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Dynamic Chiropractic Canada – March 1, 2009, Vol. 02, Issue 02
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Integrating a Weight-Loss Program Into Chiropractic Practice

By Jasper Sidhu, BSc, DC

As the obesity rate continues to increase, more and more patients are showing up at chiropractic offices with medically associated conditions relating to obesity. It's no wonder the weight-loss market is approaching $58 billion. The chiropractic profession is probably one of the best equipped to handle weight-loss counselling and treatment. We need to be positioned at the forefront of obesity management; that means understanding how to integrate a weight-loss program into your practice.

Chiropractors are in a unique position to provide weight management recommendations and counseling, considering that studies have consistently shown that regular contact with a health care provider leads to greater and more successful long-term weight loss. Chiropractors have always emphasized regular contact with patients to not only treat physical problems, but also to develop a long-term relationship emphasizing wellness care.

Most of the obese and overweight patients who will show up at your office will be seeking advice on weight loss. It's important to have the right tools in place to help them achieve their goals. In fact, 49 percent of the obese population and 24 percent of the overweight population have discussed weight loss with their physicians.1 The traditional medical profession has been limited in its ability to provide effective weight loss, although patients could benefit tremendously from the interaction.2 Unfortunately, only 22 percent receive positive advice.3 In fact, 50 percent of obese women say their physician has not recommended any of the 10 most common weight-loss methods.4 At the end of the day, the potential for chiropractors to reach out to their patients with weight issues is huge.

For any chiropractor hoping to establish a weight-loss program for their patients, keep in mind that we are constantly bombarded with a wide variety of programs to choose from, and the same is true for our patients. The type of weight-loss program you choose to integrate within your practice will be dependent mostly on your style of practice. For busy doctors who may not be able to provide adequate counselling, there's the option of working with a nutritionist. If this is not feasible, you may want to look for programs that offer meal planning and educational modules. This allows the patient to work through the programs on their own.

However, be careful in leaving everything to a self-run program. Having regular contact with your patient regarding their weight loss is critical to the success of any program. In one study, patients who were in programs that continued to provide biweekly meetings throughout the year maintained weight loss of 29.9 lbs, whereas those who had no further contact after six months only retained a weight loss of 9.9 lbs.5 Regular contact with you is critical for your patient's success.

Nutrition

Nutritional recommendations can involve a variety of approaches. Again, finding the right one to fit your style of practice and your patients' lifestyle is critical. Most doctors who have wellness centres may opt to work with programs that involve detox and cleansing; some doctors work in multidisciplinary settings and may also work with nutritionists or dieticians. Others may find that their patient population lacks time and providing a program that is convenient is a major factor for success. Hence, these types of patients may benefit from meal replacement shakes or prepackaged meals with established caloric values. There is significant research out there that shows the success of meal replacement shakes. Remember, any weight-loss program can be effective. It's a matter of connecting the right type to the right person.

Exercise

Exercise is one of the most confusing and frustrating aspects of weight loss. The type of exercise recommended by you will depend on factors such as the patient's fitness level, motivation, willingness to make time for exercise, and the presence of medically associated conditions such as arthritis and fibromyalgia. Although studies have shown that exercise alone does not produce the magnitude of weight loss similar to dietary modification,6 it happens to be one of the best predictors of long-term weight maintenance.7

In your practice, you can progress from simple exercise programs to comprehensive programs that utilize your rehabilitation space, if available. You can develop your own walking program or look for walking programs that are already established. Setting up a walking club for your patients is an effective way to increase group involvement and attract more patients. If you have the equipment available, you can convert your rehabilitation space into a fitness-oriented area and recruit personal trainers to help your patients.

Considering that you are already seeing at least some patients who have health conditions related to their obesity, developing an in-house exercise program can create a win-win situation for everyone. If you do not have adequate space available, vibration exercise therapy is rapidly gaining attention in this field. It is a strength-training exercise that can be done within 15 minutes and places minimal stress on joints. In fact, it can be utilized as a rehabilitation tool in addition to a fitness tool to maintain lean muscle mass. Whatever your choice, it's important to integrate exercise into a weight-loss program to ensure long-term success.

Counselling

As I have stressed, regular contact with your patients is critical for success. However, this doesn't necessarily mean you need to spend considerable time and effort in providing the appropriate counselling. In fact, most of the counselling and weight-loss strategies can be implemented within 10 minutes during an office visit. By combining a daily food diary and asking the patient to write down any issues they have had since their previous visit, it is easy to establish goals and strategies whenever you see the patient.

Setting goals keeps the patient focused. For those who may not have time to do this, setting up group sessions may be more practical. Once you start building up your practice, you can also utilize the services of a nutritionist or dietician. If counselling is not something you are able to provide, outsourcing this to community support groups may be an option. This can also lead to cross-referrals.

Weight loss is rapidly becoming an integral component of a chiropractic office. Before you decide to go with any program, assess how that program will fit within your practice, and especially within your patient population. Conduct a focus group survey first to assess the demand for weight-loss services. Talk to various community support groups to seek cross-referrals. Once you establish these components, your patient population will be in a better position to benefit from your continued contact and support.

References

  1. Potter MB, Vu JD, Croughan-Minihane M. Weight management: what patients want from their primary care physicians. J Fam Pract (United States), June 2001;50(6):513-8.
  2. Huang J, Yu H, Marin E, et al. Physicians' weight loss counseling in two public hospital primary care clinics.Acad Med (United States), February 2004;79(2):156-61.
  3. Evans E. Why should obesity be managed? The obese individual's perspective.Int J Obes Relat Metab Disord (England), May 1999;23(4):S3-5, discussion S6.
  4. Wadden TA, Anderson DA, Foster GD, et al. Obese women's perceptions of their physicians' weight management attitudes and practices.Arch Fam Med (United States), September-October 2000;9(9):854-60.
  5. Perri MG, McAllister DA, Gange JJ, Jordan RC, McAdoo G, Nezu AM. Effects of four maintenance programs on the long-term management of obesity. J Consult Clin Psychol, 1988;56:529-34.
  6. National Heart, Lung and Blood Institute, 2000.
  7. Pronk NP, Wing RR. Physical activity and long-term maintenance of weight loss. Obese Res, 1994;2:587-99.

Click here for more information about Jasper Sidhu, BSc, DC.

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