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Weighty Matters: Talk to patients about weight control to reduce risk of significant health consequences

Kentucky medical care providers are beginning to realize that the term “weight control” has different meanings, depending on the patient.

“Sometimes the objective is not to gain any additional weight,” said Kathleen Stanley, outpatient diabetes and nutrition coordinator at Central Baptist Hospital. “Some people see it as weight loss, and some people look at it as preventing future weight gain and trying to maintain a balance.”

This is why it is important to ask questions when a patient mentions weight control. “No one should undergo a weight-loss plan unless they are cleared to do so by their physician,” Stanley said.

There are numerous aspects to consider in weight loss, based on the individual’s health profile.

“The recommendations you make should be based on the person’s medical conditions or personal experiences,” Stanley said. “You may refer them to a registered dietician for individual counseling or to a group class setting.”

Rather than trying to accomplish a dramatic loss in a short time frame, it may be more feasible to consider different stages of weight loss or weight management.

“People should be cleared medically and follow a plan that is scientifically based and proven to be safe,” said Stanley. “The only way any program can achieve weight loss is if the individual takes in (fewer) calories than he or she needs to maintain his or her weight.” The best way to expend more calories is with exercise.

Take time to educate your patients about weight loss and weight maintenance.

“The more successful programs teach you not only to focus on calories but to learn about the quantities of foods and varieties that are important to take in every day for your nutrient needs and to promote the weight goal you have in mind,” Stanley said.

Portion control is the most important thing you can encourage for long-term success, and you should not be afraid to bring it up.

“Studies suggest that physicians are uncomfortable discussing weight loss with patients, even though it may be an established patient within the practice,” said Stanley. “It is a difficult conversation and needs to be handled with sensitivity. But (obesity) is a medical condition that needs to be addressed to hopefully reduce risk of significant health consequences, such as heart disease, diabetes, stroke or cancer.”

There are subtle strategies you can use to begin the conversation.

“Sometimes physicians go on the standpoint of looking at another condition, such as hypertension, high cholesterol or diabetes, and use it as their work-around to gently talk about weight loss,” said Stanley. An example would be suggesting losing a few pounds to a patient with high blood pressure, in addition to prescribing medication.

Some patients try to initiate the talk themselves, and as a doctor, you can help them do so.

“Some practices have a questionnaire when you come in the door where you can fill out your concerns for the day or questions you have to help steer the appointment,” Stanley said. “That would be a good opportunity for the patient to put ‘weight control’ down.”

While there are many evidence-based, medically sound weight-loss programs, make patients aware of troublesome ones.

“Programs that say all you have to do is take a pill or supplement and pounds will slip off are red flags,” said Stanley. “Research has shown that people are usually able to maintain weight loss for longer periods of time if it is gradual, which means about one to two pounds a week.” Researchers have found that personal motivation is the key.

You can encourage patients to try to choose low-fat and low-calorie versions of foods and make sure their healthy diet is not limiting or restrictive. Don’t forget to promote physical activity and lifestyle changes. To sum up your role in weight control, ask patients if they are comfortable with their weight as part of your assessment.

“You might find that patients are more open to answering that sort of question rather than whether they think they need to lose weight,” said Stanley.

This way, the conversation is open ended, and patients will express more honestly how they feel and what actions they could take.

Many patients come with the misconception that weight loss means giving up certain foods, so be sure to let them know there are more opportunities than limitations. Weight loss boils down to portion control and having realistic expectations.

“Patients should be cautious if the diet is on a supermarket shelf, in a magazine or is something they heard on the radio,” Stanley said. “But if it is coming from a healthcare professional, it is something to listen to.”

By Jamie Lober, Staff Writer

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