After reviewing the Battle in the Mind and the patient's food diary, the physician introduces the CAMES approach to creating a caloric deficit. The physician guides the patient through the concept by showing the example provided (Figure 9.1). The physician explains what each letter means, with special emphasis on the letters C and E. The example in the workbook shows the letter C is applied to 7 out of 10 items, which means the individual can continue to eat most foods eaten in the past but in smaller quantities. This does not mean the physician is blessing the patient's food selections as nutritionally sound. Personal preference for certain foods is a complex dynamic that involves personal likes, family preference, work situation, and cultural tradition. The physician is saying that portion control of whatever foods and drinks the patient consumes is the most important way to create a caloric deficit and lose weight without radically changing the diet.
Just as portion control is the most commonly used approach to creating a caloric deficit, elimination of certain foods is one of the least used approaches for a very important reason. The example in the workbook shows that E was applied to only two items, chips and vending machine snacks. Determination to stop eating or drinking a particular item is difficult and creates a sense of deprivation if it is applied to too many items. Patients who subscribe to radically altered approaches to food selection from what is normal for them will lose
TOP TEN FOODS/MENUS IN MY DIET (Determined by dietary log or from memory)
LIST OF FOODS
2. Nachos chips/Fritos
9. Ice Cream
10. Vending Machines
Figure 9.1. Example of one patient's use of the CAMES approach to create a caloric deficit (Copyright © 2001 Dr Thomas McKnight).
weight if their sense of desperation to lose weight is greater than their feelings of deprivation in changing their eating habits. Once the feeling of deprivation becomes greater than their desperation to lose weight, patients will revert to previous eating habits and typically will regain the lost weight. The decision to eliminate a particular food or drink item can only be made by the patient. This creates a sense of ownership for the decision and imparts the self-confidence regarding control over certain foods.
The CAMES approach balances the primary dietary method for weight loss, namely portion control, with other choices the patient can use to create a caloric deficit. The patient does not need to radically change his or her food preferences nor experience a diet of deprivation. Finally, this method avoids one of the pitfalls of many diets that leads to failure or regaining lost weight—boredom. If one macronutrient (carbohydrates, protein, fat) is either increased or restricted compared to what the patient normally eats, eventually the patient will become bored with eating an unbalanced selection of macronutrients. Variety of dietary choices is an important part of the enjoyment of food. For long-term weight control, the patient must be empowered to make such choices. The CAMES approach gives the patient the freedom and the responsibility for such choices. It avoids creating a diet of either deprivation or boredom, both of which are doomed to eventual failure.
You should spend only a few minutes explaining to the patient the CAMES approach. Any further refinement of the patient's diet, for example for a patient with renal failure or diabetes, should be referred to someone else. Your focus for weight loss is the creation of a caloric deficit. If you want to give more dietary advice, providing handouts of the dietary approach to stop hypertension (DASH) diet, and recommending patients eat prepared meals, like Healthy Choice or Lean Cuisine, at times throughout the week as a way to make healthy choices and limit calories are excellent adjuncts to the CAMES approach.
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