The Cames Approach

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The scientific basis for the CAMES approach has already been described. As a brief review, the C stands for cutting the amount of food a person eats. Portion control is central to any weight reduction program. The A represents adding healthy items to a patient's diet. Encouraging patients to eat more fruit, vegetables, fiber, or drinking more water improves the patient's health and reduces the amount of calories ingested from unhealthful foods like trans-fats. The M stands for moving the patient's window of eating to an earlier time zone. TV advertising encourages food consumption at all hours whether or not the viewer is hungry. If a patient is going to have popcorn every night, suggest reducing certain other foods during dinnertime and eating the popcorn earlier in the evening, not just before going to bed. The E stands for eliminating certain foods from an individual's diet. The decision to stop eating certain foods must be the patient's, not the physician's. The S represents substituting certain foods for other foods. A patient who chooses to eat strawberries with whipped topping instead of strawberry pie for dessert is significantly reducing caloric intake. The goal of this approach is to help the patient create a caloric deficit so the body will use stored triglycerides as energy. This process occurs either through a reduction of caloric intake, an increase in caloric expenditure, or both.

Upon review of Mr Crane's list of foods and drinks, a physician can be frustrated in terms of giving specific dietary advice. Counseling Mr Crane to increase vegetables, decrease meats, or change to lower-calorie beer is likely to be met with resistance either in the office or when the patient goes home. If the advice by the physician is something the patient is willing to tolerate for a period of time, then some weight loss might occur as long as the patient is motivated to do what the physician told him to do. For such a patient, weight regain is likely to follow when the motivation to follow someone else's dietary choices wanes.

Mrs Crane presents a different challenge. She has a detailed list of the foods and drinks from the past 10 days. Her recorded caloric intake is close to the amount of recommended calories suggested in order for her to lose weight. Her frustration is that when looking at what she eats and how much she eats, she does not understand why she cannot lose weight. At first review of her list, the physician might think there is little advice to offer such a patient. However, given no undiagnosed metabolic disorder like hypothyroid disease, the patient's obesity is the result of excess calories. Even compulsive patients, unless they always use a calorie counter, measure portions, and cook all their own food, are probably underreporting their caloric intake.

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