Guiding patients in making lifestyle changes that will lead to enduring and sustainable weight loss is one of the biggest challenges in modern primary care practice.

Owing to the time pressures of contemporary practice, this process often amounts to little more than handing patients some generic diet guidelines and sending them on their way with a few words of encouragement. Patients often resent this, and as a result, compliance is poor.

But if you get to know your patients’ unique personality traits and motivating factors, and you provide specific nutritional recommendations tailored to them as individuals, you will be able to go much further in empowering them to meet their weight and health goals. You’ll get better results at much lower costs than the commercial weight loss programs for which many of your patients are already spending thousands of dollars. A thorough, physician-guided program is far more cost effective for patients, and it can help you increase your practice revenue.  

View of an advanced stage 4 metastatic melanoma before and after reversing oximation and restoring autonomous homeostasis. Photos courtesy of Dr. Roby Mitchell.

It will also make your practice much more rewarding, personally and financially. Doctors who can offer patients safe, effective, medically guided weight loss programs are already in high demand, and that trend will only increase as the obesity epidemic continues to take its toll.

In my 20 years as a practicing clinical and sports nutritionist, I’ve learned a number of important lessons that when diligently applied will greatly improve your patients’ abilities to manage their weight and improve their overall health.

The first of these is simply this: When it comes to weight loss, one size definitely does not fit all! Each patient has unique needs, challenges, strengths, body composition, understanding of their own health, and motivation level. To be effective, you need to tailor your approach.  Here are a few practical lessons I’ve learned from my nutrition counseling practice that can help you improve your weight management outcomes.

Stress Drives Over-Eating: The American Psychological Association recently reported that more than half of all Americans surveyed admit to increasing their food intake whenever they feel stressed. The preferred stress-busters are, of course, high-carb, high-fat “comfort foods.” Given the current economic conditions, it’s no surprise that McDonald’s and Burger King report sales are up!

Stress eating is a big-time driver of obesity. Among my patients, the average stress eater gains approximately 20-30 pounds during stressful periods, and many are told by their doctor they need counseling for high blood sugar or pre-diabetes. Recessions like the one we’re now facing are long-term events, so we can expect a surge in both stress-eating and ensuing weight gain. These days, I’m working with people who are always hungry, even if they have eaten. What they’re really hungry for can’t be found in a pizza place or a quart of ice cream. As health professionals we need to help them understand that.

Harness the Obsession: Let’s face it: many people seeking professional help to lose weight or optimize their fitness are fairly obsessive-compulsive in their behaviors. They’re perfectionists working harder than ever to achieve the success they crave. These days, many are struggling just to stay afloat. They turn to food for stress reduction, comfort, or reward. In many cases, their personal relationships or business affairs are in disarray and eating gives them solace and a sense of security.

Some will obsess on the details of diet and exercise in a bid to gain a sense of control over their lives. They can become fixated on caloric intake, micronutrient levels, the minute daily and weekly fluctuations of their weight, and any other measurable indicator of health or illness. They’re constantly looking for the “optimal” diet or fitness plan. Some are highly motivated to learn what to eat, and they’ll readily spend out of their pockets (or on their credit cards) for counseling.

There’s a real opportunity here, because these patients are so motivated. On the other hand, the challenge with people like this is to harness their obsessive-compulsive, detail-orientation in a healthy way. By teaching them how to make healthy and intelligent food choices, and to craft a comprehensive healthy lifestyle for themselves, you can help them gain the sense of control and security they crave. They will learn to make good choices for themselves, but without the feverish fixation on the numbers.

Focus on Food, Not Fads & Formulas: A diet of meal replacement shakes and highly processed, packaged foods may lead to weight loss in the short term, but studies show 95% of patients regain the weight lost within 2 years. Roughly 60% of individuals following formula or meal replacement diets regain the weight they lost within a few months. Remember, it’s fairly easy to lose weight. The big challenge is in keeping it off, which requires sustainable lifestyle changes.

Even during the phases when these programs seem to “work,” patients are tied to meal-plan products about which they have few choices beyond, “strawberry, vanilla or chocolate” or “skinless chicken or salmon.” They never learn the principles of healthy eating that will lead to long-term health. Further, many of these shake formulas and prepared meals are loaded with unhealthy chemicals, artificial sweeteners and colorings, and other questionable ingredients. More than anything, people trying to lose weight need to learn the general principles of a healthy, plant-rich diet that minimizes intake of highly processed ingredients.

One of the keys to good compliance is to avoid absolute restrictions on favorite foods. Unless someone has specific food allergies, most if not all foods can be eaten occasionally in moderate amounts, when balanced properly. People are highly individual in their needs, depending on their metabolism, lifestyle, beliefs, culture, and level of understanding of nutrition. If you teach people how to eat and cook healthfully, they can design their own meal plans. By focusing on real food you can help them lose weight at 50% of the cost of most commercial, non-medically supervised programs.

The Carbohydrate Sliding Scale: Carbs, especially refined carbs, are the big villains in many diet programs. Doctors and patients alike may fixate on rigid carb intake guidelines. But the reality is that individuals vary greatly in their need for carbs. For example, a relatively muscular, active young man has a very different set of nutritional needs than a 45-year-old, peri-menopausal, sedentary woman with insulin resistance.

Within the same general dietary guidelines, someone with greater lean muscle mass has more latitude on carb intake than someone with less lean muscle. The goal is not to adhere to strict macronutrient counts, but to customize the program based on lean muscle mass, age, and activity level, and to harmonize the diet with exercise routines.

In my practice, we use a computer-based system called the Lifestyle Nutrition Metabolic Analyzer that gathers information on a patient’s gender, height, weight, age, lean muscle mass and activity level all of which are used to generate tailored meal plans. By quantifying lean muscle mass, calories expended on activities of daily living, resting energy expenditure, and calories burned during exercise, we can design programs based on each patient’s specific body composition and metabolism.  

We provide them with a “sliding scale” of carbs, fats and proteins rather than fixed and unwavering limits. This system was clinically validated in studies at the University of California. Having the ability to provide different programs quickly to different patients saves time, improves adherence and leads to better outcomes.

General Guidelines Generally Fail: In many practices, nutrition education and weight loss guidance amount to giving patients general dietary guideline sheets, generic meal plans, food pyramids, and a brief combination of pep talk and scare story. But this approach leaves patients feeling bewildered, overwhelmed, condescended to, uncared-for, and burdened by “homework” they don’t really know how to do. As a result, compliance is very poor.

I have found that patients do a lot better when I provide individualized guidance that spells out specific name-brand foods on a weekly basis, and when I teach them about specific healthy food combinations.  

For example, I’ll teach a patient who usually skips breakfast how to make a morning smoothie by combining a scoop of low-carb vanilla whey protein with some vanilla soy or almond milk, fresh or frozen fruit, and 3-4 table spoons of Fiber One cereal with some light Agave extract. They can drink their breakfast in on the way to work, and feel satiated for 4-5 hours with a whopping 25 grams of protein, only 20 g of carbohydrate and 10 g of fiber!  

We can change the fat content of this basic smoothie by varying the milk. For those patients needing to lose weight, go with low-fat soy or almond milk; those in a weight maintenance or weight gain program can use the full-fat forms.

This is just one example. The point is that by spelling out specific healthy food options, referring to specific and familiar brands, and tailoring the recommendation to the patient’s actual life situation, we increase the chances that he or she will stick with the program. Sure, this takes time, but the end result is better, and many patients are willing to pay out of pocket for counseling that really helps them.

Pleasure & Weight Loss Are Not Mutually Exclusive: Another key to improving outcomes is to let patients know that they can and should enjoy their nutritional programs. It need not be fraught with struggle and deprivation. By understanding a little of the science behind nutrition, they can create meals with endless variety and flexibility. By learning about what they need to eat and why, they will be empowered, and the nutritional program can become a positive uplifting experience, one that nourishes their spirits as well as their bodies.

The Lifestyle Nutrition Program® which we have developed provides customized individualized nutritional programs for each patient without pushing nutritional products and food restrictions. As I like to tell patients, “It’s a lifestyle …not a diet!”  This little slogan is the basis for long-term compliance, without deprivation.

Over the years, I’ve taught many physicians how to implement this program. Their patients usually respond very favorably and as a result, word of mouth referrals bring significant new revenue into the practices.   

Here are a few more tips and guidelines for introducing nutrition counseling for your practice and improving your weight loss outcomes:

• Use surveys and questionnaires to screen patients to find out which ones are interested in nutritional counseling. This is especially important if you don’t yet offer nutrition counseling services.
• Design programs in a series of 4-12 weekly nutritional visits, and ask patients to commit contractually & economically to a series. Provide an economic incentive to add more nutritional sessions if necessary.
• Give patients written goals & shopping lists (with name brands) each week. Give them food options tailored to the realities of their lives, including breakfasts, snacks, healthy desserts, salad dressings & beverages. Also include stress reduction & exercise tips.
• Concentrate on solutions and proactive healthy choices, not “problem eating” – this provides a more positive uplifting experience.
• Let patients know about volumetric foods that will fill up their bellies and give them that satiated sensation, but without high caloric densities.
• Teach them a weekly system for preparing soups, salads, and stir fries that they can keep on hand throughout the week, so that evening meal preparation is focused primarily on cooking and adding the protein foods.
• Provide restaurant guidance. Most people do eat out frequently, so you need to address that reality in your nutrition education process.

Christopher Fuzy, MS, RD, LD has a Masters degree in Clinical & Sports Nutrition, and has offices in Ft. Lauderdale and Boca Raton, FL.  Over the past 19 years, he has trained over 700 physicians nationwide in the implementation of his Lifestyle Nutrition Counseling Program. For More Information or a Practice Consultation, visit www.PhysicianWellnessProgram.com or call 800-699-8106.