Question 2
Average weight loss in the control group was only 1.7 kg and blood pressure was also not significantly reduced in either group. What would you say to a patient who is more concerned about weight loss than their lipid levels to show them that their diet is working? Further, is this diet something you would recommend, even though weight loss and blood pressure are not largely effected?
posted by StephHyett @ 5:13 PM
36 comments
36 Comments:
If a patient was more concerned with weight loss than lipid values, I would tell him/her that weight loss should occur slowly, and that by starting with improved lipid values is an initial weight loss step in its own. Furthermore, I would also suggest incorporating other good dietary habits (lowering sodium, fat, and overall caloric intake plus increasing fiber intake) and incorporating some exercise into the patient's daily lifestyle choices.
I meant to say I would also suggest to continue incorporating good dietary habits and exercise to the patient's daily lifestyle choices because the patients were already reducing overall caloric intake and fat intake, along with increasing physical activity.
If I was counseling a patient that was more concerned about weight loss than their lipid levels, I would first congratulate them on their hard work thus far. Obviously, the patient has made some kind of change at home, which means that they are really making a conscious effort. I would then explain how high blood lipid values can be detrimental to ones health and that weight loss does not occur over night. Furthermore, I would probably sit down and complete a 24 hour diet recall to see what changes the patient would be willing to make next. I would also ask if the client is physically active and if not, I would provide recommendations for how to incorporate at least some exercise into their daily regimen. I think that it would also be beneficial to discuss the health risks associated with high sodium diets.
For those worried about weight loss, I would still recommend increasing their whole grains because the additional fiber will fill them up and cause them to eat less in the long run. They also need to realize that weight loss needs to be gradual so just because the weight didn't seem to be coming off, doesn't mean the changes weren't beneficial.
Jen and Anna --
Both of you brought of great points that there are several things that can be changed in the diet and lifestyle (like increasing exercise) that can increase weight loss. I also like how each of you emphasized how important the improvement of lipid values would be of great importance to their overall health, although weight loss may not be seen.
I would discuss with the client the importance of both the weight loss and the lipid levels. I would tell them that it is okay to set baby goals for weight loss and that with the weight loss they will be able to see changes in their blood work. However, I would further educate them on how truly important the their lipid levels are and the damage that can be done if they are too high. I think this diet could be something to consider if the client is looking for something that is more defined in what they can and can't eat. If it is the type of client who needs a strict plan to follow.
Jenn,
Talking to them about other dietary habits is a great tool to incorporate the main components of weight loss. I think as dietitians we sometimes can get hooked on just the nutrition side and often forget that there should be a balance between what goes in and what gets burned off.
I agree with Anna – initially, it would be essential to verbalize the purpose of lowering cholesterol. On occasion this type of information is not fully explained to the patient. It would be important to help the patient identify why they are concerned with weight loss versus lipid control. This exercise will be helpful to distinguish education needs and how to assist the patient in making lifestyle changes. I would not recommend this diet as a “standalone” recommendation. Instead I would incorporate this lifestyle change into a heart healthy guideline. Given these patients have high lipids they most likely have HTN and obesity. Therefore, I would individualize my recommendations for their current medical condition and help them understand that weight loss is one facet of a healthy lifestyle. The heart healthy plan would include an increase in total fiber sources, decrease in saturated/trans fats, decrease in sodium, and stress the importance of gradual 1-2 lbs/week weight loss.
Rachel, you are absolutely right. Weight loss is just one facet of a healthy lifestyle. Until a patient is able to see the entire picture and until they take their overall health and well-being seriously, nutrition will never be a top priority in his/her life.
I would tell the patient that they are taking positive steps in the right direction for losing weight. It is important to stress that weight loss should be gradual and significant weight loss will not happen overnight. Decreasing their LDLs and increasing their HDLs is a good indicator that their diet is working and exercising will also increase HDLs. Waist circumference decreased significantly in the group that was eating the whole-grain RTE oat cereal compared to the control group. I would point out that sometimes the “number” on the scale does not always represent what is being accomplished (e.g. reduction in waist circumference has a positive relationship with reducing CVD risk). I would recommend this diet, but would also educate the patient on sodium intake and foods that are higher in sodium that they need to limit or restrict. I would also encourage the patient to continue exercising and keep up the healthy lifestyle changes.
I am going to have to agree with the previous comments when mentioned that the client must first be recounseled on the importance of lowering their lipid levels and it's effect on health and disease, specifically CVD. I would then stress the importance of changing one's lifestyle to a more healthful living and how they personally are moving in that direction which more often than not leads to eventual weight loss. As again mentioned, weight loss is not an immediate thing and if it is then usually it is because of unhealthy, temporary fixes with the emphasis on temporary! Exercise would be an excellent recommendation here to help speed along the weight loss and then you could counsel the client on other dietary choices they are making to see if there are any other modifications to help them lose weight and feel better. I would definitely recommend this diet but with some modifications to help effect the weight loss and blood pressure.
Anna,
I really enjoyed how you were first to mention congratulating the person on their steps towards a healthier lifestyle. This was something that did not come to my attention when first reading the question and encouragement is definitely a necessity when counseling someone on weight loss, eating healthier and improving their health. As dietitians this is something we need to include in our visits with patients/clients especially ones who are asked to change their whole life more or less so I really thought it was great that encouragement and congratulatuions were mentioned.
I would explain to a client that weight loss is gradual and there are other important indicators of becoming healthier (lipid levels). The importance of lowering their lipid levels should be explained. I believe that this diet is a step towards a healthier lifestyle. However, additional changes in their diet should take place to make a greater impact on their overall health.
I agree with Bethany that you made a great point, Anna. That initial step towards a healthier lifestyle can be tough. It is great to encourage and congratulate a client on their success thus far. Hopefully by doing so, they will continue making changes to improve their health.
I believe it would be important to emphasize that weight loss is just one facet of achieving overall health and that it is a gradual change. I would also explain the importance of lowering lipid values for overall health. I would recommend this as part of an overall initiative and as Rachel W. mentioned, tailor it to meet the specific patient’s needs.
I agree with Rachel W. that is would be important to help identify why the patient is concerned with weight loss versus lipid values. This would help to provide recommendations that would be specific to that patient’s needs and wants.
Well, I would commend the patient for taking the first step toward long-term weight loss. I would explain to them that they did not gain the weight in a week, so it won't come off in a week...it takes time. I would also aske them how they feel now that they have made a few changes in their diet already. Hopefully, they feel good about their choices and even though they may not be losing a lot of weight, they might notice that they are feeling better and clothes are starting to fit better. Then, we would start to make more goals based on what challenges they are facing.
While overall weight loss was not significantly different between the groups, waist circumference decreased significantly more with whole grain group compared to control group. As stated in the article, excess abdominal adiposity is strongly associated with metabolic disturbances such as insulin resistance and hypertriglyceridemia. The client should be informed of this in an effort to increase their awareness of the importance of where someone loses weight rather than just how much. They should also realize that even moderate weight loss has substantial health benefits. In addition, the client should be educated on the importance of keeping their serum lipid levels within the acceptable range. They should realize that while they may not see short-term immediate benefits from having healthy lipid levels, they will greatly reduce the risk for long-term complications such coronary artery disease and stroke. Because of its strict nature, I may not recommend the diet of only consuming 2 servings of ready-to-eat whole grain cereals per day. However, I will definitely recommend increasing overall soluble fiber intake in someone’s diet.
I think I would try to work with the client to change the diet up a bit so that they did begin to see some real improvement in their weight loss rate. A person who has done this diet faithfully for 12 weeks and has only seen 1.7kgs (3.7 lbs!) of weight loss has a right to be frustrated. I would suggest reviewing portion sizes, ensuring variety, and encourage regular physical activity. Certainly it would be important to point out the need for healthy lipid levels but I think at this point the patient needs encouragement toward weight loss - with weight loss comes improvement in lipid levels; they go hand in hand.
If a patient is more concerned with weight loss than lipid levels, I would reiterate that in order for a diet to work long-term, it must become a lifestyle modification, and that the body must be healthy on the inside as well as outside. I would try to help the patient see that healthy lipid values is just as much a success as the number on the scale. As everyone else has mentioned, I would also note that weight loss is a gradual process, and continuance of these diet modifications will result in their expected weight losses. I would recommend adding a variety of whole grain, high-fiber foods, not just the RTE cereal.
I would definitely recommend a diet rich in whole grains, similar to the one in the study, for a patient interested in losing more weight. I would, however, try to introduce a little variety into the diet, as RTE oatmeal everyday would become monotonous. I would put more emphasis on physical activity and overall healthy lifestyle, and reinforce the importance of lowering their cholesterol.
Sarah Gervais
Anna makes a good point about the 24 hour recall or 3 day diet record to investigate dietary practices that may be hindering weight loss, or what could be changed within the diet.
Sarah Gervais
For those who may be concerned with weight loss, I would also tell them what many of you have already suggested, that losing weight should be a gradual process. Also, those who lose weight at a slow, but steady rate are more likely to keep that weight off and maintain those healthy habits. I would recommend this diet to a person who may be at risk for cardiovascular disease but was at a healthy, normal, or possibly slightly overweight weight. More specifically, this diet seemed to be effective at improving the participants’ lipid levels, so I would recommend it to a client with poor lipid levels who may not have that much weight to lose.
Anna, I also like what you said about congratulating the individuals on what they have done to lead healthier lives. I think that encouragement and support are absolutely needed when someone is embarking on a lifestyle change process. It also is imperative to address more than just their diets. Physical activity, smoking and drinking habits, sleep and stress, family history and so many other things play into cardiovascular disease, so it is crucial to talk about the significance of those things as well.
If a patient was more interested about losing weight on this diet I would focus more on increasing exercise and watching portion sizes. I would also mention that the whole grains are great for weight loss since they have been shown to keep you fuller longer. I would probably use the RTE oats as a first step and work up to the other changes gradually and focus of the fact that losing weight and keeping it off requires a lifestyle change.
Anna, I really liked when you said that you would first congratulate the patient for making healthy changes thus far. I think that is a great attitude when entering a counseling situation. It seems like we are always seeking more and more changes to improve diets when sometimes we should sit back and praise our patients for hard work that is already being done.
I think all of the comments are great and realistic. It would be interesting to visit the patients again to see if this trend continued after the research was complete.
Anna Taylor said:
Even if the numbers on the scale on not moving much, you are doing your body a favor by working to improve your lipid panel. I would let them know it’s okay to want visual results of their lifestyle changes, but looking at the changes going inside of your body can be rewarding too. I would then be sure to sit down with them and look at their energy needs and their typical diet to try to help them find ways to get those results both on the scale and off.
Anna Taylor said:
Anna and Rachel~
You both made really good points—weight loss is just one facet of becoming healthier, and can be a very slow process. This is an important point to press with someone disappointed with overall weight loss after working so hard. However, like Rachel said, increasing fiber intake can make you feel full longer, helping you eat less and, in turn, hopefully see that hard work reflected on both the outside and the inside.
After getting some basic information about the patients reasoning for being more concerned with weight loss than lipid values, I would discuss with the client the importance of both of them. I would emphasize the importance of setting small manageable goals because moderate weight loss is healthy and attainable. I would also educate them on optimal lipid levels and the health benefits as well as risks of not controlling these values. I would associate weight loss with improved lipid panels as well. After building rapport with a client I would individualize a diet tailored to weight loss and improving lipid values pending on their willingness to be physically active and their current diet.
I would say that it is good to lose weight slowly, but we could certainly do some things to speed the process up beyound 1.7kg/12 weeks! I'd help them set up a healthy diet and then suggest they begin exercising. Lowering calories isn't enough; gotta get them moving, too!
you guys are right, certainly it is good to congratulate the client on a job well done thus far and reinforce the importance of a healthy lipid profile.
Amy, I like y]how you emphasized goal setting in your post. Nothing will get done until the person has a goal in min! Good work.
I would recommend this diet in conjunction with other dietary modifications. People are concerned with the numbers they see on the scale, but I think as RDs, we need to be promoting that those are not the only numbers that matter where health status is concerned.
Nicole,
Great point about how the waist circumference was significantly decreased with the whole grain group. As a profession, we should be trying to explain things like how excess abdominal adipose tissue affects other health issues like those that you mentioned. Good thinking!
Anna and Bethany, I could not agree more that positively reinforcing the client for their efforts towards a healthier lifestyle is essential. Motivation in addition to nutrition knowledge will help anyone achieve their goals in a more effective manner than one without the other.
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