Weight loss tips from our experts medscape
β’Download as PPTX, PDFβ’
1 likeβ’309 views
wt loss tips
![Start With the Low-Hanging Fruit
This will set patients up for every chance of initial success. Ask your patients whether they
want to lose weight, and what they think their biggest barrier isβand take a few minutes to
strategize with them on that first step. An initial small success will increase self-efficacy,
allowing for a later focus on bigger lifestyle changes. In fact, a recent study demonstrated that
initial weight loss at 1 month was the strongest unique predictor of percentage weight loss
after 12 months.[1]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
Recommended
More Related Content
Viewers also liked
Viewers also liked (11)
More from Dr Ankur Shah
More from Dr Ankur Shah (20)
Recently uploaded
Recently uploaded (20)
Weight loss tips from our experts medscape
- 2. Start With the Low-Hanging Fruit This will set patients up for every chance of initial success. Ask your patients whether they want to lose weight, and what they think their biggest barrier isβand take a few minutes to strategize with them on that first step. An initial small success will increase self-efficacy, allowing for a later focus on bigger lifestyle changes. In fact, a recent study demonstrated that initial weight loss at 1 month was the strongest unique predictor of percentage weight loss after 12 months.[1]
Editor's Notes
- The Basics There is a reason that they are called "the basics." We think everyone knows them, but they always bear repeating. Linda Bradley, MD, professor of surgery at the Cleveland Clinic and vice chair of the Women's Health Institute, begins with the basics: She quotes Michael Pollan by saying, "Eat food. Not too much. Mostly plants."[2]Β She also recommends that patients cook the majority of their meals and eat sitting down, and not while watching television.
- Eliminate Simple Carbs It sounds pretty basic, but a lot of patients are still consuming significant calories from easily eliminated sources. A report released in August concluded that 20%-40% of adults consumed regular soda, fruit drinks, or both daily, for an average of 151 extra daily calories.[3]Β And an analysis of food intake in kids confirmed that a huge percentage of their calories come from white-flour sweets (think cookies and cakes), pizza, and soda.[4] The first recommendation from most of our experts was to eliminate these calorie sources. Joseph Hagan, MD, clinical professor in pediatrics at the University of Vermont College of Medicine, reminds parents to limit juice to a maximum of 2-4 ounces daily for the youngest children. And always remind adults about the many calories contained in most alcoholic beverages.
- Limit Access to Junk Food Nurse practitioner Wysocki's key tip for curbing weight gain is to avoid the middle aisles when grocery shopping because that is typically where you will find the "junk" and processed foods. If junk food is not in the house and getting it requires a trip to the store, there is a greater possibility of overcoming the impulse to eat it.
- Quality or Quantity? It's often not a question of what your patients are eating, but rather how much. Numerous studies have found a correlation between portion size and caloric intake.[5]Β Put a bigger serving in front of someone, and they will often consume it. People presented with large portions generally do not report increased levels of fullness, suggesting that hunger and satiety signals are ignored or overridden. You can't provide detailed diet advice, but here's a really simple way to describe serving sizes. One cup, the appropriate serving size for cold cereal, is about the size of the average person's fist. A cupped hand approximates half a cup, the serving size for ice cream. The surface area of the palm can be used to measure a 3-ounce portion of lean chicken or fish. And the 1-tablespoonβsized thumb makes a great gauge for salad dressing or peanut butter.
- Begin Small Helping patients to cut 100 daily calories per visit adds up. JoAnn Manson, MD, DrPH, professor of women's health at Harvard Medical School, particularly focuses on between-meal eating, reminding patients of the importance of recognizing the potentially hundreds of calories consumed by not snacking mindfully. She suggests a handful of nuts, which are satiating. Portion control is still important; bags of walnuts, almonds, and other nuts are often available in 1-ounce packets. The high water and fiber content in fresh fruit also promotes satiety.
- Pick an Activity, Any Activity Most of our experts noted that the conversation has to include exercise. Dr Bradley encourages patients to do any exercise they love on a consistent basis. Mark Williams, MD, clinical professor of medicine at the University of North Carolina in Wilmington, writes a prescription for a regular exercise program for his generally retired patients, which typically involves walking at least 30 minutes daily. Patients prescribed exercise are much more likely to participate in supervised exercise classes, an effect that is even more pronounced in men.[6]Β A successful exercise prescription is succinct, measurable, and patient-appropriate and notes frequency, intensity, type, time, and progression.[7]Β Change in exercise-related motivational factors, particularly interest and enjoyment in exercise, has been found to play a more important role than diet in long-term weight management.[8]Β A final reminder comes from Dr Manson, who encourages patients to avoid sitting for long stretches, noting that prolonged sitting is an independent risk factor for weight gain.[9]Β She encourages her patients to set an alarm on their phone to remind them to stand at least once an hour.
- Don't Forget Mental Health Atypical depression, present in one quarter or more of all patients with depression, is marked by increased appetite, hypersomnia, mood reactivity, and sensitivity to rejection.[10]Whereas depression and obesity each increase the risk for the other, atypical depression is strongly associated with obesity, and weight gain often occurs during depressive episodes.[11]Β Antidepressants that are weight-neutral or potentially suppress appetite (eg, bupropion) may be particularly appropriate therapies. Binge eating and other eating disorders are also increased in those with depression and obesity.
- Plan to Start Encourage patients toΒ notΒ start on a diet after talking with you. It sounds counterintuitive to not immediately capitalize on any enthusiasm generated by your discussion, but preparation and planning are important and are key predictors of success. Selecting a start date that is meaningful and easily remembered, and then announcing it to friends and family, has been correlated with success. Research has demonstrated that patients who report initiating multiple diets are less successful at weight loss,[12]Β so emphasizing the importance of laying a strong foundation to begin with may be a necessary first step.
- Don't Leave Patients Alone For those patients who can't or won't recruit a partner, it may be possible for the primary care practice to fulfill that role. Dr Nobili notes that adherence to lifestyle changes in obese/overweight patients treated in general clinical settings is very low. In contrast, adherence to these same strategies rises to a very high level in the setting of clinical trials. Why this difference? Dr Nobili argues that it is the careful and frequent contact between provider and patient. Consider follow-up by nursing staff, group visits conducted by a nurse practitioner, Web-based weigh-ins, or other strategies that allow for more frequent contact with patients.Β Group visit modelsΒ have been found to be well received by both patients and clinicians, often allowing for greater productivity. However, it is important that clinicians considering this method be aware of HIPAA rules and Centers for Medicare & Medicaid Services (CMS) and insurer payments.[13]
- Reinforce the Message Several of our experts emphasized the importance of all clinicians in a practice sending the same message, reinforcing healthy lifestyle information at each visit. William Basco, MD, director of the Division of General Pediatrics at Medical University of South Carolina, and his colleagues useΒ Let's Go, which is based on the 5-2-1-0 plan, offers a menu of topics to discuss with families, and encourages goal-setting. Dr Montoya also emphasizes the 5-2-1-0 mantra as a prescription and asks children to tell her what it means at subsequent visits.
- Make It a Priority Dr Devries suggests a number of small steps that can be tackled in 2-minute increments. Examples are plans to decrease or stop drinking sugar-sweetened beverages, decrease bread intake, or forgo sugary desserts on weeknights. Dr Williams agrees, noting that the context and ambiance of this discussion may be more important than the "magic words." Body language goes a long way toward enforcing that this message is important for a patient's health, and is therefore important to you, the clinician who cares about that patient.
- Not One-Size-Fits-All Dr Stanford reminds clinicians that although obesity is a difficult, often frustrating, and frequently intractable clinical issue that can test the resolve of the most committed healthcare professional, the best approach is holistic. Evaluate all possible factors that could contribute to a patient's obesity (including diet, exercise, sleep, circadian rhythm disturbances, stress, genetics, and weight-promoting drugs) to determine which factors play a role in this individual patient's excess weight.
- Be Patient In approaching weight management, Dr Bolling emphasizes that the role of the clinician is that of an assistant. Patients may not act on advice to change behavior. 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. In other words: Don't just do something, stand there!"