Weighing in on Doctor Refusing 200 Pound Patients

As I turned on the morning news the other day, the attention grabbing “teaser” headliner was about a physician in Shrewsbury, Massachusetts who refused to treat anyone weighing more than 200 pounds (link below).  If you haven’t heard it, the recap is that an internal medicine physician has decided to reject all new patients weighing over 200 pounds. She indicates that her staff has been “hurt” by handling these heavier people (not sure what she means by this), and that those patients already in her practice and weighing 200 pounds were grandfathered in.  She further notes that some of these grandfathered patients proceeded to lose weight after her office policy was implemented. The physician further states that there is an excellent university affiliated medical facility nearby which is much better suited to being able to handle very large patients. This scenario seems to beg the question, “is this a new trend in the medical profession?”  Will the United States evolve to medically managed weight loss centers for all people classified as obese?

Mayor Bloomberg restricts soda pop, Michelle Obama encourages us to plant vegetable gardens, but what can individuals and society really do to take responsibility?  This will become even more pressing of a concern to individuals if primary care physicians begin to refuse treating heavier patients on a wider scale.  If those heavier people are required to find access to health care in settings equipped to handle their special needs, this could also potentially handicap the weight loss process even more-if possible.  Right now, we are failing in managing our weight as a nation, just as we are failing at balancing our national budget.  We did not come to this point because of one problem.  We are a society that is not generally inclined to move:  we stay inside for safety reasons (like dodging bullets), we sit in front of computers all day, we play video games rather than dodge ball, and we eat out constantly.  While eating out is a great treat, doing so too often really insures your energy intake is too high which translates to weight gain.  Unless you are training for a marathon or triathlon, you still need to critically manage your energy intake if you are going to manage your weight.  All too often, those that workout regularly still forget the energy content (meaning calories) of the food they consume.  So, again, what are some solutions?

I do not have a simple solution because there is not necessarily a simple solution to a laundry list of factors causing this national crisis.  Our current societal complexities seem to set us up for obesity at this point.  Both physicians and patients need to take responsibility for slimming down the nation.  Apparently, it is perfectly legal for this physician to screen her patients according to weight limits.  If this is her prerogative (and it’s her practice), she should make a point of offering some other options to her patients.  While she was relying on a nearby medical facility affiliated with a teaching hospital, she and other physicians should have business cards of dietitians, therapists, and trainers and refer to those professionals!  And, patients need to take responsibility as well.  There is no magic solution here.  The message to move more and eat less is perceived as “boring” by many.  And to many, this simple message is not really simple.  After all, how much should one really eat and move in order to both prevent and manage obesity?

What can we do as a nation?  Please provide input to this question directly on my blog.  I look forward to your comments.




6 Starter Steps to Tame Your Triglycerides

I recently had a client come to a nutrition consultation for a severely elevated triglyceride level.  While his elevated triglyceride level was a challenging and depressing situation for him personally, it was what his cardiologist told him to eat which was really depressing!  His physician actually told him to “eat grass and cardboard.”  Obviously, this doctor was being sarcastic, but the comment implied that the diet needed to be overly restrictive.  As is often the case with nutrition advice, this particular advice was misleading, incomplete, and inappropriate in terms of helping the patient improve his medical outcome.

Here are 6 simpler alternatives to eating cardboard and grass:

  • Maintain or Get to a Healthy Weight—Studies have shown losing weight and maintaining an ideal weight to be associated with decreased levels of blood fats-including both triglycerides and cholesterol.
  • Increase Physical Activity—Aerobic exercise can help with weight loss and can decrease triglyceride levels at the same time. In fact, both short bouts of aerobic exercise as well as long-term repetitive exercise have been shown to decrease triglyceride levels. Most studies find that the best bet is to do 30-45 minutes of moderately intensive exercise five times a week. First, get your doctor’s approval if you’re not accustomed to exercise.
  • Cut Down on Carbs—Carbohydrates are basically divided into two categories: simple and complex. Simple carbohydrates tend to be sweet, such as soft drinks, desserts, candies, and syrup. Complex carbohydrates are found in bread, pasta, rice, fruits, and vegetables.  It is generally recommended that people with high triglycerides avoid simple carbohydrates. Some people are so sensitive to sweets that their triglyceride levels increase drastically when they eat too much sugar. In any healthful diet, complex carbohydrates should be in the 45-65% of overall calorie intake, but even too much high-fiber, nutrient-dense complex carbohydrates can aggravate triglyceride levels when eaten in amounts exceeding 60% of total calorie intake.
  • Limit Alcohol—According to the American Heart Association (AHA), even small amounts of alcohol can increase triglyceride levels. For some people, cutting out alcohol can elicit a marked decrease in their triglyceride levels.  In the case of my patient, his triglyceride decreased a whopping 90%.
  • Choose Fats Wisely—The AHA also recommends that up to 30% of the calories you get from fat come from foods containing more monounsaturated and polyunsaturated fatty acids.
  • Eat More Fish—Most health experts also recommend eating more fish because of the omega-3 fatty acids found in fish, which have been associated with decreased triglyceride levels. Omega-3 fatty acids also help make the blood less sticky, so it is less likely to forms clots that contribute to heart attacks. Omega-3 fatty acids are found in all types of fish, but are more abundant in fatty fish like salmon, sardines, and herring. Other good sources of omega-3 fatty acids include tofu, soybeans, flaxseed, nuts, and green leafy vegetables.

While these are some steps to start you off, a licensed dietitian can help personalize your food plan to meet your goals, and do so effectively and palatably so you too can avoid eating grass and cardboard!

What’s on your plate to lower triglyceride levels?

Confused About Healthy Eating? 5 Easy Tips to Start!

We are a society on ”nutrition” overload. Messages reach us each time we turn on the ten o’ clock news or boot up the computer. Eat eggs, don’t eat eggs, do this, don’t do that-and consumers feel messages conflict and constantly spin a one-eighty every other week. No wonder the public is unsure about what to eat or who to take advice from! With that in mind, here are 5 tips I feel can help most people improve their overall health status:

  • Decrease your animal protein consumption. This will decrease your saturated fat intake, keep your calories in line, AND decrease your carbon footprint on our dear planet earth.
  • Eat more plant-based foods. The upside of this, is simply, more anti-oxidants, more fiber, fewer calories, and less of a carbon footprint on planet earth.
  • Try to focus on unprocessed foods as much as possible. The less processed the food, the more nutrient dense the food. When the food is molded, distorted, manipulated, or redesigned, the nutrition composition is most likely altered, and not usually for the better!
  • Don’t be afraid of bread! Whole grain breads are a rich source of B vitamins, iron, magnesium, zinc, and fiber.
  • Cast a wide net on the variety of foods you eat. No single food is a magic health bullet. Eating a variety of foods keeps your taste buds happy and also increases the likelihood that you are getting more and varied nutrients into your diet.

While some people should not follow these suggestions due to specific medical concerns, for most people this is a good start to up shifting to a better quality of diet. If you need to omit food groups or implement special diet therapy, consider consulting with a Registered/Licensed Dietitian to design a food plan that works for your health goals. Bon Appetit!


Ice Cream: 6 Tips to Slimming Down Summer’s Special Treat

Ice cream is a special summer treat for family outings.  For many of us, summer is the time we went to the local ice cream shop for a special treat on a hot summer day.  We did this as kids, and now with your own kids, you may be repeating family traditions.  Tradition is wonderful, but if your waistline has expanded, it may be time to go for a slimmed down version of this treat.   In fact, if not careful, you can easily end up with an ice cream calorie equivalent of a whole day’s worth of calories!

Here are six tips to carry on with your ice cream tradition without increasing your waistline:

  • Avoid premium ice creams altogether:  A single 6 oz. scoop of premium ice cream can cost you 500 calories.  Oberweis chocolate chocolate chip, chocolate marshmallow, chocolate almond, butter pecan, butter brickle, chocolate caramel crunch, cookie dough, and strawberry cheesecake flavors can all claim that calorie content!
  • Eat like a little kid:  Calories and fat will always follow portion sizes, so you can either have a bite of someone else’s treat, or get yourself a kids scoop.  A kids scoop is roughly 2.5-3 oz., so you can assume the calories are slashed 50% from the adult version, translating to much more calorie and fat control. 
  • Exercise caution with low-fat ice cream options:  Don’t assume because the ice cream is low-fat that it is fine to have a double scoop!  The Oberweis single scoop low-fat flavors range in calories from vanilla at 250 calories to chocolate marshmallow at 300 calories.  Do the math and you can see how you might still get into a calorie bind by having a double scoop.
  • Avoid the final touches:  Dipping your DQ vanilla cone in chocolate will add anywhere from 100-200 calories to your treat, depending on the size of cone you opt for.  Adding  the candy pieces, whipped cream, and nuts will also give you some additional “energy” to the tune of at least 100 calories.
  • Go for cold alternatives:  Most ice cream franchises have healthier lower fat and calorie options for consumers.  Better options include sorbet, low-fat frozen yogurt, and sherbet.  Single scoop servings of these frosty alternatives may also be significantly lower in calories.  A 4 oz. serving of sorbet can run your calorie tab 80-150 calories.  Many frozen yogurt flavors are 150 calories or less per 4 oz. serving.  While sherbet is virtually fat-free, the calories can start adding up as a 4-6 oz. single scoop of orange sherbet can run as high as 260 calories.  If slashing fat is the objective, sherbet is a good way to go, but the calorie tab may run higher than anticipated.
  • Go to the supermarket instead:  There are so many frozen treats at your supermarket to take advantage of if you are trying to stay slim this summer.  Spend a few minutes looking at the nutrition fact labels and pick a product that suit your palate and nutritional goal.  There are many ice cream-like products hitting the mainstream and specialty grocery stores all the time that are both tasty and fit into anyone’s eating lifestyle.

What do you opt for at the ice cream store?  Can you share the nutrition information of your favorite frozen treat?


A Dietitian’s Commentary: Are You a Nutrition “Purist” or “Realist”?

It seems as though these days everyone has an opinion about the field of nutrition.  There is a an old saying that “some people think they are experts on eating, because they eat.”  So, that could mean that potentially the whole human race could perceive themselves as nutritional experts!  Of course, some of those people are experts with years of college level education under their belts, but some are simply uninformed, uneducated, or misdirected, but very interested in the field of nutrition.   What I know for sure is that more people in more and varied fields are now providing nutritional advice to the American consumer.  And, more nutritional advice is rapidly and readily available these days at the touch of our fingers as well as from “doc google.”  So, this blog is about how those of you that give nutritional advice handle the words you choose while guiding those you are attempting to help with nutrition.  It is also meant as food for thought for the consumer who is seeking nutritional guidance.

It seems as though some of those disseminating nutritional advice are best described as purists.  A purist could be described as a person “who insists on great precision and correctness” in a particular discipline, nutrition in this case.  It seems that, more and more, those that are guiding consumers are often leaning to what I call this purist mentality.  This purist mentality is along the lines of “the diet must be perfect, no junk, no sugar, no fat, and so on.”  I must add at this point that I would love my clients to eat only at home, only what they know to be good for them, only whole unprocessed foods, and only in the correct portion sizes.  With that stated, my experience tells me the purist mentality does not necessarily fit all people.

A realist could be described as “a person who accepts the world as it literally is and then deals with it-realistically.”  This appears to be the case, in particular, for those practitioners who have counseled for a long time and been “around the block a few times,”  as I like to describe myself with regard to my life-professional experience.  I tell my clients that I can design what I feel to be the  “perfect” eating plan, but if they cannot follow it long enough to help their health, then what good is it?  I would call myself a realist.  I would be happy to have my clients switch to a flavored green tea rather than a high fat Starbucks Frappuccino or big serving of soda!  That’s right, the flavored green tea might not have the same nutritional edge as plain green tea, but it’s a start in the right direction!  That’s what I want from my clients-to move in a better dietary direction.  One size does not fit all, especially when telling people how to eat.  And, the concept of tailoring a diet to an individual can also mean that like a pair of slacks or suit, the “diet” can be tailored with time as the person’s nutritional requirements and acceptance of dietary change evolve.

How do you choose to counsel your clients?  And consumers, what nutritional guidance has worked for you?