Can You Lose Weight and Keep it OFF?
I see it time and again in the office. A client comes in for a health assessment and before we even begin it’s quite obvious that the individual needs to lose a substantial amount of weight to begin setting a course to true health. We have discussed in previous posts the relationships that exist between weight and disease processes, how the disease process occurs through inflammation, and the presumed “bad actors” responsible for the inflammatory cascade. Today’s focus is geared toward finding the right method to start your program and it is what I am recommending in my office.
So is it a special diet, a magic potion, a particular exercise regime, surgery, or a combination of all the above. To be honest, before taking an interest in the topic, I never knew exactly what to tell a client. When I attended medical school, perhaps I missed that day in class when we focused on helping patients get started in a weight loss program. Truthfully, I don’t know if such a lecture existed in my school or if it was ever the focus of our study. I would submit that most of our training was dealing with the aftermath of obesity – hypertension, diabetes, atherosclerosis, hypercholesterolemia, etc. What if we focused on the origin of the problem? Would that be a monumental paradigm shift in the medical community? Well, not really. We have always heard about “eating right”, exercising, etc. and that is exactly what I would say to my client. “Hey, you need to start eating right and getting into an exercise program.” Okay, doc, but how do I do that? Well, that’s where my expertise would typically reach its limit. I wasn’t also trained as a nutritionist or dietician, much less an exercise physiologist or personal trainer. In fact, rounds in the hospital during training included a multi-disciplinary team including some of the above
And then, as time passed, I heard all about this diet and that diet, and I would meet people that found success using various fad diets. So inevitably I would start recommending those same diets to my clients without really understanding anything about them or researching the literature myself. Is that bad medicine? I’m not sure but I would gather many health care providers out there today do something very similar for various reasons. I think my main reason for “taking the easy way out” was due to the fact that I was in relatively good shape and didn’t feel like I was on any particular diet so what did I know? Further, I didn’t spend the time researching the literature because I assumed my clients were just lazy and made bad choices. Again, that is my own ego affecting my clinical decisions. Not good Maverick, not good. The fact is, doctors are basically like other people in that they don’t know what they don’t know and their own frame of reference or bias colors their perspective. Could it be possible that the person was never taught to eat properly? Or perhaps they were never encouraged to workout and once they found themselves on the wrong side of the weight problem, they gave up hope or didn’t pursue correction. Let us be clear in our discussion. Obesity and its consequences are literally killing our nation. With nearly one third of the adult population classified as clinically obese, not to mention those that are overweight, the associated health costs are staggering. According to the Harvard School of Public Health, obesity was 5.5% of the indirect and direct costs of associated medical conditions in 1986 (http://www.hsph.harvard.edu/obesity-prevention-source/obesity-consequences/economic/). As the years passed, however, the percentage has continued to increase: 6% in 1998, 10% in 2006 by some estimates. In fact, other authors have suggested even higher numbers as high as 21% of medical spending or $190 billion in 2005! Big picture – if trends continue, the percentage of medical care spending will follow suit and become a larger percentage of overall health associated costs.
So let us get back to the good news. There happens to be an abundant amount of good medical literature to support health eating habits. I recommend the following two articles as good starting points:
Lifestyle Approaches and Dietary Strategies to Lower LDL-Cholesterol and Triglycerides and Raise HDL-Cholesterol, Endocrinol Metab Clin N Am 38 (2009) 45-78; and The Effects of a Mediterranean-Style Dietary Pattern on Cardiovascular Disease Risk, Nurs Clin N Am 43 (2008) 105-115.
Both articles do a very nice job of explaining the benefits associated with particular types of foods and their effects on cardiovascular health. What they summarize is a relationship between a geographic regions diet and the presence of cardiovascular disease. So can this diet help me lose weight? That’s the million dollar question. My challenge to you…give it a try, read about it, and see what happens. One of my clients that I’ve been working with over the past three months has had excellent results thus far. I introduced him to a proven method including a modified meal plan, exercise regimen, supplementation recommendations, and coupled these with an attitude and sleep pattern program that worked synergistically to enhance his health goals.
photo shot at Aro Ha