Posted by: wortix | November 18, 2008

New help in the battle against obesity


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By Jennifer Nelson, M.S., R.D. and Katherine Zeratsky, R.D.

My colleague just returned from the annual American Dietetic Association’s Food & Nutrition Conference & Expo. I’m excited by what she brought back — a new way for health care providers to approach obesity.

This method, developed by Robert Kushner, M.D., focuses on the critical skills that clinicians sorely need in order to empower individuals to make positive changes in eating, activity and lifestyle to successfully lose weight. First, some background.

Consider the challenges for you and for your health care team.

  • For you: You have a serious problem such as your weight, obesity-related conditions such as high blood sugar, high cholesterol or high blood pressure, the expense of medications and probably your feelings of frustration at not being able to get a grip on this.
  • Finances: A trip to the doctor is can be expensive and you already know that you need to eat less and exercise more. What more can your health care provider offer?
  • For the provider: You have a busy practice that barely provides time to identify patients’ problems — let alone begin to “treat” them. You really want to help, whether it’s medication, surgery, or counseling on changing lifestyle. Even if you have the experience, do you have the time? If you have the time, how do you keep from giving everyone the same old message of eat less and exercise more?

A 2001 study in the “Annals of Internal Medicine” reported on patients’ expectations of care from health care providers. The highest ranked expectation was “discuss my (the patient) own ideas about how to manage my condition.”

So how can patients’ expectations meet the health care providers’ ability and desire to help in a meaningful way?

It begins with providers probing the patient for issues contributing to being overweight. We’ve heard that excess weight is due to many things. Beyond eating too much and exercising too little, we live with “globesity” issues such as not having the time, money, or skills to change our eating and physical activity. How many of us skip meals only to eat too much of the higher calorie stuff later in the day? Why? How do we change this? How many of us eat too few healthy foods and too much meat and high fat convenience products? Why? How do we change this?

From both the patient’s and clinician’s perspectives, it may seem like there are just too many issues to address in any sort of systematic way. However, the research presented at this year’s conference has yielded some new ways to gather information from patients and how to use the patient’s ideas about managing weight issues.

This approach focuses on groups of lifestyle patterns shown to contribute to excess weight and how to change them. They can be placed into 3 broad categories: eating, exercise and coping. Each of the patterns in each of the categories has strategies for addressing the problematic lifestyle pattern.

Over the next blog or two, I want to show you how this can work. It just might give you a way to identify what you want and how to best work with your health care provider in meeting your desires. Don’t settle for the message of eat less, exercise more. Expect a frank dialogue about what you feel you can do, and what your provider can do to help you.

In order to begin, I need some information from you about the lifestyle patterns that you think contribute to unwanted weight. For simplicity, pick a category from below and one lifestyle pattern from it. Choose only 1 category and 1 lifestyle pattern that you think contribute the most to your weight. I’ll then write about the most popular ones sent back.

Category Lifestyle Patterns
Eating Skip meals
Eat at night
Snack a lot
Eat big portions
Exercise Couch potato
Don’t know how to start
I’m all or nothing
Coping Emotional eater
Doubtful dieter

Remember, choose 1 category and 1 lifestyle pattern that you think contribute the most to your weight and let me know why.

I’ll look forward to talking with you more about this.

– Jennifer

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