By Barbara Berkeley, MD
About 20 years ago, after serving as director of a hospital-based weight loss clinic, I discovered that I was that rare bird, a doctor who was fascinated by obesity. Shortly afterwards, I made the jump from general internist to weight loss specialist. Some would say that this was the equivalent of leaping off a career cliff. My colleagues and friends simply couldn’t understand why I would “give up medicine”. And indeed, a practice devoted to weight management is not quite medicine. It is also not quite psychiatry, not quite nutritional counseling, not quite personal coaching and not quite guru-ism. It is a fascinating combination of each of these things. Despite the professional challenges posed by such a misunderstood field, I feel that I’ve been privileged to spend many years practicing---yes--- medicine at the very center of what ails us in modern America.
As we’ve all come to realize since the early 1980s, obesity and it’s deadly companions (hypertension, hyperlipidemia and diabetes) have spread like an enemy force over the health landscape. This ongoing occupation creates a dilemma for doctors. The fat that we’d previously preferred to ignore has begun to suffocate our practices. While doctors are excellent diagnosticians and prescribers, most of us would be the first to admit that motivating “lifestyle change” has never been our strong suit. We know we should mention weight, but studies show that we often fail to do so When we do recommend diet, our patients seem unable to be successful.
So, how can we help our patients get serious about weight loss and achieve results? Here are a few Dos and Don’t’s I can suggest to the frustrated practitioner:
- DON’T simply tell a patient that he needs to lose weight. Be prepared with a specific plan. Your overweight patient almost certainly wants to lose weight but doesn’t know how. Contrary to the endlessly repeated conventional wisdom, weight loss is not achieved by simply eating less and exercising more. Experienced help is necessary.
- DO forge a partnership with the patient. Let her know that you understand that weight loss is a tough but worthwhile task. Tell her that you will be following her efforts with check-in visits. Be sure to be highly enthusiastic in praising positive results.
- DO look the patient in the eye and create a strong connection for him between his weight and the risks to his health. Be specific. In my practice,I do this by explaining the connection between visceral fat and the elements of metabolic syndrome. I also describe (graphically and in detail) the damage that diabetes, hyperlipidemia and hypertension do to the body. It is easy to forget how little our patients actually know about the body’s workings. Convincingly connecting the dots between fat and illness is a major step in motivating dietary change.
- DO have diet materials available in your office. If you prefer to supervise the diet yourself, ask a dietician to design pre-printed meal plans and have them at the ready. People who want to start a diet usually want to begin yesterday. After you start the patient, make a commitment to follow her with weekly, no-cost weigh-ins. Frequent contact boosts compliance and solidifies your partnership. Assign someone in your office to check on missed weigh-ins and call patients who are no-shows.
- DO consider the use of low carb diets. Low carb doesn’t have to mean the Atkins diet. In our clinic, we have learned that patients do much better if they eliminate grains, cereals, flour based foods, pasta, sugars and starchy vegetables like potatoes from their menu. They can continue to eat the carbohydrates in fruits and vegetables. Remember that calories do not tell the whole story. Carbohydrates stimulate insulin which is particularly problematic for our many patients with insulin resistance. They also have addictive properties. Eliminate them and you will eliminate many of the triggers that submarine even the most motivated dieters.
- DO your homework if you decide to outsource weight loss. Locate programs in your area that have been around for awhile and have a good reputation. The best programs see patients frequently (weekly is best). Make sure that any program to which you refer has a weight maintenance component. Offer several choices for treatment based on the patient’s ability to pay. If you are referring to a commercial program like Weight Watchers, remember that all sites are not alike. One location may have an excellent leader while another may be weak. Talk to patients who have lost weight to find out which locations have worked for them.
- DO develop your own belief system about nutrition. Keep it simple and include it in many of your patient visits. If possible, model it with your own behavior. While your nutritional mantra may well be different from mine, I offer the one I have developed here. I have found this basic strategy to be understandable and effective for patients of all ages:
If I gave you a lion cub and asked you to take care of it, what would you feed it? Naturally, you would run to the grocery store and buy it red meat. Each of us realizes that a lion is an ancient creature and has lived in a specific environment for millions of years. It’s genes have evolved to process certain foods and changing its diet would be foolhardy.
We know this, yet we’ve forgotten that we humans have a “lion” diet too. For approximately 2 million years, our hominid species were hunter-gatherers eating what was available in the wild. Your genes “know” lean meat, poultry, eggs, seafood, vegetables, fruits, nuts and berries very well. On the other hand, sugars and starchy foods like grains, potatoes and corn (“S Foods”) are quite new to our diet. Each of these foods asks our bodies to make insulin. Insulin also happens to be the hormone that stores fat. Cut out the “S Foods” and you cut your insulin production. You will be lean like the lion.
About: Dr. Barbara Berkeley is an author and obesity specialist who also serves as Medical Director of Weight Management Services for LakeHealth System in Cleveland, Ohio. www.refusetoregain.com