Monday, October 25, 2010

the doctor-patient wt management plan

it's on everyone's mind, whether you're lean and fit or obese and diseased: why can't i/they/he/she lose weight? well, if you're a doctor administering to a patient whose health can be dramatically altered by losing wt, you have several options: talk nice, give orders, don't say anything, or present the data. this article in the Times addressing a recent bit of work that shows what any fitness professional knows...but many do not practice:

now, this is my take on the issue, just my philosophy, so it does not have any more power than my experiences over the 20 plus years i've been doing training. first, my clientele - bright, educated, wealthy, primarily caucasian. second, my personality - all of the former except for wealthy, plus a former philosophy major, liberal, caring. why do i mention the latter aspects? because they factor in on how i deal with clients for whom wt loss is an issue; esp how i deal with those over long periods of time for whom advice, guidance, support, education, and training don't have any measurable benefit.

as a philosophy major, i spend many years thinking about the human condition. while i have no profound answers to offer, the one thing i learned over time is that most people won't change. they can, but most won't. neither threats of impending doom nor promises of 72 virgins in heaven will change one's behavior....until the person really wants to change. this works for individuals, societies, cultures, and nations, so you can fret the small stuff but there's no need to fret the big stuff; we just have to deal with that which presents itself.

as a liberal, however, i believe mankind, and each individual, is responsible for his/her life and decisions as to how it's lived, but that there are mechanisms, or at least should be, that will enable us to find the 'right' way to live. but, go back to the previous paragraph and you will appreciate the fact that liberalism, tho well intended, does not often work. for one thing, 'right' differs from person to person. for another, it's complicated.

for example, it's 'right' to exercise. but it's wrong to over-exercise or mis-exercise to the point of injury. raise your hand if you're an athlete who's never suffered from either overtraining or injury. good - no hands showing. well, we espouse the principle of paying for our lifestyle sins - that the obese should pay more for insurance commensurate with their risks, but then shouldn't athletes? of course, our injuries don't cost as much - now - but it was 15 yrs after my tae kwon do career ended that i needed my hip replaced; and will be a few more til i need my knee replaced. you'll say there are fewer and less severe and less costly medical conditions that sprout from being chronically active but the reality is, not all obese people will cost the system and not all athletes will save the system from costs. so, taken individually, not all of us should be hard core athletes but neither should all of us be obese. there's got to be a mid point somewhere, but who is to say where that is. there is no right level of fitness nor mechanism for getting there.

that said, as a liberal, i do believe society can facilitate the approximation of right at the expense of neglecting it. in other words, government, acting on behalf of society, should spend more money helping us to get fit, be healthy, and live more productively. i just don't know how to do that....

finally, i really do care. i want my clients to be healthy, get fitter, and enjoy their bodies and their minds. i love what i do and do it with love. those who have tried to lose wt, tho, are difficult to manage beyond their first 20-100 sessions - i say this jokingly but when someone's been trying to lose wt for 3 months or years, then there's absolutely nothing i can do to help. i don't give up but i do resort to less accommodating coaching. after reviewing one's behaviors that repetitively sabotage their stated goals, i resort to supportive questioning: that is, regardless of their answer or offered statements about dietary or exercise patterns, i find a positive spin to apply but direct them back to the 'better' method or choices. by this point, i know them fairly well so i can play this game. the one thing i never ever do is put someone down for their choices. but i have, on occasion, let them know that their choice speaks loudly for their real intentions. most of the time, this goes without saying, so i don't.

now, back to the article. docs don't have these kinds of close relations with clients like trainers. they have minutes, tens of minutes at best. reminds me of a cardiologist i met 20 yrs ago. after the movie, he asked what kind of advice i offer for wt loss. after expressing my philosophy so as to avoid sounding like a know it all - i knew a lot less back then- he shared his. he told of how he sits next to the bed of a patient who had a cardiac event, or surgery, and discussed diet. years after spending half an hour with patient after patient, sometimes the same person a couple years apart, he boiled it down to three words: greens, beans and grains. then he walks, figuratively speaking. his point is clear: he cared, he cares, he shares...then he leaves, leaves it up to the person to make a choice. it may not be the right choice. if it isn't right, he'll see him/her again, maybe. but it's all he could do.

that's why the data is not strong enough to change the way docs talk to patients. most simply don't want to listen. be nice, anyway.

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