I am disappointed by how poor primary care is in the developed world. It could easily be made better by including a VO2Max test and a DEXA scan every few years. On my own dime, I took both (cost was ~ $150 total from a private provider) and the DEXA scan revealed I carried too much visceral fat and my cardiovascular fitness was only average, things that never came up in my yearly physical. The same applies for basic strength testing, another predictor of morbidity and mortality.
For better or worse (worse), people don't go to the doctor for lifestyle analysis and rarely take lifestyle advice from their doctors.
They go to their doctors to know when to start medical interventions.
Even simple waist-to-hip ratio assessement would be a big win for identifying lifestyle concerns, but neither that nor the far more involved VO2Max and DEXA rests are going to become standard unless they becoming a gaiting condition for some celebrated drug or procedure.
And that's as much because of the patient's perspective of what they want from doctors as it is because of the doctors or broader establishment.
Who wants lifestyle advice from an American doctor? If they find out you biked to their office, 9 out of 10 of them will scold you about helmets, in the exact same counterproductive way as Americans of every other occupation.
Settling for subpar "could be good enough" heuristics instead of doing actual measurements is partly why people are less receptive.
Basically it'd just be telling them they're fat, and not what's their actual individual risk, and it would also make tracking progress overly difficult: what if after a year of exercice their VO2Max greatly improves while waist to hip only slightly changed ?
Overweight people already have distrust of doctors just telling them to first lose weight and dismiss their specific requests for help, additional advice vaguely based on statistics would probably not help.
Waist-to-hip ratio takes more time to change than VO2Max, it can even negatively change as a subject exercices more (e.g. they put more muscle than lose fat)
Waist-to-hip is a good predictor for generic subjects who otherwise never cared about improving their health. If the goal is to actually improve health, that assumption stops being true and you can't rely on generic heuristics anymore.
The article is about how morbidity and mortality relate to cardiovascular fitness. The fact that waist to hip ratio also is related to morbidity and mortality is a bit irrelevant in that specific context. One can imagine a person who vigorously rows every morning for 45 minutes and has a high cardiovascular fitness, but who also has a very poor diet and is thus fat.
"It could easily be made better by including a VO2Max test and a DEXA scan every few years."
Frankly, the vast majority of people don't need fancy tests. The thing is, the healthcare system is not about optimizing health or performance. It's mostly about fixing problems and heading off the most common ones in the easiest ways. If the goal was to optimize, it would be relatively easy for a trained individual to examine most people and tell them to lose weight and exercise more. Hell, you could blindfold the person and their advice would still be right like 80% of the time.
I think you neglect the motivation factor. Hard data that can be quantitatively tracked is motivating for many. Think of the fitness tracker market. It’s huge. For myself, the tests served as a wake-up call in a way that knowing I was 10-15 lbs too pudgy and not the fastest runner was not.
At the very least, good medical care provides information. What the individual does with it is up to them.
I get it. But you can get similar data from the old-fashioned way of measuring circumferences, weight, height, pinch test, etc to get body fat percentages, or the VO2 max approximation tests. The other thing to point out, is the only people getting/doing any of these tests are already motivated enough to give a damn.
Yes, medical care should provide information. There are lower tech and cheaper ways to provide actionable information. But like you said, it's up to the individual. Either the will is there or it isn't. If someone knows they would benefit from the visual representation of a scan, they can ask for one. Technically DEXA carries some risk with x-ray exposure if done on a recurring basis.
What would be the point of measuring VO2Max and a DEXA scan in a mostly sedentary, obese population?
"Excuse me sir, I have you VO2Max and DEXA scan results. It shows your cardiovascular fitness and body fat is problematic. But we already knew that since your BMI is 35 and you told me you don't exercise at all".
Have to weight it against whether people are meaningfully willing to act on that information. Bluntly, I go to a Dr for meds. I have never been willing to make any lifestyle changes.
