Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (7)

The Top 10 Things We Should Tell Our Patients About Weight Loss

It is estimated that in seven years from now, half of all Americans will suffer from one or more chronic diseases, a majority of which are weight related. The American Medical Association recently declared that obesity itself is a disease. Obesity advocacy groups say that this move will lead to better health outcomes by providing more treatment options, preventative programs and education, as well as better reimbursement for treating individuals fighting obesity.

But what do patients need to know about weight loss?  The good news is that a  medically healthy weight does not require a very low percent body fat.

Weight loss for health – not for appearance – comes with a different (and in many cases much less demanding) set of recommendations. So for the purposes of this blog post, I’ll focus on key evidence-based advice for patients at risk for weight related disease…

1. You don’t need to lose that much weight to realize substantial health benefits.

A five to ten percent loss of body weight can lower risk for heart disease and other killers. For obese patients, even a modest weight reduction can have significant health benefits. An eleven pound reduction in weight leads to a fifty-eight percent decrease in the chance of developing diabetes. Even just losing two pounds reduces the risk of diabetes by sixteen percent.

2. Most people who succeed at losing weight (and keeping it off) do so with a combination of diet and exercise.

According to the National Weight Control Registry (NWCR) (a database of more than ten thousand Americans who have successfully kept at least 30 pounds off for a year or more):

  • Ninety-eight percent of Registry participants report that they modified their food intake in some way to lose weight.
  • Ninety-four percent  increased their physical activity.

3. Walking is the most common form of exercise reported by successful weight loss subjects.

According to the NWCR, their study participants’ most frequently reported form of activity was walking. That’s not to say that other forms of activity (such as interval and strength training) aren’t an important part of a healthy lifestyle, but it is encouraging to know that brisk walking is a simple, affordable, and easily accessible place to start for most people.

4. Exercise itself (even without weight loss) is one of the most powerful preventive health interventions available.

Physical exercise has been shown to reduce blood pressuredecrease the risk for type 2 diabetes, strokes, certain types of cancer, and heart diseaseimprove arthritis symptoms and sleep disorders, and reduce erectile dysfunction, anxiety and depression. No pill or procedure can come close to providing all these amazing health benefits.

5.  Diet is more important than exercise for shedding pounds of fat.

As I often tell my patients, “You can’t outrun your mouth.” Which means – you can eat far more calories in a short period of time than you can ever hope to burn with exercise. For this reason, diet plays a larger role in weight loss than exercise.

6. It’s more important to lose fat than to lose it by following a particular diet.

If diet is so important for losing weight, the next logical question is “Which diet is best?” Interestingly, the answer may be – whichever one you’ll stick to. Now, of course there are some diets that are more nutritionally sound than others – but the benefits of fat loss are so great, that health benefits are achieved even on relatively “unhealthy” diets. In a landmark diet comparison study, Michael Dansinger showed that study participants achieved similar benefits (such as improved cholesterol profiles, blood pressure, and inflammatory markers) from adhering to any of four vastly different diet regimes ranging from low fat, high carb to low carb, high fat.

7. The healthiest diets limit refined carbohydrate and animal fat intake, while maximizing fruit, vegetable, and healthy fats and protein.

I’ve just argued that a variety of diets work if you stick to them, and adherence is the key to fat loss, and even modest amounts of fat loss can have substantial health benefits. So does it really matter which diet you choose? In the long run, yes. Research has shown that there are some common nutritional principles that result in optimal health. The key ones are:

  • Avoid refined carbohydrates as much as possible (such as sugar, fructose, and white flour/rice products). Unrefined carbs (such as whole grains, flax, oatmeal, brown rice, quinoa, berries, and cruciferous veggies) are an important part of a healthy diet.
  • Avoid animal fats (trans fats). Healthy fats such as olive, fish and nut oils are preferable.
  • Eat a diet rich in fiber, fruits and vegetables.
  • Choose lean protein sources, including beans, eggs, chicken, fish, pork, yogurt, and fish.
  • Limit alcohol intake and opt for water as your main source of hydration fluid.

8. Aim to lose 1 pound per week.

Cutting out approximately 500 calories from your daily caloric needs (established with a calorie calculator or by personal trial-and-error) is about as much as people can tolerate comfortably over periods of time. Diet adherence decreases as deficits exceed 500 calories per day.

9. The optimal, minimal amount of exercise for the average American adult is about one hour of moderate intensity exercise each day.

There is some disagreement on optimal exercise duration – some groups recommend half an hour per day (American College of Sports Medicine), others (such as the Institute of Medicine) a full hour. A review of the various positions and guidelines is available here. In terms of types of activity, there is general consensus that strength training twice a week should be added to moderate daily aerobic activity for best results.

10. You probably don’t need to take any vitamin or nutrition supplements.

Contrary to popular belief, most Americans (even with their sub-optimal eating habits) meet all of their basic dietary requirements with food intake. Non FDA-approved weight loss supplements have not been found to provide lasting benefits for weight loss and are generally ineffective and sometimes dangerous.

Weight loss drugs and surgical procedures may be effective last resorts for those who have failed to achieve results with diet and exercise. New prescription anti-obesity drugs and FDA-approved over-the-counter options are effective at helping patients shed extra pounds, but often come with unwanted side effects such as anal leakage and adverse cardiac events.

In conclusion, obesity underlies most of America’s chronic disease burden but can be reversed with modest weight loss through diet and exercise modifications. Patient adoption of long-term lifestyle changes are challenged by economic factors (e.g. healthy food “deserts” in inner cities), sedentary lifestyles, poor urban planning, excessive fast food and sugary beverage consumption, increasing portion sizes, and high tech conveniences that reduce energy expenditure, among other factors.

Patients are more likely to begin weight loss programs if recommended to do so by their physician, though studies suggest that they take advice more seriously if their physician is not overweight or obese herself. In our efforts to treat obesity, it may be especially important to lead by example.


You may also like these posts

Read comments »


7 Responses to “The Top 10 Things We Should Tell Our Patients About Weight Loss”

  1. drcharles says:

    Great summary, will print this out as a conversation guide in the office!
    Thanks

  2. Elina says:

    Obesity is becoming a major problem. i think this post will help a lot of people.

  3. Chris says:

    Obesity has become a major problem. I hope people get to see this post.

  4. Chris says:

    Obesity has become a major problem. I hope people get to see this post.

  5. Mark says:

    I’m also suffering from obesity and I always dream of having a family on my own but because of my weight, no one would like to date me. Your article helped a lot in changing my mindset. This is what I needed . Thank you so much!

  6. Mark R. says:

    Aside from being big, there is a big factor that your health will suffer. Being obese is not fun anymore since your health will suffer. Mental challenge is important in conditioning the minds of the patients to really focus to lose weight. The battle in our minds. Wrong mindset will not help you in losing weight.

  7. George Howell MD says:

    Straightforward, clean and correct. My opinion.

Return to article »

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

Read more »

See all interviews »

Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

See all cartoons »

Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

Read more »

See all book reviews »