely stigmatized and ignored population of patients gain relief from the pain of being overweight; and, indeed, perhaps to help them overcome obesity entirely.

For his own part, Failla believes DCs should make an effort to become involved with other health professionals, government officials and health-and-wellness businesses (perhaps through groups such as the aforementioned OAC). The resulting unity, he feels, would only strengthen the impact that can be made upon this problem.

And by virtue of her work with the OAC, Krueger seems to agree. “I became a chiropractor because I have a passion for helping people feel more comfortable in their bodies and hurt less at whatever age, shape or size,” she says. “My approach to [caring for] the obese population is a bit more complex, but this special population gets the same individual attention as all of my patients.”

As the U.S. obesity epidemic continues to grow, DCs are increasingly finding they must be prepared to approach this population not only with an understanding attitude, but also with comprehensive information about weight loss, behavior modification and wellness strategies. “We have the expertise to educate, provide healthcare and be advocates,” Krueger explains. “We can change the future of the obesity epidemic.”