American Health Care Trends: Old, Fat and Lazy

The recent AMA Executive Summary "Health in the United States: Health Care Trends" contains both a little hope and a lot of gloom.

Population Trends

By 2050 the segment of the population over 65 will double from today to 83.7 million. This means that the prevalence of chronic illness will rise dramatically. Since 1990, smoking has decreased from 29.5% to 18.1% of the adult population. Probably as a result, stroke has declined 34%, heart disease 27%, and cancer 17%. This sounds good but …

Fat and Sluggish

Since 1990, the obesity rate in adults (defined as BMI over 30) has increased from 12% to 29.6%. During the same time diabetes increased from 4.4% to 10% of all adults. Not old adults, all adults. The CDC predicts that by 2050, thirty percent of adults will have diabetes. As a result, obesity is now the leading cause of heart attacks. Physical inactivity is a major reason. Only 21% of adults get the US Department of Health and Human Services recommended 150 minutes of exercise weekly. My observation is that most get no exercise. Many employers now offer wellness programs that give financial rewards for healthy behaviors. This could be a big step in the right direction. Of course, punitive actions denying health insurance to the morbidly obese or uncontrolled diabetics could also be coming, especially if the federal government leaves the health insurance business to private companies.

Is There a Doctor in the Zip Code?

The AMA reports that primary care doctors are closing their practices and either retiring early or moving to non-clinical areas like insurance, quality management, the pharmaceutical industry or even medical informatics. Since the demand for health services will increase dramatically, an increasing percentage of primary care will be provided by PAs and Nurse Practitioners. I expect they will have increasing independence. This is not necessarily a bad thing, many of these caregivers are excellent and offer compassionate and comprehensive care. A possible byproduct of this trend may be an increase in demand for referrals and subspecialty care, such as sending diabetics to endocrinologists and COPD patients to lung specialists.

Take Responsibility or Someone Else Will

A dystopian future looms where the cost of medical care is greater than our resources can manage. In this rather terrifying situation, someone will have to be denied services, probably either the powerless or those who refuse to adopt mandatory health guidelines. It hasn't come to that yet. We still have time to make recommended changes in diet and activity. Remember, who could have predicted everyone would stop smoking?

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Current and Emerging Trends in Fitness

Fitness is a constantly changing field. There are always new machines, methods, and theories aimed at improving the quality of life. Fitness fads may come and go, but there have been several trends in fitness that have lasted several decades and continue to grow in popularity.

Aerobic exercise has always formed the backbone of the fitness industry. Running, step aerobics, dance-type aerobics, boxing, kickboxing, and spinning, an indoor cycling class set to music, have all emerged as mainstays in health and fitness facilities. Their popularity continues to grow.

Aquatic exercise has also increased in popularity. Water has the unique ability to allow cardiovascular and muscular improvements with little stress on the joints of the body. Aquatic exercise is no longer just swimming laps; almost every class that can be done on land is now being done in the water. Running, spinning, step aerobics, and even strengthening can all be done in the water.

With the improvement of health care and longer life spans, older adult exercise has expanded and has also become a necessity to maintain a positive quality of life. Not only are older adults engaging in exercise to maintain and improve health, they are taking part in competitive road races, cycling races, and bodybuilding competitions. Age barriers no longer exist and because of this, fitness classes geared toward the older population are widespread.

As grandparents and great-grandparents take part in sports and fitness, they set an example for younger generations. These younger generations have the benefit of improved technology and more abundant food, and with these things-and a more sedentary lifestyle-come the increased chance that they will live a less healthy lifestyle than their active older family members. The fitness field combats this possibility of unhealthy living with sports and fitness programs geared toward children and young adults. This fitness trend is now faced with the challenge of improving the heath of future generations and has the opportunity to encourage a lifetime of healthy habits.

But the greatest transformation in the fitness field has been the growth of the mind-and-body exercises. There has been a shift toward gentler, more introspective exercises that also contribute to improving cardiovascular health while increasing flexibility and muscular strength. Yoga and pilates would fall into this category of exercise. Yoga has its roots in ancient India (from around 2800 BCE) and focuses on breathing and mindfulness during a practice of held poses. Pilates, on the other hand, was developed by Joseph H. Pilates (1880-1967) around 1926. Pilates’ method involved a unique series of stretching and strengthening exercises. Both yoga and pilates use an individual’s breath and self-awareness as the focus of exercise. Aside from the obvious strength and flexibility benefits, these mind and body exercises are popular for their stress relieving qualities.

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