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David J. Conti, DPT, NCS, CSCS is the owner of Revive, Boost, Rebuild, Physical Therapy, LLC (RBR PT), and an adjunct professor at St. Augustine’s University. He has practiced physical therapy for 10 years, with a clinical focus on orthopedic and neurologic patient cases. He is a certified strength and conditioning specialist, and one of only 57 PTs in NC who is board-certified in neurology.

RBR PT treats patients from infants to geriatrics. RBR PT is known as an inclusive clinic and a strong community resource.


By David Conti, DPT, NCS, CSCS

David Conti

Self-advocacy: an underrated and frequently omitted component of the healthy mind, body, and spirit movement. We are living in an era of immediate gratification and passive satisfaction, an era of medication, modalities, and a host of external tools and devices—all promising the magic-wand effect. But if we have any hope of making positive, long-term, lasting impact on our health, it must include identifying and addressing the root of the problems we face.

The lack of self-advocacy is a common thread among many self-destructive behaviors. Obesity, opioid dependency, and tobacco use are three of the most prevalent crises currently manifesting themselves in this country. The hope that these battles can actually be won is deeply invested in our ability and willingness to properly identify the roots of these conditions and act accordingly in an evidence-based team effort.

Focus on Obesity

Of all the self-induced health conditions, obesity tends to be at the top of most people’s lists. For good reason: According to a 2015 briefing published by the Centers for Disease Control and Prevention, 37.7 percent of adults in the US suffer from obesity, while 17.2 percent of children are given this albatross of a risk factor. Most alarming is the upward trend over the last two decades, more so among adults, propelling this issue to epidemic proportions.

David Conti guides a client through an exercise routine.

The statistics are undeniable but also inspire a few simple questions: How and why do people become overweight? How can this trend be altered? Most of us are at least aware that weight gain or loss is dependent on the balance between calories consumed and calories burned as fuel for energy. Did you know, however, that genetic predisposition is a significant factor to be included in this formula? How about variables such as sleep deprivation, stress, or challenges to emotional and psychological well-being? Studies have repeatedly linked these variables to the diagnosis of obesity.

After determining that you have some of these risk factors, the next step is a delicate one. It must be understood that, although more challenging, you can still overcome the predisposition. It will take more discipline, and an individualized strategy—avoiding a “one size fits all” solution. As with any issue, we must identify and correct the core problem if we are to effect a lasting change.

A Multidisciplinary Approach to a Complex Problem

And the “core problem” will likely vary from person to person, and involve more than one factor. So, while standard dieting strategies can help some, most will benefit most from a more inclusive and thorough assessment to identify the contributing factors.

This may very well require an interdisciplinary approach including a number of specialists—from dietitians and personal trainers to physical and psychological therapists. It may also be essential to include the services of an internist with a focus on endocrinology and other hormone altering factors. Perhaps more important still is the communication between these parties to ensure an optimal outcome.

In short, it is not always as easy as eating less and exercising more. In fact, over simplifying it is both irresponsible and dangerous. That elementary approach has very likely contributed to stimulating this issue toward epidemic status.

Healthy, Effective Exercise

Consider for a moment the physical fitness and exercise components of weight loss. As with dieting, blanket approaches to exercise leave a lot to be desired and are frequently unsafe. Obesity generally carries with it a host of associated health concerns and can be the gateway to various life altering, if not life-threatening conditions, including: diabetes, hypertension, coronary heart disease, heart attack, stroke, kidney failure, weight bearing joint arthritis, degenerative disc disease, and even some forms of cancer.

While it is true that each of these secondary issues, in conjunction with genetic predisposition and pre-existing health history makes every subject unique, it does not mean that they cannot be helped. Despite the daunting nature of these scenarios, those dealing with obesity should maintain hope for success, as specialists are available to structure effective, safe exercise programs. And those of us who specialize in this area understand that an exercise-based weight loss program will succeed when it is patient-specific, including the patient’s entire clinical picture.

Food Addiction

The role diet plays in obesity is more complex than just numbers of calories. When addressing the obesity issue, it is useful to consider the possibility that certain foods can trigger neurobiological cerebral mechanisms often associated with addiction. Much like the more researched and discussed epidemics of drug and alcohol addiction, food can be—and perhaps for some, should be—viewed similarly.

A 2013 study published by the National Institutes of Health explored food addiction as a significant and new piece of the obesity framework. While there is no claim that all people suffering from obesity are also addicted to specific foods, it is worth considering the contribution of such cases to the epidemic whole. If we agree that the theory of food addiction is legitimate, then we should also change how we view and address obesity.

The fact is that eating is a non-negotiable component to our very existence. Unlike most drug and alcohol rehabilitation strategies, neither cold-turkey quitting or structured weaning is an appropriate approach for food addiction. Imagine if those addicted to narcotics were asked to take “just enough, but no more drugs than necessary.” This is, however, the very approach that many have applied to the problem of over-eating. We have all heard, if not offered advice such as “don’t eat so much” or “eat only when you are hungry” or even “eat in moderation.” When you exchange food with variables like narcotics or alcohol, these statements seem foolish at best. However, these clichés are so common they are frequently accepted as reasonable. Therein lies the danger of over-simplification.

The late poet and author, Maya Angelou, once wrote, “Do the best you can until you know better. Then when you know better, do better.” We must pay attention to the research and the scientific evidence regarding obesity and food addiction if we are to make the necessary strides towards altering this trend. That said, regardless of whether we are considering over-eating, induced obesity, or drug and alcohol addiction, self-accountability remains a common denominator in the formula for reversal.


It can be a sobering moment to face the reality that our choices have led us to our current state of being. It’s not easy to admit that we can positively change our status, because with that also means admitting that we are responsible. This is the reality of the self-inflicted wound and explains its perpetuation.

While a willingness to assume responsibility is vital, so is the construction and maintenance of support systems to aid those who wish to repair their self-inflicted wounds. Just as we are warned to learn from our mistakes or risk repeating them, we should also learn to emulate the strategies of our successes in solving such problems. It would be wise, for example, to acknowledge and apply the strategies associated with anti-smoking campaigns to the epidemics of obesity and opioid addiction. In short, it is clearly easier for an individual to develop self-destructive behavior than to recover from those problems on his or her own. Recovery requires support. So, the interdisciplinary team must respond with urgency and actively uphold their joint commitment to the promotion of optimal health and wellness.