Talking people into eating right and being active

[Satelite]

---

Members do not see this ad.

MSNBC had an interesting article on obesity today ( http://www.msnbc.msn.com/id/4900095/ ). According to the article 2 in 3 Americans is obese and, more interestingly, 1 in 4 of entire world population is obese.

So how do you talk/encourage/coerce your patients into eating right and being active? I'm not talking about turning them into health food freaks and gym rats, I just want them to choose to eat a bananna or a carrot and get off the couch for a little while. What works to get em up and moving?

 

[mudbug]

Actually the article says 2 out of 3 Americans are overweight, not obese, and is careful to explain the difference.

It's a huge problem, no doubt.

 

[lessismoe]

So how do you talk/encourage/coerce your patients into eating right and being active? I'm not talking about turning them into health food freaks and gym rats, I just want them to choose to eat a bananna or a carrot and get off the couch for a little while. What works to get em up and moving?

You know, I didn't see the article before, but I was thinking about this earlier today. Do you think that maybe there is an underlying american cultural basis for why people DON'T act with common sense, and act sort of hedonistically in this country?

I mean, I was just thinking about how, in a lot of Asian cultures, the norm is for people to not be overweight, and the focus in a lot of these cultures is on the good of the community. However, in the United States, the focus is on the individual, and what feels good for the individual. The Rebel Without a Cause is romanticized, as is the concept of "living for today"-- just visit any college campus or watch almost any action movie. I wonder if this obsession with the Self contributes to this contra-common sense behavior.

My dad is one of these self-preoccupied people. For years, he would flaunt the fact that he smoked in front of anyone who tried to reason with him that it was bad for him. "There's no proof!" he would assert to anyone who told him about the dangers of second-hand smoking. Meanwhile, all 3 of his children developed asthma. It wasn't until a family member was put on a permanent oxygen tank from emphysema from smoking that he actually tried to quit.

I can think of another individual in my family who gorged on McDonalds and junk food until she was diagnosed with diabetes, and as a result, she now has badly damaged kidneys and liver. NOW she reforms her eating habits and works out at the gym, but the damage is DONE.

I don't neccessarily think we can change the culture in this country, and I think that that is going to be a HUGE stumbling block for efforts to curb obesity. I mean, I think that this country's value of the individual's free will and self-actualization is WONDERFUL, but I think it is totally ironic that our fascination with self-fulfillment in the short-term impedes our efforts in the long-term.

I guess this post wasn't really an answer to your question. Unless people are forced into believing that these horrible consequences CAN and WILL happen to them (which is difficult because most people tune out when confronted by a doctor) then I don't think that there is much you can do but provide all the necessary information.

Anyhow, I'd like to hear other people's opinions too, so BUMP! 🙂

 

[Kalel]

So how do you talk/encourage/coerce your patients into eating right and being active? I'm not talking about turning them into health food freaks and gym rats, I just want them to choose to eat a bananna or a carrot and get off the couch for a little while. What works to get em up and moving?

Actually, sometimes it helps just to tell them exactly that. It's not about setting unreasonable goals for your patients, it's usually more helpful to take small steps towards the ultimate goal of diet and exercise. Eating fruit before eating meals as snacks and doing small things like taking the stairs, parking further away from the door, and avoiding late night snacks all seem to help and are "easier" steps then just telling your patients to exercise 5 times per week for 30 minutes per day and not eating any fast food at all. I think that it's similar to telling your patients to stop smoking, if you tell everyone in your clinic to stop smoking, only 1-5% of them will actually listen to you, but even with such a small yield, it's still worthwhile to take a minute or two every visit to remind your patient in case they are one of those 1-5%.

 

[SilverAngel1110]

i would guess that it might also help to take a few extra minutes to sit with your patient, set a goal or two, and come up with a specific plan for reaching those goals, instead of just saying to someone, "you need to eat better and exercise some." maybe ask the patient about what habits they feel they would be willing to work on, and set a reasonable goal to work on those, and be specific and supportive. i.e. "how would you feel about taking half your lunch to go for a walk instead of just spending the whole time eating at your desk?" or "what about making your own lunch a few days a week instead of eating at the cafeteria?" the hope would be that eventually the patient would reach the bigger goal via small steps like these. granted, i'm a first year so what the heck do i know, but i DID pay attention while shadowing in internal medicine this past year. 😀

[edit]: okay, i should really read the posts ahead of mine before repeating what other people say... hehe.

 

[k's mom]

Okay, if I could put a slightly different perspective on this. I am now in my early 30's and have struggled with my weight since puberty. I am active, eat responsibly and take care of my health, but I've consistently carried around an extra 30 pounds. I became so incredibly frustrated with physicians and nurses and nutritionists, and etc... who just say "just stop eating fried food and work out once in awhile." Well, I don't eat fried food, or pizza, or donuts. I don't binge, I don't drink beer or sugared-drinks. I work out regularly. Don't get me started on all those "weight-loss" success stories. You know, where the triumphant person exclaims "Well, I just stopped eating a side of beef with three gallons of heavy cream to wash it down every day, and the weight just melted off!!!" 😱

Essentially, I was too humiliated to get the same answer every time, so I gave up and stopped asking. Since the doctors were not interested in listening to (or believing) me, or figuring out what was really going on, I decided that I had to live with the weight. I knew that the only time I have been thin and fit was during graduate school when I worked out compulsively TWO HOURS PER DAY/SIX DAYS PER WEEK and ate sporadically, at best. I certainly can't spend two hours per day in the gym anymore, nor do I want to, so I felt essentially stuck.
well, lo and behold, I went to an endocrinologist last month for something I thought was unrelated, and it looks like I may have a pituitary disorder. Would have been nice to know 15 years ago, huh?

Listen to your patients, please.

 

[Sixdegrees]

I agree with ya lessismoe, and since obesity is such a multifaceted problem, the American culture, unfortunately, must address a number of other issues, in addition to ?obsession with self,? for it to loosen its grip on the cigarette pack and the super size fries.

I think the dynamics of choice and responsibility fall under the umbrella of what you describe. If you?re old and wanna buy a discount drug card?guess what?, they?re 71 to choose from. Last time I went shopping I think I counted a good 30 types of jeans at the Gap. Went to the library to get a general physics book?.there were nearly 50.

And those numbers don?t compare to food. Cereal: there has to be like 200 types. Microwave popcorn: can?t even get the regular stuff anymore. And who would have thought 10 years ago there would be low carb bread!

But with all these choices it?s a b*&#$ to find some good grub (especially cheap). Unhealthful food is ubiquitous and convenient.

And so how do those non-overweight 33% do it? They either slup their daily 64oz coke and are naturally thin (might not be too healthy though) or they assume the RESPONSIBILITY of not deep frying Twinkies (still can?t believe people so this) and finding that non-buttered/salted/sugared/fried/supersized item.

The more choices we as consumers have, the more responsibility with which we are burdened.

And so the NIH and other organizations are targeting responsibility through education (adolescents) and through altering environmental factors. The question: what makes some people assume this responsibility more than others? What does it take? (Must it be familial misfortune, as in lessismoe?s dad, to make people change?)

I?m optimistic. I think we?re in a time when we are learning to live with so many choices. The next step to make those choices,?.. choice.

P.S. I also think so much choice leads to preoccupation of self. Possibly contributing factor that makes rich, young children so self absorbed.

 

[Super Rob]

1st step is to know how diet and exercise impact health.

From what I've been told, this is not taught too well in medical school. There are lots of competing theories as to what sort of diets cause or contribute to health and illness. Some doctors encourage their patients to have a bagel for breakfast instead of ham and eggs, while other doctors encourage the same patients to pass on the high glycemic grain and eat all of the ham and eggs they want. Others suggest a compromise, and encourage patients to eat a little of everything. I guess I'll find out soon enough what my medical school encourages.

I'm particularly interested in WHY school nutrition curricula encourage what they encourage. There is evidence to suggest that flour products are bad for you, but I can think of a few corporations and food producers that make a little bit of money off of products containing flour... hmn, it's ironic how the food pyramid that schools often advertise suggests what? Twenty to thirty-five servings of "grains" a day? Stretching the truth a little, but you see what I'm getting at.

There is tremendous bias in the information on nutrition put forth by our federal government.

There is not a lot of money in nutrition research... no fancy drug or procedure to make a billion dollars off of.

Most of our knowledge of nutrition will come from what we were taught as kids, marketing that we have been exposed to, and a quick seminar or course offered during our first or second year of medical school. Then they set us free on the patients, who will certainly want to know what we MEAN when we say, "You need to eat better and exercise."

Also, very few people take food addiction seriously, probably because nobody goes around mugging people on the street or robbing banks for Twinkie money. We have such a steady supply of addictive foods, marketed and served to everyone, that addicts can blend right into society and appear less like powerless victims of a disease and more like lazy and unmotivated slobs. And unfortunately, this leads to all sorts of discrimination and prejudice, and less attention to the matter at hand: food addiction. You wouldn't tell a heroin addict to "Do fewer drugs and exercise," would you?

I have a theory that a lot of people suffer from poor health as a result of the food they put into their bodies. I think they put specific foods into their bodies that are highly addictive and dangerous to their healths because they come from cultures and households where eating dangerous and addictive foods is encouraged. In some instances, these foods can probably and effectively treat underlying emotional issues, just as alcohol can be used to "self-medicate" or treat underlying emotional issues.

Just some thoughts. I'm looking for future colleagues who share my interest in this. Thanks for starting this post.

 

[LoneCoyote]

Super Rob,

I am also interested in the link between nutrition and poor health and I agree with you that unhealthy foods can have addictive properties. I saw the documentary "Supersize Me" this weekend and I highly recommend it. He addresses this addictive quality of fast food in the movie. The documentary is very well done, very funny at times, and highly disturbing.

http://www.supersizeme.com

I also think that having the time to cook plays a big role in what people eat, and it ties into what lessismoe about our culture's focus on the individual and achieving things for ourselves. I have a bunch of food allergies and pretty much have to cook all my own food. I eat a very healthy diet but it takes a lot of time to prepare all of the food and to shop for it. At the end of a long day you often do not feel like cooking a healthy dinner and it is tempting and easy to grab take-out, fast food, or just throw something in the microwave.

Not to mention it is much more expensive to buy lean meats, fish, and veggies, than it is to buy junk food. And I am lucky enough to live in an area where I have access to farmer's markets with cheap produce and a selection of supermarkets and health food stores with different options. I definitely think that one of the reasons for the large amount of obesity in poorer communities is a lack of access to places to shop that offer healthy choices. If your options are fast food or snack foods from a convenience store, there really isn't an option to make a healthy choice.

 

[Masonator]

MSNBC had an interesting article on obesity today ( http://www.msnbc.msn.com/id/4900095/ ). According to the article 2 in 3 Americans is obese and, more interestingly, 1 in 4 of entire world population is obese.

So how do you talk/encourage/coerce your patients into eating right and being active? I'm not talking about turning them into health food freaks and gym rats, I just want them to choose to eat a bananna or a carrot and get off the couch for a little while. What works to get em up and moving?

Satellite's mom is so fat, that when she walks, you can't see her legs moving. It looks like she is gliding across the floor.

 

[MD Rapper]

I mean, I think that this country's value of the individual's free will and self-actualization is WONDERFUL, but I think it is totally ironic that our fascination with self-fulfillment in the short-term impedes our efforts in the long-term.

VERY TRUE ABOUT SO MANY THINGS!

 

[lessismoe]

I also think that having the time to cook plays a big role in what people eat, and it ties into what lessismoe about our culture's focus on the individual and achieving things for ourselves. ... Not to mention it is much more expensive to buy lean meats, fish, and veggies, than it is to buy junk food.

This is another thing I have been thinking about. By giving in to the temptation to pick up a bucket of KFC at the end of the day rather than cooking a meal for our children, aren't we starting a downward spiral of bad messages to our kids? We're telling kids that fast food = food. Then, our malnourished kids grow up to be malnourished adults without the proper education in what is good/bad to eat.

I have to admit, about a year ago, I realized that my husband and I were eating a gross amount of junk food, so I decided to cut out meats from my diet (but I kept fish for the Omega fats). It's really so much easier to pass up the drive-thru when your only options are a tomato burger or a fried fish sandwich (yuck!).

I actually had an ex-boyfriend tell me once that one of the things he really liked about me was that I knew how to cook a balanced meal, and that was something he wanted in a wife someday. At the time, I thought he was crazy (and to be frank, he really was, as I later found out) but now that I've seen fast food encroach on the American diet so much, I kind of see the logic behind it now.

 

[evescadeceus]

You know, this is going to be really tough to do as a doc if I'm 50-60lbs higher than a conservative BMI target weight, which I most likely will be.

I also know that a large number of parents trying to raise kids on a limited food budget can't afford all the fresh fruits and veggies and lean meats that they would like to be able to buy. This isn't just working parents who fit the definition of poor - its also true of working parents who fit the definition of middle class.

I also know that some of the ideas mentioned in earlier posts - take the stairs, park further away, no midnight snacks etc...help people MAINTAIN their current weight, rather than lose weight. It will help a large number maintain a weight that is already overweight, and slow the rate of further weight gain. But we are no longer an agricultural society (true now for most of the planet) and the only way a large number of us would ever lose weight and keep it off is to go back to walking six miles round trip to school each day, pitching hay in a barn, roping cattle etc...on top of avoiding the center aisles in every supermarket.

The corporate paradigm makes everything worse - sitting in front of a computer eight hours a day for years on end is the fate of most employees around the world. No amount of diet and exercise is going to reverse the effects of a lifestyle which powers the corporate bottom line all over the world.

I'd keep all this in mind before I open my mouth re: patients' weight.

 

[Satelite]

Small goals is the way to go. Setting a goal of a half hour plus walk around the neighborhood with the spouse (or something similar) seems to me like the best "prescription". It sets up some support and above all it is simple. (Of course, this has to be adjusted depending on individual situation.)

I do think the primary cause is cultural. lessismore, you hit it on the head in that it is easier to "pick up a bucket of KFC at the end of the day" rather than cook -- especially when you are a tired parent. As far as eating habits, I think we are the source of our childrens problems. Junk food was a "treat" in my home not a daily snack and I think that has created some good habbits.

An apple or bananna costs about the same as a bag of chips and it fills you up just as well. LoneCoyote, for me it has always been cheaper to make the healthy choice but I had never considered that those things aren't easily accessible in poorer communities. Good point.

K's mom -- what exactly was the diagnosis? You definitely don't fit into the group I am concerned about motivating.

Thanks for so many insightful comments. Does anyone know of a good, REPUTABLE source for nutrition information? Moderation in all things is a good rule but it would be good to have something more exact.

PS -- Masonator's mom is so fat that when she wears her red dress the neighborhood kids yell "Hey Kool-aid"

 

[Super Rob]

These issues we discuss are all very real:

Many of us were raised to think of fast food as real food.

Many of us were allowed to snack on junk food daily and developed an insatiable sweet tooth.

Many of us come from families that did not have the time nor the energy to purchase fresh meats and produce and to prepare dinner.

Many of the people who will come to us lead sedentary lives, fixed in cubicles in front of computer monitors.

Some of us come from communities and backgrounds where there really wasn't much access to health foods and grocery markets, and instead there were many more outlets to find quick and affordable fast food.

And we are all from a nearsighted society that demands immediate satisfaction and does not concern itself much with the future.

And plus, I still have a sticker given to me in grade school of Goofy eating a hotdog, with the words "Eating Well" printed above him.

Poor health due to a poor diet can develope over many years, and by the time many of us see our patients for the first time, their health may already be severely compromised due to years of malnutrition. Things like insulin resitance are often the product of many years worth of behavior and take years of dedication on the part of patient and health care professional if they are ever to be fixed, if they can be fixed at all.

And there's a tendency to neglect the impact of poor eating behaviors, to pretend that junk food really isn't the cause of so many illnesses, and to passively accept the alarming statistics on overweight and obese Americans (in the past, I have fit into both of those categories and will spend the rest of my life fighting to stay out of them). The tendency comes from political pressure (junk food is a huge industry, just like tobacco, and drug companies would rather you add a few pills to the menu than try to change your behaviors) and the tendency is also an end product of ignorance. Me and Satelite are in the same boat, looking for REPUTABLE sources of nutrition information. From what I've been told, what's being taught in medical school curricula is antiquated and highly politicized.

These are huge challenges.

 

[Super Rob]

http://www.supersizeme.com

Wow, thanks LoneCoyote! I'll have to see this film.

 

[leorl]

Haven't read all the messages, just glanced through some. In the US, there is the "fix it when it's broken" mentality, that has to change. Not just regarding obesity, but every day issues...sports teams that don't hydrate properly until someone dies. Someone getting a serious muscle or bone injury because they don't spend time daily to stretch, etc. It will take a very long time, but it's starting to happen in the US and moreso in Europe now - people are beginning to focus on prevention of illness and injury, which in my opinion is the better way to go. Instead of having to prescribe 16 million drugs to stop a problem that's hard to control (cardio risk factors)

 

[Celestron2000]

Hey all, Great Thread! I think you all speak the truth and are getting to the root of the issue. For GOOD, scientifically solid information about nutrition I highly Recomend Eating Well for Optimum Health by Andrew Weil, MD. He addresses the low carb vs low fat controversy very effectively as well as speaking extensively about how what we eat can cause or prevent disease.
Another book that I would reccomend for a different (more social) perspective on this issue is Fast Food Nation by Eric Schlosser, which discusses the development of our sedentary life-style and the indoctrination of our childeren by the fast food industry.

Fast Food Nation

Eating Well for Optimum Health

 

[LoneCoyote]

Hey all, Great Thread! I think you all speak the truth and are getting to the root of the issue. For GOOD, scientifically solid information about nutrition I highly Recomend Eating Well for Optimum Health by Andrew Weil, MD. He addresses the low carb vs low fat controversy very effectively as well as speaking extensively about how what we eat can cause or prevent disease.
Another book that I would reccomend for a different (more social) perspective on this issue is Fast Food Nation by Eric Schlosser, which discusses the development of our sedentary life-style and the indoctrination of our childeren by the fast food industry.

Fast Food Nation

Eating Well for Optimum Health

Another great one similar to Fast Food Nation is Fatland: How Americans Became the Fattest People in the World, by Greg Critser. He really flushes out the history of fast food and how political policy regarding agriculture subsidies in the Nixon years really moved us down the road towards the processed foods we have today. He also addressed portion size, food in school, lack of exercise, and the other social and cultural influences of this problem.

http://www.amazon.com/exec/obidos/t...104-1658210-8232722?v=glance&s=books&n=507846

I have also heard good things about The Hungry Gene by Ellen Shell, and Affluenza by John De Graaf, though I have not yet read either of them... both are on my list 🙂

 

[jdpharmd?]

You know, this is going to be really tough to do as a doc if I'm 50-60lbs higher than a conservative BMI target weight, which I most likely will be.

I also know that a large number of parents trying to raise kids on a limited food budget can't afford all the fresh fruits and veggies and lean meats that they would like to be able to buy. This isn't just working parents who fit the definition of poor - its also true of working parents who fit the definition of middle class.

What exacly is it about the healthy food that people can't afford? What do they buy instead? McDonalds meals for the entire family at $6/head? Bologna for 4 bucks a pack? Fried chicken from KFC for $15/meal? Food just isn't that expensive. Buy whole grain bread instead of white ($1.09), buy lowfat yogart instead of jello/pudding, buy multi-grain rice and pasta instead of mac and cheese, low fat turkey instead of bologna, etc. How much is a large bag of frozen corn or beans these days? Like 98 cents? There is not a difference in price between fattening/unhealthy foods and healthy foods... There is a difference in effort. (McDonalds is way easier than actually making something)

PS. Lean meats are some of the cheapest. The most expensive cuts of beef are marbled with fat (Prime rib, fillet, porterhouse, etc). The cheaper cuts (london broil) are actually healthier. 👍

 

[care bear]

we are soo hypocritical. . . most of us don't even know if we're going to be obese/overweight or not!!!!

most of this country's overweight people are not in their 20s or 30s like most posters on this board. they are in their 40's , 50's and beyond.

and yes, i know there is childhood obesity rising and etc etc which is all true and disturbing. however, it remains that many of us being so callous and harsh about weight issues are going to have a nasty surprise in 20-30 years.

out of the people on this board with 2 living parents, how many know that neither parent is overweight??

judging from myself and all my friends, i know very few people like that. maybe 2/10 of my closest friends have 2 parents of healthy weight. my mom used to be 5'6" 108 lbs when married, now she is much more. i'm sure many of your mothers have similar stories.

that's something to think about before you are so quick to put yourself in the 'us' half of an 'us' vs. 'them' dichotomy.

i agree that something needs to be done. i just think we need to be careful abt our attitudes.

 

[care bear]

oh and one more thing. 'healthy' foods vs unhealthy often doesn't make a bit of difference in weight. it's portion sizes. you may be better nourished when you buy whole grain rice or etc, but you are going to weigh the same after eating the same amount of it.

you can eat 4 snickers bars and 2 cokes a day and be pretty darn skinny (that's about 1500 calories) but you won't be well nourished. but, you'll be skinny because you ate less quantity.

now, i think nutrition needs to be emphasized as well as weight loss but i wouldn't go around promising patients (or thinking yourself) that changing *what* they eat is going to be nearly as effective as changing *how much* they eat.

 

[lessismoe]

we are soo hypocritical. . . most of us don't even know if we're going to be obese/overweight or not!!!!

most of this country's overweight people are not in their 20s or 30s like most posters on this board. they are in their 40's , 50's and beyond.

I was under the impression that the majority of us were talking about societal pressures on people that lead them into being overweight, not bashing the overweight.

But your discussion of how metabolisms slow down in your late 20's/30's is quite apt. I think that this nasty little switch in biology is also perpetuating obesity's spread in this country. I think a lot of people eat very unhealthy diets when they are young, but because they don't gain a lot of weight, they don't think that they have a problem. By the time their metabolism slows, unhealthy eating becomes an ingrained part of their lifestyle, and it is much harder to reform and shed those extra pounds.

I KNOW that this is going to happen to my husband. He's so stubborn at times! He will sit here and eat half the tub of ice cream, but because he is young and thin, he doesn't gain a pound and he insists he is okay doing it. To make it worse, his dad has diabetes, and I KNOW he's going to have problems. Grumble grumble...

I would like to acknowledge your point about women gaining weight after pregnancy and in their later years, though. Metabolic stumbling blocks can be SO hard to overcome (I know someone with genetic-based obesity who eats probably 1/3 or what I do, and she still can't shed the last 30 ponds or so). As an aside, I think it can be a good thing for women to have an extra 10 pounds or so later in life. When I was working in a rest home, it seemed like the women who survived longest were the ones who had some extra stores for sicknesses.

Of course, this makes me worried because both my mother and I are 5' and ~100 lbs (constant weight for her throughout her life, except for her "baby fat" period in college). I feel very lucky that we (thanks to her) have had good nutrition, good genetics, and good education about health to keep us so healthy. I'm really interested in this topic because I would like to help any future patients overcome health obstacles in their lives; I certainly don't think that they are bad people for being overweight.

 

[lessismoe]

oh and one more thing. 'healthy' foods vs unhealthy often doesn't make a bit of difference in weight. it's portion sizes. you may be better nourished when you buy whole grain rice or etc, but you are going to weigh the same after eating the same amount of it.

you can eat 4 snickers bars and 2 cokes a day and be pretty darn skinny (that's about 1500 calories) but you won't be well nourished. but, you'll be skinny because you ate less quantity.

now, i think nutrition needs to be emphasized as well as weight loss but i wouldn't go around promising patients (or thinking yourself) that changing *what* they eat is going to be nearly as effective as changing *how much* they eat.

Well, there are studies (like with calcium) that show that you are more likely to lose weight if you are better-nourished.

I have to give you that 1500 calories is 1500 calories, but if you want to cut down on calories without making a person feel deprived, one of the best ways is to replace high-density-calories (cokes and candybars) with high-fiber, high water content foods. Maximizing "fullness" while minimizing calories is a good goal.

Plus, I'd just like to point out that people in this country misread a lot of their body's cravings (I think there was a thread touching on this in Everyone). For example, the body's initial thirst response is often mistaken for a craving for carbohydrates. Another one is that the body's craving for sweets can actually signal a potassium deficiency, or perhaps a need for something in fruit. Figuring out a low-cal alternative to high-cal cravings can really cut down on a person's daily caloric intake.

 

[LoneCoyote]

What exacly is it about the healthy food that people can't afford? What do they buy instead? McDonalds meals for the entire family at $6/head? Bologna for 4 bucks a pack? Fried chicken from KFC for $15/meal? Food just isn't that expensive. Buy whole grain bread instead of white ($1.09), buy lowfat yogart instead of jello/pudding, buy multi-grain rice and pasta instead of mac and cheese, low fat turkey instead of bologna, etc. How much is a large bag of frozen corn or beans these days? Like 98 cents? There is not a difference in price between fattening/unhealthy foods and healthy foods... There is a difference in effort. (McDonalds is way easier than actually making something)

PS. Lean meats are some of the cheapest. The most expensive cuts of beef are marbled with fat (Prime rib, fillet, porterhouse, etc). The cheaper cuts (london broil) are actually healthier. 👍

There was a study in the American Journal of Clinical Nutrition about this. I only have a paper copy of the study but I'm putting a link to a newspaper article about it. Basically, poorer people who may be missing meals tend to eat diets that are very high in refined carbohydrates and fats because that's what makes you feel more full. I have volunteered in soup kitchens where they use this to plan the meals. They loaded people up on pasta so that they would feel full. I also have worked with underserved communities in several places and patients said they ate mostly mac and cheese, cookies, tortillas, rice, and beans, because that was cheapest and what they can afford. The best food sellers at the pharmacy I worked in that served a poor, urban community were 99 cent large bags of cookies, Ramen and mac and cheese. This Rite Aid and a few convenience stores was the main place to buy food for these people. There was no access to a grocery store to make the choice to buy whole grain bread or even a bag of frozen veggies. And if you're hungry buying the bag of veggies makes little sense if you are just looking for food to get you through your day. When people tend to eat only these high carb foods, the study found, they gain weight.

http://www.miami.com/mld/miamiherald/news/politics/7850722.htm?1c

 

[care bear]

I was under the impression that the majority of us were talking about societal pressures on people that lead them into being overweight, not bashing the overweight.

But your discussion of how metabolisms slow down in your late 20's/30's is quite apt. I think that this nasty little switch in biology is also perpetuating obesity's spread in this country. I think a lot of people eat very unhealthy diets when they are young, but because they don't gain a lot of weight, they don't think that they have a problem. By the time their metabolism slows, unhealthy eating becomes an ingrained part of their lifestyle, and it is much harder to reform and shed those extra pounds.

I KNOW that this is going to happen to my husband. He's so stubborn at times! He will sit here and eat half the tub of ice cream, but because he is young and thin, he doesn't gain a pound and he insists he is okay doing it. To make it worse, his dad has diabetes, and I KNOW he's going to have problems. Grumble grumble...

I would like to acknowledge your point about women gaining weight after pregnancy and in their later years, though. Metabolic stumbling blocks can be SO hard to overcome (I know someone with genetic-based obesity who eats probably 1/3 or what I do, and she still can't shed the last 30 ponds or so). As an aside, I think it can be a good thing for women to have an extra 10 pounds or so later in life. When I was working in a rest home, it seemed like the women who survived longest were the ones who had some extra stores for sicknesses.

Of course, this makes me worried because both my mother and I are 5' and ~100 lbs (constant weight for her throughout her life, except for her "baby fat" period in college). I feel very lucky that we (thanks to her) have had good nutrition, good genetics, and good education about health to keep us so healthy. I'm really interested in this topic because I would like to help any future patients overcome health obstacles in their lives; I certainly don't think that they are bad people for being overweight.

i want to apologize for being accusatory. it was only the attitude i read (perhaps wrongly, perhaps not) in one or two posts that led me to accuse this thread of being judgemental. i do think you have to be really sensitive and thoughtful in dealing with this issue, but i was wrong to imply that the people who have contributed to this thread lack such sensitivity.

 

[jdpharmd?]

Basically, poorer people who may be missing meals tend to eat diets that are very high in refined carbohydrates and fats because that's what makes you feel more full. I have volunteered in soup kitchens where they use this to plan the meals. They loaded people up on pasta so that they would feel full. I also have worked with underserved communities in several places and patients said they ate mostly mac and cheese, cookies, tortillas, rice, and beans, because that was cheapest and what they can afford. The best food sellers at the pharmacy I worked in that served a poor, urban community were 99 cent large bags of cookies, Ramen and mac and cheese.

I'm not talking about the poor, HOMELESS people in soup kitchens. The discussion is about people who throw McDonalds and KFC at their kids for every meal. By all means, if you're starving (literally), have a cheeseburger. They are putting fats in the meals at a soup kitchen because they are part of a balanced diet and contain energy that those people need (9kcal/g). Bobo the couch potato, with his hand in the bon-bons, does NOT need this fat and it's NOT part of his "balanced diet".

There is no grocery store?! Rite aid is easily 30% more expensive than a supermarket. Maybe a walk (or bike ride) to the grocery store would help with weight loss?

I have to give you that 1500 calories is 1500 calories, but if you want to cut down on calories without making a person feel deprived, one of the best ways is to replace high-density-calories (cokes and candybars) with high-fiber, high water content foods. Maximizing "fullness" while minimizing calories is a good goal.

indeed! 👍

 

[lessismoe]

I'm not talking about the poor, HOMELESS people in soup kitchens. The discussion is about people who throw McDonalds and KFC at their kids for every meal. By all means, if you're starving (literally), have a cheeseburger. They are putting fats in the meals at a soup kitchen because they are part of a balanced diet and contain energy that those people need (9kcal/g). Bobo the couch potato, with his hand in the bon-bons, does NOT need this fat and it's NOT part of his "balanced diet".

There is no grocery store?! Rite aid is easily 30% more expensive than a supermarket. Maybe a walk (or bike ride) to the grocery store would help with weight loss?

I can think of a couple of very urban areas where it is quite a drive to the nearest grocery store. Supermarkets take up a lot of space, and the big chains don't always want to place themselves in high-crime risk areas.

But I don't think LoneCoyote was talking about Bobo the couch potato. I think she was talking about people who work very hard for meager pay and come home very tired to an apartment in the "bad" part of town. My old boss came across a janitor late one weeknight, and accidentally woke her up. The woman apologized, and explained that this was her SECOND 8-hour job of the day, and she was exhausted. I can see how a woman in her position, struggling to support her family, might legitimately not have the energy to shop for and prepare a meal from fresh produce for her children. For that matter, in situations like these, I suspect that the parent is not always available to make the food decisions for the children. With two jobs, she might even be considered "middle class".

If you think about it; for $1, you can get about a crown of broccoli and a couple of tomatos (depending on how and where you shop) or a 1 lb frozen bag of mixes carrots, peas and corn (if it's on sale). For $1, you could buy a 1 lb. bag of flour, or 10 bags of Ramen, or 4 boxes of Mac n cheese. I think that was what LoneCoyote meant by high-carb foods being cheaper per calorie.

 

[LoneCoyote]

Yes, lessismoe, you pretty much summed up what I was trying to say. I was referring to the demographic that researchers like to call the "working poor," people who have low-paying jobs, not much time to cook, and often miss meals because they cannot afford to buy all the food they need. The soup kitchen was in reference to the high carb foods giving people people more energy argument.

jd,

There are definitely areas where there are no supermarkets. I was speaking with a colleague the other day who grew up in an inner city area where the nearest grocery store was in another city over 12 miles away. People had to take taxis if they wanted to get there, and many people could not afford to do this very often, both because of money or lack of time. As a result, they bought cheap, processed food at drug stores, liquor stores, and convenience stores. I do not see riding a bike to the store or walking to be a viable option for people who live in places like this.

I agree that there is a large problem with people who have the money and resources to eat well throwing fast food on the table. But we cannot overlook the fact that obesity is an even bigger problem in many low-income communities. These populations will be the ones that many of us will serve during our training in school at clinics and teaching hospitals, so I think discussion of the problems that such communities face when it comes to eating healthy is valuable for this thread. Luckily, these problems are becoming more well known and there are new programs, like those that bring farmer's markets to inner city areas, that are seeking to address them. But clearly there is still a lot of work to be done across the board, in both poorer communities and more affleunt ones.

 

[Super Rob]

Just as it's important to give people access to healthy foods, it's important to give people access to information about the food they eat.

I don't buy into the theory that "moderation is key." Some foods are just horrible. Most grain products and foods containing trans fat are no good. They are tasty, but they deserve no place in our diets. Unfortunately, they are also addictive, and did I mention they are tasty?

A good point that was brought up is that people who are thin in their earlier years often gain a lot of weight as they become middle-aged and beyond.

Obesity, diabetes, and heart disease seem like they're often illnesses of accumulation. People poison their bodies little by little and things sort of manifest as they get older. By the time you receive a formal diagnosis, you are most likely disabled. That's why it's important to improve screening for for conditions related to poor dieting. Perhaps, diet could receive more emphasis during an interview.

It's also a smart idea to focus on the younger generations. Kids are eating cookies and chips in their school cafeterias and while they show no signs of diabetes or heart disease today, they may be setting themselves up for those diseases later in life. Most doctors will see that the kids are thin and assume they're healthy, or they'll see that a kid is overweight but otherwise healthy. Unfortunately, these kids are given a clean bill of health, when there probably should be some sort of intervention. Why give someone forty or fifty years to make themselves ill when you can interfere with the process and encourage healthy behaviors while they are still young and impressionable?

 

[Masonator]

Not only is this post about fat people, but these are FAT posts!

 

[28657]

I don't buy into the theory that "moderation is key." Some foods are just horrible. Most grain products and foods containing trans fat are no good. They are tasty, but they deserve no place in our diets. Unfortunately, they are also addictive, and did I mention they are tasty?

I can understand your point, however, the concept of "moderation" is meant to aid a lifelong lifestyle change. You CANNOT take the good tasting bad foods out of one's diet. Invariably a "diet" of fruits and veggies will fail. Moderation is an accepted and supported method of losing weight because it accounts for both the physiological and psychological components of obesity.

 

[Super Rob]

I can understand your point, however, the concept of "moderation" is meant to aid a lifelong lifestyle change. You CANNOT take the good tasting bad foods out of one's diet. Invariably a "diet" of fruits and veggies will fail. Moderation is an accepted and supported method of losing weight because it accounts for both the physiological and psychological components of obesity.

You can take bad foods out of a diet and be left with a diet that works. Some of the healthiest people I know have diets that consist almost entirely of fresh meat and vegetables. Some do it because they don't have much of a choice. The theory that breads and pastas, margarine and cupcakes are part of a well balanced diet is the product of politics. People can do just fine without grains and dairy for instance, but you will never see those food groups removed from federal dietary recommendations.

Realistically, most of us would find it prohibitively time consuming, expensive, and emotionally troubling to eat nothing but fresh, organic meat and produce. Many of us do not have the resources or the will power to do so. We are human. It's difficult to change behaviors that are so deeply imbedded after years and years of conditioning. Eating crappy foods will make us feel better because most of these foods, and for many people eating in general, are an addiction. Ideally we'd encourage people to stay away from unhealthy foods they are addicted to, just like we'd encourage someone addicted to street drugs to stay away from the drugs as opposed to using them in moderation.

And I don't think moderation works for weight loss. Nope, especially when it comes to high glycemic carbohydrates and foods with high Insulin indices. These foods are responsible for insulin resistance. The more you eat them, the harder it becomes to lose weight. People who want to incorporate a little of everything into their diet usually stay unhealthy. While they're young, they can jog around the park and burn off the fat, but as we've alluded to, it's a different story when they're older and their bodies don't respond the same to food and exercise.

 

[care bear]

You can take bad foods out of a diet and be left with a diet that works. Some of the healthiest people I know have diets that consist almost entirely of fresh meat and vegetables. Some do it because they don't have much of a choice. The theory that breads and pastas, margarine and cupcakes are part of a well balanced diet is the product of politics. People can do just fine without grains and dairy for instance, but you will never see those food groups removed from federal dietary recommendations.

Realistically, most of us would find it prohibitively time consuming, expensive, and emotionally troubling to eat nothing but fresh, organic meat and produce. Many of us do not have the resources or the will power to do so. We are human. It's difficult to change behaviors that are so deeply imbedded after years and years of conditioning. Eating crappy foods will make us feel better because most of these foods, and for many people eating in general, are an addiction. Ideally we'd encourage people to stay away from unhealthy foods they are addicted to, just like we'd encourage someone addicted to street drugs to stay away from the drugs as opposed to using them in moderation.

And I don't think moderation works for weight loss. Nope, especially when it comes to high glycemic carbohydrates and foods with high Insulin indices. These foods are responsible for insulin resistance. The more you eat them, the harder it becomes to lose weight. People who want to incorporate a little of everything into their diet usually stay unhealthy. While they're young, they can jog around the park and burn off the fat, but as we've alluded to, it's a different story when they're older and their bodies don't respond the same to food and exercise.

however. . .in many asian and european countries some of the food is 'terrible' by the standards of being high in fat and carbs. however, you will see even elderly people being very thin. . . because they eat so little of everything. you will have to work very hard to convince me that moderation is not an excellent key for lifelong weight maintenance!

 

[Fermata]

Usually I just rip off my shirt and start posing right in front of them.

"This could be... ::flexes:: youuuuu........oh yeaaaaa."

Or this method:

"Did you get tickets?"

"Tickets? To what?"

"To...... ::Front double biceps pose:: the Gun Show!!"

I find this method to be the most successful. 😀

 

[Chrisobean]

culture has alot to do with it. if you grow up eating rice and beans or biscuits and gravy, you're chances of being overweight are alot higher. i'm italian, and i eat pasta alot, but i am still very thin. there's olive oil in almost everything i cook. i eat alot of red meat too. but i guess i have a pretty good metabolism.
anyway - losing weight is really only about a calorie deficit. burn more than you eat. this doesnt necessarily make you healthy though. thats where what you eat comes into play. (you can call me captain obvious if you want)
approaching the subject is very touchy. my 11 year old cousin weighs a little more than i do. she eats crap. fries, chips, you name it. even though she is very active in sports and dance, and is quite tall for her age, even she knows that she's fat. i feel bad, i dont want to her to be depressed, so i try to encourage her to have some carrot sticks with me or i'll take her out skating and for some veggie pizza. i think she's lucky that she hasnt been teased for it very much. her mom has struggled with her weight all her life, so she just thinks its a fat phase like she went through. when one of her doctors told my aunt that my cousin was obese, she switched doctors. its really hard to swallow, its embarassing. i think she realizes it now that she's partly, maybe even mostly, at fault for my cousin's weight. lately ive noticed a slight change in her eating habits, she eats salads more, and stopped drinking soda. so i guess she is on the right track, but she still has a long way to go.
im sure pts know dam well that they are overweight. you dont need to tell them that. if they need to get a quick bite from mcdonalds, they can get a salad. i have to say i am impressed with the steps they are taking. fast food doesnt have to be crap, it just needs to be fast!

i'd say that's about 1 cent worth.

 

[lessismoe]

approaching the subject is very touchy. my 11 year old cousin weighs a little more than i do. she eats crap. fries, chips, you name it. even though she is very active in sports and dance, and is quite tall for her age, even she knows that she's fat. i feel bad, i dont want to her to be depressed, so i try to encourage her to have some carrot sticks with me or i'll take her out skating and for some veggie pizza. i think she's lucky that she hasnt been teased for it very much. her mom has struggled with her weight all her life, so she just thinks its a fat phase like she went through. when one of her doctors told my aunt that my cousin was obese, she switched doctors. its really hard to swallow, its embarassing. i think she realizes it now that she's partly, maybe even mostly, at fault for my cousin's weight. lately ive noticed a slight change in her eating habits, she eats salads more, and stopped drinking soda. so i guess she is on the right track, but she still has a long way to go.
im sure pts know dam well that they are overweight. you dont need to tell them that. if they need to get a quick bite from mcdonalds, they can get a salad.

Oh, you bring up a great point for discussion, Chrisobean!

A lot of people automatically become defensive or go into denial when they are confronted with a problem that they feel personally responsible for or guilty about.

I would love to hear from people who have struggled with their own weight, or who have been in this situation, about what is the best way to broach this subject with a pt.

You are totally right, Chrisobean, they probably don't need to be told that they have a problem. But, they probably need to be confronted about it, in a tactful manner. How do you do this without making someone tune out or run away?

 

[Heal&Teach]

I would love to hear from people who have struggled with their own weight, or who have been in this situation, about what is the best way to broach this subject with a pt.

You are totally right, Chrisobean, they probably don't need to be told that they have a problem. But, they probably need to be confronted about it, in a tactful manner. How do you do this without making someone tune out or run away?

This is a difficult situation to approach, and unless you can relay personal experience (which may not be the best thing to do in a doctor-patient relationship), it might be helpful to talk about weight loss in the context of the person's life. For example, if you constantly go to the physician and he tells you "you need to stop eating that stuff or it's going to kill you", obviously this is problematic (but fear tactics do sometimes work). However, if you speak to someone in the context of their family history of a disease, and how the person's disease has affected others around them (e.g., whether it be through loss/death, health care and quality of life costs), it may be more helpful. Hopefully, the patient will be able to relay this information to their family members as well, in order to effect positive change for everyone. The key is remaining positive about the situation, and focusing on the benefits of behavior change (in this case, lifestyle habits than contribute to overweight and obesity).

It may also be helpful to assess barriers that prevent the patient from making healthier food choices. Yes, it may be cheaper to buy the veggies and meat and cook at home, but fast food value meals may be just what the doctor ordered in terms of satiating the neverending cycle of cravings for high-fat, high-sugar foods. The patient must be allowed to create REALISTIC goals for themselves ("No Mrs Jones, we can't guarantee that you can lose 30 pounds in a month on the SlimFast plan, and it is not healthy to lose that much weight so quickly"), so that the patient realizes that small steps can make big improvements in health. More importantly, the patient has to understand that CHANGE IS DIFFICULT, and they're not going to see results overnight, but will see something with a dedicated effort. It would be helpful to discuss specific strategies to help them increase their daily activity, whether it be walking the stairs instead of taking the elevator, and working with their families to choose heart-healthy foods and minimize the junk ("Let's try the wheat pasta tonight, and ground turkey instead of beef"). It's difficult, esp. in the limited time period that you have with your patient, but just a few words may make all the difference.

Of course, this is ideal, but using messages that are relevant to patients that empower them to take control of their own health, may be the best way to tackle this problem.

H&T

PS To address carebear's earlier concern: i agree with and completely understand what you mean about eating certain foods in moderation, but it is important to note that thin does not always equal healthy. There are thin people whose cholestrol and blood pressure readings are through the roof and may be considered more unhealthy and have hearts three times the size of someone who may be considered overweight. Perceptions in our society sometimes fuel negativities that don't serve to help people who are overweight or obese to change, and may instead force them to strive for an unattainable norm in weight loss.