Know, patient: losing weight is not easy (1)

There is nothing easy or pleasant in the process of losing weight

Evgenia Kobylyatskaya, licensed nutritionist (USA)
Published in the magazine "Snob"

My lecture summary of one of the leading experts in the treatment of obesity in the world, Dr. Arya Sharma, for professionals. Kingston, Ontario, 2014. 

Here comes to you a patient with a diagnosis of "obesity". Don't ask him if he wants to lose weight. It's clear that he wants to, since he's here. Everyone wants to lose weight, even slim people for some reason want to be even thinner. It's better to start like this: "Would you like to discuss your weight?"

It is absolutely impossible to ask the question: "How did you get to such a state?". Don't accuse him of neglecting himself. Don't be intimidated by the consequences. Avoid negative emotions. Only positive. Let him focus on how cool it will be if he loses extra pounds. You can't go far on fear alone.

The assumption that fat people eat ice cream from morning to evening and lie on the couch is a deep misconception. By the way, some of them know much more about calories and proper nutrition than slim people.

Let's say you and a patient are the same height. But you weigh 60 kg, and he weighs 100 kg. He is 40 kg heavier than you. If you distribute 40 kg of weight evenly over your body and walk the same distance with the patient, then it will be very difficult for you. And he walks with him, with this weight. You would have already fallen if you were carrying these 40 kg. And he walks.

Explain to him that losing weight and maintaining a normal weight is a serious job. And there is absolutely nothing easy and pleasant in this work.

Also, dispel his misconceptions that you can do everything slowly, in small steps. Minor changes – minimal effect. Yes, you can start with small steps, then add a wider step, then even wider.

Feel his situation. If he wants to lose weight, then he will have to change a lot. Perhaps all my life, the whole habitual way. For example, to give up parties with friends, change jobs, sell a car and buy a bike. Is he ready for this? Believe me, it's far from easy. Just imagine that everything you do should be done differently. Everything that you are used to, everything that you love – you can't do it anymore. And it can't be easy or joyful.

Moreover, the treatment of obesity requires strange and unusual actions from a person. Counting calories, careful control over the size of portions, reading information on packages and weighing products on kitchen scales – can not be considered normal actions or the norm of behavior. For most people, these actions seem strange and ridiculous. And they are really abnormal. For you specialists, this is probably normal. Many of you like it, some just love counting calories. But for everyone else, no.

I repeat. Measuring the amount of food, weighing everything and writing it down is an abnormal, unnatural behavior for many. But– alas – this is the treatment.

Remember that people don't like the words "obese", "fat". You will have to choose your expressions carefully. For example: "Have you always been this size?" or "Who else in your family is overweight?"

General guidelines don't work. He needs personal ones. "Are you worried about your weight? How big is your concern?" "When did the weight problem arise? How long does it last?" "What effect does excess weight have on your health? For your life?"

Before the end of the first reception, you should get accurate answers to these questions. And also outline a plan – what you will do with it. Clearly indicate which barriers will have to be overcome.

What to do next?

Stress, sleep and time are the three most important factors to pay attention to first.

Time. Sleep. Stress.

How long does it take for the brain to receive a satiety signal? At least 20 minutes. Healthy low-calorie food involves prolonged chewing. If you want to get enough of a small amount of food, chew for a long time. At the same time, you can not be distracted – watch TV or read a book.

Three times a day for 20 minutes.

And also buying groceries, cooking, measuring portions, weighing products on kitchen scales, and even eating all this slowly, carefully chewing and paying attention to the taste – how long does it take? Do any of you spend an hour a day just chewing? Note that after bariatric surgery, eating alone takes two hours a day. Usually people don't eat for so long – they don't have time for it.

If you are very hungry, you have already missed the right time to eat – you will definitely eat too much. No one will say, "I'm starving! Where is my broccoli?" If you are very hungry, you prefer high-calorie food. And you're eating too fast. By the time the brain receives the satiety signal, you will have already eaten more than you need. Speed is a problem. In fast food, "fast" is a bigger problem than "food".

Well, let's say. We found an hour a day for food. How about an hour a day for sports? He plans to: "I'll get up early and run." Uh, no. Not at the expense of sleep. Lack of sleep is one of the most significant causes of obesity. To get up early, you need to go to bed early.

Before you lose weight, you need to master the practice of "time management", organize your life accordingly. "You'll have to find the time. Think about how to sleep the required 8 hours. What exactly should be done for this?"

An hour for food. An hour for sports. Go to bed early. It's just to be healthy and beautiful. And when to do the rest of the business?

"Don't you have time for this? Then I won't waste mine on you."

"And how will you manage stressful situations without resorting to sweets? What do you have to do for this?"

And only after solving these questions, you can move on to discussing the food itself – and ask the patient your famous question – what do you usually eat for breakfast?

Another important aspect. Money. The funds he has, the type of his work, the number of days off. Poverty can be the cause of excess weight – maybe he eats cheap high-calorie foods. He may have lost his job because of his weight, and the treatment of obesity will cost him a pretty penny. Maybe he has personal problems and he "comforts himself" with chocolates and ice cream.

Emotional state, antidepressants, painkillers can also be the primary cause of excess weight.

By the way, how much time does a doctor have in an ordinary polyclinic to find out all this information from an obese patient? How many minutes does he spend on it? Don't you know? I'll tell you. Zero minutes. In no country in the world do they ask these questions to an overweight patient in primary care centers. These questions are like pieces of a puzzle. Unfortunately, only in specialized clinics, they build a general picture from the answers and outline a plan of action.

Another serious aspect of weight loss that needs to be discussed at the first visit. Let's say you've lost weight. So what? Do you want to continue living like this? In the same mode? Can you continue to live in the same mode? How many people do you personally know who have lost weight and kept the weight? How do they do it? Have you ever wondered how they live? So I'll tell you. And let's see if you change your mind.

(To be continued).

Reference: Arya M. Sharma, MD/PhD, FRCPC, (Professor of Medicine & Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Clinical Co-Chair of the Alberta Health Services Obesity Program. Dr. Sharma is founder and Scientific Director of the Canadian Obesity Network, a network of over 10,000 obesity researchers, health professionals and other stakeholders. He is also the Past-President of the Canadian Association of Bariatric Physicians and Surgeons.

Portal "Eternal youth" http://vechnayamolodost.ru  30.06.2016