obesity is here to stay and not going away: how to discuss this potentially sensitive clinical issue...
TRANSCRIPT
Obesity is Here to Stay and Not Going Away: How to Discuss This Potentially
Sensitive Clinical Issue with Your Patients
JEREMY CLORENE, PH.D.Lead Psychologist
Advocate Weight Management 565 Lakeview Parkway, Suite 102Vernon Hills, IL 60061c 847-877-1331
An estimated 97 million adults in the United States are overweight or obese. That figure represents more than 50% of the American adult population. Of this group, 11 million adults suffer from morbid obesity (100 pounds over weight). CDC
Heart Disease DeathsEach year, about 600,000 people die of heart disease (#1)
Heart Attacks
Per year 715,000 people in U.S. have a heart attack.– About 190,000 people who have survived a heart attack go on to
have another.
Nearly 8 million people in the United States (3%) have had a heart attack.
Disability
Three most common causes:
arthritis or rheumatism (affecting an estimated 8.6 million persons)
back or spine problems (7.6 million),
heart trouble (3.0 million)
National Health and Nutrition Examination Survey (NHANES),
WHY THE TREND?
1970’S “FAT FREE FALACY” RESULTED IN MORE CARBS/SUGAR (TASTE)
CARBS/SUGAR ARE YUMMY, CHEAP, AND ADDICTING…AND BTW…MAKES US FAT!
What does this mean?
Health decline, disability, financial impact, social judgment, occupational impact, discrimination, emotional impact, interpersonal impact, chronic negativity(gender differences on many issues)
What is the Biochemistry / Physiology?
We love sweets, sweets, sweets
Also, Turning off of “full centers” in the brain
Numbing all other feelings…
Sugar is the great anesthetic!
What is the psychology?
CONVENIENCE...
"I want it easy"
Because the rest of my life certainly isn't!
Who are we battling?
Billion dollar corporations sole purpose is to get you to eat…specifically to eat carbs/sugar!
-McDonald’s, General Mills, Boston Market, Coca-Cola, Mars, Kellog Co., Kraft Foods, H.J. Heinz, Hormel, Ralcorp, Smucker’s, Sara Lee, Land O Lakes, PepsiCo, Auntie Anne’s, Dean Foods, Ocean Spray, Campbells, Smucker’s, Pepperidge Farm, Frito-Lays, Hershey’s, Nestle’s…
OBESITY…WHO’S FAULT IS IT?
Not our patient’s!!
But it is their problem …and ours!
Obese / Overweight People...
STIGMA /
BIAS /
STEREOTYPES
Unfortunately multiple negative stereotypes...lazy, sloppy, less competent, lacking in
self-discipline, disagreeable, less conscientious, and poor role models.
Overweight employees may suffer wage penalties, paid less for the same jobs, more likely to have lower paying jobs, less likely to get promoted than thin people with the same qualifications
Medical Staff...plenty of bias against obese pts
physicians, nurses, psychologists, dieticians, medical students...
less intelligent, unsuccessful, weak-willed, unpleasant, overindulgent, and lazy.
No surprise obese patients may avoid obtaining medical care because of these negative experiences.
Research shows obese patients more likely to cancel, delay appointments, avoid preventive health care services, particularly among women.
DIETS
DIETS
DIETS
WHY DO WE CONTINUTE TO GO ON DIETS?
• Because Dieting actually works– You will have weight loss!!
• Average dieter makes 4-5 attempts each year.• Successful diets last approx. 3 months and
people lose 6-15 pounds. • But most regain and more!
Then why, then, do we continue to believe in dieting?
• No matter how frustrating and hard the process is...
Dieting gives us hope, hope, hope!
• Dieting is seductive, intoxicating belief that we are just one diet away from changing our bodies, mood, confidence, health, lives.
THIS RESULTS IN…
ALL OR NOTHING THINKING AND BEHAVING !!
I’m either avoiding the issue entirely or jumping in all the way
• WHAT DOES THIS MEAN FOR HEALTH CARE PROFESSIONALS?
– Pts have had negative experiences…stigma, no success– Pts have tried to lose many times without success– Complex issue and not simply about “Will Power”–Many factors contribute to weight gain and obesity– Understanding readiness for change is key– Can’t change “Lifestyle”…can change one behavior– Small, sustainable weight loss is big victory for health
PATIENT / STAFF OBESITY BILL OF
RIGHTS
1. YOU WILL BE SUPPORTED AND TREATED WITH RESPECT, NOT INGNORED OR JUDGED.
2. MEDICAL STAFF WILL BE ENDLESSLY PATIENT AND APPROPRIATELY PERSISTANT.
3. THE MEDICAL TEAM IS A POSITIVE RESOURCE FOR YOUR WEIGHT MANAGEMENT JOURNEY
4. THE FOCUS IS ON SUCCESSFUL SUSTAINABLE BEHAVIOR CHANGES
5. IMPROVING HEALTH IS THE PRIMARY GOAL
Defined as: more active, less medications, better health markers such as lower weight, improved blood pressure / blood sugars, and better mood
WHAT TO SAY AND HOW TO SAY IT?
First…review “Bill of Rights”
Second…ask questions, let the patient talk…
They may be right!
• "WOULD YOU OBJECT TO DISCUSSING YOUR WEIGHT AND ISSUES SURROUNDING WEIGHT LOSS?"
• "HOW READY DO YOU THINK YOU ARE IN ADDRESSING THIS ISSUE?"
• "WHAT HAS WORKED FOR YOU IN THE PAST?"
• "WHAT WOULD YOU LIKE TO DO?"
• "WHAT CAN WE DO TO HELP AND BEST SUPPORT YOU
IN THIS JOURNEY?"
• "WHERE ARE YOU IN THE PROCESS OF YOUR WEIGHT LOSS?"
• "WHAT DO YOU FIND MOST DIFFICULT IN LOSING THE
WEIGHT?"
• "WHAT DO YOU FIND MOST DIFFICULT IN KEEPING THE
WEIGHT OFF?"
• "IF THERE IS ONE BEHAVIOR YOU WOULD WANT TO CHANGE
WHAT WOULD IT BE?"
• "WOULD YOU OBJECT IF I MADE SOME SUGGESTIONS?"
• "WOULD YOU OBJECT IF WE CONTINUE THIS DISCUSSION
WHEN YOU RETURN FOR YOUR FOLLOW-UP?"
KEYS FOR PROVIDERS:
BE COMPASSIONATESTAY PATIENTBE PERSISTANTEXPECT SUCCESSBE POSITIVE BE REALISTIC…REPEAT…
Goals today:1. Frame and better understand the problem -
Obesity: Serious health issue that is not going away weight management is a
complicated behavioral, medical, and personal journey.
2. Develop some techniques to better communicate with our patients -
Tone is about respectAsk questions first, suggestions after
QUESTIONS?