Transcript What is the Biochemistry / Physiology?

Obesity is Here to Stay and Not Going
Away: How to Discuss This Potentially
Sensitive Clinical Issue with Your
Patients
JEREMY CLORENE, PH.D.
Lead Psychologist
Advocate Weight Management
565 Lakeview Parkway, Suite 102
Vernon Hills, IL 60061
c 847-877-1331
An estimated 97 million adults in the
United States are overweight or
obese. That figure represents more
than 50% of the American adult
population. Of this group, 11 million
adults suffer from morbid obesity
(100 pounds over weight). CDC
Heart Disease Deaths
Each year, about 600,000 people die of heart disease (#1)
Heart Attacks
Per year 715,000 people in U.S. have a heart attack.
– About 190,000 people who have survived a heart attack go on to
have another.
Nearly 8 million people in the United States (3%) have
had a heart attack.
Disability
Three most common causes:
arthritis or rheumatism (affecting an estimated 8.6 million persons)
back or spine problems (7.6 million),
heart trouble (3.0 million)
National Health and Nutrition Examination Survey
(NHANES),
WHY THE TREND?
1970’S “FAT FREE FALACY”
RESULTED IN MORE
CARBS/SUGAR (TASTE)
CARBS/SUGAR ARE YUMMY,
CHEAP, AND ADDICTING…AND
BTW…MAKES US FAT!
What does this mean?
Health decline, disability, financial
impact, social judgment, occupational
impact, discrimination, emotional
impact, interpersonal impact,
chronic negativity
(gender differences on many issues)
What is the Biochemistry / Physiology?
We love sweets, sweets, sweets
Also, Turning off of “full centers” in
the brain
Numbing all other feelings…
Sugar is the great anesthetic!
What is the psychology?
CONVENIENCE...
"I want it easy"
Because the rest of my life
certainly isn't!
Who are we battling?
Billion dollar corporations sole purpose is to get
you to eat…specifically to eat carbs/sugar!
-McDonald’s, General Mills, Boston Market, CocaCola, Mars, Kellog Co., Kraft Foods, H.J. Heinz,
Hormel, Ralcorp, Smucker’s, Sara Lee, Land O
Lakes, PepsiCo, Auntie Anne’s, Dean Foods, Ocean
Spray, Campbells, Smucker’s, Pepperidge Farm,
Frito-Lays, Hershey’s, Nestle’s…
OBESITY…
WHO’S FAULT IS IT?
Not our patient’s!!
But it is their problem
…and ours!
Obese / Overweight People...
STIGMA /
BIAS /
STEREOTYPES
Unfortunately multiple negative stereotypes...
lazy, sloppy, less competent, lacking in
self-discipline, disagreeable, less
conscientious, and poor role models.
Overweight employees may suffer wage penalties,
paid less for the same jobs,
more likely to have lower paying jobs,
less likely to get promoted than thin
people with the same qualifications
Medical Staff...plenty of bias against obese pts
physicians, nurses, psychologists, dieticians,
medical students...
less intelligent, unsuccessful, weak-willed,
unpleasant, overindulgent, and lazy.
No surprise obese patients may avoid obtaining
medical care because of these negative
experiences.
Research shows obese patients more likely to cancel,
delay appointments, avoid preventive health care
services, particularly among women.
DIETS
DIETS
DIETS
WHY DO WE CONTINUTE TO
GO ON DIETS?
• Because Dieting actually works
– You will have weight loss!!
• Average dieter makes 4-5 attempts each year.
• Successful diets last approx. 3 months and
people lose 6-15 pounds.
• But most regain and more!
Then why, then, do we continue to
believe in dieting?
• No matter how frustrating and hard the
process is...
Dieting gives us hope, hope, hope!
• Dieting is seductive, intoxicating belief that
we are just one diet away from changing
our bodies, mood, confidence, health, lives.
THIS RESULTS IN…
ALL OR NOTHING THINKING
AND BEHAVING !!
I’m either avoiding the issue entirely
or jumping in all the way
• WHAT DOES THIS MEAN FOR HEALTH CARE
PROFESSIONALS?
– Pts have had negative experiences…stigma, no success
– Pts have tried to lose many times without success
– Complex issue and not simply about “Will Power”
– Many factors contribute to weight gain and obesity
– Understanding readiness for change is key
– Can’t change “Lifestyle”…can change one behavior
– Small, sustainable weight loss is big victory for health
PATIENT / STAFF
OBESITY BILL OF
RIGHTS
1. YOU WILL BE SUPPORTED AND
TREATED WITH RESPECT, NOT
INGNORED OR JUDGED.
2. MEDICAL STAFF WILL BE
ENDLESSLY PATIENT AND
APPROPRIATELY PERSISTANT.
3. THE MEDICAL TEAM IS A
POSITIVE RESOURCE FOR YOUR
WEIGHT MANAGEMENT
JOURNEY
4. THE FOCUS IS ON SUCCESSFUL
SUSTAINABLE BEHAVIOR
CHANGES
5. IMPROVING HEALTH IS THE
PRIMARY GOAL
Defined as: more active, less
medications, better health markers
such as lower weight, improved blood
pressure / blood sugars, and better
mood
WHAT TO SAY AND HOW TO SAY IT?
First…review “Bill of Rights”
Second…ask questions, let the patient talk…
They may be right!
• "WOULD YOU OBJECT TO DISCUSSING YOUR WEIGHT
AND ISSUES SURROUNDING WEIGHT LOSS?"
• "HOW READY DO YOU THINK YOU ARE IN
ADDRESSING THIS ISSUE?"
• "WHAT HAS WORKED FOR YOU IN THE PAST?"
• "WHAT WOULD YOU LIKE TO DO?"
• "WHAT CAN WE DO TO HELP AND BEST SUPPORT YOU
IN THIS JOURNEY?"
• "WHERE ARE YOU IN THE PROCESS OF YOUR WEIGHT
LOSS?"
• "WHAT DO YOU FIND MOST DIFFICULT IN LOSING THE
WEIGHT?"
• "WHAT DO YOU FIND MOST DIFFICULT IN KEEPING THE
WEIGHT OFF?"
• "IF THERE IS ONE BEHAVIOR YOU WOULD WANT TO
CHANGE WHAT WOULD IT BE?"
• "WOULD YOU OBJECT IF I MADE SOME SUGGESTIONS?"
• "WOULD YOU OBJECT IF WE CONTINUE THIS DISCUSSION
WHEN YOU RETURN FOR YOUR FOLLOW-UP?"
KEYS FOR PROVIDERS:
BE COMPASSIONATE
STAY PATIENT
BE PERSISTANT
EXPECT SUCCESS
BE POSITIVE
BE REALISTIC
…REPEAT…
Goals today:
1. Frame and better understand the problem Obesity: Serious health issue that is not
going away weight management is a
complicated behavioral, medical, and
personal journey.
2. Develop some techniques to better
communicate with our patients Tone is about respect
Ask questions first, suggestions after
QUESTIONS?