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Losing weight requires dramatic behavioral and lifestyle changes. Here’s how physicians can get patients on board.
The CDC reports that 38% of American adults over age 20 years are obese, which the CDC defines as adults with a body mass index (BMI) of 30 or higher. As most pediatricians across the country already know, children also struggle with obesity. In fact, 21% of adolescents are considered obese, as are 18% of children between the ages of 6 and 11 and 8% of children between the ages of 2 and 5.
ApovianIt's incredibly difficult to lose weight and then sustain that weight loss, says Sharon Movsas, a registered dietitian and coordinator of the Diabetes Education Program at Montefiore Medical Center in Bronx, New York.
There’s no “magic bullet,” agrees Caroline Apovian, MD, director of the Nutrition and Weight Management Center at Boston Medical Center.
While there are many interventions for treating obesity, the hard reality is success requires dramatic behavioral and lifestyle changes-and that’s why it’s so important for physicians, advanced practitioners, and nurses to engage in patient coaching.
1. Understand the life experiences of patients who are struggling with obesity. Many of the obese patients Apovian treats have significant financial challenges-and that can restrict access to healthy foods. “They can’t afford to go out to Whole Foods and buy expensive fruits and vegetables,” she says. Instead, they typically eat fast-food.
Primary care doctors can become more aware of these issues, and provide information about support services, by leveraging the “Five As,” says Apovian. The Five As stand for:
Providers should also keep in mind that CMS now covers multiple visits for weight management, and that patients can be seen monthly or even more often at the beginning of their weight-loss journey, says Apovian.
2. Establish trust and build rapport.
MovsasThe most powerful way to work with a patient who is struggling with obesity is to help them feel safe in the coaching environment, says Movsas. And the best way to do that is to see the patient “as a person who has a rich life and is here with you for one piece of their life.”
For example, many people are stress eaters due to demanding work situations. Movsas says many of her patients skip lunch due to stress, and they overeat when they get home.
Her strategy for helping these patients is to ask them to identify overeating triggers. “If, for example, my patient is overeating because her boss yelled at her at work and she feels anxious, I ask her to still make sure she eats lunch and recommend that she reaches out to a friend to vent about the situation with her boss,” says Movsas.
An important strategy when coaching obese patients is to focus on their life priorities. For example, Apovian recently talked to one of her patients who had lost 180 pounds after gastric bypass surgery. What matters to her patient-and what keeps her motivated to keep the weight off-is the fact that she’s able to play with her young daughter.
3. Reeducate patients about weight loss expectations.
Movsas says it’s important to set appropriate expectations about weight loss. “Explain that the evidence shows that losing a lot of weight and sustaining it isn’t a realistic expectation. However, a modest weight loss of 5% to 10%-or about 10 to 20 pounds-is more manageable and is adequate to improve health,” she says. An additional benefit of the weight loss is that insulin will work better for diabetic patients, and patients will experience lower blood pressure and an improvement to their cholesterol levels, says Movsas.
It’s also important to share with patients that diets generally don’t work, says Movsas. What does make a difference are changes to eating and activity habits.
4. Educate patients about healthy foods and how to cook them-and celebrate their success.
MarchPeople struggling with obesity know how to go on a diet, says Vicki March, MD, codirector of the BodyChangers program at the University of Pittsburgh Medical Center (UPMC). Chances are, they have been on many diets and gained back the weight each time, she adds.
The reason they gain the weight back is their old habits creep back in-and that’s compounded by the fact that they’re living with or are friends with people who have similar habits, she says.
UPMC’s BodyChangers program provides members with a free newsletter and information about community events that are devoted to encouraging healthy lifestyles, such as exercise and cooking classes, in addition to support groups.
One cooking class coordinated by BodyChangers has been particularly successful, says March. Participants spend $35 for the meals they cook in class, and they go home with nine healthy meals. The cooking class is taught on a monthly basis by students in the dietitian program at the University of Pittsburgh.
Participants can celebrate their weight loss by modeling in a fashion show. “The fashion show is a celebration of positive self-image, courage, and determination,” says March. The participants share their stories of how they have maintained significant weight loss and transformed their bodies by adopting dietary changes and staying physically active. Funding for the program, which runs on a shoestring budget-the most significant expense is for a part-time program coordinator-comes from UPMC, she says.
Aine Cryts is a writer based in Boston.