How Will You Lose Weight?Saturday, January 29, 2011
Today’s post is another excerpt from “Best Weight: A Practical Guide to Office-Based Weight Management“, recently published by the Canadian Obesity Network.
This guide is meant for health professionals dealing with obese clients and is NOT a self-management tool or weight-loss program. However, I assume that even general readers may find some of this material of interest.
HOW WILL YOU LOSE WEIGHT?
How does your patient plan to achieve weight loss? Most patients have some idea how they would like to achieve their goal. Some will have a positive plan, while others have thought more about what they are not willing to do, such as liquid diets, going to the gym or giving up soft drinks. Listen carefully to the patient’s intentions, as these will help provide proper guidance.
Plan vs. No Plan?
The more specific a patient’s plan, the greater the likelihood of success. A patient may state a plan to cut out soft drinks, snacks, or high-glycemic index (GI) foods. Patients with unrealistic plans involving approaches such as a cabbage-soup diet, a 10-day fast, or eating no food after 5 p.m., should be counselled on more appropriate strategies. The impact of what you say may be minimal, but it is better to try and discourage patients than do nothing. Patients who have no specific plan will need positive guidance. The question “What can you see yourself doing?” may be helpful.
Past Successes and Failures
Traditionally, the weight-loss component of obesity treatment has been relatively simple: all a patient had to do was suffer. Of course, if weight is lost through suffering, it will almost certainly be regained when your patient has decided that they have suffered enough and they revert to their original lifestyle.
Patients will often define success only in terms of the amount of weight lost. A more meaningful definition would be whether or not the weight loss was maintained.
We often advise patients to use the same approach that has worked for them in the past. However, it is important to explore why the patient abandoned that last effort. If a patient says, “It worked, but I hated it,” new approaches should be discussed. The vast majority of your patients will regain some, if not all, of the weight they lose. While a large part of this is likely due to a patient’s inability to sustain lifelong lifestyle changes, it is also partly due to the fact that our biology is designed to protect our weight and ensure that any lost weight is regained.
This is a good time to discuss the need for ongoing treatment once weight loss is achieved. To emphasize this point, we sometimes tell patients, “Maybe you should go and lose some weight and then come back for obesity treatment.” They should understand that the more weight they would like to permanently lose, the more of their lifestyles they will need to permanently change. And lifestyle changes alone may be insufficient — some patients will require the ongoing use of partial meal replacements and/or medication as adjunctive treatments. As with any other chronic medical condition, the cessation of treatment will result in the recurrence of the condition. If a patient ceases any aspect of their obesity treatment (lifestyle changes and/or partial meal replacements and/or medications), their excess weight will likely recur.
In some cases the only successful treatment may be surgical, but even surgical weight management approaches require sustained lifestyle changes and, sometimes, medications.
Unfortunately, there is currently no “cure” for obesity: whatever treatment is chosen, it will have to be continued forever — treatments that are not sustainable do not result in sustainable weight loss.
© Copyright 2010 by Dr. Arya M. Sharma and Dr. Yoni Freedhoff. All rights reserved.
The opinions in this book are those of the authors and do not represent those of the Canadian Obesity Network.
Members of the Canadian Obesity Network can download Best Weight for free.