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Monday Jun 22, 2015

Help Patients Trim the Fat Out of Fad Diets

As primary care physicians, we constantly help patients battle obesity, which is a formidable adversary. I have found this experience to be one of the most rewarding journeys I regularly embark on with patients but also one of the most challenging.  

Although a weight-loss supplement or fad diet may help a patient achieve rapid and sometimes dramatic results, we often are discouraged by how quickly weight is regained. Could it be that we have missed the mark when it comes to educating our patients and assisting them in meeting their weight-loss goals?

Lest we get too discouraged, let’s look at the facts. Never before has there been such a wealth of information and resources to assist us in achieving optimal weight management. We are continually inundated with new diet fads, exercise programs and trendy new weight-loss gimmicks.

In an era of rising obesity rates across the country(www.cdc.gov), it seems the general population is finally moving toward a more health-conscious attitude. As marketers attempt to capitalize on this trend, new supplements and diets seem to be popping up everywhere, creating an even greater challenge for physicians as we field frequent questions from patients about the safety and efficacy of the latest buzz that has piqued their interest.

The HCG Simeons therapy(www.ncbi.nlm.nih.gov) seems to be a great supplement for the patient who has lost the desire to eat. The egg wine diet(eggwinediet.com) may work wonders for detox lovers who care more for tannin appreciation and less about consuming essential nutrients.

The point is that it can be difficult to find the wheat in the sea of chaff of today’s trendy supplements, diets and detoxes. Fear not, however, for what matters most about analyzing a new diet or supplement is rather simple: maintenance, calories, nutrients and safety.

Many patients are frustrated with dieting because they suffer from the “yo-yo” effect: dieting to lose weight but regaining lost pounds -- and sometimes more -- after resuming a normal diet. A fundamental principle of nutrition is that "diet" is a noun referring to what you eat; it should not be something one “goes on.” When a patient asks for our advice, we must first decide if a diet can be permanently incorporated into the patient's life.

For the vast majority of patients, emphasizing a small move toward long-term health is preferable to a total diet replacement, no matter how bad their original diet seemed. A patient is much more likely to avoid the yo-yo effect if he or she is satisfied with a diet and maintains a healthy relationship with food.

A popular idea now is that not all calories are created equal. This is hard to rebut, as you may vaguely recall some relationship between glucose, insulin and the effects on metabolism from biochemistry in your preclinical years. And although this may be true, and there are certainly physiologic effects determined by hormones that respond to the food you eat, it may not really matter to most people.

But for every study touting the colossal impact of hormones on weight loss, there is another showing that when calories are restricted, the pounds come off. For example, a nutrition professor at Kansas State University proved that a diet consisting almost exclusively of junk food(www.cnn.com), when consumed under moderate caloric restriction, can not only result in weight loss but improved blood cholesterol and triglyceride levels, as well. Of course, eating an all-Twinkie diet is not something we would endorse, and lowering cholesterol is not the same as lowering a patient's risk for heart disease or other preventable health problems.

The point is not that there is no value to fine-tuning the levels of metabolic hormones; the point is that their role is less significant in most patients, and total calories should be the primary concern. But be aware that counting calories is painstaking; therefore, emphasize consumption of lots of fresh vegetables. Other than the benefits of the nutrients in vegetables, they have a low caloric density. This allows your patient to eat larger portions without overconsuming.  

Although weight-loss diets are generally restricting, it is important to consume adequate amounts of essential nutrients. Many patients forget the importance of protein as an essential nutrient, and we should emphasize the many benefits of adequate, complete protein. Examples of complete proteins include most meats or fish, dairy, soy and quinoa. Proper protein intake is essential to maintain lean body mass through weight loss, and has its greatest effect when the patient is also engaging in regular exercise.

Not only does protein intake help attenuate muscle loss, it also has been shown to increase satiety. When more protein is incorporated into the diet, patients feel fuller longer(ajcn.nutrition.org). This benefit is twofold: Patients tend to snack less, and it makes the changes easier to follow.

Another tip: Approach supplements with skepticism. The FDA generally doesn't get involved with supplements unless problems and complaints arise, so it is wise to think of them as only as safe as the brand they represent.

There are many well-respected diets out there: low-fat, no-meat, low-carb, no-carb … the list goes on. Which one is right for the patient in front of you depends on many factors. Place an emphasis on fresh foods and vegetables because it is difficult to eat enough kale to stress the stitching of your waistband. The U.S. Department of Agriculture recommends that at least half our diets consist of fruits and vegetables, which are high in essential vitamins, minerals and fiber.

Whichever maintainable diet makes it easiest for your patient to get a good serving of complete protein three to four times per day, while eating the most vegetables and fewest snacks, is probably the best diet for them.

So, here are some takeaways:  

  • Making weight management a priority in our practices is key to achieving lasting patient satisfaction and long-term health goals.
  • Remember, patients are keeping up-to-date with the latest weight-loss fads, so we must stay current and competent to help patients separate fact from fiction.
  • Don’t be afraid to learn from patients.
  • Don’t be discouraged. More resources mean you have a better chance of finding the perfect weight-loss solution for your patient.
  • Don’t practice cookie-cutter weight management. The most successful programs are the ones that are tailored to the individual patient’s needs.
  • Keep at it. Be your patient’s No. 1 cheerleader and health coach. Lifestyle modification is a longitudinal process often filled with trial and error and much persistence. Patients are looking to us to help them achieve and maintain what they have spent most of their lives chasing -- weight loss.

Kurt Bravata, M.D., is a family physician who practices primary care, geriatric medicine and addiction recovery in Buffalo, Mo. He served as the AAFP's Resident and Fellow Section delegate in 2013 and was the alternate delegate in 2012.  

Zachary Treat is a second-year student at the University of Missouri-Columbia School of Medicine. He received his bachelor's degree in exercise science from Truman State University, where he worked with a research group to study muscle protein synthesis. His interests include nutrition and ergogenic aids for use in weight loss and athletic training.

Posted at 04:02PM Jun 22, 2015 by Kurt Bravata, M.D., and Zachary Treat

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