The motivation is more important than the reversal of obesity Information

September 7, 2012 by Dr. Val Jones health, advice, opinion

Recently, I found my way to a podcast of interesting NPR via a link to Dr. Ranit Mishori (@ ranitmd) on Twitter. The host of the show interviewed a physician (Dr. Mishori), an obesity researcher (Sara Bleich), and is a family nurse practitioner (Eileen O'Grady) on health care providers how to try (or not) to help patients to manage their weight. Several of the patients and called practitioners participate.

First of all, I found this fascinating that research has shown that the BMI of the attending physician has a significant impact on the question of whether if he or she is willing to counsel a patient on weight loss. Physicians weight normal (those with a BMI of less than 25 years) were more likely to address the subject (and follow with weight loss and exercise of planning with their patients) than doctors who were overweight or obese. Sara Bleich believes that this is because an overweight and obese doctors is recognize the problem to other people who have similar body types or personal shame on their weight makes them feel that they do not have the right to give advice because they do not practice what they preach. While 60% of Americans are overweight or obese, 50% of doctors are also in these categories.

Although it is not entirely surprising that sensation of physicians overweight or obese as they, it made me wonder what could influence other personal conditions based on evidence of the care for patients. Is a doctor with hypertension less able to encourage accession salt restriction or drugs? What is depression, smoking cessation tobacco or erectile dysfunction? Is there some personal diseases or conditions which threaten the good care and treatment in others?

Several calls told negative experiences with physicians, where they have been "read the Riot Act" on their weight. Said overweight woman she handled this by avoiding simply go to the doctor at all, and another said obese man her doctor made her cry. However, the man continued to lose 175 pounds thanks to changes in diet and exercise and said that the "magic" is just what he needed to galvanize action.

Dr. Mishori found that the "Riot Act" approach was rarely useful and usually insane patients. She advocates a more nuanced and more sensitive approach that takes into account the social and financial patient situation. She explained that there is no use advocates personal training of a person on food stamps. Doctors must be more sensitive to the conditions of life of the patients and physical capabilities.

In the end, I felt that the nurse practitioner Eileen O'Grady contributed to some useful observations - it was argued that the factor limiting the speed in reversing obesity is not information, but the motivation. Most patients know what they "do" but just do not have the motivation to start and keep at it until they reach a healthy weight. Ms. O'Grady has dedicated his practice of coaching by phone weight loss, and believes that the phones have a large advantage over in-person visits: patients are more likely to be honest when there is no direct visual contact with their provider. His secret of success, beyond a non-moralistic therapeutic environment, highlights small achievable goals. She said that if she does not believe that the patient has at least 70% chance of success, they should not set this particular goal.

Objectives can be as simple that "find a training outfit suited." As the patient grows in confidence with their success, bigger, wider goals can be set. Intensive group therapy and weight loss training can be more motivating strategy that we must help the Americans to shed unwanted pounds. Apparently, universal service providers working group accepts, as they recommend "intensive behavioral interventions, multi-component" for those who screen positive for obesity in their cabinets.

I think it is unfortunate that most physicians believe that "simply don't have time to advise patients on obesity." Diet and exercise are two medical the most powerful tools we have to fight against many chronic diseases. What else is so important that it is further our time focusing on the "elephant in the room?".  Pills are not the way forward in the treatment of obesity - and we should have the courage to admit it and to better address the problem head-on in our offices and our own lives also.

Tags: BMI, Coaching, advice, education, Information, Motivation, NPR, obesity, BMI, Podcast, nizatidine doctor Mishori, USPSTF recommendations, weight loss

Can Childhood Obesity Hinder the Brain?

Reading, Math Worse in Kids With Many Obesity-Related Risk Factors

Sept. 4, 2012 -- A new study shows that children who are overweight or obese may face problems with brain development, especially if they have risk factors for metabolic syndrome.

Metabolic syndrome is a cluster of problems that set the stage for diabetes and heart disease.

 The risks for metabolic syndrome include:

Belly fatHigh levels of blood fats called triglyceridesInsulin resistance or prediabetesHigh blood pressureLow level of "good" HDL cholesterol

Researcher Antonio Convit, MD, says the bottom line is, "We are seeing brain changes in kids with metabolic syndrome and we don't know if this is reversible."

Children with metabolic syndrome scored 10% lower on mental tasks that are important for learning, he says. The findings appear in Pediatrics.

In the new study, obese or overweight teens with metabolic syndrome could not read as well, scored worse on math tests, and took longer to complete tasks than children who did not have metabolic syndrome. What's more, their brains also had physical differences.

The new study included 49 teens with metabolic syndrome and 62 without it. The more metabolic syndrome risks that participants had, the more pronounced the brain changes were, the study shows.

Convit calls for testing for insulin resistance among at-risk children, particularly those who are very overweight and those who have a family history of diabetes or heart disease.

Other solutions include having physical education programs in school. "We should invest more in physical education so kids are fitter and less likely to have insulin resistance, which is the main driver of these brain changes."

Insulin is a hormone that helps the body turn sugar into energy. Insulin resistance occurs when the body does not use insulin properly.

Michele Mietus-Snyder, MD, says the new findings should serve as a wake-up call.

"Every cell in every organ system requires energy to live and insulin is the gatekeeper," she says. "Insulin resistance has reached beyond the traditional organ systems to the brain."

"We need to be very vigilant when children start to gain belly fat because we don't want children to fall behind the metabolic eight ball." If that occurs, it becomes a catch-22. "How can you expect someone to make healthy choices when they are [mentally] impaired?"

Scott Kahan, MD, MPH, is the director of the National Center for Weight and Wellness in Washington, D.C. "Metabolic syndrome was unheard of in kids until recently," he says. "It is striking that a significant number of kids have metabolic syndrome, but the fact that we can show further consequences in the brain is even more striking."