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How Being a Physician Living with a Chronic Disease Impacts my Work with Bariatric Patients



“You can make $20 per stool sample?” You would have thought I had won the jackpot! I just thought my colleagues and I were getting one over on the “Diarrhea Clinic” in Guadalajara, Mexico. I attended medical school there and was making a habit of “donating” regularly. What I did not realize was that I wasn’t just suffering from “Montezuma’s Revenge.” It wasn’t until I returned home that I learned I had Crohn’s Colitis, an often debilitating inflammatory condition of the GI tract characterized by abdominal pain, diarrhea, and rectal bleeding. It can often result in multiple surgeries to remove diseased colon and worse, colon cancer.

I spent the next several years on different medications including monthly infusions and weekly injections, all of which had many side effects. During my residency, I spent 10 days in the hospital due to a flare that resulted in over 20 abnormal stools per day, anemia, and almost constant pain. Despite this, I returned to my career determined to not let this disease slow me down.

I became a family doctor and practiced in the primary care setting for nine years. During that time, I discovered a passion for bariatric medicine. This evolved out of a desire to keep myself healthy which required changes in my diet. I found that eliminating processed foods and added sugars, except those naturally occurring in fruits and vegetables, helped me to keep my colitis at bay. With the help of an excellent gastroenterologist, I healed and continued to enjoy excellent health for many years. However, this hasn’t always been easy and this is where bariatrics comes back into the picture.

Taking care of myself every moment of every day requires a lot of work. It means pushing myself to exercise even when I am exhausted. It requires eating salads and protein when others are enjoying pizza or ice cream. It requires actively engaging in positive thinking and using tools like meditation, cognitive behavioral therapy and affirmations to manage stress levels. And I don’t always feel like doing these things. These are exactly the same challenges that, on a day to day basis, my bariatric patients experience.

I find that using these tools myself adds an additional layer of empathy and relatability to counseling my patients that otherwise wouldn’t be there. They often greatly appreciate this and find that I am able to help in a very unique way because I “get it.” I share my story with patients because when a doctor is able to be vulnerable, they realize they are not alone and that anything is possible.

Every day, I continue to discover new and powerful ways to care for myself, mind, body, and spirit. As my practice continues to evolve, I incorporate as many of these amazing modalities as possible. I hired a mind-body medicine physician to teach yoga, meditation and other skills who has inspired many of my patients. I have a behavioral counselor who keeps us all on track. But most of all, my patients, staff and I are all just trying to be the best version of ourselves on this human journey. I still struggle regularly — as do my patients — but we all have found better ways to be in this world. And because of that, I have found this work far more gratifying than anything I could have imagined and I believe my patients are better for it.



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Obesity — A Term that Carries a Lot of Weight. Should We Change It?



The idea of obesity is a difficult subject to broach on many levels. The term itself is loaded with stigma, and people who suffer from this condition can become resistant to even hearing the word, let alone talk about it. The shame and anticipation of judgement can be disabling, and yet the language we use when discussing weight is so limited. What can health practitioners do to break down the wall?

In a study published in a 2012 issue of the journal Obesity, researchers asked 390 obese adults in primary care settings in the Philadelphia area to complete a questionnaire about the terms that are most and least acceptable to describe excess body weight. Out of the 11 terms that were offered, “fatness” was rated as the most undesirable, followed by “excess fat,” “large size,” “obesity” and “heaviness.” (The most preferred terms were simply “weight,” “BMI,” “weight problem” or “excess weight.”)

These words encompass the majority of terminology currently used in health care to describe excess weight. But in an effort to change how physicians and patients engage with the topic of obesity, the American Association of Clinical Endocrinologists, or AACE, and the American College of Endocrinology, or ACE, have proposed a new diagnostic term to describe obesity: Adiposity-Based Chronic Disease, also known as ABCD.

“Right now, obesity is relegated to a simple construct of having a [body mass index] over 30,” says co-author Dr. Jeffrey Mechanick, a professor of medicine and medical director of the Kravis Center for Cardiovascular Health at the Icahn School of Medicine at Mount Sinai in New York City and past president of AACE. “But the word obesity doesn’t confer sufficient information about the disease risks.” ABCD on the other hand, focuses on a complications-centric approach to diagnosing, categorizing, and treating overweight.

The categorization takes into account a number of measures. In addition to BMI, this new system also takes into account the person’s waist circumference, waist-to-hip ratio, fat identified on advanced body imaging techniques such as ultrasound and MRI, and perhaps inflammatory markers on blood tests. The proposed model also includes three distinct stages:

Stage 0: The person is carrying excess weight but doesn’t have health complications from it.

Stage 1: The person is experiencing mild to moderate complications — such as prediabetes or slightly elevated blood pressure — due to excess body weight.

Stage 2: The person has more severe complications – such as type 2 diabetes or significantly high blood pressure – that are related to carrying excess weight.

What category a patient falls into would inform treatment, and would also increase the likelihood that a physician would focus on treating not just weight related complications, but also the excess body weight itself.

This new model will hopefully not only create a less biased way for physicians to engage with patients about their weight; it will also hopefully be a way for weight loss treatments to be more readily covered through insurance by having this new diagnostic term being incorporated into the medical coding structure — such as the ICD-10, or the International Classification of Diseases.

How we talk about obesity matters. And perhaps a better way to talk about obesity is to not talk about “obesity.” Not in the way people are used to hearing anyway. What are your thoughts?

Source: U.S. News


Blog written by Vanessa Ramalho/Robard Corporation


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A 'Mental Diet' for Weight Management



Getting healthy and losing weight is not an easy endeavor — especially, if you are not following a mental diet. So much energy and focus tends to go into the physical components of weight management, but the mental aspects are just as vital. I would like to propose a “Mental Diet” to go along with the physical aspects of weight management.

For Breakfast
The morning can be a critical compass to direct your focus for the day. Even if you are not a “morning person” that is full of energy, it is important is to start your day off with intention. This means that you will set aside time for self-care before too many responsibilities or distractions consume your morning. The morning is actually the best time for exercise or meditation, even if it is for five minutes, as you will have less excuses/distractions and more “willpower” in the morning. As the day progresses, we deplete our “willpower tank” which tends to result in an inability to tackle difficult tasks in the evening. So, the ingredients for a good mental breakfast include: At least five minutes of exercise or meditation, self-focus, gain insight and perspective on the day and start the day after taking care of yourself first.

For Lunch
It is important that you schedule time to break for lunch. If you are the type of person that gets busy and easily distracted, you will want to set an alarm to remind yourself to take a break. We are such as fast-paced society that we may not pay attention to how much and how fast we are eating. It’s not uncommon for people to engage in “mindless” eating while sitting at their desk, in front of the TV or driving — suddenly you realize that the food is gone and you have not paid attention to satiety. Instead of just go through the motions of putting food in your mouth, focus on eating slowly and truly paying attention to each bite and monitoring how we feel. The ingredients for a healthy mental lunch include: 15-30 minutes to recharge by refueling with a calm, mindful meal or shake.

For Dinner
You need to have a moment to digest the day. It is important to recognize that “emotional eating” and cravings may increase toward the end of the day. Unfortunately, you may have used most of the energy from your “willpower tank” and begin to want sweets or snacks after dinner. After a long day, “rewarding” yourself with unhealthy foods may sound like the perfect way to unwind. However, indulging in unhealthy foods will only leave you craving more and potentially feeling guilt and remorse. Instead of trying to “eat” your emotions, talk it out or journal your thoughts and feelings. As you prepare for sleep, limit your time with “screens” such as TV, phones and computers and start to focus on relaxation. So the healthy mental dinner includes: Reduce the mental weight of the day by writing down three things that went well for the day and if there is anything that you might need to do for the following day.

Behavioral change and extensive patient education materials are interwoven into all of Robard’s weight loss programs. If you’re a medical provider and would like more information, click here.

Blog written by Devin Vicknair, Ph.D., LPC, Behavioral Health Coordinator at Gwinnett Medical Center: Center for Weight Management.




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