In This Article
- Many patients use the new year as a time to commit to weight loss and seek professional support. But New Year's resolutions can backfire and ultimately discourage even the most well-intentioned patient
- Angela K. Fitch, MD, FACP, FOMA, associate director of the Massachusetts General Hospital Weight Center, shares advice for clinicians working with patients seeking weight loss support
- Providers should encourage patients to focus on health-based, rather than weight-based, resolutions; set SMART goals; consider metabolic advantage factors and encourage patients to focus on living their healthiest, happiest lives
New Year's resolutions are notoriously difficult to maintain. Yet year after year, patients look to this time of year as a fresh start in their weight loss journey. For clinicians, this presents a challenge. Your patient's renewed investment in their health is important to acknowledge. However, a healthy lifestyle is more nuanced, and resolutions can quickly backfire—leading them to cause more harm than good.
Angela K. Fitch, MD, FACP, FOMA, is the associate director of the Massachusetts General Hospital Weight Center, which provides comprehensive multidisciplinary treatment with prescriptive lifestyle intervention, behavioral therapy, medications and metabolic surgery to treat patients with all stages of obesity. In her work with the Weight Center, Dr. Fitch works closely with patients struggling with the disease of obesity by promoting healthy weight attainment and management.
In this Q&A, Dr. Fitch discusses takeaways from her clinical experience that guide her treatment methods year after (new) year.
Q: Do you see an increase in weight loss consultation appointments in January? How do you encourage patients who are driven by their New Year's resolutions?
Fitch: In general, people want to lose weight to start off the year. The average American gains 2-5 lbs. a year, by nature, and there are studies that show the typical weight gain occurs between October and February. Weight loss is particularly difficult because it is not a normal process for the human body. We are engineered to gain weight as a survival mechanism. All of our physiology is created to defend against weight loss. So many people with the start of a new year have a resolution to reverse this process.
I see many patients with unrealistic expectations for their resolutions. For example, a patient who weighs 250 lbs. may come in wanting to lose 50 lbs. A 50 lb. weight loss is 20% of their weight. In studies of intensive behavioral programs, less than 10% of people are able to accomplish a goal of 20% weight loss. This isn't their fault—although unfortunately they may feel it is—it is their physiology. Changing physiology with surgery and medications can get more patients into the 20%-40% weight loss category.
As a provider, my goal is to help patients have realistic expectations and education around treatment options to help them reach their goals. A focus on health-based resolutions versus weight-based resolutions can be more rewarding and has great benefit in preventing or managing chronic diseases such as diabetes and hypertension. Health-focused resolutions include eating five servings of vegetables and fruit a day or increasing their activity, rather than focusing on a number on the scale.
Q: What advice would you give medical professionals in talking to patients about health goals in the new year?
Fitch: Setting smaller SMART (specific, measurable, attainable, relevant, time-specific) goals around lifestyle can help. Focusing on an initial five percent weight loss is a good first goal if weight loss is going to be the main outcome. Five to 10% weight loss is beneficial and reduces diabetes risk in patients with prediabetes by over 50%. Helping patients understand this and be realistic is important.
Whatever we do, we have to find motivation and accountability to continue the change all year and not just in January. The accountability is key. Either creating this in MyChart or having the patient come into the office every three months to check in can set up a routine for better success.
Q: Are there any specific tips, tools or reminders you provide patients that other medical professionals could learn from?
Fitch: We all need structure, accountability, environmental control and a metabolic advantage to produce sustained weight loss. Using resources provided by wellness programs can be a good place to start. Using online programs or tracking behavior in apps can be helpful for accountability and structure.
Environmental control means helping patients understand there is no such thing as "willpower." We all want to eat things that taste good that we have access to. We have to engineer our environment for success. Helping people improve their metabolic advantage involves several things:
- Constant sitting: Encouraging people to get up frequently every 20-30 min can give them a metabolic advantage, since sitting promotes fat storage
- Sleep: When patients don't sleep well, for enough hours (> 7.5) or at the right time, or if they have untreated sleep apnea, they are at a metabolic disadvantage
- Medications for obesity and metabolic surgery: These give us the biggest metabolic advantage to promote better weight loss and remission of obesity as well as the diseases it brings
I encourage my patients to pick one change at a time. Focus on quality, quantity and timing of eating. Begin tracking in an app or use a more structured approach with a planned menu of whole foods. Try to decrease processed food consumption as much as possible. Changing the timing, quality and caloric density of our intake produces the greatest results. Exercise does not produce a lot of weight loss. Exercise is good for us for other reasons and good for weight maintenance, but does not produce much weight loss without changes in nutrition. Helping patients attain structure or referring them to a dietitian or a program that can help them with that is the key to success.
Q: Have you learned anything from patients or your peers that has shaped the way you view patient care, particularly at this time of year?
Fitch: Yoni Freedhoff, MD, a colleague in Canada, published an idea I really like in a recent NPR article: Your best weight is the one you reach when you live the healthiest life you can actually enjoy. Sometimes we have to lose weight because we need to get to a certain weight so we can have a heart transplant or to make other diseases go away. Other times we want to feel better and reduce our risk of future diseases. Whatever the motivation, we have to be happy with the life we are living and we have to be able to be happy with the changes we make as well as make changes we can live into.
Many patients are also reluctant to take medications for obesity. Medication can double your odds of losing 10% of your weight. Initially, patients worry about taking medication and having to take it lifelong for sustained results. But those who are able to lose 10%-20% of their weight with the help of medication usually don't want to go off it once they get there. When you take medication for a disease such as hypertension you don't stop it when the blood pressure normalizes. The same is true for the disease of obesity.
The New England Journal of Medicine recently published an article predicting that by 2030, over 50% of the U.S. population will have the disease of obesity. We have to get medication and accountable lifestyle programs to more than the one percent of the population that gets treated with anti-obesity medications today if we are going to affect change in this disease. Obesity increases cancer risk by 30%-50%. Treating obesity can lower the risk of many other diseases, but we need to get away from self-blame and shame in order to do so.
Q: When should a primary care provider consider referring a patient to a place like the Mass General Weight Center?
Fitch: The Mass General Weight Center serves patients with a BMI greater than 27 that are looking for help in treating the disease of overweight and obesity. Patients who have tried to lose weight on their own or with other programs, patients who are needing to lose weight urgently for other reasons (e.g., needing knee replacement, organ transplant or hernia surgery) and patients for whom the disease burden of obesity needs more intensive treatment with surgery and/or medications are all encouraged to seek treatment. We encourage more primary care providers and other physicians to use medication and prescriptive lifestyle interventions to help patients get access to obesity treatment. We are now providing e-consults so more patients can be treated.
Q: What other advice do you offer your patients?
Fitch: I remind patients to have a resolution every day—not just at the start of the new year. Live into your best and healthiest life possible for you. Don't judge yourself by a number on a scale, but by how you feel. Creating a healthy lifestyle is a work in progress and a continual journey that is constantly evolving.
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Refer a patient to the Mass General Weight Center