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Weight Loss Part 1

Nutrition with Intention

It's New Year's resolution time, and that means many of our patient visits this month will focus on weight loss. This month and next, I'll be providing strategies you can implement successfully and realistically in practice.

Assessing readiness

The first step should be an honest assessment of readiness to make a behavioral change. The Patient-Based Assessment and Counseling for Physical Activity and Nutrition, known as the PACE questionnaire, can be used to ascertain the patient's level of readiness to make the changes necessary for weight loss. You can download the PACE questionnaire for free.

The results of this questionnaire can provide valuable guidance to patients and providers as they make decisions about weight loss plans. Someone who is not at a stage of change isn't likely to be successful in making the significant improvements required for weight loss.

Establishing goals & taking first steps

The tried-and-true method to drop weight does exist. It's a matter of mathematics, and it requires eating fewer calories and incorporating physical activity.

Advise patients to start slow and to set achievable goals. I recently polled members of the Weight Management Dietetics Practice Group of the American Dietetic Association about establishing goals and taking first steps toward weight loss. One registered dietitian (RD) recommended avoiding fad diets and drastic alterations in eating. Small dietary changes are more likely to stick. I agree completely. Throughout my 17 years of counseling patients on diet and nutrition, my busiest times are the late spring and summer. Why? Fad diets - and "diets" in general - may only yield results that last 3 to 12 months. Most patients start a diet or completely alter their nutrition and eating habits in January and by spring or summer, they have regained most or all the weight lost.

Establishing goals and taking the first steps toward weight loss can be simple. Websites such as or provide valuable tools for recording nutrition, exercise, fluid and mood - all the essentials for weight loss and weight maintenance. Educate patients about resting metabolic rate, activity rate and daily caloric needs. This is information they'll need in conjunction with these programs.

RD-authored books such as The Healthy Eating & Weight Management Guide by Dorene  Robinson, RD, CDN, can be great resources for health professionals prescribing weight management strategies.

Weight Watchers

Also in 2011, establishing weight loss goals for a patient may include suggesting the new Weight Watchers Points Plus system. This revamped approach to weight loss suggests making eating choices based on protein and fiber content as well as calories. Foods with substantive protein and fiber fill us up, keep hunger away and help with weight loss. In the new Weight Watchers Points Plus system, calorie-dense foods that have more fat and simple carbohydrate are assigned more points. Even better, fresh fruits and non-starchy vegetables can be consumed in unlimited quantities with zero points used.

Methods to stay accountable for eating choices are an asset to patients trying to lose weight and eat nutritiously. Suggest the new Weight Watchers Points Plus system. It works for patients who are ready to change, and it will keep working long term because it's not a fad; it's a way to eat for life.  

Eating with intention

Intention is a powerful tool. I ask patients to write down how they intend to eat versus how they might resolve to eat. Intention is more powerful and suggestive of success. It overshadows the "I will" with an "I am" attitude toward eating healthy.

Want to find out how real dietitians eat? Suggest that patients follow RDs online as they blog about their dietary intake and provide other great nutrition information on: .

Avoid overwhelming patients with information. Keep it simple. Insights into why a person eats, how he or she eats, and what the satisfaction is with eating are all "need to know" items for patients trying to lose weight. A pound equals 3,500 calories and losing 1 pound a week therefore requires ingesting 500 fewer calories per day. But unless a patient knows what drives him or her to eat, a positive outcome is not likely.

Creating a focus on behaviors can be as simple as the plate rule (half should be filled with fruits and/or vegetables, a quarter should be filled with proteins [about the size of a deck of cards], and a quarter should be filled with carbohydrates [about the size of your fist]).

Encourage planning the day's intake ahead of time, to avoid the temptation to stray from the eating plan. Remove trigger foods from the household and help control portion sizes by purchasing smaller sizes of favorite foods.

Partner up & exercise

On the exercise front, recommend that patients start out with small activity goals. I cannot emphasize enough that working out with a spouse, friend or child can greatly assist in adherence. Ask patients to make three or four exercise appointments with themselves per week. The best exercise is whatever the patient enjoys doing, whether it's walking around the neighborhood, taking a Zumba class or riding a bike.

Family resources

If you are caring for an entire family and they are interested in learning more about nutrition, a useful website is It is written by RDs and it's full of recipes, eating tips and dietary suggestions for children of all ages.

Nutrition Now in 2011

In 2011, we'll continue to discuss where calories should come from. We'll see more on the new dietary guidelines, and we'll examine the issues surrounding fat intake. If you have question or comment, please post below. You can also e-mail me directly.

To your patients' best health in 2011 ... Happy New Year!

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 or visit her website at On Facebook and Twitter, search for nutritionmentor.


Nutrition Now Archives

Spot weight loss is difficult - please see past columns where I've written about this piece. Aerobic exercise and proper strengthening exercises for the core in addition to eating nutritiously are exceedinly helpful. Good luck! Robyn

Robyn Kievit,  NP, RD, CSSD,  Private/Emerson CollegeJanuary 07, 2011
Boston, MA

what can i do to lose inches at my waist?

ocotlan montoya,  rnJanuary 06, 2011
andrews, TX


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