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| Obesity: Do As I Say, But Not As I Do |
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by David Mittman, PA - September 19, 2009
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Provided by Clinician 1
Two weeks ago I spent four days at the Duke Diet and Fitness Center. It is world renowned for helping people gain control of the factors that may have caused their being overweight and is truly a wonderful place. I went to visit my wife who went there to get back in control, exercise and reestablish her relationship with food. I stayed on the Duke Diet, exercised with all the people in the program and had a fantastic time. Lost a few pounds and had a great visit. There was an NP there who was a participant in the program, and my wife met an NP on staff, and she said was one of the finest clinicians she has ever had the pleasure to be cared for by. Enough of the commercial for Duke.
Obesity is something I have personally dealt with for years. For those of you old enough to remember it, I drank "Metrical" in high school. Over the years I have found Weight Watchers to be invaluable and have been a "Life Time" member for over 15 years. You have to go back for it to work though. From my heaviest, I have lost over 50 pounds and I have re-lost and regained thousands I bet.
When I got back from Duke, obesity was all over the news. A recent report showed that obesity accounted for 10% of our healthcare spending. The article in the Journal Health Affairs went on to say that "New research shows medical spending averages $1,400 more a year for an obese person than for someone who is of average weight.” Overall obesity-related health spending reached $147 billion, double what it was nearly a decade ago. The higher expense reflects the costs of treating diabetes, heart disease and other ailments far more common for the overweight, concluded the study by government scientists and the nonprofit research group RTI International. RTI health economist Eric Finkelstein offers a blunt message for lawmakers trying to revamp the health-care system: "Unless you address obesity, you're never going to address rising health-care costs." As a PA I say amen. But how?
I also have to tell you that there is a fair amount of obesity among those of us that are NPs and PAs. I am torn by that fact. I know it does not make us better or worse clinicians but I honestly do question if it makes us less effective clinicians. Is the message we send to our patients a good one if it is one of "Do as I say, not as I do"? Can a clinician who smells from smoke adequately be believed when they ask you to stop smoking? Will they be as effective? How about the bald physician who runs the hair restoration clinic? Effective? Or is your first question, "How can you tell me what to do, when you obviously don't believe your own preaching?" Even our new Surgeon General got criticized in some newspapers. MedPage Today ran a poll last week asking healthcare professionals if it was the right image for clinicians to portray if, as some have said, the new Surgeon General was obese. 35% of the healthcare professionals who answered said it was not a good image.
So where do we as PAs and NPs go with this? Not only for our patients, but as clinicians who have to tell people to lose weight and exercise. Firstly, we have to realize obesity is a multifaceted problem. One with diverse etiologies which all contribute to it. From anxiety to depression, from side effects of needed medications to a poorly functioning thyroid, and scores of conditions in between, all contribute to obesity. Those of us that are thin have to realize it is not just a problem of "poor will power". It's damn hard to stop over eating. Truth is for most of our patients and for ourselves, the problem of obesity is reflected by two behaviors. Not enough exercise and too many calories.
I believe we have to try to model the behavior we ask others for. If that means we start to exercise more than we do now, fine. If it means a trip to Weight Watchers once a week (I have not gone back for 9 months), then again, fine. If it means we start to have menus at conferences that watch calories and help out people who are trying to lose some extra weight, even better. How about a morning meeting at each conference where people could walk for 15 minutes and then talk about options for good food they have discovered at or near the hotel? Or just coach each other a bit. Or all meet for a swim at 4? I am not asking for us all to be perfect, just to do what we would ask anyone else in our position who came to us for guidance to do. Let's realize we have some power here and do a bit more to take some of it back. Do as I say, or do as I do?
Ready to step on the treadmill?
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| Allyn L. ACNP in Radiology (Phoenix, AZ) |
on 30 Sep 2009 at 1:42 pm |
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| I totally agree with this article. Although I am in good health and run 1/2 marathons I have to work at it. How can I as a health provider tell a patient to loose weight and be obese. I think that it is often lack of will power and not putting down the fork that leads to major obesity in my profession. I see it on a daily basis among many of my colleagues. We should lead by example and this is a perfect instance of this. I am glad that the article was written. |
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| PA 1 (USA) |
on 31 Aug 2009 at 4:23 pm |
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| Obesity is multifactorial, those who state no will power are seriously lacking in their knowledge base. We as midlevels should do our best to support and educate patients, whether it is from a been there done that point of view or hey look I am healthy emulate me point of view. Each patient is an individual and not everything is a clear cut DO NOT EAT situation. It is important that how ever we approach patient with obesity, that we individualize our approach and work on being non bias. |
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| Deborah-Cardiology NP (Atlanta, GA) |
on 12 Aug 2009 at 10:27 pm |
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| David, thanks for bringing up such an important topic! I have thought of this very \"problem\" for years. I have never had a problem with my weight-as I have ALWAYS been active since I could run as a child. I think the key is to assist and coach people to their own personal understanding of why they are overweight/obese. I am convinced that it is imperative that the individual \"own\" the responsibility for their health. We must assist them in accepting responsibility as well as believing that they can have explained to a patient during a stress test today, caring for ME, and about my health is not unlike caring for someone else with whom I am in a relationship. I am in a relationship with myself, I care about myself ..relationships require nurturing and Hard Work. I don\'t believe in diets, and I prefer the words \"physical activity\" to exercise. My message has always been clear: I do as I say. I tell patients that I work everyday at being healthy. I think practitioners who are struggling with their weight are in a unique position. My advise to them is to \"tell a story\"...share their stuggles and successes with their patients/community. Of course, after a certain point, words are not enough..ACTION must speak louder. I work in an imaging stress lab, and I see weight-challenged individuals all day long (patients and colleagues). It truly saddens me. For some the \"reason\" is legitimate, for others perhaps not so much. I refrain from judging....not sure if our patients afford us the same courtesy. So, colleagues..Do as YOU say! |
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| Lisa (MO) |
on 11 Aug 2009 at 8:10 pm |
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| Melissa from NY. I really like your comments. I am overweight too, but if we let our pts know we are in it with them and truly understand their struggles instead of preaching at them, I think that is truly beneficial. If we don't do that I think it does hinder us. I get so convicted by it though. The title of this is so true...do as I say not as I do. |
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| Holly |
on 11 Aug 2009 at 5:56 pm |
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| Each case of obesity should be evaluated clinically and true physiological causes treated in line with recommendations. I would like to address the MAJORITY of obesity in America. While it is true that there are many factors that contribute to obesity, we must do a few things before we can address this cultural problem of obesity. First, we must empower ourselves by TAKING RESPONSIBILITY for our weight. Second, we must be honest that lifestyle is the only true way to combat obesity. Thirdly, we must admit that lifestyle is a choice, and is therefore within our control. Fourth, we must exercise that control - TAKE ACTION! Finally, we MUST be an example for our patients. I am a former obese child and teen and both of my parents are obese. I maintain a current, steady BMI of 20 and have done so for the last ten years of my life. I did this through the above steps and I know others who have done the same. You can do this and so can your patients! |
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| Ruth (Philadelphia) |
on 05 Aug 2009 at 5:04 pm |
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| I found myself in the exact situation I was constantly recomending patients lose weight to improve their sleep and to reduce their need for weight related OSA and need for CPAP, I was obese, with a BMI of 42, I finally after years of trying to lose weight went and had bariatric surgery, It was the best thing i ever did for myself and my patients. I no longer feel like a hypocrite. and I have so much more energy to do my job to the next level and I use to think I was doing a great job. Now I am more efficient and have more energy to give to my patients and myself. |
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| Fiona (Houston TX) |
on 01 Aug 2009 at 2:00 pm |
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| Many times overweight/obese patients underestimate the amount that they eat. I suggest keeping a food diary which can be reviewed with them. I agree that part of the problem is contemporary lifestyle which has led to longer work days and arriving home late with little time to shop or cook meals. Easier to stop for fast food on the way home and pick up fried chicken for the family. Smaller meals throughout the day are beneficial, as this keeps insulin from spiking too much which can lead to cravings. Start exercise slowly (5 mins walking) and add 5 mins each day until a half hour is reached. I encourage patients to set realistic goals so as not to become discouraged. Motivation is key, which is why we sometimes prescribe an appetitie suppressant as a "jump start." |
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| Jared |
on 29 Jul 2009 at 1:38 pm |
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| Gee, sounds like "I'm too old, I don't like excercise, and I don't have time" are perfect examples of "lack of willpower". So you see, that is the problem along with ingesting too many calories and lack of excercising, unlike the author suggests. |
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| nextone (Tampa) |
on 29 Jul 2009 at 12:03 pm |
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I keep a picture of me from 2000, at my highest weight, in my office. At 5'2, I hit 170 lbs during my dissertation process and was dx with Type 2 diabetes.
Now, at age 53 and 40 lbs lighter, I look years younger than that photo! I have been off alI diabetes meds for a year with HGA1c of 5.8. I explain to patients the changes I HAD to make to avoid the diabetes related death and disability both of my parents faced.
I keep a picture of my daughter and me at the fijnish line of the Disney marathon taken in 2007 handy to show that it IS possible to change your dietary and lifestyle habits even at this age. Patients have told me that they find this encouraging and inspiring. I do share the struggles that I've encountered getting into shape and also staying there. Also, it allows me to gently refute their excuses, "I'm too old", "I don't have time", "I don't like to exercise", Etc. |
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| genePA (fl) |
on 28 Jul 2009 at 8:36 pm |
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| Yes, it would be a good idea if providers who counsel patients on obesity, weight loss, smoking cessation also adhered to guidelines and presented an appropriate appearance. After all, the last thing a patient needs is a lecture from a provider who could stand to lose a few pounds themselves. Of course, it would also be nice if the new Surgeon General were less than a "plus size" herself. Don't you think? |
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| Melissa (NY) |
on 28 Jul 2009 at 7:30 pm |
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Agree with you and as an obese healthcare provider who battles the demons of boredom, frustration, lack of sleep, anxiety and stress... I freely tell my patients that I am in the same boat as them and I am trying hard. I ask them to be my partner and work together. I tell them that we will meet and discuss at our next visit.
I let them know that I am not lecturing them but I am their team mate in the jouney of life and I share the same problems but I am willing to help. I try not to be judgemental and I want to be supportive... I keep telling them to kee[ trying..,,,and I will do the same.
that is just the tip--I provide them with a nutritionist consult and ask them to move just a bit more. I also give them reasonable goals 5% weight loss--hey you have tostart somewhere from here....and I give them the freedom to choose with full awareness of the problems faced by overweight people- discrimination, assumptions of laziness and health adversity facing decreased quality of life... lectures dont work--they havent worked for me...but information does and finding each persons motivator is improtant...I support them in WW, OA and other programs in which they are trying...I send them to bariatric surgeons if they ask my advice...but I give them ultimate responsibility for their behaviors.
I do feel bad that I am not more of a role model but I do think that I am more of a human model for my patients... |
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| Hilario R. Monreal (El Paso, Texas School of Nursing) |
on 28 Jul 2009 at 3:03 pm |
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| I agree with David, that one must exercise and cut down on calories. I was in the military for 21 years and always had to fight to keep my weight down within standards. Until I went to a Master Fitness Trainer Program for the Army. Excellent program and I learned ONE important thing! and the secret to keeping the weight down and off!!!!!!!!............This program was designed to assist every person as an individual to help them lose weight. I can honestly say that I worked this job for 2 years and bought down my elephants who weigh 290-340 lbs to a good working weight of 200 -220 in a six month period. The challenge was to keep it off!!!!! Here it is; drink lots of water only, no coffee, cokes, kool aid, at all!......walk everywhere as much as possible. Take walk breaks at your work, instead of Smoke or coffee breaks. Gradually exercise by using flexiability and motivational images.......try NOT to use the word "exercise" rather moving or working.......because that is what it is. I was 210 lbs when I retired from the military worked out 3 times a day running and lifting. I am now 195 still doing the same thing. The key was EATING the right foods! I do not eat sweets, grease, fried, or anything with sugar. I eats lots of vegetables and meat and eggs. I know this will not work for some people but NOT eating fast foods and enjoying home cooked meals is the way to survive the "DUNLAP" of the battle of the folds......feel free to write for advice or assistance. Hilario Monreal The University of Texas at EL Paso School of Nursing at hmonreal@utep.edu |
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