Tuesday, 18 February 2014

Saying what no one wants to hear.....weight maintenance

As a dietitian most, if not all of my clients want to lose weight. I would even guess that most people I know want to lose weight. It does not matter the reason, nor does it really matter how much they actually weigh- many people want to change it, regardless of the healthiness of their weight. So, how do I go about suggesting that they should abandon their goals/dreams/hopes? Very carefully.
For some people, maintaining their weight rather than losing weight may be the healthiest option- both for the mind and for the body. This applies both to healthy weight people and - yes- people who are labelled as overweight or obese. Many studies over the last 10 years have shown a weak link between being a fit heavy person and development of diseases. So the age old statement of "I want to lose weight to be healthier" is no longer relevant. The act of losing weight may not have an impact on health if blood pressure, blood sugar, cholesterol levels, etc do not actually improve. This may happen if these risk factors are already in the normal range or if an unhealthy approach to weight loss is taken. Not to mention any psychological issues that can arise from dieting! (guilt, deprivation and shame do not help anyone eat healthier!)
So, how does a dietitian broach the subject that weight maintenance may be the best bet for a client? I have had this discussion a few times recently and despite their differences, each client's situation was eerily similar. My first client was a gentleman who has been struggling to lose weight through exercising more and calorie counting to try to eat less. He has found a nice balance between feeling hungry and eating just enough so that his cravings for certain foods has decreased. With less hunger, he can focus less on eating and more on work/life/family. He has been maintaining his weight for the last 2 months. He feels he cannot dedicate more time to exercising nor can he imagine eating any less (or changing much about his food choices)- but he wants to lose weight. Unfortunately, there is no magic trick I can pull out of my hat for him. Instead of following the same old dietetic approach of offering advice on eating more fibre, less dense foods, etc, I decided to listen to what he was really saying. Reflecting back to him this conundrum and pointing out the facts that he just mentioned (not possible to change exercise or eating),  I helped him come to the conclusion that maybe maintaining his weight right now is the best option. It is a good option because anything else may lead him to further frustration.
The other client was in a similar position except her family and work obligations meant she could not spend any more time exercising. She already was very conscious of what she ate and could not dream of eating less or being more careful.
Neither person was putting their lives in danger by maintaining their weight. In fact, by realistically maintaining rather than unrealistically losing weight and likely putting it back on, they are actually healthier.
Sometimes the role of a "Diet"itian is to give clients permission to maintain weight rather than take jabs at their weight like so many others do.

1 comment:

David said...

Hey Lisa, I appreciated reading this. I completely identify with this! Cheers, Dave

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