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  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 better suited for treating 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?

Who should take responsibility?

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.

Failing at weight management

Right now, we are clearly failing in managing our weight as a nation. We did not come to this point because of one problem. As a society, we are not inclined to move. For safety reasons, we may stay inside (dodging bullets). We sit in front of computers all day, 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?

What’s the societal solution?

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. While she was relying on a nearby medical facility affiliated with a teaching hospital, she and other physicians have other options. How about business cards of dietitians, therapists, and trainers and refering 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.

A bit more on this story.

 

 

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.

6 ways to decrease triglycerides without eating grass and cardboard

Maintain or get to a healthy weight.

Triglyceride and cholesterol reduction may result from losing weight if overweight. Maintaining an ideal weight is important for all aspects of health, including triglyceride reduction.

Increase physical activity

Aerobic exercise can aid with weight loss and decrease triglyceride levels at the same time.Triglyceride reduction occurs with short bouts of aerobic exercise as well as long-term repetitive exercise. Most studies support doing 30-45 minutes of moderately intensive exercise five times a week. Have your doctor sign off on your exercise if you have been inactive!

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. Bread, pasta, rice, fruits, and vegetables are sources of complex carbs.

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

Up to 30% of the calories you get from fat should come from foods higher in monounsaturated and polyunsaturated fatty acids, according to the AHA.

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. Fatty fish like sardines, herring, and salmon are good sources of omega-3 fatty acids. Other good sources of omega-3 fatty acids include: tofu, soybeans, flaxseed, nuts, and green leafy vegetables.

While these are steps to start you off, a licensed dietitian can personalize your food plan to meet your goals. You do not need to eat cardboard and grass!

What’s on your plate to lower triglyceride levels?

Healthy Eating Confusion? 5 Easy Tips to Start!

healthy eating confusion

Wondering how to Eat? Follow 5 steps to clear up healthy eating confusion!

If you are confused about how to eat, you are far from alone. 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 to clear up healthy eating confusion. These tips can help most people improve their overall health status.

5 important and easy tips to clear up healthy eating confusion

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.

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.

Some people should not follow these suggestions due to specific medical concerns. But  for most people, this is an excellent start to eating 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!

 

Are You a Nutrition “Purist” or “Realist”?

dietitian commentary are you a realist or puristIt 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 the whole human race perceives themselves as nutritional experts! For me, it seems that is the case sometimes! 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. That begs the question about being a  nutrition “purist” or “realist” in terms of professional conduct.

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. So let’s take a look at nutrition “purist” or “realist” thinking!

Nutrition Purists

It seems as though some of those disseminating nutritional advice are best described as purists. Insisting on great precision or correctness in a particular discipline is a purist. 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, sugar, fat, and so on.”  I must add at this point that I would love my clients to eat only at home, eat only healthy unprocessed foods, and in the correct portion sizes. With that stated, my experience tells me the purist mentality does not necessarily fit all people.

Nutrition Realists

A realist is a person who accepts the world as it is. Then, deals with it, but realistically. This appears to be the case for those practitioners who have counseled for a long time. I tell my clients that I can design what I feel to be the  “perfect” eating plan. However, if they cannot follow it long enough to help their health, then what good is it?

I’m a realist. I would be happy to have my clients switch to a flavored green tea rather than a Starbucks Frappuccino! 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. The concept of tailoring a diet to an individual means 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, so can the diet.

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