wellness
Your Roll in Fitness and Nutrition
Myriad factors impact your patient's health. It pays to examine them all.
RICHARD S. KATTOUF, O.D., D.O.S.

Since junior high school, I have had an interest in fitness and nutrition. I have found that even though genetics play a significant role in health and wellness, your personal habits and environment can equally impact your well-being.

Personally, I have been blessed with excellent health, no illnesses and no dependence on medication. Is it an accident? Could the fact that I lift weights and run six days a week have any bearing on my wellness level?

It's not my intent to recommend that my patients or my O.D. colleagues mimic my physical schedule. My message to both groups is to assess your present level of nutrition and fitness and gradually improve. This is the first of six articles in 2007 on wellness, nutrition and fitness (WNF).

Most patients enter your office thinking of materials (glasses and contact lenses). This is the reason that consumers who wear visual aids seek their eyecare professional every 2.9 years. This is what I term the "empty cup syndrome." The patient enters the office with an "empty cup" in regards to preventive eye health and when he leaves, the cup is still empty. You have an obligation to fill the cup with medical knowledge that will assist the patient in WNF and change his recall philosophy from three years to annual preventative eye health evaluations, which may not even require materials on each visit.

Your comprehensive exam

The examination required by every individual state is very basic. Most O.D.s have chosen to add such things as corneal topography, automated perimetry, automated refractometry and keratometry, telebinocular, etc. The addition of the following medical screening tests, the education of the patient and the consultation of the results gives you the opportunity to be a true preventive practitioner.

A Sphygmomanometry: blood pressure (BP) screening. No State Board requires you to perform this test. Why should you? A total of 29.3% of Americans have high blood pressure, according to a study published in December's Hypertension (a Journal of the American Heart Association).¹ The good news: The overall rate of patients who controlled their high blood pressure improved from 29.2% in 1999 to 2000 to 36.8% in 2003 to 2004. Also, awareness of high blood pressure improved from 68.7% in 1999 to 2000 to 75.7% in 2003 to 2004.

Even if a patient's BP is within normal limits, you still have an obligation to discuss or give handouts that teach the patient how to prevent a systemic condition that can cause permanent vision loss with no symptoms. When we choose to add this type of testing, it elevates the image of the entire office. Optometry needs to foster and embrace the preventive medical model of health care.

A Glucometry: blood sugar screening. Again, this test is not required by any State Board. A total of 20.8 million people in the United States (7% of the population) have diabetes, according to the latest statistics from National Diabetes Information Clearinghouse (http:// diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm). What's even more disturbing is that 6.3 million of these people are not aware they have this life-altering condition. Also, about one in every 400 to 600 children and adolescents has type 1 diabetes, and regional studies and clinically based reports suggest that type 2 diabetes, while considered rare, is being diagnosed more often in children and adolescents (particularly in American Indians, African Americans and Hispanic/Latino Americans.)

Educate patients   

O.D.s need to council patients on many WNF fronts as follows:

• Eating six smaller meals every two hours increases metabolism. This helps weight control. Each meal should have a protein portion and a carbohydrate the size of your fist. You can add vegetables as well. This type of meal keeps the patient's insulin level very stable. The weight control aids in preventing hypertension, HBP and diabetes.^2,3

• We are a society of high carbohydrate consumption. This raises insulin levels, slows metabolism and causes weight gain. Environmental choices can create disease. This is the information that many patients do not understand.

• Prescribing fitness such as cardiovascular activities and weight-bearing exercises. This burns calories, raises metabolism, improves circulation, reduces inflammation, raises mental alertness and improves mental well-being.

Regardless of whether we like it, optometrists are perceived as spectacle peddlers. The approach outlined in this article raises the image of the O.D. In following the WNF course, you are promoting prevention and wellness. This tells the patient how much you care about his overall health and sets you apart from the crowd of generalists who call themselves your competition.

Two contributors will be used as references and/or co-authors in future articles on WNF. Dr. Valerie Kattouf Sosne, my daughter and professor of optometry at Illinois College of Optometry, and Dr. Richard S. Kattouf II, O.D., my son, who has authored the book "Forever Fit" and has been rated an All-American Duathlete.

1. Ong KL, Cheung BM, Man YB, et al. Prevalence, Awareness, treatment, and control of Hypertension Among United States Adults 1999-2004. Hypertension 2006 Dec11; [Epub ahead of print].

2. Tsakuda P. Rev Up Your Metabolism! L.A. Health News http://www.lahealthnews.com/article.php?articleID=532 (Accessed 12/22/06').

3. By: Stokes DM. More Food, Less Fat: Scarfing 6 meals a day boosts energy, builds muscle, and sheds pounds. But what to eat? Here's your quick 'n' easy guide. http://www.menshealth.com/cda/article.dosite=MensHealth&channel=guy.wisdom&category=holiday.survival.guide&conitem=b54a99edbbbd201099edbbbd2010cfe793cd____ ((Accessed 12/22/06').

DR. KATTOUF IS PRESIDENT AND FOUNDER OF TWO MANAGEMENT/CONSULTING COMPANIES. CALL (800) 745-EYES, OR SEND E-MAIL TO ADVANCEDEYECARE@HOTMAIL.COM.