Prescription for fitness

Don't be surprised at your next checkup if the doctor measures your waist and writes a prescription for exercise: They are among the recommendations in a new "call to action" for primary-care physicians.

By now it's a familiar refrain: Americans need to lose weight and get fit. But the necessity couldn't be more dire, the report says, citing data showing that about two-thirds of U.S. adults -- 131 million people -- are overweight.

Nearly every day, nurse practitioner Debbie Sutherland sees patients at Physicians Associates in Cape Girardeau who are overweight or obese. She talks to them about better health and eating habits, but isn't sure she's getting through.

Despite the enormous public health impact of excess weight and a sedentary lifestyle -- at least 300,000 premature deaths and more than $90 billion in health-care costs each year -- many doctors are failing to capitalize on their unique ability to help change patients' ways, the report says.

"It's a hard sell," Sutherland said. People want a magic pill to take the weight off. "I haven't given up yet because out of every 10, if one or two take it to heart that keeps me going."

Sutherland, as a nurse practitioner, already tries to focus on wellness and education with her patients. And that's what primary-care doctors need to do.

Many doctors might think they do not have time during already-rushed office visits, but the new recommendations could take only three extra minutes, the authors said.

That is less time than doctors spend treating high blood pressure, high cholesterol, diabetes and heart disease -- some of the major complications of being overweight, said Dr. JoAnn Manson, the report's lead author and chief of preventive medicine at Harvard's Brigham and Women's Hospital.

"We're treating the symptoms of the disease, rather than the root cause," Manson said. "We will be spending more and more of our time addressing the health consequences of obesity if we don't spend these few minutes with prevention."

Sutherland said even just a few minutes of exercise is all it takes to keep people from putting themselves at risk. All she asks of her patients is 20 minutes of exercise three times a week -- and that seems like a strain in a world of busy lifestyles, she said.

But promoting good health shouldn't be left to diet books and health clubs, said Dr. Philip Greenland, a Chicago heart specialist, who co-authored the report. "This is really a serious medical issue and it should be conveyed to patients as a serious medical issue."

The message is directed at the journal's more than 105,000 subscribers, most of whom are internal medicine doctors who serve as primary-care physicians.

The recommendations include:

Assessing body mass index and waist measurements and discussing patients' activity levels at every visit. Patients who are not overweight should be congratulated. Overweight patients should be told about the dangers, which include a doubling of the risk of heart disease and a tripling of the risk of diabetes for people with a body-mass index of 30 or higher, which is obese.

Counseling overweight patients to reduce their daily food intake by 500 to 1,000 calories and get more exercise, with a goal of losing up to two pounds a week.

Writing a prescription for exercise, such as walking a mile briskly at least five days a week. Sedentary patients also should be advised to incorporate more activity into their daily routines by doing things like using stairs instead of elevators, walking during lunch breaks or getting off the bus or subway a stop early and walking home.

Strength training or weightlifting, to help raise metabolism.

Weight-loss medication for obese patients who do not shed pounds after several months of cutting calories and increasing activity.

Features editor Laura Johnston contributed to this report.