Addressing overweight and obesity can be a daunting task for doctors. Below are practical tips based on the scientific literature that physicians can use in their practices.
Proactively address prevention with overweight patients. Being overweight is the #1 risk factor for obesity which, once present, may be more challenging to address. Therefore, doctors should not wait until patients develop obesity to address the importance of proper nutrition and physical activity.
Implement a multi-factorial intervention strategy. Physicians should construct an individualized treatment plan involving different treatment modalities. These may include highly structured diets (e.g., partial or full meal replacement), increases in physical activity, medications for appropriate candidates, and surgery for treatment resistant patients with clinically severe obesity.
Inform patients with obesity of the challenges to weight loss maintenance. Help patients understand that they may become more metabolically efficient with behavioral weight loss and have to ingest up to 300 fewer (or burn 300 more) calories as someone of the same weight who never had obesity just to maintain that weight. It may also be necessary to discuss the fact that dieting may be insufficient once they have had obesity for an extended period of time, and that the use of biologically-based treatments (e.g., medication or surgery) is not a reflection of weak will.
Continue to monitor progress and adjust treatment strategy as necessary. Address and provide resources for weight loss maintenance to patients who are able to achieve weight loss via lifestyle modification. A clinical weight management strategy should be ongoing and take into account the fact that weight loss maintenance is more difficult than weight loss. For example, medication may be considered at the point that behavioral weight loss efforts wane, prior to typical weight regain.
Recommend surgery when appropriate. Currently, bariatric surgery is the only effective long-term unimodal treatment for obesity. Attempt highly structured lifestyle modification and discuss pharmacotherapy first. Patients, particularly patients with clinically severe obesity, for whom this is not successful should be informed about the risks and potential benefits of bariatric surgery and provided with or referred for further information so an informed decision can be made.
I just did the math and wrote this into a grant proposal for the National Institutes of Health. How big of an impact small changes can have over time…
“An obesity prevention program that was successful in getting its participants to lower their caloric intake by only 25 calories (e.g., 1.75 peanut M&Ms, 2 Doritos or 2.5 French fries) per day would effectively halt unhealthy weight gain in the majority of overweight individuals.”
Point is, you would never notice two fries missing from your extra value meal but that is exactly what is making America fat- consuming just a tiny bit more than what we need to. Think about it- very few people get fat overnight. In fact, it’s such a gradual process that most barely even realize it until they have to buy a bigger pant size. I say, if you’re going to get fat, you should at least enjoy the journey. Tragedy is people don’t. We call it passive overconsumption. Don’t live in denial until you are looking for a dress in a 12 and don’t starve yourself. Start now, all you have to do is cut out a few calories each day- just the ones you won’t miss!
Let’s be honest, nobody likes restricting themselves from eating delicious foods, particularly during the holidays. Problem is, nobody likes the excess weight gain associated with the holidays either. Even more alarming is the fact that overweight and obese individuals gain more weight over the holidays than do lean individuals. If the laws of physics are correct, something has to give here. Trick is to cut the excess calories we don’t even notice or enjoy. Below are a few tips for keeping the belly happy during the holidays without feeling guilty and expanding your waistline after.
- Watch calorically-dense appetizers. Limit creamy/cheesy dips, fried anything, frozen hors d’oeuvre, (eg, pigs in a blanket, mini quiches) pretzels and chips. Instead, go for nuts, salsa, shrimp cocktail, veggies, and fruit. The more you eat of the good stuff, the less you will eat of the bad stuff. It works. Plus, there is usually so much good food floating around on the holidays, do you really want to waste the calories on chips?
- Load up on turkey and ham. These are relatively lean meats that will deliver a lot of protein with very little fat and few calories. Eat more of this and less sides such as potatoes, stuffing, and cranberry sauce. Think about it, this is the most expensive component to a meal (when you order Chinese, notice they sometimes load it down with vegetables and skimp on the chicken, beef or shrimp?) and the best for you. Added bonus- protein makes you feel fuller and fuller longer so load up on the lean protein and you will eat less of the much more waistline expanding bad stuff.
- Don’t unbutton your pants unless you are going to the bathroom or changing. What we really mean here is don’t eat to the point that you are uncomfortably full. Think about it- why should being uncomfortable be a part of holiday enjoyment? For most of us living in the US, nobody is going to steal the food; it will be there all night so pace yourself. You continue to get fuller after you stop eating. So, if you stop eating when you are 3/4 full, you will be perfectly satisfied but if you stop eating when you are full, you will likely become uncomfortably full in a little while.
- Take smaller portions and go back if you are still hungry. Studies show that we eat pretty much whatever is in front of us so loading up two heaping plates is going to result in tons more calories than eating more smaller portions. We get full over time so, again, pace yourself. Also, people tend not to go back for 4ths and 5ths and the belly is already plenty satisfied. Using this technique, you can eat as much as you want (within reason of course) and still usually ingest fewer calories than you would if you loaded down two heaping plates.
- Watch salad dressings and sauces. Unless you’re going to a health conscious household, these will typically be full fat and full calorie versions. These are as bad or worse than the triple chocolate cake dessert. No kidding. Opt for fat free versions or extra virgin olive oil and vinegar instead. The same is true for any mayonnaise or cream based sauces. Mustard is actually a very healthy option and a very under appreciated condiment in our humble opinion.
- Limit alcohol. It’s the holidays, we’re off from work, a lot of us tend to have a few drinks. Some times more, especially if you have to put up with the in-laws all night. Just be aware that alcohol increases hunger and decreases dietary restraint so you’re more likely to pack in the calories and pack on the pounds the more you drink. Try red wine instead of hard liquor or beer. Also, be aware that alcohol itself contains a ton of calories (about 100 calories for a glass of wine, light beer or shot of alcohol) and this does not include mixers!
- Wait to eat desserts. Give some time after dinner before diving into the desserts. If you cram everything into your belly at once, you’re going to load down too many calories. The body can only metabolize (burn) so many calories at one time and then the rest basically get stored as fat. That is why eating more smaller meals is better. Use this trick during the holidays and beyond! Also, as mentioned earlier, fullness increases over time so, even though you may be tempted by the pecan pie right after dinner, you probably won’t want it as much 10 minutes later.
- Keep desserts to a reasonable level and avoid “a slice of everything.” Yes, most desserts are loaded down with fat, sugar and calories, and have little if any nutritional value. That’s why they are desserts. Even things that may seem benign like fruit tarts are often in the same category of butt bulgers. Enjoy in moderation and avoid having a slice of several different things- the brain will allow us to force even more into an already full stomach when the flavors vary a lot. Ever notice that you can be painfully full and then see the dessert tray and feel like you could maybe just try a slice of whatever? You can eat more of different things- we call that sensory specific satiety.
- Limit soda and other caloric beverages. Most people forget that caloric beverages can and will make you just as fat as food. Even worse, unless it’s 100% fruit juice (which still has a lot of calories), it’s likely delivering zero nutritional value and won’t do much to reduce appetite. So overloading on caloric drinks and food during the holidays is a double-whammy. If you’re going to indulge, make it with delicious foods- you can have a glass of soda anytime.
- Be conscious of where you’re spending calories. It’s a fact, unless you’re a marathon runner or Olympic athlete, you can only pour so many calories into your body until they show up where you don’t want them to. No need to carry a note pad and estimate calories and do complex fractions. Just use your brain- eat more healthy stuff than unhealthy stuff and be aware of hidden calories frequently found in the potatoes (butter, sour cream, oil), vegetables (oil) and sauces (saturated fat). By all means, enjoy the food and eat some unhealthy stuff, just balance it out with healthy stuff!