Weight Management                              Return to the Beginning

Weight management and obesity are prevalent health concerns in the United States. Often physicians will attempt to address this in their patient’s care by ordering a calorie restricted or weight loss diet while the patient is hospitalized. There are multiple factors involved in successful weight management, which cannot be or should not be addressed in the hospitalized patient. However, discharge instructions may highlight components of lifestyle and diet changes that can start patients off on the right foot when they return home. This information coupled with a listing of resources to explore in the outpatient setting (the dietitian’s phone number, a list of local weight management programs, etc.) can help you provide your patient with the best care possible to encourage his or her success.

The cause of overweight status and obesity cannot be attributed to a single problem or source. Genetics play a strong role in overall body type and tendency to become overweight. Lack of exercise and general physical activity can result in slow or rapid weight gain if a high caloric intake level is maintained. For example, eliminating 30 minutes of walking daily results in 100-150 fewer calories burned in a day. With no decrease in oral caloric consumption, this could lead to approximately a ten pound weight increase in one year. Compounding the potential risk from genetics and activity level is age and lifestyle. As people age, they tend towards changes in lifestyle which often affect a person’s eating habits. An example of this includes eating at restaurants more often due to not desiring to cook at home for only one or two people, time schedule changes, and travel. There are some medical conditions that also contribute to weight gain. However, they are more appropriate to be discussed individually and therefore are beyond the scope of this information piece.

One tool to define obesity and the severity of obesity that is correlated with disease risk is the Body Mass Index (weight in kilograms divided by height in meters squared). The National Institute of Health defines Body Mass Index (BMI) categories as follows: 25-29.9 is overweight, 30-34.9 defines obesity class I, 35-39.9 equates to obesity class II, and greater than 40 represents class III, or extreme obesity. Progressively increasing BMI presents greater disease risk (diabetes, heart disease, cancer, etc.). Disease risk is further increased when abdominal obesity is present. The criteria for this includes a waist circumference for women over 35 inches and over 40 inches for men whose BMI is in the overweight to class II obesity categories. It is not used for BMI’s greater than 39.9 as these people are already at high risk based on their BMI alone.

The relationship between diet and weight is a simple equation. More calories in versus out cause weight increase, while more calories out versus in cause weight decrease. Therefore the goal is to create this negative caloric balance to achieve weight loss. This can be done using diet or activity/exercise, or a combination of both. Diet is a more realistic avenue for most patients as it may be easier to find a way to restrict calories eaten than to find a way (and time) to burn the equivalent amount of calories through exercise. The best way to achieve initial and long-term weight loss is to apply both, caloric restriction and increasing exercise/activity. When you have a motivated, interested patient, a registered dietitian can create a plan that takes into consideration lifestyle, preferences, knowledge base, and activity ability. While it is most successful in an outpatient setting when it is the focus of the patient’s visit, an initial introduction via written or verbal information can “jump start” a patient’s desire for weight loss when he/she is made aware of the help available.

When discussing diet or a plan with a patient, there is some particularly useful information needed to create a negative caloric diet. One thing a patient needs to do is examine his/her current eating habits. This can be done by recording a food record (what, when, how much, any emotional/environmental cues at the time), which can be assessed by the patient with the help of a registered dietitian. For the patient, a visual record of what they are eating may make them more conscious of what they are consuming. This may also help a patient identify low nutrition, high calorie foods that he/she could alter in the diet. A food record is also useful in examining and readjusting portion sizes. The actual diet plan is very individualized and is a primary focus of the registered dietitian. It is important to note that often a patient will tell you they have tried diets before that have failed. Often when you delve further into this statement you will find that they are referring to excessive restriction or fad diets. Both are unhealthy options because without proper management or information this could cause nutrient deficiencies, affecting a person’s health negatively. This may also lead to disenchantment with the desire to make changes due to the difficulty in following some diets.

For long-term weight loss a dietitian or weight loss program are important resources. However, you can give your patient survival skills to get them thinking and trying to make changes on their own.

 

Weight Management Survival Skills

• Switch to calorie-free or low calorie beverages.
• Eat three to six times per day.
• Avoid fried foods, high fat meats, fast food, and whole fat dairy products.
• Increase consumption of fruits and vegetables.
• Consider replacing sugar with a substitute or decrease its use.
• Decrease alcohol consumption if warranted.
• Provide examples of portion sizes (e.g. ¾ cups cereal, ½ cup juice, 1 cup fresh fruit, 8 oz. milk, 3 oz meat).
• Caution against fad diets.
• Discuss the value of keeping a food record.
• Provide contact information for a registered dietitian or reputable weight control program.