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Patients’ Health Not Improving? It’s Why I Treat Obesity



I think we are at a crossroads in medicine right now. Imagine the perfect storm. Life expectancy is decreasing for the first time in generations. Public health measures have gotten a hold of cigarette smoking only to have obesity rise up and surpass it as the leading cause of preventable death. Major attempts at curbing obesity and diabetes have failed. The final data on Healthy People 2010 outcomes showed obesity and overweight individuals worsened over the measured period. At the same time, health care costs are high, outcomes are poor, and there is a scourge of physician and provider burnout — there’s even a shortage in some areas.

Is this a coincidence? I can still practically taste my frustration of seeing my patients get worse and worse every three months when I saw them. Their blood sugar, blood pressure, and cholesterol got just a little worse each time. Heartburn, reflux, sleep apnea, depression, etc., would creep up on them. The medication list, the problem list, the referral list, the order list, all got longer and longer. The patients kept saying the same thing, “I want to get better.” I would manage their numbers effectively, for the most part. Their “ABCs” of diabetes met my quality goals for my bonus. But they did not “feel” better — they felt worse, and so did I. Was this why I went to medical school? I did not feel I was healing anyone; rather, I was only managing numbers with pharmacology. Something had to change.

When I first started offering obesity counseling, it was based on a Mediterranean type diet and food exchange. I started to see some exciting trends in blood sugar, blood pressure, and weight, as you would expect. I did not expect to see the changes I saw in the patients themselves. They became more engaged and optimistic about their health. For some patients, this program was all they needed. But, for many people farther on the spectrum of obesity, it was only the beginning.

That was when I quit my safe and secure position at a large health system and opened my own practice based on the program offered by Robard. And that was when the really exciting results started happening. That was June 2015.

At first, it was the ones who already knew me from primary care who trickled in. Then, it was their friends, families, coworkers, kid’s teachers, and anyone who saw them. Word got around, and the floodgates opened. They all said the same thing. The program gave them hope and then gave them their life back. They wished they had had it sooner. They wished they had known it was out there. They wished their doctor had told them about it. They wished more people could hear of it.

Since then, I have opened a second clinic and the patients have lost a combined total of 29,572 pounds. They report the program is the easiest diet they have ever done, most of them enjoy the taste of the medical foods and would like to be reassured that they will still be allowed to have one for breakfast or lunch once they reach their goal weight. They typically report that taking food away for a period made a huge difference in the role that food plays in their life, their relationship with food, their eating habits, and their cravings. I have learned that taking food away is one of the most important behavioral aspects of the program, even if only for a month. Since food can be addictive for some people, taking it away completely can be crucial for long term change, which is the opposite effect that you may be warned about by some critics of a short term rapid weight loss program that is “unsustainable.”

When patients come in the first time, they are sick and tired of feeling sick and tired. They have a hard time making it through the day, let alone going to the gym after work. I tell them casually not to worry, after the first 40 pounds comes off, they will feel much more like being active, they look at me like I am crazy. When I tell them that they will most likely not need any insulin after four weeks, they burst into a smile. When I tell them that after all the dozens of diets they have tried, with cabbage and lemons and meal prepping, all they have to do is drink a shake every four hours and the weight will come off, and they can go on with their lives of caring for their kids, parents, sick spouses and full time job, they are truly relieved.

And, for me, I now know why I went to medical school. Obesity is like lupus. It does involve every system in the body. You do have to treat the whole patient for the best outcomes.

So, for me, I honestly had some selfish goals. I wanted to feel purposeful and like I was making a difference. I mean, I get to cure diabetes, taking people off of 150 units of insulin who had been told they would be on it for the rest of their lives, freeing them from over one hundred shots of insulin a month. It is like curing cancer or chronic pain. Now, the biggest problem with my work is that I am so busy and I can’t seem to tell anyone “no” because I know the results they will get and they cannot get similar treatment anywhere else — at least at this point. So, I am working longer hours, but I love every minute of it, and at least I am not a helicopter parent and I hope my kids are learning “grit” and determination and non-normative gender roles by observation, but that is another talk.

So, I implore you to take bold action. In the name of decreasing life expectancy, plummeting quality of life, astronomical health care costs, physician burnout and sell out, turn away from the focus on HEDIS measures, patient satisfaction, quality bonuses, resource allocation and meaningful use. Before we turn into Wally World, stop missing the forest for the trees. Be the little boy who called out the Emperor’s New Clothes. Choose the path less traveled, operate at the sharp end of the sword, do what no one else can without those initials after their name can do, and fix the underlying problem.

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Being Sensitive to Weight Loss Patients’ 'Bad Habits'



How do you get patients to stick with the plan?
Compliance to a medical treatment can be challenging, to say the least. Patients want to be healthier, more active, and more energetic. Yet time and time again, they fall off the wagon and resort to going back into the same old habits that don’t support their progress. Why? (Click here for a flashback on 5 Bad Habits that Lead to Weight Gain)

For health care providers, it can be frustrating to check in with a patient and hear that their diet or exercise plan isn’t going so well. But it can also help to understand how habits form so you can not only help set realistic expectations for your patient, but also for yourself.

Studies on habit formation have shown that habits form as part of a three-step process. First, there’s a cue, or trigger, that tells your brain to go into automatic mode and let a behavior unfold (i.e. hunger). Then, there’s the routine, which is the actual behavior that we associate as being the “bad habit.” The third step is the reward: Something that your brain likes that helps it remember the “habit loop” in the future. In the case of overweight patients, the pleasure of enjoying “off-limits” food can be their reward. (Learn more about this physiological pleasure connection for those suffering from food addiction in our free white paper.)

Neuroscience has shown that habitual behavior and conscious decision-making are handled by two different parts of the brain, and the area of the brain that controls habits can often supersede and shut down the decision-making area. So when patients revert back to old habits, it is not that they are just battling low motivation or self-control. Their brains are hardwired to return to the behavior that it is used to, even when they no longer benefit from it.

So what can health care providers do?
First off, be patient with your patients. It’s not that they are less committed to their goals; for many it can just be that they require a little more time to relearn healthier habits. Studies show that it can take anywhere from 18 days to 254 days for people to form a new habit. And there will be trips along the way.

Secondly, don’t stress too much about when they mess up. Researchers have found that “missing one opportunity to perform the behavior did not materially affect the habit formation process.” In other words, it doesn’t matter if you mess up every now and then. Reassure your patients that an occasional binge is not the end of the world and encourage them to get back on the horse.

Third, understand that old habits are not forgotten, but replaced with new ones. We can’t magically expect patients to stop a damaging behavior without providing an easier alternative. For overweight people who have an unhealthy relationship with food, there can be a benefit to introducing something like meal replacements. Rather than expecting patients to completely change how they relate to food, they can replace their normal food habits with an easy shake or bar and make it part of a new routine that is easier to implement.

Dr. Valerie Sutherland of Rainier Medical Weight Loss and Wellness notes, “[Patients] typically report that taking food away for a period made a huge difference, even if only for a month. Since food can be addictive for some people, taking it away completely can be crucial for long term change, which is the opposite effect that you may be warned about by some critics of a short term rapid weight loss program that is ‘unsustainable.’”

For a more help on helping patients set realistic goals they can stick with, instantly download our free Short Term Goal Helper Worksheet!

Sources: NPR, MIT News, HuffPost


Blog written by Vanessa Ramalho/Robard Corporation


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Childhood Obesity Predictors May Not Be What You Think (Part 1)



Finding the motivation to pursue a healthy weight can be difficult sometimes. But a new study out of Stanford University may be able to add an increased sense of urgency and purpose, particularly for parents: Do it for the kids!

Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. While many factors have contributed to this, including increased access to fast foods and higher birth weight, more evidence shows that the factor that puts children at greatest risk of being overweight is having obese parents.

“The findings of this study suggest that at-risk children may be identifiable in the first few years of life,” says W. Stewart Agras, MD, Professor Emeritus of Psychiatry and Behavioral Sciences, whose team assessed both established and hypothesized risk factors in a study published in the July issue of the Journal of Pediatrics.

Agras says parental obesity represented the most potent risk factor, a finding that confirms previous observations, and the connection between overweight parents and overweight children is likely due to a combination of genetics and family environmental influences.

Childhood obesity can lead to many other health issues for children. According to the American Obesity Association, pediatricians are reporting more frequent cases of obesity-related diseases such as type-2 diabetes, asthma and hypertension — diseases that once were considered adult conditions.

It can be emotionally conflicting to think about the ways that one’s own health can negatively impact one’s children. But remember that the focus of this study and its findings is not about blame or shaming overweight parents, but rather about prevention. “It’s important to identify risk factors because they may provide a way to alter the child’s environment and reduce the chance of becoming overweight,” Agras says.

Remember: Good health is paramount for many reasons. The first reason is YOU. Obesity can prevent you from living a long, happy, and healthy life. The next reason is the people that you love. You play an integral role in building a healthy family. But while bad eating and exercise habits in children can be passed down from parents, the good news is that we have the power to change those unhealthy habits for ourselves, as well as for our children. Stay tuned for Part 2 for 5 tips for a healthier family….


Sources: American Heart Association, News Medical, Centers for Disease Control and Prevention


Blog written by Vanessa Ramalho/Robard Corporation




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