The contributors to this thread have made
substantive remarks in response to Dr.
Rosenblatt’s “plea” (my term) for some direction
regarding podiatric education in the area of
obesity counseling and what this means in a
podiatric medical context.
It is true that most physicians know they have
minimal education on the subject of diet and
exercise. There was a recent article regarding
how poorly trained physicians are to address the
obesity epidemic - Vitolins MZ, et al. Obesity
educational interventions in U.S. medical
schools: a systematic review and identified
gaps. Teaching and Learning in Medicine. 2012
Jul;24(3):267-72.
Unfortunately, the situation that typically
exists with podiatrists is that when we discuss
walking for exercise-movement it is usually
reduced to a discussion about shoes and a
recitation of the ACSM exercise guidelines.
This is a discussion that any shoe technician
could have, and while this isn’t necessarily a
bad thing, if one is going to provide physician
level counseling worthy of reimbursement, it
needs to be based on a higher level
understanding of how movement impacts a
patient’s metabolic health.
Educated physicians would understand the impact
of walking-movement on systemic inflammation,
insulin sensitivity, muscle insulin release,
muscle glycogen metabolism and storage, fat
mobilization and ketone metabolism, liver
function, lipid levels, the immune system, etc.
Physicians of the structures responsible for
human movement should be qualified to speak on
at least a basic level about the role of
movement produced myokines and their metabolic
participation in muscle-brain and muscle-liver
crosstalk.
While podiatrists have the scientific background
to understand this topic, it has not been
formulated in a didactic way and placed in the
podiatric physician’s paradigm such that it can
be practically and effectively communicated to
patients in the clinical setting. With or
without the current obesity and diabetes
epidemics ravaging our country, this is a vacuum
that is begging to be filled.
Robert Creighton, DPM, St. Petersburg, FL,
rcreightonjr@hotmail.com
