Finding a Solution to the Chronic Disease Problem – A New Role for Canadian Chiropractors?
By Jeffrey S. Bland PhD FACN CNS
By Jeffrey S. Bland PhD FACN CNS
Canadians are among the healthiest people around.
At 81 years, Canada
has one of the world’s highest life expectancies. By comparison, the average
life expectancies of the United States
are 78 and 74 years, respectively. 1
health, like everything, is relative. Like the rest of the world, Canada is
caught in the grip of a health crisis of epidemic proportions.
Lifestyle-related, non-communicable chronic
diseases such as type 2 diabetes, heart disease, and hypertension factor in the
death of nine out of 10 Canadians and affect the daily activities of millions
more.2 According to the Centre for Chronic Disease Prevention and
Control, more than one third of adults, and more than half of seniors, suffer
from one or more chronic conditions.3 Forty per cent of people have
high blood cholesterol, a major cardiovascular disease risk factor and 20 per cent
of people have high blood pressure. (Of those, nearly half are unaware of their
condition, and fewer than one in five have it treated and under control.)4
The international picture is just as bleak. According to the World Health
Organization (WHO), chronic diseases account for 60 per cent of deaths. By the
year 2015, this number is expected to increase by 20 per cent; most notably,
deaths from type 2 diabetes are projected to rise by nearly 40 per cent.5
The good news is, as a nation, Canada has been more progressive
than most in recognizing lifestyle-related chronic diseases as a public health
threat. In fact, public policies promoting both population-wide approaches and
individual interventions are attributable in averting an estimated 1 million
deaths from cardiovascular disease between 1970 and 2000.
More recently, in its 2003 Accord, the
Health Council of Canada has committed to make chronic disease prevention a
priority and accelerate work on a public health strategy for improving the
nation’s health status by the year 2015. Three measurable targets—all aimed at
healthy living—have been defined: better nutrition, increased physical fitness,
and healthier weight.
Research suggests that even modest gains in
this direction could significantly impact Canada’s chronic disease burden.
For example, a Simon Fraser University team of researchers estimated that
reducing salt intake by less than one
teaspoon per day would reduce the incidence of high blood pressure by 30
per cent, and it would save up to $430 million per year due to a reduced need
for physician visits, laboratory tests, and medications.6 And the
WHO estimates that a mere 2 per cent annual reduction in Canada’s chronic
disease death rates over the next 10 years would result in an economic gain of
Certainly, the problem is enormous and public health officials will continue
to grapple with these issues for years. But, the numbers of newly-diagnosed
cases of lifestyle-related non-communicable chronic diseases continue to
skyrocket. What can be done in the meantime?
Therapeutic Lifestyle Change (TLC) Programs
Widespread adoption of therapeutic
lifestyle change, or TLC, programs may be a promising solution to this
ever-growing problem. These professionally-supervised programs are focused on
teaching healthy lifestyles, with the goal of delivering long-term health. Also
referred to as lifestyle modification or lifestyle intervention programs, TLC
programs have been proven effective in the prevention, management, and even
reversal of some of the most common lifestyle-related chronic conditions,
including high cholesterol, hypertension, type 2 diabetes, metabolic
syndrome/insulin resistance, and overweight/obesity.
Ample scientific evidence suggests
that TLC programs are effective in addressing chronic disease. A review of
three recent, high-profile clinical trials—the Da Qing Study, the Finnish
Diabetes Study, and the Diabetes Prevention Program—concluded that lifestyle
intervention was more effective than conventional care in significantly
reducing the progression from pre-diabetes to diabetes. Progression to diabetes
was reduced by 40 per cent, 58 per cent, and 58 per cent, respectively.7
Not Weight Loss Programs
TLC programs should not be confused
with diets or weight loss programs. Whereas these efforts typically fail, TLC
programs have been remarkably successful in helping produce long-term benefits.
However, the two programs do bear similarities. For instance, as in weight loss
programs, TLC patients typically enroll for 12 weeks, meeting weekly with a
healthcare practitioner during the first four to five weeks, then meeting
bi-weekly for the remainder of the program.
Some of the key differences are as
professional supervision. A physician or allied healthcare
professional will assess the patient’s current health, establish goals,
and develop a personalized step-by-step plan. Frequent follow-up visits
are needed to track progress and make any necessary adjustments.
multi-disciplinary team approach. Although the supervising practitioner
may conduct the entire program, certain services may be referred to
others, such as a fitness trainer or nutritionist. Office staff members
can help manage patient contacts, schedule follow-up visits, and prepare
take home materials.
- Emphasis on
body composition. The goal of a TLC program is to achieve a healthy
body composition, not merely to shed pounds. In fact, while weight loss
may occur, it is only secondary to achieving a healthy lean muscle-to-fat
- “24/7” lifestyle
management. Program extras may include tips on shopping at the
grocery store, meal planning, and time management.
Lost Opportunities in Primary Care
In the peer-reviewed journal, The Internist, a team of prominent
German researchers opined that preventive medicine is “the stepchild of
internal medicine,” and argued that “pharmacotherapy can only be an adjunct” in
the prevention of arteriosclerotic cardiovascular disease.8 To the
chagrin of many in the public health arena, despite being knowledgeable about
the benefits of lifestyle intervention and an ever-increasing demand for these
services, most physicians still fail to provide them. Certainly, time
constraints, financial pressures, lack of appropriate tools and training, and
low patient compliance make it difficult to address lifestyle issues in
everyday clinical practice. These attitudes were borne out recently in a large
recent survey of more than 13,000 primary care physicians which found that few
provided written prescriptions, performed fitness assessments, or referred
patients for lifestyle counseling.9
An Opportunity for Chiropractic Professionals
In its November 2006 Call to Action, the
Chronic Disease Prevention Alliance of Canada implored individual communities and
public health officials to undertake health-promoting policies, stating that “Canada’s health
care system cannot cope now, and is not prepared for the next decade when a
tidal wave of chronic diseases will become overwhelming.”10 Given
the need for lifestyle counseling and the limited availability of these
services from the current medical system, a considerable opportunity exists for
allied healthcare professionals to fill the void.
As one of the country’s largest
primary-contact healthcare professions, and with their knowledge of diet and
nutrition, chiropractors are especially suited for this task. Indeed, becoming
established as the community TLC specialist can potentially generate increased
physician referrals and word-of-mouth advertising, in turn creating new and
sustainable revenue streams. More importantly, chiropractors who seize the
moment have the opportunity to secure their place as key partners in resolving Canada’s
chronic disease dilemma.
World Health Organization. WHO Statistical Info System
(WHOSIS). Life expectancy at birth (years), both sexes. Available at http://www.who.int/whosis/database/country/compare.cfm?strISO3_select=VCT&strIndicator_select=LEX0Male,LEX0Female&language=english&order_by=FirstValue%20DESC.
World Health Organization. Facing the facts: the impact of
chronic disease in Canada.
Available at http://www.who.int/chp/chronic_disease_report/media/CANADA.pdf. Retrieved
Broemeling AM, Watson DE, Prebtani F. Populations patters of chronic health
conditions, co-morbidity and healthcare use in Canada: implications for policy and
practice. Healthc Q.
Heart and Stroke Foundation of Canada. Available at
World Health Organization. The impact of chronic disease in
low income countries. Available at www.who.int/chp/chronic_disease_report/en.
Joffres MR, Campbell NR, Manns B, Tu K. Estimate of the
benefits of a population-based reduction in dietary sodium additives on
hypertension and its related health care costs in Canada. Can J Cardiol. 2007;23(6):437-443.
Rasmussen SR, Thomsen
JL, Kilsmark J, et al. Preventive health screenings and health consultations in
primary care increase life expectancy without increasing costs. Scan J Public Health.
Windler E, Zyriax BC, Beil FU, Greten H. Primary prevention
of cardiovascular diseases. Stepchild of internal medicine. Internist (Berl). 2004;45(2):173-181.
Petrella RJ, Lattanzio
CN, Overend TJ. Physical activity counseling and prescription among Canadian
primary care physicians. Arch Intern Med.
Chronic Disease Prevention Alliance
cannot cope now with chronic disease and is not ready for the tidal wave in the
next decade: call to action says help the worst, first. Issued November 8,
Jeffrey S. Bland, PhD, FACN, CNS,
is a nutritional biochemist and author of several books on nutritional medicine
for healthcare professionals and the general public. Dr. Bland is Chief Science
Officer for Metagenics, Inc., a life sciences company and leading developer and
manufacturer of science-based nutraceuticals and medical foods sold to
healthcare practitioners worldwide