Population Health and Nutrition: A Tool to “Transform Society”

Population Health and Nutrition: A Tool to “Transform Society”

By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CNPT, CSCS, NSCA-CPT, Cert-DN

Recently our editor of the Physical Therapy Journal (PTJ), Alan Jette, highlighted a recent article that took a focus on a Framework for Population Health for physical therapists (PTs). Population health considers the health and outcomes of a group of people, and how those health outcomes are distributed within the population. The view of population health is much broader and encompasses not just quality of life and health but also the interplay of the social determinants of health (SDOH), such as individual behavior, healthcare, physical environment, genetics, and social environment. Before we dive into how PTs, using such a framework, can transform society, here’s a great diagram to demonstrate the encompassing view and interplay of population health:

Source: https://www.improvingpopulationhealth.org/blog/what-is-population-health.html

PTs have the unique opportunity to influence many of the social determinants of health, as well as the main outcomes of health (left side of the diagram). We know from our experience that our traditional physical therapy (PT) treatments greatly improve health related quality of life. Our gait training helps people walk to work; our therapeutic activities help older adults transfer in and out of the car so they can go grocery shopping independently. We also know our advocacy for life-long exercise can help to reduce mortality. Evidence supports a reduction of death when people engage in daily physical activity as well as structured exercise over their life. But is there another way to impact both the left and right side of the diagram other than through exercise?

One amazing way to focus our PT care on not just the SDOH but also the health outcomes is through nutrition. Study after study shows that lifestyle is a major contributor (explains about 80%) to disease, early mortality, early morbidity, and poor quality of life (QOL). This is why there is a large arrow pointing from the right to the left side of the diagram. SDOH impact outcomes greatly. The biggest contributor to lifestyle that affects health outcomes? Nutrition! 

Nutrition has been shown to impact outcomes (QOL and mortality). We know from the literature that reducing body mass index through positive changes in diet can boost health-related quality of life. The evidence also shows how patients with cancer can improve their QOL with a combined intervention of both nutrition and exercise (but not simply nutrition changes alone). Moreover, a publication in the Journal of the American Heart Association highlighted the benefits of a whole-food plant based diets in reducing cardiac mortality -- what a relevant and evidence-based way to show how nutrition can affect mortality! 

PTs can also offer nutrition interventions that impact the SDOH. By adding nutrition services in our PT chest of “tools” it improves our health care system. Progressive models of healthcare show how various licensed healthcare providers are encouraged to engage and discuss nutrition with their patients in order to maximize health and reduce costs. Nutritional interventions can also impact human behavior, which is a major driver for chronic, non-communicable diseases. Our first and second courses in our Nutritional Physical Therapy courses focus on why humans behave the way they do relative to nutrition, as well as how to change such behaviors through goal setting, patient-driven interviewing, and behavior change models. Nutrition interventions can also change the social environment through educating patients on where to seek out food in areas of food deserts, how to shape a healthy food environment by buying only healthful foods, and connecting people in the community for healthy food-sharing programs (like CSAs and farmer’s markets). Lastly, we know the literature has shown that our diet directly impacts our genes. From telomere shortening that reduces neural plasticity and longevity related to encoding genetics changes in our gut biomes that are passed on to our children...diet impacts not only the patient but also the patient’s children and grandchildren. You are what your grandmother ate!

If we as PT are going to meet The American Physical Therapy Association (APTA) vision to transform society, then we need to embrace nutrition into our practice and address both outcomes and SDOH. Nutrition impacts health directly and can influence almost every realm of SDOH. The APTA needs to further expand this population health model and nutritional education into PT schools nationwide. For the PTs currently licensed and wanting to learn more about nutrition, our team at Nutritional Physical Therapy encourages you to check out our online board-approved nutrition courses for PTs at www.nutritionalphysicaltherapy.com See you in class!

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Disclaimer: The above article is written as opinion piece and does not convey specific legal, insurance, and/or practice act advice. Consumers of the content above, students, and participants need to check their State laws, practice act, insurance regulation and compliance, and other legal restrictions before implementing nutrition interventions or assessments. The consumer of this article and our courses acknowledge that the State laws, practice acts, and restrictions can and do change and the above copy is merely suggestions and opinionated ideas: not legal or practice advice. The Nutritional Physical Therapy team cannot be held liable for changes to laws or regulations: the student, PT, or person engaged in such nutrition actions are responsible for examining laws and regulations as they see fit.

Keywords: nutrition, population health, social determinants, physical therapy, continuing education, CEH, PT