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MyHealthNewsDaily
If you want to know whether you’ll lose weight or not, don’t ask a doctor.
In a new study, physicians predicted about 55 percent of patients would be "likely" or "very likely" to follow their recommendations for losing weight, eating healthier or getting more exercise. But three months later, only 28 percent of patients had lost at least two pounds, 34 percent were eating less fat and more fiber, and 6 percent were getting in one more hour of brisk walking each week.
It was surprising, researchers said, that in slightly more than half of cases, doctors said they believed their patients would follow their recommendations, because other work has not shown that physicians have that level of optimism about their patients' behaviors.
Why the optimism? While physicians generally think patients are unlikely to follow recommendations, after talking with any given patient, doctors become optimistic that the patient will change, the study researchers say.
The findings were published Feb. 7 in the journal Family Practice.
Recordings of doctor's appointments
More than 60 percent of Americans are overweight or obese, according to the Centers for Disease Control and Prevention.
In the study, the researchers made audio recordings of conversations between 40 doctors and 461 of their overweight or obese patients. The doctors and patients knew their conversations were being recorded, but were told only that the study they were participating in would look at how doctors "addressed disease prevention" with their patients — not that weight loss goals would be looked at, specifically.
After each visit, physicians were asked questions such as: How likely will the patient follow your weight loss recommendations?
When considering the patients who the doctors said would likely improve, most of the time, the docs got it wrong. Only 16 percent of those predicted to lose weight actually lost weight over the next three months. Of those that the doctors predicted would follow their healthy eating recommendations, only 19 percent actually improved their eating habits. Four percent of those predicted to get more exercise actually started doing so.
The physicians were more often accurate in their guesses about who not improve.
While previous studies had surveyed physicians about their expectations for their patients in general, none had asked doctors what they thought about specific patients immediately after an office visit, according to the study.
Is optimism good?
Doctors' expectations about their patients ability to change is important, because a doctor with low expectations "can lead to patients being less likely to improve their behaviors," the researchers said. When patients don’t improve behaviors, doctors' expectations only sink even lower, and a vicious cycle ensues.
But physician optimism might have some benefits. "Patients might feel more confident that they can lose weight when they feel their physician believes they will change," the researchers wrote. However, this optimism might mean that the doctors are overestimating the effect their recommendations will actually have on patients, and could make doctors less receptive to learning effecting techniques for counseling patients, according to the study.
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I have read on discussions on this site time and time again how doctors are not interested in diet and nutrition, and only want to push pills to fulfill some devil's pact with the pharm industry
Those people can now sit down and be quiet, as they see the truth--how difficult it is to truly get people to get healthy and exercise more
Agree that it is extremely difficult to get people to make healthier choices with food and to exercise more, even in the midst of medical issues that could benefit from it. But I hear too many times that the recommendations range anywhere from "eat a healthy diet and exercise" to "don't eat fat, or cut out the sweets or don't eat fast food and get some exercise". That's not going to cut it.
Eric... I totally agree!! See it often.
Kelly and others... Physicians are extremely (on the whole in the US) well trained on treating physical/medical issues, yet most have very limited training on preventative treatment for behavioral (diet, exercise, cigarettes, alcohol, etc.) issues.
The problem is that to create changes in behavior and thinking requires a complex set of not only therapeutic interventions but also psychological diagnostic skills (that can't be taught in a few CME's). You MUST be able to assess where a patient is at in their desire to change. Someone who doesn't want to change will take a much different intervention than someone contemplating change, which both are different than someone in the process of making changes. You also can't easily assess where someone is at in their change thought processes in 15 min or even with questionaires as people often will say "I'm ready to change" when they really have no desire to change. Many are only saying they will change because their physician or spouse wants them to, and they'll sound very convincing!
Once you have determined where someone is at in their stage of change (can take 30min to an hour or even multiple visits to determine) you modify your approach in supporting them in that change process. For instance, providing a stack of literature on the evils of eating junk food or even a preaching lecture telling them they're going to die does little to motivate someone who isn't ready to change. It's also often a waste to retry something that the patient has done a dozen times that didn't work in the past. With someone who doesn't want to change you have to build rapport then explore what is motivating them to not want the change and that takes time.
It's not easy to fit all of that in when you're trying to treat the various medical issues that originally brought the patient in to begin with. That's why you are seeing a shift in some medical practices toward adding Primary Care and Medical Psychologists, who are adept at determining where patients are at and the best strategy for helping them to make needed health changes. You are also seeing many physicians starting to refer patients out to psychologists for intensive behavior therapy.
There is finally a change toward allowing preventative counseling by medicare for physicians, PA's, nurse practitioners, etc. But again, many are not well trained enough to help those who are difficult or resistant and may even use interventions learned in a CE class that are harmful for those who are already in the process of making changes. Unfortunately, many insurance companies and even medicare strongly resist paying for preventative care counseling/therapy by psychologists even though they are the best trained to provide such and in the long run it would dramatically reduce heart disease, diabetes, etc.
"Your all worthless and weak".
Niedermeyer
People know if they are fat or not. What they are missing is the catalyst for change and a deep understanding of the medical ramifications of being obese. It is a system failure to diagnose a patient as obese, and then not be able to follow it up with immediate referrals to a dietitian offering a precise, prescribed meal plan, a physical therapist, behavioral counselor.
I don't really agree. Most physicians are over-qualified to give general nutrition and activity advice. Its just like this article says--few people have the will to follow through. Further referrals are just a waste of money in an already strained health care system. (unless you have evidence to the contrary)
Your point is well taken about people not understanding the ramifications, though
I agree that physicians are highly trained in giving advice, BUT to help people make changes when they really don't want to change "advice" is often the most unhelpful thing one can give. Appropriate advice and information without threats is great for those in the process of and dedicated to making changes. Thus my comment above.
What a joke this is. I don't know if you've ever been to medical school, but allopathic doctors require about 6 hours of basic nutrition classes in order to complete their M.D. As a doctor myself (PhD in biology and nutrition) I find this statement telling of how trusting the masses are of their physicians. If I could count how many times I've heard utter nonsense, including the "low fat" drivel that this article suggests, coming out of doctor's mouths, I'd run out of numbers.
The problem isn't "big pharma" in most cases. The problem is a combination of (a) Western doctors not knowing jack s**t about nutrition -- it's a completely different field of study, and they have little to no business pretending they know how to advise the masses; and (b) the masses, once advised properly (or improperly, as this article suggests) simply not having the discipline required to follow through.
Actually, some people DON'T know that they're FAT or underestimate the number of pounds they should lose to regain health and fitness levels. Others are in denial. Some mistakenly blame their excess weight on food additives, preservatives, or other such nonsense.
Too often, people who live in families and work in communities where a large percent are overweight or obese simply fail to recognize the dangers to themselves or recognize that their children are overweight because they look like most others. These fatties will even make fun of slender, fit people and call them "anorexic" or sickly.
These misguided folks are toxic to YOUR health and ideal weight.
@ Jon above. I agree that doctors could know more about nutrition, but most of the time their general "advice" would help the extremely overweight and obese people. Almost everybody could use more exercise, and while a general Doctor might not be the best person to ask when it comes to what type of exercise, the idea remains the same. Eat less, exercise more. I think that's the message most doctors try to convey.
Jon,
unfortunately, you are the joke. Do you think that nutrition is the only class you learn about the impact of food choices on health? What about cardiac pathophysiology, when you study the relation between saturated fat intake and lipid plaque formation?
And you are forgetting about this tiny thing called residency, where there are hours upon hours of didactics focusing on proper diet and activity choices.
Im sorry to have to break it to you, but having a phd in nutrition does not give you an exclusive license on the knowledge of dietary choices
Eric,
What strained health care system are you referring to?
Physicians may not know as much as a phd nutritionist but they do know more than enough about nutrition to offer good advice about diet. A nutritionist may know everything about an appropriate diet but if one doesn't understand the process of creating behavioral change and how to work with difficult patients to implement it, all of that advice might as well be given to a stump.
Again.. "advice" giving, even when the advice is excellent and from the most skilled person out there does little to help make behavioral changes in a large portion of the cases. Depending on the particular behavior maybe 33% of patients are at the point where just advice is useful. A majority are not, a major factor in the results of the study.
jb,
ummm...the american one?
People might know that they are overweight--but, sadly, medicine knows very, very little about what it takes to lose weight effectively, and they certainly have no clue how to address the problem with people who have a limited income.
Among the stupid things one still hears: "Just get 20 minutes of exercise a day, including walking, and you'll lose weight!" BS--it takes an hour of heavy aerobic exercise per day for middle-aged women to maintain their weight and not get that "middle-aged spread." The "20-minute-a-day" nonsense is based on young men with high metabolisms, and probably on those who were in the military.
Among the stupid things one still hears: "Eat a diet high in fiber and low in fat." Nonsense--one does not gain weight from fatty foods any more than one gains weight from fiberous foods (calories are calories), and fat makes one feel full and also promotes brain health. A certain amount of fat in one's diet is good, and foods that people think are high in fiber (like whole wheat bread) are often packed with carbohydrates that lead to the vicious circle of getting a sugar high, then crashing, and then feeling woozy and hungry.
Among the stupid things one still hears: "People use food as a substitute/crutch in order to solve emotional problems." No, food has a direct effect on one's mood--low blood sugar also makes one feel ill. People who develop metabolic issues that will lead to diabetes have trouble with their blood sugar: quick rises and spectacular drops. The only way to keep this from happening is to either keep one's blood sugar spiked all the time (snacking on carby foods) or to eat a lot of protein. This is exacerbated by the fact that poor people can only afford carby foods which do not fill them up but aggravate their blood sugar problems, while wealthier people can afford the expensive high-protein foods.
There are a lot of stupid things that one still hears--and there are a lot of stupid people who do not understand that much of the information on websites (Fitbie is a prime example) is provided by people who are orthorexics: people who suffer from an eating disorder that causes them to see food as an "evil" and regard those who eat it for anything other than medical/health purposes (who fail to eat the "correct" foods) as morally corrupt. Orthorexia is extremely common among nutritionists and "obesity experts."
The idea that obesity is a moral failing, and that people need to acknowledge that they have a "problem" and then "make progress" in "addressing their failings" comes from orthorexics. The problem is not people--the problem is our food chain (which provides meat packed with steroids, foods with too much corn, and high calorie, low nutrient food as the lowest-cost items), our work environment (which forces people to work under artificial lighting; multiple part-time, low pay, high stress jobs; and sit on their fanny at a computer for hours on end), and the structure of our communities (many of which, like mine, are not built for walking or bike riding . . . try walking in my neighborhood, as you'll get run over quickly).
People are no more weak or lazy or gluttonous than they ever were--yet, they are fatter. It's about time that people look at the environmental issues rather than blaming the people who are just living the life that is available to them in the 21st century. Obesity is the black lung of the 21st century--it's an environmental health hazard.
The real answer is exercise. My doctor scared the hell out of me by telling me to lose weight or get diabetes. When I was a kid, I saw this old man who had his foot chopped off because of diabetes and an ingrown toe nail and then saw his leg cut off. The doc caused me to go out, exercise (1000 calories a day) and limit my food intake for the first 20 days to 2000 calories. I went from 260.9 to 240.9 in 20 days. Overall I lost 40 lbs. although I've since over the years put back on 15 of those lbs. I figure for my 225 lb. body, without any exercise, I will burn 3000 calories a day. If I exercise, I can eat a bit more. As to what kind of food, it really don't matter. Eat what you like, just limit the calorie intake. If I ate 3 Big Mac's a day at 540 calories a piece and ate nothing else, for my weight, I'd lose weight. I have no doubt of that. It is good to eat 5 fruits or veggies a day to help your body pass the food, but the real key to losing weight is know how many calories a day your body burns doing nothing. Take your weight, divide by 225 and multiply by 3000. That's pretty close to what your body will burn in a day with no exercise. Limit yourself to that many calories. Look at the labels to see how many calories are in this and that. A Pizza Hut Pizza medium about 260 calories a slice. Use the formula Pi r squared to figure area and when you go from a 6" radiius pizza to a 7" radius pizza, calculate a value for the 7"in. slice. 7*7/6*6 = 49/36 X 260 = about 353 calories a slice. Then add exercise. Walking = 120 calories/mile X your weight/225. Bike riding = 57 calories/mile X your weight/225. There you have it.
My former doctor told me to lose weight, but put me on a drug that added TWENTY POUNDS in just three weeks!!! Yes, twenty. My pants were popping, the seams in my tennis shows even popped open. I stopped the meds (many other side effects even worse), changed doctors, dropped 10 pounds immediately just being off those pills, took over a year to drop the other 10 pounds. Ironically, shortly before that poison, I had slowly been losing weight, about a pound every other week (6 pounds in 3 months), even though the new doctor found my thyroid was very low, as well as vitamin D and B12 levels, all of which interfere with weight loss. Many doctors are way too fast to reach for their prescription pads. Many of us would be much better off if our doctors refrained from prescribing a little more, and if we tried to eat more natural rather than preservative filled processed foods.
eae,
may I ask what medicine this was that caused you to gain so much weight?
Statins. She said I was a heart atack waiting to happen because of my cholesterol, which I later found out was borderline high. It dropped as soon as I was put on the proper dose of thyroid. My current doctor says it sounds like the statins had an immediate effect on my kidneys and most the weight gain was fluid retention, why half dropped immediately, with some weight gain also because I totally stopped my daily excersizes until the leg pain went away, which took months. Apparently, they did quite a number on my leg muscles.
Previous doctor wanted me to go back on them and run tests. New doctor said enough proof was there in labs she took compared to labs just before the statins to consider ever putting me on any statin dangerous. Besides, as she predicted, getting the thyroid right made a big difference in the cholesterol and started me back on my gradual weight loss.
I am not anti-medicine. I just believe that if something is not an emergency, that doctors and patients need to seek the most natural and least harmful solutions first. "First, do no harm."
EAE,
To put on 20 pounds in 2 weeks you would need to have eaten 70,000 kcal of food above your base metabolic rate, or 5000 calories EXTRA (above and beyond what your body burns to live) per DAY. I don't care what medicine your doctor put you one, even if it lowered your BMR to zero, you still had to eat the mass to put it on.
First law of thermo still applies, put the fork down and stop blaming other things.
@Remydon,
Your forgetting about fluid retention. To put on 20 pounds OF FAT you would need to eat an additional 70,000 Calories. You could retain an extra 20 pounds of water without ever taking a bite.
@eae
wt gain with statins is highly unusual. I have prescribed statins to literally thousands of patients and have never seen the type of reaction you describe
Statins are excreted mainly through hepatic metabolism and have no effect on the kidneys
Your doc did a good job in recognizing thyroid disease. I must admit I rarely check for it before prescribing statins. Maybe I will more from now on..
Scubasteve - my new doc diagnosed it as fluid retention. She decided to let nature take it's course rather than prescribe something for it, because when she compared my kidney labs with those from just before the statins that the previous doc had done she was concerned about further stress on them. Eric - Statins can cause muscle break-down in some patients. There was some word, myopathy (?), anyway muscle waste goes into the blood and in some people overloads the kidneys. Patients with uncontrolled thyroid problems and people with a history of kidney infections that may have left kidneys weaker than normal are at greater risk. I fit in both categories.
Ironically, while my new doctor's approach to thyroid treatment resulted in the best labs in all areas that I have had in years, this past December, she also found I have inflammatory breast cancer. Because I could trust her judgement in these other health matters, when she insisted I needed to be at a major university cancer center for treatment, I didn't argue about distance, inconvenience or cost, but immediately agreed. I understand that she and her staff had quite a fight with my insurance company to get them to agree with her referral, too. From what I have learned about IBC since, her quick diagnosis and determination to refer me where she did, probably has saved my life.
My weight issues are hormonal in nature, and quite brutal because they have absolutely nothing to do with what comes in to my body. I don't have food allergies or addictions. I don't buy chips and snack foods. I don't sit in front of the TV eating (don't even have a TV, actually). I never have seconds at a meal, and I don't eat big meals, bearing in mind that the human stomach is the size of a fist.
Within as short a time as eight hours, and without eating and barely drinking anything (I've tried fasting before a period numerous times, to little or no avail), I will still develop a prominent amount of belly fat that wasn't there in the morning, and have to go one size up in jeans to accommodate my unwanted guest.
To "help" me lose weight, under the auspices of also reducing acne and controlling my mood swings, two doctors prescribed two different types of birth control pills. The first one, a commonly-prescribed pill, gave me a period that lasted a week and a half, and pushed my weight up by ten pounds in about a week. The second one, Yaz, gave me a two-and-a-half week long period and put me over 200 pounds in about half a month! (I'm 5'4") You know what? I'll keep the acne. I'll keep the mood swings. So long as my weight doesn't push me in to shopping in the specialty plus-size stores for clothes, I'm good with that.
"My weight issues are hormonal in nature, and quite brutal because they have absolutely nothing to do with what comes in to my body."
Weight has EVERYTHING to do with what you put in your body. You can't gain weight if you don't eat more calories than you burn off. Period. If you are still gaining weight even with eating healthy, you need to exercise more (or at all).
No it doesn't. It has a LOT to do with what you put in your body, but I know people who don't eat much at all, and eat healthy, and are still large. They have other medical issues going on that contribute to the weight. And yes, they see a doctor and work to keep as healthy as they can.
The overwhelming majority of people carrying extra weight have dug their own graves with gluttony and sloth. Careful balancing of calories taken in and calories expended through exercise and daily living will solve weight issues for most.
Funny, something similar happened to me. I was put on several different birth control pills in hopes of controlling my endometriosis. And I also had the ridiculous weight gain (but mine was due to depo provera). I went from being a petite 5'4" and weighing 115 to being 185. I wasn't eating more. I was eating small portions with lots of vegetables and low fat foods and trying to keep my calorie intake below 1200. And as for exercise, I was running religiously.
My doctor was flummoxed, and when I asked her what I should be doing to lose the weight she said that essentially I was doing everything right and that given my diet and exercise I should have been in great shape. When I finally got the meds out of my system post-hysterectomy is when I finally lost the weight.
So Rado, I hate to burst your bubble but it isn't always about diet and exercise. Sometimes, even with the proper combination of both, you're going to pack on weight if you've got something hormonal going on.
And StandUp, I'm not a medical professional, but what you're describing about having your stomach grow on you after tiny amounts of food....have you had your doctor check your gallbladder? I was having something very similar where I'd eat a tiny bit of food and swell up to the point that I looked pregnant and it turned out to be a sign that my gallbladder was giving out on me. Just a thought, but not sure if it'll help.
Most doctors are clueless when it comes to weight loss. They think 'calories in calories' out is a prescription for weight loss that anyone can follow with success and they regularly fail to go beyond seeing their overweight patients at lazy and non-compliant to find out why people have so much difficulty losing weight even when they follow doctors instructions. Weight can be a symptom of so many other conditions, but doctors are 'taught' to treat by platitudes. Eat less and exercise more! and all your problems will go away.
99.99999% of people are overweight because they eat too much. Are you really going to sit there and argue about the 50 people in this country that are overweight because they are hypothyroid, have cushings, or on steroids (lookey lookey, we WERE taught medical reasons for being overweight after all)
I wouldn't speak about what drs are taught unless you have been to medical school and completed a residency. Otherwise you come off sounding like you did in the post above--ignorant, and wrong
Best motivation to get healthy: Sit there and watch your other unhealthy friends die! Stop coddling the weak. How long will we pollute the human genetic pool?
SO why are there so many "healthy" & "exercising" people having heart attacks & knee & hip replacements?
To me that should not be covered by insurance as it is self inflicted. same as obesity/bulimia
My doctor tells me to walk to lose weight. But for years I have been complaining about foot pain and he says there is nothing he can do. So I'm supposed to do a lot of walking on a foot that sometimes hurts so bad at the end of the day (without walking) that I have to use an ice pack on it.
Thanks for nothing.
Maybe your feet hurt because you're overweight? What's the doctor supposed to do about it if that's the case?
Have you tried other forms of exercise besides walking? Maybe bicycling or something with less impact on your legs and feet?
Losing weight is not as easy as exercising, esp. when one has severe heart disease, herniated discs in they're back, osteroarthritis, etc. etc. Diet by itself has to be the key because of physical limitations, but even that is difficult to change because of bad choices patients have made continiously t/o their lives. Patients need professional help in losing weight from dietician help to exercise specialists. I often think of the young patient under 40 that thinks losing weight is not so hard if you just go out and exercise. With most health problems seen in patients in their 50s on up, weight loss solutions are more complex than a simple.. I will lose weight doctor.. type of statements. Even the healthcare systems need a new approach to helping patients lose weight!!
I find it amusing/puzzling that people have to go to a doctor to tell them how to live a healthier lifestyle and/or lose weight. My gosh, that information is readily available everywhere out there: on tv, in magazines, books, etc. A lot of it is just common sense! Why pay a doctor to tell you something you can learn for free??? I'm sure there are a small number of people that need a doctor or dietician's guidance, perhaps in the case of specialized conditions that require certain diets, but the vast majority can lose weight by eating healthy (more fruits, vegs, whole grains, lean protein; less fat, processed foods, fast food etc.) and moving more. I agree that most people are either in denial or just do not want to do it. They are too ingrained in their habits and do not have the self determination/will to change. I have seen it in many people that I know.
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Of course there are a lot of other factors that are involved in weight loss. Obesity, like any other condition, is simply the outward expression of an imbalance in one or more of the bodys fundamental control systems. However, that aside, I agree with the basis of this article that successful weight loss has as much to do with human nature as it does diet itself. I have been working with Metabolic Typing (tm) with my clients for a number of years now. When properly applied it cannot fail. Metabolic Typing is a method of determining each persons individual dietary requirements, setting a starting point, and learning to read the bodys language in order to make corrections and adjustments accordingly. It cannot fail because it is the bodys response that dictates the method and changes as the bodys requirements change. My biggest challenge is human nature, working with the individual and helping them to make the changes they need to make. A earlier post stated the importance of coaching skills, I agree. A majority of my clients do not feel they need coaching, that they can do this perfectly fine on their own. Most underestimate the influence of food cravings, food intolerance's, social settings, family dynamics, etc. It really doesn't take much at all to have a set back, that by its self should only be a minor thing, turn into the straw that breaks the camels back. This is where coaching and support are critical to success. Our doctors do not have the training or the time for this kind of coaching work. Many people want to improve their health but don't know how. Our culture and environment are stacked against them but with proper help they can achieve their goals.
Very interesting article about weight lose, also, I found a very interesting guide about eating dessert and never get fat, you can check it here : <a href="">
Define: Eating healthier.
If this means being a 20-35% fat/45-65% carbs/10-35% diet, count me out. I don't agree with the preposterous "insulin makes you fat," but I do think that fat, being the most satiating macronutrient, should be the majority of diet. I eat a primal high fat/low carbohydrate diet right now, and am lucky if I eat 1300 calories a day, only 200 calories coming from carbohydrates, and am one pound away from my goal. I get the majority of my calories from butter, grass-fed, grass-finished calf liver, organically raised pork, the very occasional wild-caught herring, and quality green vegetables.
I think the setpoint/food reward theory works nicely in understanding obesity. Our hypothalamus controls body temperature and blood pressure, why not body fat? A nicely regulated hypothalamus will automatically balance the calories in and calories out, while a dysregulated one will obviously not.
Obesity researchers hypothesize that food reward (aka something that reinforces behavior) also drives the setpoint further up. Sure calories in - calories out (though a simplified equation for an open system) guide fat loss/gain, but that tells us little.
Then of course there is the almost proven point that leptin resistance causes insulin resistance, thus making the picture all that more complex.
If plants are so much better sources of calories than meat, why did meat and egg intake lower by 20% in the 20th century, and at the same time vegetable fat raise by 400% and our heart disease rates go up by over 5 fold?
Well, we should always discipline ourselves if we want to lose weight because if we still don't not right even if we do exercise regularly but your eating habit is still there, then you will never lose weight.
<a href="">How Do I Lose Belly Fat</a>
Well, we should always discipline ourselves if we want to lose weight because if we still don't not right even if we do exercise regularly but your eating habit is still there, then you will never lose weight.