Practical Tips: For Doctors to Address Obesity

Addres3b25a39sing 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 getty_rf_photo_of_doctor_giving_patient_second_opinionand 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.

Informative: New Nutrition Labels

Do you use nutrition labels?  You should!  And the FDA is finally making it easier to do.

Nutrition labels have been notoriously difficult to interpret and most individuals report not regularly checking nutrition labels when they purchase packaged foods.  However, this is changing and nutrition labels are changing.  The nation as a whole is becoming much more conscious about nutrition and what we put in our bodies.  This is a large reason why rates of obesity at least appear as though they are starting to level off for adults (and even declining in very young children).

With this comes the first significant change in nutrition labels in 20 years!

nutrition labels

There are 3 major changes, all of them good:

1. Serving sizes are going to be adjusted to reflect what people normally consume. So you’ll see nutrition info for a full 20oz bottle of soda instead of just 40% of it (note a few companies did this voluntarily already- good job) and a cup of ice cream instead of 1/2 cup.

2. Calories are being made much more prominent. Hands down the most important thing an individual can pay attention to with regard to diet is the number of calories consumed. That’s not to say that other things aren’t important but, plane and simple, calories determine our body weight.

3. ‘Added Sugars’ has been added. Therefore, manufacturers now need to report just how much (and it’s often an insane amount) of sugar they dump into your food and drinks. Hopefully this will not only help people to become aware of just how much added sugar they are ingesting (a can of soda has 8 teaspoons, while the RDA for women is only 6!!), but also get manufacturers to start lowering the amount of added sugars.

Several other minor changes have been proposed but those are the big ones.  These are GREAT changes, and the FDA should be commended.  But…  it’s still going to be a couple years till we actually see the new labels on food products on the shelves.

Click here to see Dr. Ochner talk about the new nutrition labels on ABC News Digital.

Relevant Musings: Children on Diets?

FatKidWhy All Children should be on Diets: Response to Backlash over The Heavy by Dara-Lynn Weiss

Listened to radio show this morn where people were freaking out, aghast that a mother (Dara-Lynn Weiss) put her 7-year old daughter on a diet & then wrote book about it (The Heavy).  Over and over parents vehemently defended the position that we shouldn’t restrict our children’s eating.  Really???

When did ‘diet’ become a four letter word?  I was never good at math by the way.  What about ‘proper diet’ or ‘healthy diet’?  Diet does not mean starvation!  It should mean healthy nutrition.  Ever go into McDonald’s and see a morbidly obese person scarfing down a portion sufficient for 3?  Most people have and a lot think something like “and they probably wonder why they’re fat.”  Somehow, these are the same parents that would just as soon push clergy in front of traffic for suggesting that they should restrict what their child eats.

Newsflash: The habits you model and teach your children are likely to be maintained into adulthood, including and especially dietary habits.  If you teach them it’s OK to overeat hamburgers and ice cream at every meal as children, why would you expect them to ‘spontaneously’ adopt healthy eating habits as they advance into adulthood?

Wanna hear something else scary?   Once someone is obese for a while, the body adapts and that becomes the body weight that their biology will defend as necessary for survival.  Physiologically speaking, the body then literally reacts as if the person is starving to death when they try to return to a healthy body weight.  This one of the main reasons why diets typically don’t work and we say ‘don’t just diet.’  Unfortunately, surgery has become the only long term effective option once someone (even a child) is obese for an extended period of time.  Point is, don’t contribute to your kids getting to the point where surgery is the only option they have of being healthy.  Please!!

Practical Tips: Top 10 Tips for Avoiding Holiday Weight Gain

party-buffet-table-small-100x150Let’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.

  1. 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?
  2. Load up on turkey and ham.  These are relatively lean meats that will deliver a lot turkey1of 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.
  3. 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.
  4. 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.
  5. 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.
  6. 116591-dmn-wine-glass-evans-2011-thumb-820x1024-116590Limit 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!
  7. 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.
  8. Keep desserts to a reasonable level and avoid “a slice of everything.”  Yes, icecream-pie-su-1816277-lmost 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.
  9. 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.
  10. 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!

Quick Tips: Healthy Eating Out

Brief practical advice for healthy eating on the go:


hotdog pizza small

Yes, a little satire but you would be amazed how many of us shovel things that are not necessarily great tasting and definitely not healthy in to our mouths.  At the very least, make sure you’re getting one of those things- some less healthy things are worth if if you absolutely love those things and eating them brings you immense joy.  Sans joy in eating something, why not make at least make it healthy??

The overall point is that we are happier when we enjoy our diets.  Things that can get in the way of our happiness are not eating foods we enjoy eating and being unhappy with our bodies.  Things like hotdog pizzas and cold leftover restaurant meals don’t provide much in terms of eating pleasure  but contribute heavily to our waistlines.  These foods should be the first to go!