Friday, February 10, 2012

Weight loss

Sometimes the bane of my medical practice day is talking to patients about weight loss. I hate it. They hate it. I dread it. They dread it. My medical assistant tells me how a patient will get on the scale and sigh, then say "Dr. Nieder is going to yell at me." Now truth be told I do NOT yell. But I do try to be consistent with my advice and not ever let an obese patient leave the office without hearing that they would be better off to lose weight. With the overweight patients I try to encourage them to stop gaining weight now before it's too late.

It's not as painful with the patients who understand that one can't gain weight on air, that too much intake and not enough exercise is why they are gaining weight. And it is harder to lose it as the years mount up. In my twenties if I wanted to lose five pounds I would just not eat much for a couple of days. For the last ten years I've been battling the same ten pounds. Five pounds will disappear with lots of effort and the minute I let my guard down, BOOM, the pounds have returned. It's very frustrating. Losing five pounds takes a month of concentrated effort and I HATE IT! It is unimaginable to think of needing to lose 100 pounds.

So I can commiserate with patients who are frustrated but what I can't do is go home with them or go to the grocery store with them. Honestly, it would be a helpful and educational thing to do, for both of us. I stand in line behind 220+ pound people at Kroger's and look at the contents of their baskets. What do I see? "White mushy bread??? 4 cases of soft drinks. Hot dogs (eeeww!) Whole milk. Hamburger helper. Canned vegetables. Cap'n Crunch (I LOVE Cap'n Crunch but I NEVER buy the stuff). Potato chips. No fruits or vegetables unless they are in cans, no whole grain anything, lots of processed foods and all dairy products are full of fat. Seriously?

Yes, it's hard for me to lose those five pounds but I suspect the glass of wine in the evening, the french fries I had for lunch, the con queso I had for dinner last night or the peppermint bark cookie I ate for a late night snack may have contributed to the problem. Your hormones, your thyroid and your mother-in-law did not cause your weight gain. Your diet did. Your lack of activity made it worse, but it is what you put in your mouth that caused the problem. The sooner you can face that and move on, the easier it is on everyone. Tell me that you know you need to lose weight and that you are your own worse enemy and I can empathize. Tell me that you NEVER eat anything, that you've been starving yourself for years and it's very hard for me to help you. No controlled study has ever backed up any claim that people gain weight on air.

People want a "kick start" with pills which occasionally I will acquiesce to. Nine times out of ten, this helps them to lose about five pounds and then they stall out, quit the pills because they are also not the quick fix they'd hope for and five months later they've picked up another five to ten pounds.

After 20+ years of practice I can agree that diets really don't work. Only life-style changes do. Or sometimes, a gastric bypass or similar surgery. When patients ask what the best way to lose weight is, I tell them Weight Watchers because it is a lifestyle change. It is the most successful weight loss program I can attest to after all the years I've been in practice. People who stick to it, lose. Not 20 pounds a month. Sometimes not even five pounds. But consistently over months, the weight comes off. Add a good six days a week exercise program and suddenly people feel great and look great. BUT, it is HARD work. Very hard work. Of course most good things in life are hard work.

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