:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
Friday, August 06, 2004  

Self-directed education on obesity

I was excited to find out that Alex created his own medical school elective in obesity and nutrition. It's true, medical schools usually do a poor job of teaching students about obesity, nutrition, preventive health, behavioral interventions, and motivational interviewing. I've observed numerous gastric bypass operations, but have not gained much knowledge on counseling patients on obesity, in my medical school education. And given obesity is becoming an "epidemic" in America, it's nice to know that some students are taking initiative to learn more about how we as future docs can work with patients on weight control and loss. Like Alex, I'm interested in working with patients over periods of time to create lasting changes in health (this kind of stuff is what some -- but not all -- of my med student colleagues would call "bullshit" work, not meant for physicians). Alex writes:
The gap between our patients' expectations and the reality of what can actually be accomplished (in terms of long term weight loss) is enormous. Like lemmings, they glom on to the latest dieting trend, be it low fat, low calorie, South Beach, North Beach, East Coast, West Coast, low carb, low whatever, and they end up achieving terrible results -- and end up at a weight even greater than the weight at which they started. I never knew that taking an "obesity history" was so important to the care of these patients. The degree of baggage they carry into their subsequent weight-loss attempts figures prominently into tailoring interventions appropriately.

Mary L. wants to lose 100 pounds, but the reality of it is that she will face a tremendous uphill battle to lose just 28 pounds (10% off of the weight of her 5' 3" frame) in the next 6 months. Managing expectations is a huge part of the health care team's job. We're starting her off slow -- for the next 4 weeks, the only things she's going to do are keep a diary of her eating and exercising habits and walk for 30 minutes a day, 5 times a week. I'm rooting for her.


posted by Anjali Taneja | 8/06/2004 07:55:00 PM | |


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