Are We Barking Up the Wrong Diet?

A patient comes into the office pleading, "Doc, I’ve got to lose weight,” or a clinician says, "Mr. Smith, you’ve got to lose weight.” The average citizen, and not necessarily the clinically obese person, who is concerned about his/her weight, is constantly looking for a diet plan to give him/her the result that is wanted. As clinicians, what should our role be when helping a patient reach and then maintain a desired weight?

The general approach to weight concern (whether or not we collaborate with a dietician or nutritionist), traditionally revolves around finding a way for our patient to lose weight. Often the patient is looking for a way to lose weight fast. The comprehensive process in which we engage our patients will often encompass 5 phases: 1) deciding on a poundage goal, 2) discussing the complications of being over-weight (for the purpose of potentially getting better compliance), 3) reviewing possible obstacles in the weight loss process, 4) analysis of overall strategies (e.g. the role of diet, the role of exercise, the role of maintenance, etc.), 5) and then the selection of the technique(s) (e.g. drugs, surgery, exercising, food control, calorie counting, etc.) to be applied in order to achieve the ultimate goal (traditionally defined as "losing the desired amount of pounds” in the desired amount of time).

I recently saw a popular TV commercial that depicted the before and after images of a woman. In the commercial she states, "I finally found a diet that works.” One implication of that statement is that diets must be pretty specific and that a given diet plan might work for one but not for another. Ergo one may go from diet plan to diet plan to find one that works. Also there was no mention as to how long the weight that was lost with that particular diet plan had remained off. There was a reference to how quick the weight had come off. So if we try to aid a patient in selecting a diet plan as a weight loss technique, are we satisfying our responsibilities by just helping the patient to decide to cut calories, walk more, eliminate fats, or some combination of techniques? We then sit back while the patient may decide to not walk today, or think, "I’ve been good all week so this one slab of cheesecake won’t hurt.” It may be that what we clinicians have to do is get the patient to see that to be effective healthfully, one may have to change/alter a life style in order to lose, and then maintain, a desired weight.

Chances are, the average individual is not knowledgeable in the values of various nutritional elements, or has distorted perceptions as to the values of nutrients. When we educate patients, we tend to stress or advise, "read the labels,” or "you must add or reduce your calories,” or "you should look for specific concentrations or percentages,” or "you must count the grams.” This generally is the extent of educating our patients. Perhaps, instead or in addition, we should be explaining just what the body’s energy is, how it is derived, what foods account for it, and the relationship between any carbohydrate and glucose in the body. Perhaps we should explain just what constitutes growth and the need for protein for "things called cells.” The small toddler becomes the bigger teen, the muscle size increases, the skin grows and recovers from bruising, all because the body both produces new and/or enlarges old cells. Why can’t we tell patients that proteins are essential for these structures? Why can’t patients be told that all of the body’s chemical reactions are stimulated or inhibited or occur faster or slower because of certain proteins, vitamins, and/or minerals. Sounds like a course in Anatomy & Physiology, but maybe we should be telling patients via some rudimentary explanations about their bodies. Perhaps if we properly educate the patient first, then the 4-5 phases mentioned above become more meaningful and motivating.

Via advertising, the public has been on a seesaw with regard to "what is good…what is bad” E.g. fats are bad, sugars can kill, vitamins can be overdosed, minerals/metals can be harmful. The average citizen hears these comments and even if there are subtle disclaimers or qualifiers, the individual hears it as all encompassing, and thus "they all are bad, cut them all out,” or "if a few are good, more would be better.”

When Joe comes into the office saying he wants to lose weight, or when the clinician tells Sally that she has to lose weight, instead of deciding "here is what you should be doing,” perhaps some degree of educating should be undertaken first such as explaining the variety of good roles that fats play in the various body organs or systems, or explaining some of the facets and functions of the conversions of the variety of forms of carbohydrates/sugars. The average individual will read a particular label that lists carbohydrates but not sugar and does not know that carbohydrate translates into sugar in the body. The average individual does not associate that protein is to body structure as brick is to house and therefore needs a realistic explanation of the need for protein. The activities and the roles of and differences between fat soluble and water soluble vitamins and the importance of specific minerals/metals should be explained.

How often do we hear the parent tell the youngster, or the relative tell the elder, "you should eat because you need the energy,” or "you should eat to keep up your strength,” or tell a youngster, "you should eat because you want to grow.” Yet that person being advised probably has no (or very limited) understanding of just what carbohydrates / sugars mean to energy or protein means to growth, or for that matter what "growth” actually entails.

Generally speaking, if someone doesn’t know he/she is more apt to be afraid. The bottom line is that if people are more knowledgeable about something, they tend to be more comfortable, agreeable, and motivated in dealing with it.

There’s an old expression, "some people live to eat while some people eat to live.” Which should be a priority for us? Perhaps we shouldn’t be so quick to "talk doing it” (e.g. selecting a diet) and thus quick to "bark up the wrong tree (diet).” Instead perhaps we should first talk about "what and WHY we have to eat!”


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