The AMA And The Disease Of Obesity - Fitness Industry Professionals Should Pay Close Attention

You probably heard the news. The American Medical Association  (“AMA”), the largest physician organization in the U.S., recognized obesity as a disease this month (June 2013). In doing so, AMA President Ardis Dee Hoven wrote, "The purpose of the policy is to advance obesity treatment and prevention. It issues a call for a paradigm shift in the way the medical community tackles this complicated issue so that we can reduce the number of Americans suffering from the effects of heart disease, diabetes, disability and other potentially life-changing health conditions." So why is the AMA doing this ?

There is no doubt that for a variety of reasons, including inactivity, obesity is a major public health problem. However, by identifying the problem as a disease, the AMA isn’t being just altruistic. You see there is money involved; and to this point a more revealing commentary by Dee Hoven was published in US New’s online debate club, when she wrote on June 27, 2013 :

“Recognizing obesity as a disease will spur new interventions and treatments for patients and encourage greater dialogue between patients and their doctors about which behavioral, medicinal or surgical options may be right for them.”

I underlined portions of her quote for emphasis and if you are a fitness or health club professional you should pay close attention.  When the President of the AMA mentions “new interventions and treatments for patients” does anyone really think she is talking about the services a fitness professional or wellness coach might deliver? I propose she is only speaking of services delivered by a medical professional (medical in this context being differentiated from fitness) . Note that of the three topics of “greater dialogue” she mentions only one is behavioral change.  Is anyone surprised ?

If my view appears cynical, please forgive me but read on. There are certainly altruistic medical professionals, many whom rightly identify lifestyle as an important aspect of disease prevention . ACSM’s Exercise is Medicine program is an excellent example of how physicians and facilities can work together in a collaborative way. Physician referrals have the potential to serve as a means for clubs and physicians to work together. However, the sad truth is that as an overall percentage of the bricks and mortar fitness business these collaborative models are few and far between. In fact research has established that exercise referrals often don’t work (See: Exercise may be Medicine, but the Referral Process is not Working).

While I believe we are entering a golden age for the fitness and wellness industry, of which fitness and bricks and mortar facilities can play a big part, we should remain aware of some business realities. In defining obesity as a disease the AMA is really making a land grab for the huge business opportunity it represents and while we all know lifestyle management is the best long-term medicine, pharmaceuticals and surgeries among other “new interventions and treatments” will be a major emphasis by the sick care system because regretfully its about how this current delivery system financially works. You see the AMA move is really a way for its members to get more federal dollars. In other words its all about the cash friends (see Michael Tanner's Obesity Is Not A Disease Article). Having someone take care of themselves by eating right, managing stress and getting enough activity is not something the sick care system can make a buck from right now. One reason the epidemic exists in the first place is because outside of personal choice there has been "no dog in the fight" for primary prevention policy, since there isn't nearly as much profit in that as opposed to, for example, $40,000 bariatric surgeries.

I’ve written before about the fact that the fitness industry, particularly health clubs, should be more concerned about competition from other industries serving as significant competitive threats as opposed to competition within our space (see Hey Fitness Leaders I've Got a Secret). The AMA announcement serves as an example. Therefore, we’ve got to start thinking about some opportunities and challenges that exist for the health club and fitness industry that we’ve yet to tackle and which leave us vulnerable to competitive attack from the medical community. Here are my top 5:

1. We need higher professional standards and governmental sanctioned licensing for fitness professionals. There is a great vulnerability from other professions that already have government sanctioned licensing processes in place to take away opportunities and revenues from fitness professionals going-forward. While self-regulation has been the position of industry associations for some time, the realities are that as obesity becomes a medical condition the ability for non medically licensed professionals to “treat” the condition will become limited. Competition is coming from licensed medical professionals;

2. We need technology standards for equipment and devices. Caloric burn rates are inconsistent among equipment manufacturers. There are no standards to document that reported calories burned on fitness equipment are accurate. This and interoperability among devices and equipment in facilities as well as easy data collection and integration are needed to make it easier for members to track information with little effort. Its all about outcomes and failing to provide a seamless and easy way to use information to measure for outcomes will make facilities less relevant. This can be a competitive advantage for facilities and our industry. That is why I'm involved with FIT-C (the fitness industry technology council).

3. We need facility standards and we must promote why they matter. The recent establishment of minimum standards for fitness facility certifications, put forth by the Joint Committee, creates a path that enables certification of facilities. The Medical Fitness Facility Standard is another example that establishes minimum requirements. This is important for a host of reasons and these standards must be put on a fast track to be further developed and adopted around outcome models which the market will require for us to address the obesity issue effectively as an industry. We need these facility standards;

4. We need more entrepreneurs to create business models that successfully incorporate outcome models to demonstrate the model works. A combination of technology, coaching, nutrition, physical activity and stress management that proves enhanced lifestyles and health outcomes among member groups is necessary to establishing a clear cause and effect and thus reimbursements. There are not an adequate number of these integrated and outcome measured fitness business models out there and none at scale today. Increased competition from pure digital models, like RetroFit, as well as hybrid competition from bricks and mortar player such as CVS and Wallgreens (see an example here) will take the place of what facilities could offer if we don't wake up ; and

5. We need more of an abundance attitude and less of a view to scarcity among leaders in the fitness and health club space. Our focus needs to be on broadened and collaborative efforts . While these efforts exist, they are taking to long to inact. See Collaboration: What Do Transmissions Have To Do With Health Clubs, Fitness and Wellness ?

Those are my top 5 , what are your top 5 and what do you think about the AMA's classification of Obesity as a disease? Let me know your views on this and the 5 areas the fitness and health club industry should focus on. Do you see the medical community as a potential collaborator or competitor ? Let me know your thoughts and hopefully you enjoyed the article.

About the author:

Bryan O’Rourke is a health club industry expert, technologist, financier, shareholder and executive in several companies. He works for Fitmarc, which delivers Les Mills programs to over 700 facilities and 5,000 instructor professionals in the US. He advises successful global brands, serves as a member of the GGFA Think Tank, is a member of the American Council on Exercise's Industry Advisory Panel and serves as CEO of the Fitness Industry Technology Council. To join FIT-C visit . To learn more contact Bryan here today .

Being Ahead Of Your Time - Apple's Newton & iPad

The term "PDA" (personal digital assistant) was coined around Apple's Newton. Launched in 1993 at a price of $699, the Newton project was thought by many to be an abject failure (Jobs cancelled it shortly after terminating John Sculley) - but was it ? Reflecting on its history, the device was ahead of its time and technology. Consider that in September 2009, Michael Tchao, one of the Newton's marketing product champions, returned to Apple to join the iPad team and two ex-Apple Newton developers founded Pixo, the company that created the operating system for the original iPod. in fact, the nexus for iPad was Newton. (Kim Arnold shares this view here).

When writing or speaking about the future and the rapid pace of technological change that is and will increasingly impact everyone (particularly in the fitness and wellness arena) ; its often good to reflect on past "failures", seeing where they ultimately end up. The tablet market is now the 4th largest consumer electronics category in the world at nearly $9 billion annually.What does that say about Newton ?

So what do you think ? Please let me, Bryan O'Rourke, here from you. Was Newton a failure ? Watch the iPad and Newton commercials below. I think there are some similarities don't you ?

Think Mobile Trends & Social Media Are Related - You Bet They Are

The infographic above shows the current size of major social networks as well as the other well-known online services used on a daily basis relative to their peers. It also overlays the size of each company’s mobile user base. You’ll see Skype, Facebook, Twitter, Gmail, MySpace, LinkedIn, and more (wonder why Microsoft paid what they did for Skype?). Check out the agency’s infographic from last year to see the relative changes. Notable differences include: The rise of Chinese Qzone and Twitter, the fall of Myspace, and the stasis of Friendster.

Below are stats from JESS3 to consider. Please tell me, Bryan O'Rourke, what are your thoughts about these trends ? Is your business, your fitness or wellness business or any business or organization for that matter, planning, thinking or preparing for the revolution tied to these technologies ? I look forward to hearing your thoughts about what is happening and what is next.

Some other notable trends in the geosocial universe, courtesy of JESS3:

  • Mobile: 5.3 billion mobile devices are used worldwide — that’s 77 percent of the world’s population
  • Smartphones: 21.8 percent of all mobile devices are smartphones. Despite what one might think, Apple does not top the list in sales—Nokia does
  • Skype: Mobile usage continues to increase thanks to Skype’s wise investment in apps and its mobile platform
  • Facebook: Now tops 629 million registered users with almost 250 million people accessing the site via mobile
  • Qzone: China’s version of Facebook, Qzone, is experiencing supernova-like growth with 480 million registered users
  • Twitter: Broke the 200 million registered user mark with nearly 40 percent of people tweeting via mobile
  • Email: Hotmail still dominates email, but Gmail is gaining fast
  • Yelp: Yelp is topping 50 million unique visitors per month. Its move to team up with OpenTable earlier this year will only increase its relevancy
  • Foursquare and Gowalla: These geosocial specialists are still growing, but growth seems to be slowing down a bit

The Economics Of Aging

You've probably heard the news: Many of the nations of Europe are literally shrinking in population. In fact in Italy today 60% of children do not have a sibling, aunt, cousin or uncle: only parents, grand parents and or great grand parents. Birth rates are inadequate to sustain these populations, which are getting much older. This will pose great challenges for businesses and organizations that have traditionally relied on households of families as the largest group of customers. There is no doubt that the percentage of these are declining and further more that India and Africa will be the biggest contributors to world population growth in the coming decades. What are the implications ? They are significant. Check out the Nieslen research deck "The Aging Globe" below and think about it. Are you preparing for a future customer base that is older than the one you have now ? What are the implications to the health club business and to wellness in general ? I think they are significant. Contact me, Bryan O'Rourke, and share your views on The Aging Globe.


As 2011 Approaches The Future For The Health Club Business Is Promising

This is an excerpt from an upcoming article written by Bryan K. O'Rourke, MBA, that will be featured in the Gold's Gym Franchisee Association's digital magazine "The Voice".

As we enter 2011, the health club business, like many, faces tough times.  Slow growth stands in contrast to a history of expansion.  However, short term problems might ultimately serve to separate the capable from the unprepared. By adopting new business models and technologies, smart competitors will flourish while others struggle to survive.  As economic conditions improve, the strategic minded club operator will be positioned to do very well and have the chance to wrestle away market share while potentially growing the industry overall. How will a promising future unfold in light of recent struggles?  Here are some thoughts.

Economic Outlook Is Slowly Improving

Economic conditions are improving, albeit slowly. According to the November IHS Global Insight Economic Outlook Index, real GDP growth is forecasted at 2.2% in December through March of 2011, with 5 of 11 leading indicators being positive. While lending remains tight, funds are available for good credit risks. Despite slowly improving near term economic conditions, more important long term transformative factors are impacting the health club business along with other industries as technological advancements, changing consumers and new economic models create challenges and new opportunities.

New Business Models

Larger “budget club” formats like Equinox’s newly developed “Blink”, among others, reflect a further evolution of business models, offering monthly membership dues of as little as $10. Meanwhile new, hi-end, experiential and niche facilities such as Lifetime’s Lifepoweryoga, Soul Cycle, and Fitness Euphoria offer memberships for $80 or more per month with the option to pay for single sessions starting at $20. These more experiential facilities offer higher levels of membership engagement at a higher price point. Bottom line is these and other new models are generating positive ROI's and reflect evolving concepts and formats that will drive growth for the health club industry.


The bricks and mortar fitness industry is changing. Internet ubiquity, mobility and social platforms are changing the way business is and will be done in and outside of the four walls. The potential for engaging members and prospects using these technologies is unlimited. Solutions, like SCVNGR, Foursquare and others are already being used for marketing and brands like Gold’s, Equinox and others have launched sophisticated applications for their members. With online services and memberships growing, this is only the beginning of what is to come, as intelligent operators will use these technologies to interact with and service their existing and prospective members in new and exciting ways.


While the popularity of fitness has increased substantially during the past several decades, the idea of illness prevention is a concept that national health policy can no longer ignore. With national health care costs topping $2.7 trillion in 2010, the health club industry by comparison represents less than a penny on each dollar spent on illness. This despite wide ranging research showing the benefits of exercise and diet in preventing most major chronic illnesses.

New monitoring technologies and health club services and programs offer an answer to the health care crisis. As health care costs become untenable, employers and the government are seeking prevention solutions. In a recent ground breaking decision Medicare began reimbursements for Pritikin’s intensive diet and exercise programs for qualifying individuals with a history or risk of cardiovascular events. Employers are also embracing wellness programs as a means to cap their exploding health care costs as well. This is a big business opportunity for health clubs.

Art Curtis, Chairman of IHRSA, recently called on the leaders of the health club industry to launch a comprehensive campaign that will improve our nation's health through positive personal behaviors and working closely with important stakeholders like government agencies, educators, the medical community and others. Art is right and many health club players will intelligently enter the prevention business in the years to come.

What Do You Think ?

Contact me, Bryan K. O'Rourke, and tell me "do you think the future for health clubs is promising?" Why or why not ? Read my upcoming article in the GGFA's "The Voice" to learn more on key trends around the future of the health club industry.