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.

 

 

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?

 

What Dietitians Do: This Dietitian’s “Do’s and Don’ts

what dietitians do

Friendly counseling

Did you ever wonder what dietitians do for clients or patients? The range of our services is tremendous. We address most aspects of eating and exercise behavior needed to sustain a long-term quality of life. In order to help you understand what a dietitian does and does not do, I present a brief overview below which can better prepare you should you decide to consult with a dietitian. Bear in mind that each dietitian has a unique counseling style, and various areas of strength. For example, I consider myself to be a seasoned generalist, with the following areas of specialization: weight management, gastrointestinal diet therapies, hypertension, type 2 diabetes, cardiac disease, cancer, wellness, and nutritional supplement strategies.

What this dietitian does for you

Dietitians listen

You speak and I listen. By gathering information relating to your diet and lifestyle we are able to launch a realistic food plan tailored to your specific needs. For my practice, this initial information gathering session is a minimum of 2 hours. By the end of the appointment, you will have your own personalized food plan.

Dietitians evaluate

We evaluate your food intake patterns and work on improving them to help you achieve your health and weight goals. Evaluation processes vary from dietitian to dietitian. Most dietitians would like clients/patients to document their food intake. As of this month, I have a new online platform for clients to document their food. This means I can see how you are doing between appointments!

Provide accountability

Often, sticking to a diet and exercise plan requires having someone to oversee it. Dietitians offer this accountability by helping you to monitor your diet and eating behavior on an ongoing basis. That way, it becomes more difficult to put off your healthy lifestyle goals.

Offer support

Starting a new diet or exercise regimen is not an easy process. Dietitians provide encouragement and support. We help you brainstorm ways to keep you on the path to a healthier lifestyle. We have suggestions for how to eat well away from home, eat well when there is no time, eat well when you are not feeling well, and eat well when life gets in the way. Clearly, dietitians play a crucial role in the formulation and maintenance of your diet and exercise plans.

What this dietitian won’t do for you

Create prefabricated cookie cutter food plans

While certain tools such as the new USDA food plate and old food guide pyramid have a place in nutrition education, such tools are not the centerpiece of my counseling. Each client is presented with cutting edge information and individually tailored dietary recommendations.

Write prescriptions

While clinical dietitians generally have significant medical knowledge, they are not physicians and do not prescribe medicine. I may, however, suggest supplements if I find a nutritional gap in your diet based on your food preferences and my monitoring of your diet. So we don’t write prescriptions in a conventional way, but we do prescribe in our own way.

While I have no magic wands, I am confident that in working together, I can help you achieve your goals for a healthier lifestyle. A few examples from my 25 years of nutritional counseling best illustrate this:

  • A physician referred a patient to me who needed to lose 100 pounds in order to undergo a heart transplant. After receiving my nutrition counseling services, the patient lost the 100 pounds, and ultimately no longer required the heart transplant. His significant weight loss allowed for his cardiac enzymes and heart function to return to normal.
  • Hundreds of my patients have had their physicians discontinue certain medications altogether as they have either successfully lost weight or modified their diets to address their specific medical conditions. Although many physicians are frequently surprised at the outcome of medical nutrition therapy, I don’t believe most dietitians are at all surprised because we know counseling and diet therapy are effective.

Impactful counseling

As you can see, the impact of nutritional consulting can be tremendous. Dietitians are able to do a great deal to help you achieve your diet and exercise goals. Ultimately, this sets you on a path to a healthier lifestyle. And, while there are many that dispense advise, dietitians are uniquely trained to do so. There are “purists” and “realists”, as a coin them. The realists are the counselors that can work with your needs, and not their own, to get your goals accomplished.

To learn more information on how a dietitian can help you, here’s a video from the Academy of Nutrition and Dietetics. 

Has a dietitian made a difference in your life?