But the approach of healthcare providers to obesity must change in two respects if we are to successfully address its implications for health, care and cost. The first change is to recognize that fitness is more important than fatness. The second is to monitor and measure physical activity as part of routine data-collection of patients' vital signs. Monitoring and measuring are essential to improvement, and there's no better way to capture the data routinely than to incorporate it into electronic medical records.
Recent studies have confirmed that fitness and fatness are not mutually exclusive. A study published in September 2012 in the European Heart Journal, for instance, concluded that “People can be obese but metabolically healthy and fit, with no greater risk of developing or dying from cardiovascular disease or cancer than normal weight people.”
The findings showed that “there is a subset of obese people who are metabolically healthy—they don't suffer from conditions such as insulin resistance, diabetes and high cholesterol or blood pressure—and who have a higher level of fitness, as measured by how well the heart and lungs perform, than other obese people.” As Francisco Ortega, first author of the study, noted: “This research highlights once again the important role of physical fitness as a health marker.”
But measuring physical activity is not something doctors typically do. They ask patients about lifestyle choices (smoking and drinking, for instance) and may inquire about their physical activity. But it has not routinely been assessed as a part of healthcare delivery.
Intermountain Healthcare has long pioneered in the use of electronic medical records. In 2013, it introduced a new tool for assessing physical activity in its electronic records. The “Physical Activity Vital Sign” is located on the Vital Sign bar, and it prompts physicians and team members to collect data on physical activity, interpret it and recommend actions to improve it.
It asks for simple but specific data on physical activity—days per week and minutes per day, and the intensity of physical activity (light, moderate or vigorous). It also has a drop-down bar for the physician to indicate if the patient was counseled to start, increase or maintain his or her physical activity.
Recording and measuring this data is easy and straightforward and leads to recommendations regarding physical activity to promote health, prevent disease and reduce morbidity from established disease. But while simple, it's also crucially important to health and healthcare, since low physical activity levels and low cardio-respiratory fitness are the greatest contributors to premature mortality—even more than tobacco use, elevated cholesterol, diabetes or obesity.
In America, we're suffering an epidemic of obesity, but we're seeing what's visible rather than what's evident. It's not reducing fatness that is the key to better health and lower healthcare costs. It is elevating the nation's physical fitness because increasing physical activity and improving cardio-respiratory fitness are associated with significant reductions in mortality, even in the absence of weight loss.
By changing the vital signs that healthcare providers record and monitor, they can prompt their patients to address their physical inactivity and obesity. The results should quickly become evident in the form of better health, better care and lower costs.
Dr. Elizabeth Joy is medical director for clinical outcomes research at Intermountain Healthcare,Salt Lake City.