The Primary Care Setting for Controlling Obesity

The No Nonsense Teds Fat Melting

The No Nonsense Teds Fat Melting System

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Larry Peterson goes around the country encouraging people that they can lose weight and keep it off long-term. His personal story is remarkable. He lost over 265 lb without surgery or using medication. He did it through an intense lifestyle change that he continues to this day. He shares his story with other obese individuals in the hope that they will be inspired to lose weight. Unfortunately, as amazing as Larry's story is, a chronic disease that impacts the majority of Americans, and whose rate increased by over 5% in one year, is not likely to be slowed, stopped, or reversed by one person's success story. The epidemic is simply too great and advancing too rapidly.

Last year approximately 103,000 patients underwent gastric surgery of one form or another [42]. However, even with large numbers of bariatric operations for the morbidly obese, the incidence of this disease may slow but will not stop or reverse its upward trend. The problem is that millions of American adults and children are affected. For most obese patients surgery is not the answer, and the number of obese patients exceeds the ability of a surgical intervention alone to make a national difference.

The nation's family physicians, pediatricians, and internists collectively are a medical force large enough to make a difference in the rising rate of obesity. They are the nation's primary care physicians and collectively total over 200,000. If each physician assisted just 10 to 20 patients in losing 10% of their weight, as suggested by the National Heart, Lung, and Blood Institute (NHLBI), then the obesity rate in America would begin to slow. The primary care physician movement, coupled with community initiatives and legislative guidance, is America's only hope to slow, stop, and then reverse this healthcare crisis. More surgical cases and dramatic individual success stories are not the medical community's answer to the obesity epidemic.

In the past, to combat this epidemic in the primary setting, physicians had only the NHLBI Obesity Guidelines and various books and articles written by experts outside the primary care arena. What was lacking was a time-efficient process that could be implemented in any rural or urban primary care setting and utilized by any patient regardless of educational or socioeconomic background. Consequently, thousands of obese patients pass through America's primary care doors daily without having their obesity addressed.

Comparing the 1995-1996 National Ambulatory Medical Care (NAMC) data from 55,858 adult visits with the 1988-1994 Third National Health and Nutrition Examination Survey (NHANES) makes this point. Physicians reported obesity in 8.6% of patient visits while the NHANES survey reported a prevalence of 22.7%. Just over 33.3% of patients identified as obese received weight loss counseling [43]. Only 16.6% of obese patients received any care for their disease. Obesity in America only continues to worsen while it is often not addressed in the primary care setting.

Practitioners from a variety of disciplines, including dieticians, behavioral psychologists, and personal fitness trainers, are important components of a comprehensive weight management program. However, most of my obese patients either cannot or will not see these specialists. Typically, rural patients have only their local family doctor to help them manage their obesity. For the most part I serve as my patients' dietician, behavioral psychologist, and personal fitness trainer. Therefore I need dietary, behavioral, and fitness tools that I can share with a patient during a 15-minute appointment.

One such tool focuses on effective communication with the patient. Primary care physicians have little time with each patient to clearly communicate exactly what the patient needs to understand and to do. Succinct words and phrases can quickly communicate such information. For example, the food diary is the best opportunity the healthcare provider will have to obtain a reasonably accurate recording of a patient's food choices. This list is critical in helping patients create a caloric deficit in order to lose weight. Yet obese patients are notorious for underreporting their food intake. A patient who fails to keep any recording or seriously underreports food intake will likely be unsuccessful at weight management. Therefore, at the end of the first appointment, when speaking to the patient about the requirement to keep a 10-day food diary, I always say at least three times before the patient leaves the room, "If it goes in the mouth, it goes on paper." This message is delivered in a friendly, light-hearted way. It eliminates any question about what does or does not need to be recorded. Also, it keeps me from having to discuss what foods or drinks I am talking about. The phrase is time efficient, simple, memorable, and effective. All patients understand it. More than anything else, this phrase helps patients remember what is to be written in their food diary. I shall discuss communication with patients in greater detail in Chapter 2.

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