Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Obesity and the Healthcare Professions: Cooperation or Assimilation?

Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Obesity and the Healthcare Professions: Cooperation or Assimilation?

Article excerpt

Abstract

Obesity is an epidemic in developed countries. Its ramifications range from cardiovascular disease to cancer to musculo-skeletal disorders. The causes of obesity are not solely biological, as the brief time frame toward the current epidemic has been insufficient to allow for adequate alterations in the gene pool. It has been estimated that variation in body fat is approximately 25% genetic (Bouchard 1998), with 45% of the remaining variance explained by lifestyle factors. Additionally, in the United States, an ageing population of "baby boomers" will compound the need for chronic disease prevention and treatment. No single health discipline/profession can solve the growing obesity-chronic disease problem. Thus, there is a need for "intellectual civility" (Boone 2002) among the individuals and the governing bodies of central paramedical professions such as nutrition, exercise physiology and physical therapy. Unfortunately, overlapping scopes of practice can lead to legal contests and an expanding number of certifications that could leave the increasingly at-risk overweight public with inferior care when evidence-based interventions and standardized referral are needed. This presentation will address examples of scope-of-practice competition (attempts at "assimilation"), and collaboration and submit referral guidelines for discussion.

Introduction

Obesity is currently an epidemic among Westernized cultures and is experienced by a variety of their subpopulations. In fact, only sub-Saharan Africa is reportedly free of the obesity pandemic (American Heart Association 2005). Resulting health consequences are well described and include elevated risk for diseases, both chronic and acute, that are leading causes of mortality such as high blood pressure, high blood cholesterol, type 2 diabetes, coronary heart disease, and other health problems (National Institutes of Health 1998). There is a decrease in quality of life and decreased lifespan among the obese (Haomiao and Lubetkin 2005; American Heart Association 2005). In the United States (U.S.) the incidence of obesity among children has risen to 30% and the percentage of overweight and obese adults is "growing unabated", presently at 60% (McInnis et al. 2003; Schwarzenberg 2005). As of 1998, the total costs attributable to obesity-related disease approached $100 billion annually in the United States (National Institutes of Health 1998). Similarly in Great Britain, overweight and obese persons comprise approximately two-thirds of the adult population, while obesity has risen from 9.9% to 13.7% among young British children since 1995 (Cole 2006; British House of Commons Health Committee 2004). Associated costs are conservatively set at 6.6-7.4 billion [pounds sterling]. (British House of Commons Health Committee 2004) One British report (Mayor 2005) suggests a need for a national obesity institute or nutrition council to enhance coordination among different stakeholder groups to reduce the problem effectively. Further, this report urged the government to mount a "sustained and consistent" public education campaign. Logistical issues and inconsistency also appear to affect the U.S., where the responsibility rests more on the individual and his or her healthcare provider (Jain 2004).

Despite a general agreement among healthcare authorities that obesity is a serious and widespread problem, there remains an element of competitiveness in the U.S. regarding who should play a central role in treating it. The purpose of this paper is to describe the various professions addressing obesity in the U.S. and their additive benefits to patients and clients (cooperation). Further, health professions' overlapping scopes of practice and examples of contention at the legal, organizational and practitioner levels (assimilation) will be presented to invite discussion about how to best coordinate anti-obesity efforts. Existing guidelines and partnerships face challenges because the different states in the U. …

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