As I said last week – I am making some changes to HDHH, this is the first of a few, and me introducing my “Medical Minute” – where I’ll be posting an article or articles of medical type topic. If there are health related topics you want to hear more about – please continue to comment and leave me your feedback.
Now before you roll your eyes and stop reading I’m not really going to talk all that much about the ACA.
But for the purposes of this post – what you need to know is this: with more and more people now able to go to doctors, this has placed a significant and additional amount of work on the shoulders of primary care providers. Meaning?
They have certain benchmarks and criteria they need to meet in order to get reimbursed – and before you roll your eyes – reimbursement is also heavily tied into patient satisfaction – so patient outcomes and satisfaction are taken into account as well- so again a lot of responsibilites are placed on the physician’s “to-do” list.
But let’s think really realistically about a truly problematic patient: someone who has a very unhealthy weight, unhealthy waist circumference, diabetes, high blood pressure, high cholesterol – or abnormal lab values etc – this is a lot of things to educate on and improve in what (in many cases) is 30 minutes or less of physician to patient contact.
Many times these primary care doctors are steering the ship in terms of comorbidity and disease management- not a bad thing- but again we are talking about limited patient contact due to high patient volumes.
This is a really key place that an RD can come into play. Because how many of the issues I mentioned above …. can be aided with dietary changes? All of them. Unfortunately as it stands right now – RD’s are not available at every doctor’s office – so again, this leave the physician in a situation of either making a recommendation and/or a referral.
So with keeping in mind that physician’s need resources in guiding their patients to losing weight – these are where these articles come in- they were looking at evidence in terms of weight loss, and effectiveness to aid physicians in recommending diets or programs for patients to try.
Looking at the evidence from the articles – Jenny Craig was able to show the “best” results – but even those results were modest! Like 4.9% loss after one year – if that is the best success – then we need other options!! Both of the articles are discussing the same study – but one was more direct in terms of discussion the nitty gritty of the results – which were not significant.
As it stands currently the gold standard for weight management programs are intensive programs – in which a client has structure and access to frequent visits, or even email/phone access to a physician, dietitian, and ideally a psychologist.
Another thing to really consider here – is how sustainable some of these programs really are. Nutrisystem, and Seattle Sutton for instance – that boast pre-packaged meals. I work with individuals all of the time who cringe at the meal thought of seeing another pre-packaged meal.
Additionally when programs are very restrictive whether it be in carbohydrates, or calories or both – and if you are miserable following “the plan”, or the thought of the “diet plan” in question. Then the question that needs to be asked is: “Can I do this for both weight loss, and continue to do so in weight maintenance?” >>OR the simplifed version: “Is this something I can do, that allows me to flexible, and enjoy foods I love, and can do indefinitely?” If the answer is no – then it’s not an ideal method for weight loss. Because weight maintenance is an integral stage of weight loss.
And agian the programs with the best results Jenny Craig, and WW, are both programs that do provide some semblance of structure, and flexibility with eating, however – these still rely on the patients to use them. And yes, one could argue that when an individual has an appointment with a MD or RD it’s still on them to show up- which it is, but in the case of structured appointments RD’s or support staff can call their patients and remind them of their appointments, if patients are identified as struggling sometimes that phone call to “check-in” is what’s needed.