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Weight Loss Part 2

Nutrition With Commitment

One month into 2011 and perhaps you've already seen patients who express feelings of failure about weight-related efforts. What strategies can primary care providers incorporate to help patients feel and experience success? Have we been suggesting nutrition with intention instead of making resolutions?

The Best Approach

Hope Damon is a registered dietitian and certified diabetes educator in New Hampshire. She suggests recognizing any and all progress patients make toward weight loss. I wholeheartedly echo her advice. Many of my patients tell me they have had negative experiences with healthcare providers with regard to their weight loss attempts. (I am proud to say that they often tell me they have had the best care when they leave my office!) Even a 1 to 2 pound weight loss in 4 weeks is progress! Losing a half pound per week means the patient has either exercised 1,750 calories more than before or has eaten 1,750 calories less in a week. This is no small feat!

"Even if the measurable result is modest in number of pounds lost, we as healthcare providers can have great effect in helping patients continue their efforts," Damon adds. She suggests asking the patient what changes he or she has made in eating or activity, rather than focusing on pounds alone. Helping patients pace his or her goals is imperative. Asking a patient who has never exercised to go walk 7 days per week will not work. Asking that same patient what they like to do for activity and then suggesting that he or she incorporates this activity two to three times per week for a month before a follow-up visit is much more realistic.

Adjusting Expectations

Joanne Ikeda is a master's level dietitian and nutritionist emeritus at the University of California at Berkeley. In response to my posted question to the American Dietetic Association's Weight Management Dietetics Practice Group, she referred to a paper written by the Association for Size Diversity and Health (ASDAH). This group believes it is time to adopt a new approach to weight management and health that is built on the following principles:

  • Accepting and respecting the diversity of body shapes and sizes
  • Recognizing that health and well-being are multidimensional and that they include physical, social, spiritual, occupational, emotional and intellectual aspects
  • Promoting all aspects of health and well-being for people of all sizes
  • Promoting eating in a manner that balances each patient's nutritional needs, hunger, satiety, appetite and pleasure
  • Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss

The ASDAH argues that promoting a healthy lifestyle that includes adequate amounts of physical activity and rest, as well as a nutrient-dense diet, is a much more promising approach to improving health and well being. Continued adherence to the notion that weight loss is the only path to health for overweight and obese people is outdated and unhealthy. To find out more about ASDAH, visit www.sizediversityandhealth.org.

Common Hurdles

"I have no time to exercise." "Grocery shopping takes so much time." "I always start out the day with a healthy breakfast and then by dinner time, I'm starving." "I eat more when I make food for my kids." "My whole family is overweight so I know I will be too." "I lost 20 pounds in 3 months and then I gained it all back last year."

The experiences expressed above are quite common. How do we help patients overcome these hurdles to stay on track? Anne M. Fletcher, MS, RD, author of Thin for Life: 10 Keys to Success from People Who Have Lost Weight and Kept It Off, interviewed more than 200 people who lost weight and maintained it. She found that they stay motivated by recognizing how far they've come and staying focused on not returning to the way they were before. Accordingly, she suggests that people keep a diary of "mind, body and spirit" successes (no matter how small) from the day they start losing weight. This will help them recognize accomplishments in addition to pounds lost. For instance, a patient might record the following:

  • I have more energy.
  • I'm sleeping better.
  • I feel more confident.
  • I was able to cut my blood pressure medication dose in half.
  • My cholesterol dropped 30 points.
  • I can get in and out of my car more easily.
  • I can button my favorite pair of pants now.
  • My knees don't hurt as much.
  • I can go up and down the stairs without getting out of breath.

Whenever a patient hits a plateau or feels discouraged, pull out the diary to review his or her accomplishments. Journals and food diaries have long been a standby for me with patients working on weight loss and weight maintenance. Often, the lesson learned first is that by writing a food down, they realize they may choose a healthier option. Recording exercise is also valuable. Walking to pick up a few items or complete errands instead of driving that same mile or two can equal 100 to 300 calories burned.

Simple e-mail reminders such as the Healthy Monday campaign, used on college campuses and in schools, have applications for all ages and lifestyles. Patients can receive an e-mail or text every Monday to remind them of a healthy eating, exercise or wellness tip. More information can be found here: www.mondaycampaigns.org.

What Is Your Approach?

What is your personal approach to weight maintenance or weight loss? Can you share what you have encountered as common hurdles, and what strategies you use for fine tuning and helping patients stay on track? People listen and absorb what works for others. Use the above tools and suggestions to help patients stay on track by not only checking in with you, but by checking in with themselves.

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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