Nov. 25--Q: How should doctors advise patients who are overweight and want to
Answer: It's not enough to tell them to just eat less and move more, said Dr.
Anna Vedina, an internal medicine physician with HCA Virginia's James River
"I try to be more supportive. It's always easy to just say, 'You're obese and
you need to exercise or eat better.' But if I see that is an issue and the
patient is gaining more and more weight, I sit down and talk to them," she said.
Doctors were given more specific guidance on counseling patients about obesity
recently when a panel of heart doctors and obesity experts issued revised
guidelines on how to help adults lose weight and maintain the loss.
The American Heart Association, the American College of Cardiology and the
Obesity Society developed the recommendations, which offer doctors an algorithm
or flowchart of best practices to follow.
For instance, doctors should calculate a patient's body mass index (BMI), a
measure of height and weight, and take the patient's waist measurement, at least
once a year. To lose weight, women should follow a diet with 1,200 to 1,500
calories a day, men 1,500 to 1,800 calories a day, adjusted for physical
The guidelines also address when weight-loss drugs and weight-loss surgery
should become part of the conversation.
"We definitely measure the BMI," Vedina said. "We talk about exercise."
She said a lot of patients think they are eating healthy, but once she quizzes
them about their nutritional choices, she finds otherwise.
"There are patients who cannot afford to eat fruits and vegetables. We go over
what is better than what they are eating right now and that they can still
afford," Vedina said.
The guidelines recommend patients work with a trained health professional, such
as a registered dietitian or a trained weight-loss counselor, in a primary-care
Vedina said if a patient is really motivated and they work out a treatment plan,
she is willing to see that patient every month.
"Obesity has a very negative impact on a patient's health," Vedina said. "It is
very important that we work with our patients and remind them how important it
is to lose weight and be there for them to help them try to lose weight."
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