RobardUser Robard Corporation | Treating Obesity

Why Weight Loss is Not as Simple as Cutting Calories



When it comes to calorie counting, not many people — if any at all — like doing it. It’s monotonous, tedious, and restrictive. It takes all the joy out of eating. You counted all your calories, so you should be losing weight, right? Well, not necessarily. If you stop to think about what a calorie is, you will find that it’s not just how many calories you consume that affects healthy weight loss, but what kinds of calories.

Download the Calorie Equation: Learn to indulge in colorful, flavorful foods without loads of calories with this picture lesson from Dr. Howard Shapiro’s book, Picture Perfect Weight Loss.

Simply put, a calorie is a unit of energy. Our bodies actually need calories to survive because without energy, our cells would die, and our organs would stop functioning. We acquire this energy through food and drink in the form of calories. The number of calories food contains tells us how much potential energy they possess.

Keeping track of how many calories one consumes is, of course, important to weight loss. If you burn off more calories than you consume through physical activity, the body will locate other calories to burn for energy, ultimately using the calories from the body’s fat reserves, and thus stimulating weight loss.

The problem comes in when “empty calories” are consumed; that is, foods high in energy but low in nutritional value. Such foods include fast foods, and foods high in fat and/or sugar, such as ice cream and bacon. More than 11% of Americans’ daily calories come from fast foods, and Americans consume an average of 336 calories per day from sugary beverages alone. To put it more simply, 2,000 calories in the form of vegetables and lean protein will provide a very different result than 2,000 calories in the form of a large fast food burger.

Ultimately, to achieve fast and, most importantly, healthy weight loss, it is important to advise patients to stick to a low calorie diet, but through foods and supplements that are high in nutritional value. Many people continue to find it challenging to stick to a low calorie diet on their own. This is why it is important for health professionals to be proactive in asking overweight patients about their weight loss goals*, and educating them not just about the benefits of achieving a healthy weight, but also about the options that are available to them, such as a Very Low Calorie Diet (VLCD) or Low Calorie Diet (LCD). With a medically supervised VLCD, patients could expect to lose 3-5 pounds a week, enjoying a variety of meal replacements, snacks, and food products that taste great and are scientifically designed to have high nutritional value.

Obesity is on the rise, and healthcare costs and early mortality rates are rising with it. But adding weight loss as a service for your patients is easier than you might think, and can actually get started in 60 days or less with the help of an experienced partner. Contact Robard today and learn how you can increase the quality of care for your patients by starting an obesity treatment program.

*For practical tips on how to speak with patients about their weight, check out this free webcast!

Sources: Medical News Today

Editor’s Note: This post was originally published in July 2017 and has been updated for freshness, accuracy, and comprehensiveness.


Blog written and edited by Vanessa Ramalho/Robard Corporation


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Patients’ Health Not Improving? It’s Why I Treat Obesity



I think we are at a crossroads in medicine right now. Imagine the perfect storm. Life expectancy is decreasing for the first time in generations. Public health measures have gotten a hold of cigarette smoking only to have obesity rise up and surpass it as the leading cause of preventable death. Major attempts at curbing obesity and diabetes have failed. The final data on Healthy People 2010 outcomes showed obesity and overweight individuals worsened over the measured period. At the same time, health care costs are high, outcomes are poor, and there is a scourge of physician and provider burnout — there’s even a shortage in some areas.

Is this a coincidence? I can still practically taste my frustration of seeing my patients get worse and worse every three months when I saw them. Their blood sugar, blood pressure, and cholesterol got just a little worse each time. Heartburn, reflux, sleep apnea, depression, etc., would creep up on them. The medication list, the problem list, the referral list, the order list, all got longer and longer. The patients kept saying the same thing, “I want to get better.” I would manage their numbers effectively, for the most part. Their “ABCs” of diabetes met my quality goals for my bonus. But they did not “feel” better — they felt worse, and so did I. Was this why I went to medical school? I did not feel I was healing anyone; rather, I was only managing numbers with pharmacology. Something had to change.

When I first started offering obesity counseling, it was based on a Mediterranean type diet and food exchange. I started to see some exciting trends in blood sugar, blood pressure, and weight, as you would expect. I did not expect to see the changes I saw in the patients themselves. They became more engaged and optimistic about their health. For some patients, this program was all they needed. But, for many people farther on the spectrum of obesity, it was only the beginning.

That was when I quit my safe and secure position at a large health system and opened my own practice based on the program offered by Robard. And that was when the really exciting results started happening. That was June 2015.

At first, it was the ones who already knew me from primary care who trickled in. Then, it was their friends, families, coworkers, kid’s teachers, and anyone who saw them. Word got around, and the floodgates opened. They all said the same thing. The program gave them hope and then gave them their life back. They wished they had had it sooner. They wished they had known it was out there. They wished their doctor had told them about it. They wished more people could hear of it.

Since then, I have opened a second clinic and the patients have lost a combined total of 29,572 pounds. They report the program is the easiest diet they have ever done, most of them enjoy the taste of the medical foods and would like to be reassured that they will still be allowed to have one for breakfast or lunch once they reach their goal weight. They typically report that taking food away for a period made a huge difference in the role that food plays in their life, their relationship with food, their eating habits, and their cravings. I have learned that taking food away is one of the most important behavioral aspects of the program, even if only for a month. Since food can be addictive for some people, taking it away completely can be crucial for long term change, which is the opposite effect that you may be warned about by some critics of a short term rapid weight loss program that is “unsustainable.”

When patients come in the first time, they are sick and tired of feeling sick and tired. They have a hard time making it through the day, let alone going to the gym after work. I tell them casually not to worry, after the first 40 pounds comes off, they will feel much more like being active, they look at me like I am crazy. When I tell them that they will most likely not need any insulin after four weeks, they burst into a smile. When I tell them that after all the dozens of diets they have tried, with cabbage and lemons and meal prepping, all they have to do is drink a shake every four hours and the weight will come off, and they can go on with their lives of caring for their kids, parents, sick spouses and full time job, they are truly relieved.

And, for me, I now know why I went to medical school. Obesity is like lupus. It does involve every system in the body. You do have to treat the whole patient for the best outcomes.

So, for me, I honestly had some selfish goals. I wanted to feel purposeful and like I was making a difference. I mean, I get to cure diabetes, taking people off of 150 units of insulin who had been told they would be on it for the rest of their lives, freeing them from over one hundred shots of insulin a month. It is like curing cancer or chronic pain. Now, the biggest problem with my work is that I am so busy and I can’t seem to tell anyone “no” because I know the results they will get and they cannot get similar treatment anywhere else — at least at this point. So, I am working longer hours, but I love every minute of it, and at least I am not a helicopter parent and I hope my kids are learning “grit” and determination and non-normative gender roles by observation, but that is another talk.

So, I implore you to take bold action. In the name of decreasing life expectancy, plummeting quality of life, astronomical health care costs, physician burnout and sell out, turn away from the focus on HEDIS measures, patient satisfaction, quality bonuses, resource allocation and meaningful use. Before we turn into Wally World, stop missing the forest for the trees. Be the little boy who called out the Emperor’s New Clothes. Choose the path less traveled, operate at the sharp end of the sword, do what no one else can without those initials after their name can do, and fix the underlying problem.

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Being Sensitive to Weight Loss Patients’ 'Bad Habits'



How do you get patients to stick with the plan?
Compliance to a medical treatment can be challenging, to say the least. Patients want to be healthier, more active, and more energetic. Yet time and time again, they fall off the wagon and resort to going back into the same old habits that don’t support their progress. Why? (Click here for a flashback on 5 Bad Habits that Lead to Weight Gain)

For health care providers, it can be frustrating to check in with a patient and hear that their diet or exercise plan isn’t going so well. But it can also help to understand how habits form so you can not only help set realistic expectations for your patient, but also for yourself.

Studies on habit formation have shown that habits form as part of a three-step process. First, there’s a cue, or trigger, that tells your brain to go into automatic mode and let a behavior unfold (i.e. hunger). Then, there’s the routine, which is the actual behavior that we associate as being the “bad habit.” The third step is the reward: Something that your brain likes that helps it remember the “habit loop” in the future. In the case of overweight patients, the pleasure of enjoying “off-limits” food can be their reward. (Learn more about this physiological pleasure connection for those suffering from food addiction in our free white paper.)

Neuroscience has shown that habitual behavior and conscious decision-making are handled by two different parts of the brain, and the area of the brain that controls habits can often supersede and shut down the decision-making area. So when patients revert back to old habits, it is not that they are just battling low motivation or self-control. Their brains are hardwired to return to the behavior that it is used to, even when they no longer benefit from it.

So what can health care providers do?
First off, be patient with your patients. It’s not that they are less committed to their goals; for many it can just be that they require a little more time to relearn healthier habits. Studies show that it can take anywhere from 18 days to 254 days for people to form a new habit. And there will be trips along the way.

Secondly, don’t stress too much about when they mess up. Researchers have found that “missing one opportunity to perform the behavior did not materially affect the habit formation process.” In other words, it doesn’t matter if you mess up every now and then. Reassure your patients that an occasional binge is not the end of the world and encourage them to get back on the horse.

Third, understand that old habits are not forgotten, but replaced with new ones. We can’t magically expect patients to stop a damaging behavior without providing an easier alternative. For overweight people who have an unhealthy relationship with food, there can be a benefit to introducing something like meal replacements. Rather than expecting patients to completely change how they relate to food, they can replace their normal food habits with an easy shake or bar and make it part of a new routine that is easier to implement.

Dr. Valerie Sutherland of Rainier Medical Weight Loss and Wellness notes, “[Patients] typically report that taking food away for a period made a huge difference, even if only for a month. Since food can be addictive for some people, taking it away completely can be crucial for long term change, which is the opposite effect that you may be warned about by some critics of a short term rapid weight loss program that is ‘unsustainable.’”

For a more help on helping patients set realistic goals they can stick with, instantly download our free Short Term Goal Helper Worksheet!

Sources: NPR, MIT News, HuffPost


Blog written by Vanessa Ramalho/Robard Corporation


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