Family medicine has a number of unique features, not least the responsibility to take on the chronic management of problems in social and lifestyle issues: smoking, diet, alcohol consumption, exercise.
Patients have a tendency to come to the doctor’s office saying “help me lose weight.”
I know as well as any of my patients how hard it can be to lose weight. How hard it can be to not eat that bag of potato chips in the car on the way home, to not have the buttermilk pancakes and bacon at Sunday brunch, to not have the bowl of ice cream while watching Gray’s Anatomy. I know how hard it is to fit regular exercise into a busy life.
But don’t bullshit me please.
When I ask you about your diet, if you say, I don’t get it, doc, I hardly eat a thing, I know we aren’t going to get very far. At that point I want to say, Bye now, see you when you are ready to work with me. You don’t get to 240 lbs without eating.
If your weight is stable, the math is simple:
calories in = calories out
So, suppose you are a 5’6″ (167 cm) woman weighing 200 lbs (90kg). If you didn’t leave your bed, you’d still need 1700 calories a day. Supposing you actually DO anything (and everybody tells me they are far more active than the average person, that they in fact are always running around chasing after the kids and whatnot), the number is far higher. That very active overweight woman needs at least 2800 calories a day to maintain that weight.
So if in fact you are not losing weight, you are certainly consuming at least the number of calories per day you need at your activity level to maintain your weight. Busted.
To lose weight, you can either decrease the calories coming in (diet), increase the calories going out (exercise), or do some combination of both.
There are a couple of things about this equation that make it frustrating for the dieters of the world (myself included): once you have managed to lose weight, if you relax and go back to the old amount of exercise, and the old amount of food, you are going to go right back to the old weight. Oprah is right about some things, and changing your lifestyle to maintain your weight really is necessary.
That amount of food at that amount of exercise for that person reaches a set point at that weight. So that’s it, if you’re relying on Atkins or South Beach or even ye olde Scarsdale, if you want it to have long-term results, you have to commit to it forever. Which is a long time to avoid carbs in my opinion, but I LIKE carbs.
Things I think everyone should know if they REALLY want to lose weight:
It is vanishingly rare for a weight problem to be “hormonal”, so don’t fool yourself.
It doesn’t matter if it says “low fat,” if you eat four of them.
Soft drinks count. Alcohol counts. Food sneaked at midnight counts. Food snarfed on the run counts. Everything counts.
Lying to me (your doc) doesn’t help. First, I care but I don’t care that much. Second, I’ll know you’re lying the instant you step on the scales so why bother?