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Like many Americans, Michael Fleming, MD, ate what he wanted, rarely exercised, and was obese from childhood. By the time he was 52, he was on four different hypertension medications, and his blood pressure still wasn't where it should have been. He was 6 feet tall, weighed 290 pounds, and had a body mass index (BMI) of 39, putting him on the edge of obesity and teetering toward morbid obesity.
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So it's no wonder that when Fleming, a family physician in Shreveport, La., and past president and board chair of the American Academy of Family Physicians (AAFP), told his patients they needed to lose weight for their health, he didn't feel like a very credible adviser.
"People said, `What about you, doc?'" he recalls. He remembers talking to a patient with diabetes about diet changes and exercise, and the patient said, "I will if you will." Another obese patient said he chose Fleming as his physician because "you can't tell me anything." That, Fleming reflects, "hurt a lot."
He knew he had to do something, and he decided to do it in a public way, challenging not only himself but also the many overweight colleagues he saw around him. His personal agenda fit right into an initiative that the AAFP was developing.
VISIBLE LEADERSHIP
"Obesity is a pandemic," says Sarah McMullen, AAFP's manager of public health initiatives. "We realized it was important for us to take this on and provide our physicians with tools they could use with their patients."
She adds, "We needed visibility from our leadership. We were sensitive about approaching Dr. Fleming since he was a portly fellow, but we also knew how good-hearted he is, and thought he'd be receptive. He was."
In September 2003, when Fleming was installed as AAFP president, he told the 900 physicians at the Academy's annual meeting, "I commit that when I stand here again next year to address you, there will be a change. There will be less of me to speak to you."
His address outlined not only his personal goal, but a challenge to all AAFP members to set healthier examples for their patients, what he sees as a necessary step in the nation's battle against obesity and the sedentary lifestyles that lead to it. AAFP's Commission on Public Health developed a program called Americans in Motion (AIM). AIM challenges family physicians to lead healthier lives and provides tools for them to do so and pass it on to their patients.
TAKING STEPS
One of AIM's primary tools is a pedometer, which counts the steps the wearer takes each day. The Active Lifestyle program of the U.S. President's Council on Physical Fitness and Sports, whose guidelines AIM has adopted, sets a target of 10,000 steps a day. (That adds up to about 4 miles.) Or the goal can be 30 minutes of activity 5 days a week.
"We're not asking family physicians to look buff," Fleming emphasizes in his explanation of AIM to other AAFP members. "We simply want them to lead healthier lives [and] create momentum that will carry over to practice staff and patients."
Because family physicians can address fitness from a unique perspective, AIM founders feel the program can have reverberating effects with the potential to improve the health of all Americans across all age spans. The program is planned in three phases: 1) to reinforce the health of physicians and their families, 2) to extend the effort to specifically target office staffs, and 3) to create tools and resources to improve patient health. This last step includes identifying ways to improve reimbursement for patient fitness work.
A component of the first step is an initiative seeking to gather data on the fitness of family physicians. Nearly 2,500 physicians responded to an online survey last year, with 60% admitting that they have problems with their own weight and more than 80% indicating that they would like more skills or tools to manage obesity in their patients.
Phase 2—to involve office staff—was officially kicked off this fall, but Rick Kellerman, MD, a family physician in Wichita, Kan., got a bit of a head start bringing staff into the program. His staff had a simple goal: Walk to Paraguay.
Kellerman decided on his own a couple of years before AIM began that he needed to lose weight to be a more convincing role model for patients. At 6 feet, 203 pounds, he wasn't obese, but the pounds had accumulated over the years, and he was overweight and out of shape. "I was approaching that age, the heart attack age," he says. "I felt I had to do something." He shed about 20 pounds by becoming more aware of his food intake and increasing physical activity. When he heard about AIM, he says, "it really resonated with me." He and an office colleague picked up pedometers; Kellerman is convinced that using the pedometer has been a big help in maintaining his weight loss.
Soon 10 of his staffers committed to counting their steps, and they decided on a cumulative goal of walking to Paraguay. They placed signposts along the way to designate tourist destinations they reached, albeit virtually. Staff members did not weigh themselves—the goal was to reach Paraguay, not lose weight, although several did. When all was said and done, it took them five and a half months to finish.
AAFP has disseminated the AIM initiative to its membership through journal articles, e-mail, and newsletter communications; the response, McMullen says, has been "overwhelming and very enthusiastic," providing a "teachable moment" that family physicians are looking for. While early results have been heartening, she underscores that the effort is long-term.
"It took 30 years to see tobacco-related behaviors change," she notes. "It will take 10 to 20 years to see societal benefits of this. We're investing in the next generation, and in the next generation of family practice physicians."
AAFP is promoting curriculum changes in medical schools that will improve education about nutrition and teach doctors how to prescribe exercise for fitness.
As for Fleming, he has lost 54 pounds with his new attention to diet and
exercise, and is optimistic that he will be able to reach his goal of losing
another 40. "I'm not denying myself," he says, "and when I
miss a day of walking, I feel like I'm really missing something. I feel better
than I can remember ever feeling." 
Footnotes
Further information about the AIM initiative is available by calling AAFP at 913-906-6000 or visiting the AAFP web site, www.aafp.org.
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