When the American Medical Association announced that it now recognizes obesity as a disease that requires a range of medical interventions, the gates opened for the field of obesity medicine. Barely two years later, the treatment landscape has transformed.
Gastroenterologist and director of the Johns Hopkins Center for Integrative Medicine Linda Lee takes a common-sense approach, based on a growing body of knowledge of what can be the bewildering complexities around gaining and losing weight. The two keys are helping patients understand what to expect from treatments and programs, and making sure that the weight loss is sustained for the long term.
LEE: I have patients who want to lose weight and patients who want to gain weight. My approach is the same; the theory is that if patients are concerned about weight, the first questions they have to answer is about their ideal bodies. How much should they weigh? Do they know how many calories they should be eating to maintain health?
I work with patients to find a goal that’s healthy and attainable. If someone wants to lose 100 pounds, that’s fine. But we start with something easier to reach.
INSIDE TRACT: Do you find that patients have high expectations about the amount of weight they should lose in a short period of time?
LEE: Yes, that’s often the case, so we develop a program where patients lose about a half a pound per week. Now, before anyone says that’s not enough, think about it: Half a pound a week adds up to 26 pounds per year.
There are faster ways to lose to weight, but the goal is to shed it permanently.
INSIDE TRACT: Once you’ve determined a healthy goal weight and reasonable expectations, what’s next?
LEE: We ask our patients to keep a food diary for three days, and as simple as it sounds, it’s a powerful exercise.
INSIDE TRACT: Why?
LEE: Patients might think, I know what I eat: breakfast, lunch and dinner. But many of us tend to forget that piece of candy we took from the bowl on a colleague’s desk. And that someone else brought cookies to work. And yesterday’s late-night snack.
The diary is a real eye-opener for patients over the course of those three days. It helps people become a lot more mindful of what they are consuming.
After the three-day period, we look at calorie intake and other things, such as the types of carbohydrates they are taking in. We ask where that patient might cut, say, 300 calories a day from his or her diet. Again, eliminating 300 calories a day doesn’t sound like much, which is exactly why it’s an effective weight-loss strategy.