Monthly Archives: January 2014

New Obesity Guidelines – A Gift or a Burden for Wellness, Weight Loss, Integrative and Preventive Medicine Providers

The new obesity guidelines aren’t complicated, but they’re really important, for every practitioner (medical doctors, osteopaths, chiroractors, physician assistants, nurse practitioners), in every discipline of medicine: family practice, OB/GYN, weight loss, holistic, integegrative, functional, anti-aging and endocrinology, cardiology, bariatric or diabetes management, to name just a few.

So, in a recent webinar, we unpacked the new Obesity Guidelines and asked the question: “Are these guidelines a gift? Or a burden?”

Actually, they’re both. You can watch the webinar replay here and find the transcript below the video. Share it, comment, enjoy.

So, we’re going to explore briefly

– What the Obesity Guidelines are. And then,

– What the Obesity Guidelines MEAN for EVERY medical and wellness practice.

– We’ll also cover how to attract and keep more patients by leveraging better weight loss care with LESS work through automated follow up as well as using a Directed Care Path for better, sustainable outcomes.

– I’m also going to address how you can increase the patient life cycle as a customer for additional revenue opportunities and how available technology can make all of these things happen with you actually doing lesswork than you’re doing now.

First of all, I want to thank all of you who joined us today.  I know it’s a busy holiday season, but we’ve been overwhelmed at the interest in this topic as doctors prepare for weight loss season, so there are a lot of you on the call today.  To avoid audio problems, I have everyone on mute but I do want your questions.

If you have any topic you would like covered during this webinar, please send an email at any time to info@bodysite.com and we’ll try to cover it during the webinar. If we cannot cover your question during the webinar, I’ll reply to your inquiry when we’re finished.

Again, if you’re just joining us, my name is John Cummings and I am the founder of BodySite Wellness.  I have worked with hundreds of medical practices in the areas of patient education and marketing since 1998 and wellness is a passion of mine. So let’s get started unpacking the guidelines and what they mean for your practice.

First of all WHAT ARE the Obesity Guidelines and why should you care?

Well, The Guidelines were jointly issued in November by the American Heart Association, the American College of Cardiology and the Obesity Society in a call to action to get doctors to give better care and address the growing overweight and obesity problem. This all happened at the first ever Obesity Week conference.

What the issuance of the guidelines makes clear is that doctors, more than anyone else, are on the front line of the obesity epidemic and in possibly the best position to get people to lose weight.

According to the writers of the new guidelines, the focus of them is to help primary-care providers address weight management as a pathway to promoting the health of their patients.

And this explains part of my headline today. No matter what kind of doctor or practitioner you are, YOU are a weight loss doctor. If you’re an OB/GYN, a cardiologist, an endocrinologist or a chiropractor, you’re seeing patients every day that are overweight. You are a weight loss doctor. In other words this is your burden.

Sadly, very few other people, if any are going to help those patients. And it’s with great respect for the medical community that I say that doctors SHOULD feel burdened with the weight of this responsibility.

And this goes beyond the oath to “do no harm”.  In a sense, what these guidelines represent, is an urgent call to action, by at least three prominent and respected medical organizations, for doctors to do more.

But the guidelines are also a gift, to both doctors and patients. Because they provide clear guidance on what needs to be done to start reversing the rising tide of obesity They also provide an evidence-based opportunity to leverage some simple solutions to medical conditions that can help you attract and keep more of your patients.

First, let’s look at some facts we can’t ignore. Obesity is spiraling out of control. You’ve heard that this was coming for years but now it’s here and getting worse.

Obesity has gone from a pretty serious 27.5% of the US population to 35% in just 10 years.  And it’s only getting worse. It’s projected to be as high as 43% by 2018. That figure is staggering but possible because of the fact that 18% of our children are obese right now.  That should shock the conscience.

And the cost of obesity is rising with the tide.  From $144 B in obesity related costs this year, a continuing trend would put that number at $344 B by 2018.  That just can’t happen.

One of the first things to realize is that there’s not point in trying to figure out what when wrong or who is at fault except to use that as a jumping off point to the new recommendations. We can blame restaurants, food companies, even health insurers and doctors or point fingers at patients but what’s really needed is a change in focus.

Doctors on the front line of this battle need to educate patients, help to prevent people from slipping into obesity, reduce the overweight of those already there and support maintenance of that weight loss.

So how do we do that.  Well, let’s look at what’s being recommended.

If it’s that simple why has obesity become, as the American Medical Association labeled it earlier this year,  a chronic, relapsing disease?  Maybe it’s because our playbook was out of date.

Some it stems from patients not having enough education or information about the right choices to make combined with the overwhelm of unfocused information available on the internet. Patients just don’t know what to do every day.

From the provider side, doctors are often not equipped to promote behavioral change and have unrealistic goals for patients based on what can realistically be expected. Overweight is often pushed aside as someone else’s challenge and often very few patients are given any information to deal with it. If they are, there’s often simply not enough ongoing support because of a lack of effective and available tools to educate and provide the support.

I’m only going to get technical for a moment about the guidelines, because the gift of the guidelines is that the solution is pretty straightforward and really just common sense. OK, first, doctors should continue to use the Body Mass Index (BMI) to identify who may need to be counseled to lose weight.  Use waist circumference as an indicator of risk for type 2 diabetes, cardiovascular disease, and all-cause mortality.

Calculate BMI at least annually

And realize that bariatric surgery may be indicated for BMI over 40 (of 35 or more with comorbidities)

Second, in a departure from the 1998 guidelines, the BMI cutoff for treatment is now a BMI of 25 or more with just 1 comorbidity.  And elevated waist circumference can be one of those comorbidities.  Previously, a BMI of 25 or more was only a concern if there were also 2 comorbidities.

Third, even modest weight loss is good. Doctors should not abandon hope when patients lose even a small amount of weight.

Whereas most studies recommend a goal of 5% to 10% of weight loss.

Clinically meaningful health improvements can be seen with weight loss in the range of 2% to 5%.

OK, so let’s get practical.  Here is the gift of the guidelines.  The starting point for weight loss is actually really simple: lifestyle change.  And the most effective approaches include diet, physical activity and behavioral counseling

And this is where I want to provide the most practicaladvice from the guidelines.

You don’t have to get hung up on ONE particular eating plan. The evidence indicates that no one particular eating plan is recommended over any other.  There is no ideal diet for weight loss and there’s no superiority for any of the diets that were examined.

That’s right.  These organizations studied 17 weight-loss diets and found none of them superior to another except that patient preferences and patient health status should guide the choice.

And the central theme of the new recommendations is acknowledging that patients need more help to lose weight.  What the writers of the guidelines concluded is that telling patients they need to lose weight and advising them to loseweight is not enough. Although some patients are successful, most are not — they really need help to achieve the skills to produce and sustain that energy deficit.

Now, here’s the hard part. The “gold standard” for helping patients lose weight is behavioral counseling. In other words, actually providing advice on how to increase physical activity and reduce calorie intake for at least 6 months or longer as part of program with a qualified healthcare provider including web-based or even some commercial programs.

Obviously, the most effective behavior change programsinclude frequent face to face contact for at least 6 months but depending on the price you can charge your patients, there is likely only so much time you can spend with the patient and what the guidelines expect is continuous andfrequent patient communication.

Do the guidelines ask too much?  Is it feasible, due to time constraints and cost, to have you or your staff interacting with patients as often as everyday.  Probably not.  But can you imagine what a difference you could make in the lives of your patients if you COULD give patient advice, chosen exactly for them and delivered as often as daily? Timely advice that they actually receive each day as an affirmative interaction from you or your staff.

If you can’t justify the amount of care for the cost of staffing it, a web-based automated, education, follow up and support system can do most of the heavy lifting for you.

NEXT SLIDE

In Addition to Face to Face Encounters, You can use a cloud-based, smartphone and web accessible portal to Provide Daily or Periodic:

Support

Information

Advice

To patients that is specific to them.

Unlike the sometimes less than meaningful information available in an EMR, you should maintain an online library of programs:

•             Exercise

•             Diet

•             Lifestyle

•             along with Meal Plans and

•             Physical Activity Recommendations

and provide tools for patient feedback  . . .

Use a Mobile Ready and Web Accessible:

•             Food Tracker

•             Weight Tracker

•             Measurement Tracker

•             Allow your staff Real Time Cloud Based Access to Patient Feedback Metrics

Look, you may be giving patients printed materials or sketches of exercises to do but the truth is, people don’t want more paper, more DVD’s and more information to lug around with them. They just won’t do it and they won’t follow it. But there is one thing that every one of your patients IS carrying around with them, almost every minute of every day.  Go ahead, say it.   Exactly it’s a smart phone or an iPad.

Story about Bethesda health

The reality is that most practices don’t have a meaningful way to interact with patients about their care.  I mean the EHR / EMR meaningful use push is supposed to do that but there’s really nothing meaningful or useful about most of the information patients can get from those platforms.

So patients go elsewhere or are even told to go elsewhere for additional support, exercise, diet alternatives.  Weight watchers online and Jillian Michaels and Livestrong.com are making it expected that patients should have access to information, support and tracking as a supplement to their care.

But why send them to other sites for this?  And if you already have a program like HCG or other medical weight loss, what should patients do when they finish the program to avoid falling back into old habits or regaining the weight?

The truth is that if you want patients to follow YOUR care, your advice and get your support, you need to be able to provide all of these things.  Although you wouldn’t have believed it ten years ago, its what patients want and in a year or two, they won’t settle for anything less.  They’ll find a provider who does offer a comprehensive solution, that they can access on their phone, on their table, on the laptop.

Now I know many of you have a protocol, like HCG. Many don’t and want to add one. And even if you have one or more programs, you could probably use some help with adding additional support and programs for the long term when patients want more exercise, alternative diets and follow up care.

Well this is why we created BodySite Wellness. It does all of the things I’ve just covered and I want to show you how other practices like yours are using it to improve what they deliver in their office every day.

 

Man Loses 37 Pounds and Lowers Cholesterol Eating at McDonalds for 90 Days – A Lesson for Healthcare Providers

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Have you heard about the Iowa teacher who lost 37 pounds in 90 days by eating only food from McDonalds?  It’s hard to believe but it’s instructive as to why your patients often fail to lose weight or keep it off. Here’s a quick run down:

An Iowa science teacher, John Cisca, ate everything at McDonalds every day for 90 days: from Big Macs to salads to sundaes to shakes to quarter pounders. But something was very different than the story in the “SuperSize Me” documentary (where the participant gained alot of weight).

The first difference is that Cisca didn’t pig out. He ate 2,000 calories per day and balanced the intake of nutrients based on the FDA’s reference daily intake tables by combining different items from the fast food chain’s menu.

So you can’t say “well he went to McDonalds and he only had the salads. No, he had the Big Macs, the quarter pounders with cheese, sundaes and ice cream cones.”

The second difference is that Cisca started to walk 45 minutes a day, like any normal human being should do.

The results: his weight dropped from 279 pounds to 242. The overall cholesterol level went from 249 to 170, while his bad cholesterol dropped from 173 to 113.

Should you put your clients on Cisca’s McDonald’s Diet? Certainly not. Losing weight by eating at a fast food chain for 90 days would not be considered good practice for anyone to recommend, much less as a medical weight loss solution. But the tale is instructive of a basic tenet that is often overlooked in fitness and unfortunately, even by health care providers engaged in preventive medicine.  Patients need to be told what to do.

Learn how to put patients on an automated, directed care path that works

Losing weight and changing lifestyle is about making good choices. So why do most people fail to make the good choices? Are they ignorant? Are they lazy? Well maybe in some cases but for the post part the problem is that they don’t really know what choices to make in a sea of information. Most people won’t find their elbow from their ankle if you leave them to figure out what to do in the information age.

Are you sending patients to internet websites to figure out what to do, eat, track? Do you tell patients they ought to lose weight but don’t give them exercise advice? Are you sending patients home with printed materials that they don’t read? Do you know what patients are actually doing between visits?

Patients need a specific plan for every day that keeps them on task and they need to actually be told, DAILY, what their plan for the day entails. The problem is most doctors don’t have the time, or want to spend the time, to give advice to patients everyday. How is that even possible?

Well, it’s possible if you realize that you don’t need a perfect plan, just a plan that has been demonstrated to work for a great number of people. And you don’t need to have 100 plans to choose from. Practices that offert their patients a laundry list of diets to choose from have patients that have just another excuse not to make up their minds.

Put your patients on a directed care path by specifying what they should do each and every day for the next 30, 60, 90 or even 120 days. If you’re wondering how that’s possible, be sure to check out the cloud-based patient intervention and directed care path platform at BodySite.com.  The platform literally automates nearly every aspect of follow up care in virtually any medical setting and is ideal for hundreds of structured medical protocols involving weight loss, anti-aging, preventive medicine and treatment plans before and after surgery and any medical procedure.

Stop leaving it up to patients to fill in the blanks. Even if you have a protocol, do your patents really “get” it when they leave the office?  If you’re not sure, check out this video about a solution that ensures your patients not only “get” it, but get it daily, from you exactly as you want them to.