Approaches to weight management

Discussions about how to best manage weight occur frequently in physicians’ offices. Patients enter our offices with the desire to lose weight for myriad reasons, from management of cardiovascular disease, diabetes, sleep apnea, osteoarthritis, or gastro-esophageal reflux, to emotional, psychological, or appearance-related concerns. This article provides a brief overview of counseling tools and strategies to help address the complex field of weight management. 

Behavioral strategies
Advising patients to lose weight or to focus on a specific amount of weight loss without outlining a means to this end may be less effective and ultimately lead to patients feeling frustrated. Enter SMART goal setting: specific, measurable, attainable, realistic, and timely or trackable goals[1] for behavior change. The most successful SMART goals are patient-centred and patient-designed; for instance: I will reduce the number of times I eat out at restaurants from 4 to 2 days per week over the next 3 weeks.

It is recommended that patients focus on behavior change and work toward a sustainable and not overly ambitious goal. Keeping a simple log of each day’s eating and activity behaviors can help patients determine where they can adjust their lifestyle for added weight and health benefits.

Dietary patterns
The DASH (dietary approach to stop hypertension) diet has been rated the best overall diet by the US News and World Report for the sixth consecutive year.[2] Evidence shows that in as little as 2 weeks of following the DASH diet, both systolic and diastolic blood pressure can be reduced by several points. Though effects independent of weight loss may be seen, a primary or secondary goal of weight management can also be achieved on this diet.

The primary messages of the DASH diet are:
•    Eat plenty of vegetables, fruits, and whole grains.
•    Include low-fat dairy products.
•    Choose fish, poultry, beans, nuts, and soft/liquid vegetable oils.
•    Limit foods high in saturated fat such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils.
•    Limit sugar-sweetened beverages, added sugars, and sweets.
•    Spice meals with sodium-free herbs and spices.

Though the mechanisms aren’t fully understood, the power players of the DASH diet are calcium, magnesium, and potassium, in conjunction with lowered sodium intake. As with other healthy eating patterns such as the Mediterranean diet, research continues to emerge on the many health benefits of the DASH diet beyond reducing cardiovascular disease and weight.

Practical tools and visuals
Some patients may respond well to a visual aid such as Health Canada’s Eat Well Plate[3] to better understand healthy portions. A variety of healthy-plate visuals have been developed. These visuals are similar in their recommendation that we fill half our plate with vegetables and fruit, and the remainder with meat/meat alternatives and whole grains. The Eat Well Plate also suggests we enjoy our meal with a glass of water or milk/milk alternative. Details can be found on Health Canada’s website.[4] Physicians can also suggest that patients use a smaller plate to be mindful of healthy portion sizes.

Physical activity
Canada’s Physical Activity Guidelines[5] recommend that adults engage in at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week in 10-minute or longer intervals. This amount may need to be increased to 60 or more minutes on most days for successful weight management. A SMART goal example is: I will increase brisk walking from 45 to 60 minutes 5 days of the week.

Prevention
Obesity prevention starts with toddlers and children. It is recommended to plot toddlers’ and children’s weight/height/BMI and identify if they start to cross percentiles.

Monitoring weight can also be done in adults, particularly in patients at risk for weight gain due to medications. It is well established that a loss of as little as 5% to 10% of one’s body weight can have significant benefits for health promotion and disease prevention.

Resources for BC physicians and patients
•    Dietitian services at HealthLink BC (www.healthlinkbc.ca or 8-1-1).
•    MEND (mind, exercise, nutrition, do it) and Shapedown programs throughout BC.
•    SCOPE’s Live 5-2-1-0 program (www.live5210.ca).
•    The Physical Activity Line (www.physicalactivityline.com).

—Kathleen Cadenhead, MD
—Tanis Mihalynuk, PhD, RD
—Margo Sweeny, MD
—Helen Thi, BA

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This article is the opinion of the Council on Health Promotion and has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Mayo Clinic. Weight-loss goals: Set yourself up for success. Accessed 31 March 2016. www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/ar....
2.    US News and World Report. DASH diet. 2016. Accessed 31 March 2016. http://health.usnews.com/best-diet/dash-diet. 
3.    Health Canada. Build a healthy meal. Use the eat well plate. Accessed 23 March 2016. http://healthycanadians.gc.ca/alt/pdf/eating-nutrition/healthy-eating-sa....
4.    Health Canada. What is a food guide serving? February 2007. Accessed 31 March 2016. www.hc-sc.gc.ca/fn-an/food-guide-aliment/basics-base/serving-portion-eng...
5.    Canadian Society for Exercise Physiology. Canadian physical activity guidelines and Canadian sedentary behaviour guidelines. 2012. Accessed 31 March 2016. www.csep.ca/CMFiles/Guidelines/CSEP_Guidelines_Handbook.pdf.