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Microsoft word - webformat- weight loss therapy_kolasa_weight loss stratigies that really work.doc
Weight Loss Strategies That Really Work
This article is especial y for busy physicians who are not sure how to advise or treat
their obese patients. Written from a doctor’s point of view, the author (Dr. David Col ier,
who is a Family Practitioner) offers clear, concise practice recommendations.
First of al , the author recommends setting a weight loss goal for the patient of 5 – 10%
of total body weight. This goal should result in major health benefits, without being
overwhelming to the patient. His practice recommendations are summarized as fol ows:
• Use Weight Loss Tools – Clinical management tools are increasingly available
and downloadable. A few examples of some that offer ideas for interventions and treatment related to specific comorbidities are:
o California Medical Association Foundation’s Obesity Provider Toolkit o North Carolina’s Eat Smart, Move More program
• Review Medical Guidelines – Find out what the experts are saying by reviewing
o National Heart, Lung, and Blood Institute o US Preventative Services Task Force o American Dietetic Association o American Col ege of Physicians
• Diagnose Obesity When You See It – Don’t hesitate to tel a patient he or she is
obese. Many patients do not consider themselves to be obese, even when they are. Calculate and document Body Mass Index (BMI) of al adult patients and use it to diagnose obesity in patients with a BMI ≥ 30.
• Review the Patient’s Medications – If possible, reduce or find an alternative for
• Consider Patient Literacy – Instead of offering printed literature or statistics,
encourage low literacy patients to consider the negative effect obesity has on their quality of life.
• Assess Patient Dietary Patterns – Try using REAP, the Rapid Eating Assessment
for Participants, a quick and easy to use nutritional assessment and counseling tool.
• Prescribe a Food Plan – Set a safe and achievable goal to reduce body weight at
a rate of 1 to 2 pounds per week for 6 months to achieve an initial weight loss of up to 10%. Pick a diet the patient is most likely to stick with and that is best suited to the individual’s health issues.
• Offer Strategies for Success – Here are some motivation recommendations:
o Limit eating away from home. o Select healthy options when eating out. o Eat more fruits and vegetables. o Avoid large portion sizes. o Eat foods that are high in micronutrients but low in calories per gram. o For children, add these to the list above: limit TV/video games, engage in
o For pregnant patients, encourage breast-feeding to promote the mother’s
weight loss and avoid potential childhood overweight issues for the baby.
• Recommend a Food Diary – Personal accountability and anticipated discussion
of food choices is a great motivator to stay on track.
• Prescribe Physical Activity and Sleep – Patients may need help finding the best
activities to provide enough physical activity to result in health benefits. Sleep is known to enable weight loss; eight hours per night is the optimal number.
• Consider Meal Replacement and/or Pharmacotherapy – For some patients, meal
replacements, such as high protein, low carbohydrate shakes and bars, help with food selection and portion control. The author warns of the risks associated with most weight loss dietary supplements but encourages use of fiber supplements, as fiber decreases food intake and hunger without the risks inherent with many other supplements. He notes that the fol owing weight loss drugs, when combined with diet or physical activity, may help:
o Lipase inhibitors, such as Xenical o Appetite suppressant, such as Merida o Metformin, when used to help prevent excess weight gain associated with
sort-term use of atypical antipsychotics, although its use for this purpose is off-label.
• Consider Bariatric Surgery – The author recommends this alternative for patients
who have failed at comprehensive weight loss programs and are at risk of weight related disease or death. Available bariatric procedures include:
o Roux-en y gastric bypass o Adjustable gastric banding o Biliopancreatic diversion o Sleeve gastrectomy
• Use a Team Approach – Doctor office staffs should promote, model and work
with obese patients to help them achieve a healthy lifestyle. The author also recommends referrals to dietitians, psychologists and community services.
Lastly, the author reminds his readers that the thing patients most value is support from
his or her physician. Surgeon Comments
Physicians are understandably hesitant to talk to their patients about obesity. There
seem to be two primary concerns:
• Concern about offending the patient • Lack of a concrete plan to offer
In this article, Dr. Col ier offers specific advice about the approach to patients who suffer from obesity. Research into patient attitudes about physician interactions on the subject of obesity has consistently demonstrated that patients realize their obesity is a problem and that they have a strong desire to discuss their obesity in a realistic and constructive manner. Source Kolasa, Kathryn M. Weight Loss Strategies That Really Work; The Journal of Family Practice; Vol 59; No. 7; 378-385.
Transient global amnesia followingcoronary angiographySir, Transient global amnesia (TGA) is a memory disorder, which is characterized by an episode of amnesia and bewilderment lasting for several hours. A few cases have been reported in literature following coronary angiography. In this paper, we present the findings of a case and briefly discuss the various etiologies which are responsible fo
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