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The Weight Loss Quest

Three More Ways to Help Patients

Today I read an article about another new weight loss device on the horizon. The product, Abiliti, uses sensors to determine when a patient eats or drinks and then emits low-energy electrical pulses that trigger feelings of fullness (http://www.intrapace.com/index.php). Abiliti is implanted in the abdominal wall during a 1-hour laparoscopic procedure and is based on pacemaker technology. The device also features an activity sensor that tracks a patient's food intake and physical exertion levels. It sends this information to a computer so that patients and their healthcare providers can monitor and adjust eating habits. The device was developed by IntraPace of Mountain View, Calif. It is investigational in the United States but is already approved and in use in parts of Europe.

Residential Programs

Since we don't know when or if Abiliti will become available here (and whether it will be effective and affordable for patients), we must continue to consider all options that can help patients lose weight.

Some dietitians and healthcare providers refer patients to residential programs such as Structure House, a weight loss facility in Durham, N.C. (http://www.structurehouse.com/). Lee Kern, LCSW, is the clinical director for Structure House. He describes it as a residential weight control program that distinguishes itself by focusing on each patient's ability to solely focus on his or her relationship with food.

"The phrase 'relationship with food' is at the core of our philosophy," Kern explained. "When here, participants practice what we call structured eating - eating 3 meals that are nutritious, filling and balanced, and sufficiently low in calories to results in weight loss. This method of eating creates a kind of window that participants can look through to better understand what was going on with food at home. It is, in a sense, eating for fuel, rather than eating for effect. They can then look through the window to see that food is being used to meet nonfood needs - eating to calm, to soothe, to escape, to numb, to entertain, to reward, to stimulate."

Many overweight people use food to produce effects that are largely psychological in nature, Kern said. "Our program represents a way to get off this cycle of overeating and this destructive weight gaining merry-go-round. People need to confront how they have been using food, what triggers them to eat excessively, and they need to see that there are ways of recovering that put them back in control not just of food, but of how to live more meaningfully and effectively."

Structure House recognizes three main triggers or antecedents to food use: habit, boredom and stress. Participants in the Structure House program learn to address these triggers in proactive ways by recognizing urges and cravings as a way of digging deeper to identify the true need, then learning how to meet the need more functionally. The treatment program at Structure House incorporates health, exercise, nutrition and behavior change.

A residential stay at Structure House encompasses classes, activities, nutrition and exercise recommendations. Some patients return for follow-up or access further care and support in remote programs. Patients who cannot visit Structure House may benefit from the book The Structure House Weight Loss Plan, written by program founder Gerard J. Musante, PhD. Several of my patients over the years have received treatment at Structure House and achieved weight loss. I concur with the program's intuitive approach to weight loss and weight maintenance.

Online Communities                                                                                      

I consider the website and community www.sparkpeople.com a great resource for patients seeking to lose weight. Recently, SparkPeople was a topic of discussion on the list serve for the Weight Management Dietetics Practice Group of the American Dietetic Association. Members of the list serve were debating weight loss - how it happens, why it occurs, precipitants to weight loss and setbacks patients face. Participants also discussed why a few additional calories during a weight loss journey can be necessary - something patients are not often too willing to hear. During this time I had a chance to read some quotes from the dietitian who oversees the SparkPeople website, Becky Hand, RD. I asked Hand if I could use one of these comments as it seemed to sum up what might help a patient come off a weight loss plateau, and she agreed.

"By eating a few more calories, patients feel better throughout the day and therefore burn more calories because they are not as sluggish and tired. They are able to do more," Hand wrote.

This statement reiterates that although a calorie restriction might be beneficial in the beginning of a weight loss journey, when combined with real changes, metabolism and exercise, increasing or changing caloric intake may become necessary at some point.

Matching Solutions to the Patient

Taking our patients through the practice of weight loss is not always easy. Setbacks, habits, plateaus and dips in self-esteem can negate the health benefits associated with successful weight loss. Offering patients solutions that match their needs as a person, not just the number on the scale, is of utmost importance.

This column highlighted three more ways to help patients achieve weight loss success. What do you recommend to your patients? Let me know by commenting here.

Robyn Kievit is a family nurse practitioner, a registered dietitian and a certified specialist in sports dietetics. She operates a private nutrition practice in Boston and is on staff at Emerson College. E-mail your nutrition and weight loss questions to robyn@robynkievit.com or visit her website at www.robynkievit.com. On Facebook and Twitter, search for nutritionmentor.


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