Weight Management for Health Care Professionals

Today, nearly two-thirds of Americans are overweight or obese—and most individuals who lose weight gain it back. Individuals enrolled in population health improvement programs are at particularly high-risk of overweight and obesity—or weight-related complications. And health care professionals are not immune—particularly those working by phone or in other sedentary roles. At times, overweight or obese health care professionals may sometimes feel awkward giving their patients the same advice on healthy eating and physical activity that they find hard to put into practice in their own lives. Do the health practices of health care professionals’ matter? Should health professionals talk about their own struggles with weight loss? Which weight loss plan works best? What are the best options for individuals who are planning a weight loss program?

A number of studies have examined the link between health care professional self-health practices and their health coaching behavior and impacts. Many of these studies have focused on physicians. In one study, patients who viewed a video of a physician giving advice about diet and exercise reported that the physician was more believable and motivating if the physician disclosed his or her own health practices. Additionally, physicians who have better personal health habits were more likely to bring up the topic of lifestyle change with their patients.1 And in the Women Physicians’ Health Study of over 4,000 female physicians, practicing a positive health behavior oneself was the strongest predictor of physicians’ counseling patients on health-related topics including lipid management, breast self-examination, exercise, and alcohol and tobacco use.2

Most health coaches also know that their own struggles with weight can be an asset. These professionals often approach their work with overweight or obese patients with an extra measure of empathy and more realistic expectations for patient change. These professionals may also draw from their own experiences about what works and what doesn’t work in maintaining health and weight. Properly timed and delivered, personal examples can build credibility and trust. Helpful tips and “lessons learned” can be briefly shared with patients. However, most experts agree that self-disclosure must be delivered skillfully to avoid taking the focus off the patient. There’s a big difference between sharing “Here are some steps that I have taken to keep the weight off,” and detailing struggles and frustrations with keeping weight off.

While the use of evidence-based health coaching approaches is critical, health coaches also need to demonstrate and advocate for good weight loss and weight management “literacy.” While we know that the only way to lose weight and keep it off is by reducing caloric intake and burning more calories, many health professionals try fad diets, skip meals, or engage in overly restrictive dieting regimes that are not sustainable—or healthy. However, it’s not usually the diet plan that’s the problem. The largest-ever study of various weight loss methods—published in the New England Journal of Medicine in 2009—found that most diets work equally well. After two-years, there were no differences in weight loss between participants who followed an Atkin’s-type (low carbohydrate), the Ornish-type (low-fat), or Mediterranean-type (low-animal protein) diets.3

How can health care professionals manage their own weight and be effective weight management coaches? In a recent article published on July 4, 2009 in the New York Times, Kelly Brownell—a psychologist and director of the Rudd Center for Food Policy and Obesity at Yale—discusses the subject of weight management. Brownell concurs with the results of the New England Journal of Medicine study: Of all factors, “What matters most is your level of motivation and your willingness to change.” Accordingly, all health care professionals can be most effective in their roles as weight management coaches by applying the evidence-based approaches that build motivation such as motivational interviewing. But it’s also important to help patients choose an overall strategy that fits their needs:

1. Do it Yourself. If you already know what you need to do and are sufficiently motivated, the do it yourself option may work. You’ll need to reduce your caloric intake, learn new eating habits that can be sustained, and increase your physical activity level. One free resource for you or your patients is the Weight-Control Information Network developed by the National Institutes of Health available at www.win.niddk.nih.gov. Remember to eat lots of vegetables and fruit, avoid added sugars or fats, choose low-fat protein sources, go for 100% whole grains, and use vegetable oils moderately. You’re generally best off avoiding any prepared or processed food. Read labels carefully if you do choose prepared or processed foods. Manage portion sizes by serving food on small plates or in small bowls. Aim for a minimum of 30 to 40 minutes of brisk walking or other moderate or vigorous activity each day.

2. Buy a Guide Book. If you or the patients you’re working with are sufficiently motivated, but need further guidance or structure, a good book can suffice. Of the many diet books, Brownell recommends the “South Beach Diet,” the “Best Life Diet” and the “Volumetrics Weight Control Plan.” These three books offer sound advice for individuals planning a personal weight loss program. For “chronic dieters” he recommends David Kessler’s new book “The End of Overeating: Taking Control of the Insatiable American Appetite.” One other recommended read for those focused on keeping weight off is Dr. David Hill’s book “The Step Diet.”

3. Join a Group. For individuals who are looking for more structure and peer support, Weight Watchers and Jenny Craig are two good options. The membership fee for weight watchers is $15 to $20—and $13 to $15 for weekly meetings. You’ll learn how to use the Weight Watchers point system and you’ll weigh-in weekly. A more expensive option is Jenny Craig—with yearly membership fees of $399— and $83 a week on average for special meals. According to Brownell, "The programs that provide meal replacement are more effective than those that don’t.”

4. Enroll in a Hospital Program. For individuals who are obese, or who have a serious chronic disease such as diabetes, specialized professional help may be required to lose weight safely and effectively. Many local hospitals have weight loss programs staffed by multidisciplinary teams that can assess needs and help design a personal plan. At Johns Hopkins’ Weight Management Center in Baltimore, for example, participants pay $250 for an initial, four-hour assessment with a physician, registered dietician, psychologist and trainer—with follow-up visits at $125 a week including food.

Don’t be discouraged. While overweight and obesity are chronic health conditions, even the loss of a few pounds can significantly improve health. According to Jim Hill, psychologist and founder of the National Weight Control Registry at www.nwcr.ws, “Keeping weight off permanently is a lifelong process. Diet is key for losing weight, but physical activity is the key for keeping it off.” As with all behavior changes, having a good social support system is essential. People who lose weight often report having family members, friends or coworkers cheering them on.

While there are no magic bullets, some health care professionals do have some tricks up their sleeves. “I keep a picture of my grandchildren on my desk, and every time I feel too lazy to put on my walking shoes I look at that picture and think ‘I want to be a great-grandmother one day.” Or, “I told my husband that I am not buying junk food from now on, and if he wants to buy junk food he will be doing his own shopping. I don’t want junk food in the house.” Another nurse shared, “Before I leave for work each morning, I set out my walking shoes and workout clothes right next to the door—it’s the first thing I see when I come home from work every night. I literally have to trip over them to avoid my workout!”

 

1 Lewis, CE, Clancy C, Leake B, Schwartz JS. The counseling of physicians’ prevention-related practices. Arch Intern Med. 1991;114:46-53. 

2 Frank E, Rothenberg R, Lewis C, Belodoff BF. Correlates of physicians’ prevention-related practices. Arch Intern Med. 2000;9:359-367.

3 Sacks FM, Bray GA, Carey VJ. et al. Randomized trial comparing fat, protein, and carbohydrate composition of diets for weight loss for two years. NEJM, 2009;360: 859-873.