• Domino Delivers on Babies, Weight Loss

    Nov. 2, 2023, David Mitchell (Chicago) — It was before 8 a.m. on a Sunday at the end of a long week spent far from home, but Jignesh Dholaria, M.D., was right where he wanted to be.

    “This is what I look forward to most: Frank Domino,” said Dholaria, pointing to the McCormick Place ballroom where Frank Domino, M.D., was slated to deliver his mainstage presentation at the Family Medicine Experience that morning. “He summarizes things we might have missed.”

    Domino, a professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School, editor-in-chief of The 5-Minute Clinical Consult and host of the “Frankly Speaking About Family Medicine” podcast, has been a staple of the FMX main stage since 2017.

    His humorous, rapid-fire annual update of evidence-based research findings is hugely popular and attracts a big crowd, so Dholaria, an FMX regular from Alpharetta, Ga., was there early to get a good seat.

    “The speakers recharge you from the daily grind, and it helps knowing everyone is in the same boat,” Dholaria said.

    Oh, Baby!

    Domino’s anecdotes included a story of young parents who were letting their infant eat a chicken leg every night. The family physician, known for his colorful language, practiced restraint during that patient encounter.

    “I took a couple of deep breaths and said, ‘Oh really? … Why would you do this?’” he recalled.

    Turns out, baby-led weaning is a thing, and a study published last year in Frontiers in Pediatrics found that letting infants eat what they want expanded their diets after 6 months of age.

    “I’m OK with a Cheerio, but a chicken leg?” Domino asked. “That’s ridiculous. It expanded their diets, but they also had more vomiting, spitting up, gagging and choking.”

    Domino also recounted a tale of a road trip to a family friend’s baby shower during which his wife lamented that she had hated Lamaze and wished she had known about Pilates during her own pregnancy.

    That sparked the curiosity of Domino, who highlighted for his FMX audience a systematic review and meta-analysis published earlier this year that found women who did Pilates had less weight gain during pregnancy, fewer cesarean births and shorter delivery times. 

    Story Highlights

    However, Domino said Lamaze still has value. In fact, he recommended that physicians encourage their pregnant patients to utilize both exercise and the Lamaze breathing method because a 2001 review found that Lamaze increased rates of vaginal delivery, shortened length of labor, alleviated labor pain and decreased postpartum bleeding.

    Domino also discussed a Pediatrics study from April that looked at getting infants and toddlers to sleep with varying levels of parental intervention, options Domino described as crying it out, controlled crying and camping out.

    “Let them cry it out,” Domino quipped. “That’s nice: ‘Go to sleep.’”

    The study found minimalist interventions were more difficult in the short term, but they were faster and more successful than those involving more parental presence. The tough love approach was also preferable, Domino said, to that of parents in his practice who were sleeping on the floor of their 15-month-old’s room in order to get their child to sleep at night.

    Put the Phone Down

    Domino highlighted multiple journal articles related to children, families and screen time, including an August JAMA Pediatrics article that found more screen time for 1-year-olds was associated with developmental delays at ages 2 and 4.

    “Screens are everywhere,” he said. “They pacify children.”

    However, in a national poll released in August, the top three concerns of parents were screen time, social media and internet safety, which ranked ahead of depression/suicide, bullying, stress/anxiety and unhealthy diet.

    Those top three issues are clearly connected, but Domino wondered whether a connection exists for all seven concerns, noting that depressive symptoms in children increased dramatically during the pandemic.

    “I’ve got to believe it’s because of something they are seeing digitally,” he said, noting that high screen use increases risks for obesity and depression. “We know suicide risks are up. We need to ask (kids) about screen use and how it makes them feel.”

    Domino had little sympathy for parents struggling to control their kids’ screen time. He cited a 2022 JAMA Pediatrics study that found when parents limited their own phone use, their children’s activity level increased by 45 minutes per day.

    “When a parent asks you, ‘What can I do to get my kids to limit their screen time?’” Domino said, “tell them to put their damn phones down.”

    Weight Loss and Cancer

    Domino, who lost his mother to breast cancer, highlighted a JAMA Surgery article published in June that found bariatric surgery was associated with a significantly reduced risk of developing breast cancer for women who previously had obesity. 

    “We need to talk to patients about aggressive weight loss and possibly bariatric surgery,” he said. “For women at very high risk, this could be a life-saving intervention.”

    What’s App, Doc?

    A study published in June found that making patients mindful of what they are eating is the key to weight loss. Specifically, researchers found that participants who tracked their food intake digitally as little as 29% of the time lost 3% of their weight over the course of the six-month study and those who tracked more frequently lost a higher percentage of their weight.

    Domino also cited studies that highlighted the importance of a healthy diet to lower cardiovascular disease and of soluble fiber to improve outcomes in adults who are overweight or obese.

    “We don’t have a pill as effective as helping patients change their diet,” he said.

    Ah, but what about patients who need more help? 

    Domino pointed to a study published in April that found semaglutide and phentermine/topiramate were associated with greater weight loss after one year than all other drugs. The research also found that drugs approved for weight management were safe.

    “These drugs work,” Domino said. “Don’t be afraid to use them.”

    Grab a Brush

    Finally, Domino cited an American Psychiatric Association poll that found less than half of Americans use creative activities to relieve stress or anxiety. Physicians should take note, he said, because those who rated their mental health as good or excellent were more likely to participate in such activities more often than those who rated their mental health as fair or poor.

    “I have the artistic ability of a 7-year-old,” said Domino, who shared some examples, “but I still do watercolors because it helps my brain.”

    See You Next Year?

    FMX drew about 7,800 attendees, including more than 4,100 physicians. That’s a sizeable crowd, but Domino pointed out it’s only 4% of AAFP members.

    “You’re coming with me to Phoenix next year,” Domino said of FMX 2024, which is scheduled for Sept. 24-28 in Phoenix. “I want this room to be too small. Be an ambassador. Please come — and bring a friend.”