I lost 35 lbs in 6 weeks!

Obesity is a major and increasing problem, and one that I find extremely difficult to deal with. TV commercials with promises like the one above are not helping as patients become increasingly exasperated when they can’t achieve the same results.

A big obstacle that I face is that being overweight is often a family affair involving both parents and one or more children. This should be a bonus since a diet change that affects all members of the household should be less problematic to implement but this does not seem to be the case. Interestingly, I find much more family involvement when adapting to a meal plan change for a patient with newly diagnosed type 2 diabetes. It seems that diabetes is regarded as a disease but obesity is not yet there.

There is also a great deal of denial. The patient I was asked to consult on as he was transitioning from an insulin drip following his three vessel bypass weighed in at 280 lbs, having graduated from high school 30 years ago weighing 180 lbs. He kept focusing on his exercise program that allegedly took 45 minutes each day and was a “real workout” including walking, swimming, and lifting weights. For the past few months he had to stop every few minutes because of chest tightness but he ignored that as well until he infarcted. Talk about denial!

I do not have much success to write about regarding the management of obesity but one tactic that has worked from time to time is to tell the patients to ignore the scales and focus on how their clothes are fitting. More often than not I find that the patients overall appearance has changed to the point where family and friends comment favorably but the patient remains frustrated because it has not yet shown on the bathroom scales. I presume that the mechanism is conversion of fat to muscle before loss of body mass but I have no documentation that is the case. I have taken to targeting “two dress sizes” a year for women and “one belt notch” a year for men. That seems an achievable goal without the continuous negative feedback from the scales. It has taken many years to gain the weight and the patient should not expect that the weight will come off overnight.

Weight loss clinics no doubt work but we are never told how much backsliding there is. If you have an approach that you have found successful please take a moment to share it with your colleagues.