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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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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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