Tired of my griping? So am I. I don’t want the reputation, but it comes with the territory. When your voice is in the minority, and you are trying to educate people (type 2s, pre-diabetics, the overweight and obese, and just about the whole human race) about “healthy eating,” and your message is contrary to what is held as “perceived wisdom” by all the power sources (government, the medical establishment, big pharma and agribusiness), you’re constantly griping about their message. Besides, I am predisposed to be a contrarian. A newspaper editor once asked me to write a “Country Curmudgeon” column.
So, when I read the subject line on my Medscape Medical News feed, I assumed, wrongly as it turns out, that I was being fed more bad advice by “our experts.” Turns out, the 15 tips put together by Laurie Scudder, DNP, NP, Executive Editor of Medscape, are very good. Not once did I see the words “saturated fat” or for that matter “fat,” or “cholesterol.” There was a little of the “more fruits and vegetables” pitch, but it was vestigial, not the central message. So take a look. The slide presentation title is “Weight Loss Pearls: Helping Patients Help Themselves.” I like it already!
#1: The title page; introduces “the most successful clinical gems to help overweight and obese patients.”
#2: Strategize for initial success: success at 1 month “was the strongest unique predictor” of 12mo. weight loss.
#3: “The Basics,” they bear repeating: “Eat Real Food, Watch Portions, Turn TV off, Sit Down to Eat.”
#4: “Eliminate sugary beverages (regular soda & fruit drinks); also white flour snacks (cookies, cakes, pizza).
#5: “Avoid the middle aisles at the grocery store, where you find ‘junk’ and processed foods.”
#6: Control portion size; use your hand as a measure. (The examples I called “vestigial” messages are here.)
#7: Help patients cut 100 daily calories per visit. Focus on between-meal snacking, portion control & satiety (nuts, fruit).
#8: Write an exercise prescription; “Encourage patients to do any exercise they love on a consistent basis.”
#9: Don’t forget mental health; Depression is strongly associated with weight gain, often accompanied by carb craving.
#10: Set a start date that is meaningful, get a partner to do it with you, and announce it to friends and family.
#11: Don’t leave patients alone; frequent visits, follow-up by nursing staff, and group visits all correlate with success.
#12: Reinforce the “healthy lifestyle” message: more fruits/veggies; less screen time; more exercise; fewer sugary drinks.
#13: Dedicate 2 min. each visit to nutrition; pick 1 very specific topic to address, set a goal & follow up. Show you care.
#14: Each patient is unique so approach each holistically; determine which factors play a role in individual’s weight.
#15: “Remember that your role is to be an assistant to your patient. Do not get discouraged when they do not take your advice to change behavior.” This “tip” was my favorite. The “expert” was Christopher F. Bolling, MD, Division of General and Community Pediatrics, Cincinnati Children’s Hospital and Medical Center. I think Dr. Bolling missed his calling. He should have specialized in “Non-surgical Bariatric Medicine.” His further excellent expert advice was as follows:
“The major lifestyle change required for weight loss occurs when it reaches a level of importance in someone's life and is accompanied by a level of confidence that this change can actually be accomplished. In other words, change will happen on the patient's timetable, not that of the healthcare provider. He encourages clinicians to think of their role as that of a close friend who doesn't nag. ‘Be there and be helpful when your patient is ready to act. Until then, be patient.’”
Boy, that is a clinical gem! Why do I say that? Because that’s how it was with me. My doctor had nagged me for years. And when he had a registered dietician on staff, she did too, always with “bad” advice, especially for a long-term type 2 diabetic: Eat a restricted calorie, one-size-fits-all, “balanced” diet, as (still) recommended by the entire public health establishment, and exercise more. Needless to say, when I tried it, I failed to lose weight or keep off what weight I did lose. I was hungry.
Then one day 12 years ago, I weighed myself at the Fulton Fish Market (on a commercial scale because my doctor’s scale only went to 350 pounds) and discovered I weighed 375 pounds. “It was a rough day,” as Marie says in the TV commercial. Losing weight finally “reached a level of importance” for me. A few days later, when I walked into my doctor’s office for a regular check-up, he greeted me with, “Have I got a diet for you!” Turns out he had read Gary Taubes’s “What If It's All Been a Big Fat Lie” in the New York Times a few months before and had lost 17 pounds following Atkins Induction. He suggested I try it. I did. I lost 170 pounds, and I’ve kept most of it off after 12 years.My motivation to lose weight was “accompanied by a level of confidence that this change can actually be accomplished.” Change happened on my timetable, and my doctor never had to nag me again. He just smiled when I walked in the door.