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Mulrow, Cynthia D.Helping an obese patient make informed choices. (Clinical Review) British Medical Journal v317, n7153 (July 25, 1998): 266 (2 pages).Copyright 1998 British Medical Association (U.K.)
Not long ago, a patient, whom I will call Mrs. Bariatrico, asked me to prescribe a diet pill for her. Mrs. Bariatrico is a middle class woman aged 48 years. She is 1.6m tall and weighs 77.2 kg. Her body mass index is 30.2 and her waist to hip ratio is 1.0 Mrs. Bariatrico is healthy and does not smoke. She told me she plans to enroll in a commercial diet programme and believes her ability to change her lifestyle is good? Her main concern is cosmetic--she values "looking good" and considers weight loss an important outcome.
As her primary care provider, I had several concerns. I knew the health insurance system that serves Mrs. Bariatrico has no formal weight loss programmes, and the cost of appetite suppressing drugs in not reimbursed. I had some doubts about my own ability to manage obesity and asked the following questions:
Work Janis A.. Exercise for the overweight patient.Physician and Sportsmedicine v18, n7 (July, 1990): 113 (2 pages).
Exercise alone is not enough to achieve weight loss for an obese patient. The overweight patient must exercise to keep off the pounds lost through dieting. Exercise programs must involve a minimum of 20 to 30 minutes maintained at a conversational level (i.e. being able to maintain a conversation during exercise) and patients should exercise lasting one hour per session and performed three to fives times a week is recommended to burn calories and avoid injuries.
Exercise performed on a regular basis is as important as the duration and therefore walking three times a week or every day is highly recommended, since it is safe and can be performed anywhere. There is reduced risk of trauma and overuse injuries form swimming; however, patients may be self-conscious in a swimsuit and this type of exercise may not be a good first choice.
Cross country ski machines, stationary bicycles, and rowing machines may be used, and in fact, any form of activity is good so long as it is safe for the patient. Exercise for overweigh patients should involve total body motion of the use of large muscle groups. It is important to remember that the dropout rate from all exercise programs is high; statistics show that only 20 percent of those that start an exercise program continue it for one year. Exercise must become part of a patient's life and it may be a social event if the patient joins a gym or exercises with a friend. Patients should be encouraged to follow a routine in a health club before purchasing equipment and attempting to exercise at home. Physicians should motivate patients in order to achieve the benefits of exercise. The patient and the physician should plan a program that is realistic and includes activities that the patient will enjoy in order to achieve long lasting results. Physicians should communicate to the patient both the benefits of exercise and the health risks of not exercising.Some obese patients may have multiple musculoskeletal problems, and before initiating an exercise program it would be useful to encourage patients to simply become more active. Patients should avoid the use of television remote controls, they should walk instead of driving a car, and should climb stairs instead of using an elevator. Patients with health problems such as hypertension or diabetes, or those on very low caloric diets may require special considerations. Exercise is an important component of maintaining weight loss and should be a positive lifestyle change. (Consumer Summary produced by Reliance Medical Information, Inc.) 7.
