Getting to Goal
This morning we had a “dry run” of the first module for the community “group visit” – the topic was identifying your goal. The idea is that patients need to think deeply about why it is they want to be in the WW program. Wanting to lose weight is not good enough – patients would need to be quite explicit on why they’d want to lose weight and what exactly it is they want to achieve by getting the pounds off. They also need to recognize potential barriers and plan strategies on how to overcome these. The community team came up with a fantastic script – very well thought through, lots of interaction, great ideas – now we need a couple of pilot sessions to see how things flow, but I am confident that this group visit will make a big difference as we proceed with restructuring the WW program towards delivering effective bariatric care. Great job everyone! Looking forward to the next “modules”, AMS
The Six Natural Laws of Weight Gain
With all the talk of “thrifty genes” and how our “hunter-gatherer genome” is overwhelmed by the “obesogenic” environment, it may be time to revisit my favorite theories about the “Natural Laws of Weight Gain“. This is something I came up with almost 10 years ago and have used in a lot of talks over the years. I’ve always wanted to put these ideas into a book but somehow never got around to it. Simply stated, my Six Natural Laws of Weight Gain are as follows: 1. Always eat when food is around2. Always go for the gravy3. Always eat as fast as possible4. Always eat as much as possible5. Don’t move if you don’t have to6. When fuel runs short, turn down the furnace If anyone is thinking, “hey, that’s me”, you’re probably not alone (in fact it’s me too!). If you take a minute to think about it, you’ll probably recognize just how deeply these Natural Laws are engrained in our biology and culture and may realize how we’ve actually designed much of our environment to accommodate these laws. Suddenly terms like “mindless eating”, “fast”food restaurants, “all-you-can-eat” buffets, “poutine”, “super-size it” and “couch potato” take on a whole new meaning. While through the millennia of evolution these Natural Laws guaranteed the survival of our species, in our current obesogenic environment, they also pretty much guarantee weight gain. As I have often pointed out in my talks: “In today’s obesogenic environment, people have to develop “abnormal” behaviors to avoid gaining weight”. Doing things that came “naturally” to most of us is a surefire recipe for weight gain – in today’s enviroment, fighting obesity literally means going against our “nature”! No wonder it is so hard to do. OK, I realize that by now some of you are screaming that this must be wrong, that I am grossly oversimplifying the complex psychosociobiology of obesity, and that I am just providing obese people with an easy “excuse” to blame it all on nature. Of course I realize that in reality things are way more complex and that there are many paths that lead to obesity ranging from childhood molestation to antipsychotics or from genetic defects to endocrine abnormalities (the list of possible causes if far longer than you may think!). Nevertheless, I do believe that perhaps with the exception of such “special causes” the Natural Laws do provide a reasonable and useful… Read More »
Dr. Kushner’s Personality-Type Diet
At the recent Obesity Society meeting in New Orleans, I had a long chat with Dr. Robert Kushner, Professor of Medicine, Northwestern University Feinberg School of Medicine, Medical Director, Northwestern Memorial Hospital Wellness Institute and Past President, American Board of Nutrition Physician Specialists. He is also the incoming President of the Obesity Society (formerly NAASO). The reason I bring this up is because I has the opportunity to listen to Dr. Kushner’s ideas on “personalizing” obesity treatments. As I understand it, his point is that it is not enough to consider motivation or readiness for change. One also has to consider personalities, as no matter whether or not someone is ready or not, their personality cannot be ignored and may pose an important barrier. This is not simply about “high achievers” or “low achievers” or “introverts and extroverts”. It is more about whether or not you are a: Hearty Portioner or an Unguided Grazer? Hate-to-Move Struggler or a No-Time-to-Exercise Protester? Can’t-Say-No Pleaser or an Emotional Stuffer? Dr. Kushner has a whole bunch of categories (if I recall correctly there are 17 types!) that need to be considered in order to appropriately counsel for weight management. All of this comes with an elaborate personality type test that one can take (66 questions in all) on his website, which also promotes his best-selling book. I must admit that I have neither read the book nor taken the personality test – but the idea that people’s personalities must be considered when counselling on weight management intuitively makes sense. What I’d like to see now is a study on whether or not including counseling strategies based on Dr. Kushner’s personality types actually yields better long-term results than conventional approaches. Knowing Dr. Kushner, I expect that such studies are underway. AMS
Does Exercise Help With Weight Loss?
This morning, I debated the award-winning US science journalist Gary Taubes on the CBC Sunday TV News about one of the central theses of his new book (Good Calories, Bad Calories) where he challenges the widely held view that exercise is the best way to lose weight. Actually, Gary and I did not have much of a debate around this issue, as for years I have been telling my obese patients that exercise ALONE will seldom do it for them – weight loss requires negative energy balance, which is hard to achieve without also restricting caloric intake (we did not get into the discussion about which calories to restrict – another interesting discussion altogether). The normal response to exercise is hunger, which if you respond to, essentially restores your energy balance back to “normal” – so don’t expect to lose weight. Now of course, this should not be taken as an excuse to stay on the couch – the benefits of a physically active lifestyle are manifold: improved insulin sensitivity less intra-abdominal (bad) fat less stress cardiovascular fitness better coordination and balance less osteoporosis less dementia etc, etc, etc. Just don’t expect to see massive (or even any) weight loss – you are more likely to see inches disappear from your waist (as abdominal fat is replaced by muscle and perhaps some subcutaneous fat) but the numbers on the scale will not change – will you be healthier? Most likely! By the way, although exercise may not be the best way to lose weight – people who are more active are more likely to keep the weight off – and after all, that’s what obesity treatment is all about – if you can’t keep it off, why lose it at all? Better still to be as physically active as you possibly can and not gain the excess weight in the first place (yes, I know that there are many active people who still put on weight – but just imagine where they would be without that activity?) AMS
Transforming "Wait" Wise
With over 250,000 obese people living in the Capital Health Region, it should be no surprise that there is currently a waiting list of over 2000 people to be seen in the Adult Weight Management Program (as this is less than 1% of all obese people in the CH Region, I am frankly surprised the list is not far bigger!). So perhaps it is timely that several of us from WW just spent the last two days at the first of a series of workshops called Alberta AIM (Access Improvement Measures) that should take us from an 18 month waiting list to a “same-day” appointment over the next year or so. If anyone thinks that this is impossible, you are probably not alone in thinking so, because I am a big a sceptic myself. On the other hand, there is no question that WW could be made a lot more efficient and significantly improve not just the throughput of patients but also the quality of care (however we decide to measure it). There is no question that much of the effort that goes into managing a waiting list (and the angry, frustrated, disappointed and frantic patients who are in it) could be channelled into better access. In order to do this we need to look at both macro an micro factors that affect the list. I guess some of the basic questions to ask are: Who is waiting? What are they waiting for? Are they in the correct line? Can they be doing things while in the line? Do we even need a line? Well, we’ve taken back a bit of homework from the workshop (which is just the first in a whole 18 month process of change): We need to look at “demand”, determine our “supply”, and look at where we can eliminate inefficiencies that are clogging up the system. While I may have been sceptical when I first heard I was attending this workshop, I must admit my scepticism has been tempered – in fact, I believe it is fair to say that all of us, who on behalf of WW had the opportunity to attend this workshop, have come away with a huge surge of enthusiasm and optimism that we can turn things around – we have a whole slew of interesting ideas that we will be discussing with all of you over the coming weeks and… Read More »
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