Have you lived this movie time and again?
Over the last two months you’ve enthusiastically taken steps to live a healthier lifestyle or, as you may put it, follow a diet. You’re tackling a host of action steps that might include some of the following:
Are you under the impression, though counter intuitive, that downing diet drinks will add pounds to your hips and scale? The root of this notion stems from several large observational studies, which over the last several years, have fed the media’s hunger for headlines to paint diet beverages and low calorie sweeteners as the dieter’s devil.
Yet, when most experts analyze these observational studies as a group their conclusions, such as those from Pereira, conclude this is “an artifact of reverse causality.”(1) In the case of diet beverages this means that the people in these studies at higher risk for weight gain, obesity and/or type 2 diabetes may be more likely to increase their intake of diet beverages to attempt to reduce their disease risks. It doesn’t prove cause and effect.
Maybe, just maybe, due to one more prospective randomized control study (studies which can test cause and effect) published by Peters, et al., on May 27, 2014, people who wisely count their calories and opt for calorie free vs. calorie and sugar-loaded beverages, will finally be at ease sipping diet beverages.(2)
Just before I departed for a week’s vacation and last blast of summer I spotted an intriguing tweet about the article A Call for an End to the Diet Debate in the August 21, 2013 issue of Journal of the American Medical Association (JAMA). I clicked to the recap in the tweet and was further intrigued. I recognized the name of the first author, Sherry Pagoto, PhD. Ah yes, I follow her on Twitter (@drsherrypagoto).
After arriving at our first home away from home in Asheville North Carolina and enjoying a yummy and healthy dinner of sushi, I sat down to digest the article...and sushi.
It warmed my heart. Thank you Drs Pagoto and Appelhans! I applaud your efforts and absolutely concur with your sentiments. They echo those I penned over a year ago in a blog titled How Much Carb, Protein or Fat? Does it Really Matter for Weight Loss or Keeping Pounds Off? and continue to speak about.
As a dietitian and diabetes educator I know the critical importance of weight control as part of disease prevention and/or control and healthy living. I also know how challenging it is to keep pounds lost ….well, lost forever. It takes inner strength, fortitude, perseverance and much more. Compared to taking the pounds off, keeping the pounds off is THE hard work and it goes on endlessly. Good news is experts say it gets easier over time.
In this blog I’m dialoging with Bob Wilson, a dietetic technician in his day job. Bob was a morbidly obese teenager. He weighed 400 pounds in the 8th grade. He lost 250 pounds over 2 years when he hit 21. He has now kept his weight between 155 and 160 for 39 years. He’s been on a remarkable journey. Through his struggle to manage his weight Bob has amassed many learnings and skills and shares these at his website: balancedweightmanagement.com and in his book "Lighter and Free from the Inside Out". Bob wants millions of others to win “The Biggest Maintainer of Weight Lost” award. He graciously agreed to share.
HW Q: You discuss 12 Essential Skills for long term weight loss/control. Can you list the top 5 and briefly state why they’re most important to long term success?
BW: A: My overarching message: for lasting success discover skill power, not willpower!
A few facts are crystal clear:
- Myriad adults would improve their health status and potential longevity by losing a few pounds. Five percent seems to be the magic number to reap health benfits.
- Two thirds of adult Americans are overweight or obese, including many Medicare beneficiaries.
- Losing weight, even a few pounds, and keeping those pounds off is tough work which requires tenacity.
- Primary care providers (PCPs), including general and family practice physicians, nurse practitioners, physicians assistants and others; aren’t known for addressing or spending the time it takes with clients to counsel them on weight control. (In all fairness, they haven’t been allotted the time until now.)
- Susan Yanovski, MD, in her 11/24/11 New England Journal of Medicine editorial Obesity Treatment in Primary Care – Are We There Yet? (abstract), stated: “less than 50% of PCPs report consistently providing weight-control advice to adults and less than 25% report regularly referring people to other providers who may help them with weight control.”
- It’s well known that PCPs receive a minimumof nutritional science in training and it’s highly unlikely that many have obtained the skills known to be effective in weight management counseling from studies on long term weight management.
Yet despite these facts, on November 29th, Medicare (Centers for Medicare and Medicaid Services) announced in their Decision on Intensive Behavioral Counseling for Obesity that it will start to cover obesity counseling services when provided by PCPs (as defined by CMS).