Since the mid 1990s, we’ve been listening to policy makers emphasize the importance of regular physical activity. The day before the start of the Centennial Olympic Games in Atlanta, the U.S. Department of Health and Human Services published the first Surgeon General’s report on physical activity and health. This was a milestone report, one often compared to the Surgeon General’s 1964 report on smoking. However, in contrast to the smoking document that shook the foundations of an unhealthy industry, the report on physical activity has not had the same impact. In fact, over the last 25 years the numbers of obese Americans, an unhealthy byproduct of this physical-activity deficit, has only increased. In 1991, not a single state had an adult obesity rate over 20 percent. But by 2015, obesity rates exceeded 30 percent in 25 states and were above 20 percent in all states. And in four states, the 2015 obesity rate exceeded 35 percent.
In 1991, not a single state had an adult obesity rate over 20 percent. But by 2015, obesity rates exceeded 30 percent in 25 states and were above 20 percent in all states.
Let’s just face it: the obesity rate is a more insidious public-health issue than smoking ever was. I mean, what are we going to do — start putting skull-and-crossbones symbols on sofas and comfortable chairs? Advances in technology are great, but have only caused us to be more prone to sitting around, not less (see the addition of “binge-watch” to the lexicon; Merriam-Webster’s first known usage, 2003). And what about diet and the ways our food supply has changed? It is not just calories “out” that has changed among Americans, but calories “in” as well.
Making things even worse, health policymakers and insurance companies pay lip service to the problem, saying all the right things and generating plenty of accurate and potentially helpful content, while doing little to increase the population’s access to physical activity. And when insurance and home-health providers do deploy professionals to engage people where they live, the specialists they typically send are in the business of fixing things after they are already broken, not preventing them from breaking down in the first place.
At the turn of the 20th century, the greatest health problems we collectively faced involved poor environmental conditions and the spread of infectious disease. But by the start of the current century, we had shifted toward a different type of health of problem: one caused by chronic, “lifestyle” diseases. We have still yet to adjust our approach. We have done little in either the public or private sectors to try to prevent these diseases from occurring in the first place, and ironically we rely on our medical advances and technology to a fault. This is one of the clearest cases ever of not being able to see the forest for the trees.
What if by midway through the previous century, they’d had access to all the medicines and vaccines we have now, and they’d even had access to our smart phones with apps that tracked things like how many times people washed their hands per day, but showers and sinks were still rare in homes, and indoor plumbing was not the norm in public buildings? How effective would all that information, technology and medicine be without basic access to clean, running water?
When it comes to the obesity epidemic and its associated chronic diseases, we are not in need of a new “magic pill” or nifty fitness app. What we need is an army of faucet installers.
In order to get this turned around, three things must begin happening: employers should start adopting more fitness initiatives at work that actually allow people to get up and moving; local governments should kick efforts to make city’s more walkable and bikeable into high gear; and insurance companies and home-health providers should start contracting with professionals whose focus is squarely on preventive health, not just ones whose mission is to help those who are already sick or injured.
When it comes to obesity epidemic and chronic diseases, we are not in need of a “magic pill.” What we need is an army of faucet installers.
For the latter to be adopted in the right way, this would be an approach that is part progressive, part conservative. Progressive in that we finally start doing something in preventive health in a meaningful way. We stop paying lip service to the problem and begin deploying community-level exercise physiologists to help keep people out of health clinics and hospital beds. And conservative in that this approach is one that’s supported by decades of empirical research, and one that could be carried out by educated, highly-credentialed professionals. I would suggest tapping ACSM Certified Exercise Physiologists and ACE Medical Exercise Specialists, the only two NCCA-accredited personal trainer certifications to date requiring at least a bachelor’s degree in exercise science, for this type of preventive prescription; let ACSM Registered Clinical Exercise Physiologists and physical therapists keep working with individuals in hospital and rehab settings.
It is time we start adhering to the advice of the original Surgeon General’s report on physical activity and help “all people in the United States increase their regular physical activity to a level appropriate to their capacities, needs, and interest” through informed, individualized exercise prescription. Only when we implement this approach on a mass scale will we see obesity rates begin to fall with health costs soon to follow.
This article first appeared in Health:Further.