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Sunday, July 30, 2017

Talking About Obesity

Talking to patients about weight isn't easy.

There's no question that obesity is a growing problem, with about a third of the population obese, and another third overweight.

But, just about no other condition lends itself more to ridicule and discrimination in our society.  And yet no one wants to be obese; unfortunately, those eating and lifestyle habits that many consider "normal" lead to excess weight.  Fat shaming is ever-present, and there's even research suggesting that people skip going to the doctor so that they can lose weight before their appointments.

So, how do I as a doctor discuss obesity with my patients?  It's challenging.  I want to help my patients without making them feel like they are being shamed; I want to be empathetic, but I do want to encourage changes that will lead to weight loss.

Regardless of my patient's body size, I ask the same questions of all new patients -- do you exercise?  If not, why not?  Tell me about your eating habits.  Do you eat fruits and vegetables?  Do you eat your meals at home?  Do you do the grocery shopping?  Do you know how to cook?

In someone who is obese, there are more likely to be answers to those questions that are less than ideal.  And, as we talk, we discuss ways of making changes that will improve health and ultimately lead to weight loss.

Of my follow-up patients, I keep track of trends -- if an overweight patient is losing weight, we discuss how he is doing it.  If a patient is gaining weight, I discuss with her what factors might be causing weight gain and how we can turn this around.

As a cardiologist, so many diseases that I treat -- coronary disease, atrial fibrillation, hypertension, hyperlipidemia -- are related to lifestyle and body size.  I have helped many of my patients to lose extra weight, and hope to continue to do so.

4 comments:

William said...

I know this doesn't qualify as any study or trend, but of the 4 lifetime vegans I know, 3 of the 4 are obese (very little exercise), 2 had cancer, and one died of cancer. The only of the 4 who was not obese, a vegan farmer who never had healthcare, died of cancer, age 77. Both diet and exercise are important. Based on this small experience, exercise/lifestyle and good healthcare more important than a strict vegan diet, as the longest lived societies are not vegan.

Me personally, was a vegan for almost 2 decades. Past several have moderated to include more fish and very occasional poultry. Have found it more conducive to being an elite masters athlete, age 57. Being successful in a power sport, fighting the effects of sarcopenia and maintaining low body fat, some animal protein in the form of fish has helped me, my athletic performance as proof.

Angela said...

Thank you William, for sharing. And I very much appreciate this blog. I've been vegan for over 10 years, and the last couple years have struggled terribly with weight gain, cravings, and quite honestly, a lack of "umph" for my former athletic ways. It seems I just don't care. All have this it seems has been and is a slippery slope for depressive states. In addition, I've seen some illnesses (including cancer) with some super health-conscious friends.

William, I'm wondering if you had a structured change...a certain "program" you followed or read, doctor's advice, or did you just begin experimenting?

Doctor Shenkman, Do you have any advice to vegans like me who can't seem to hold it together? I've been telling myself, "This is CRAZY--you're LAZY--and have so little willpower." It's such a weird place to be-- to have "been healthy," and then now...feel so NOT! The road back seems long, daunting, and I'm not sure it actually worked!
~angela

VeganHeartDoc said...

Angela, I sympathize with your struggles. It might not be a bad idea to start with a therapist or psychologist, to get to the root of what has affected your motivation.

William said...

Angela,
I have not followed any doctors recommendations on diet, but with a family history of heart disease, upon Dr's recommendation, I had a calcium CT heart scan 2 months ago, my score was zero. Since my high cholesterol reading last Aug. (219 total), I no longer eat eggs or butter/canola blend. I rarely eat bread or baked goods now that I'm approaching competition season (indoor track) and reducing body fat, I'm eating more protein, less carb. Right now I'm a 'much above avg level of fitness,' able to run a 400m dash in 60 sec, but to get to that world elite level in my age group of 55-56 second 400m, is about the hardest thing I've even done, and it gets harder every year. Training is brutal.

It's my belief that the older one gets, the less efficient the body is at burning calories and the more accelerated the loss of muscle mass and testosterone are. While being a vegan served me well during my youth, the addition of more protein in my mid-late 50s has helped me maintain a high level of athletic performance, which hasn't diminished greatly in 7 yrs, although I can see it coming as I can not do the same workouts I did 5 yrs ago. My first yr of masters track in '11, I ran a PR 400m in 55.54, in '12 55.14, in '14 55.11, and most recently at the '17 WMACI in Korea 55.17. 5 USATF masters 400m titles, 4 World Medals including one world title this yr (M55 200m - WMACi Korea). I think it's working, at least for me as a sprinter. Now as an endurance athlete, it might be different.