Advice to Patients Dealing With Weight Regain
By Kevin Suttmoeller, MD
Just ask anyone who has ever tried to lose weight: losing weight can be hard, but keeping it off is often the more challenging.
In fact weight regain has been shown to happen frequently after weight loss. As part of the chronic disease of obesity, patients are known to struggle with their weight for years. Some will even undergo weight-loss surgery to assist with weight loss, only to have some of their weight return. Regaining any weight lost can often be devastating. The enthusiasm that builds up from watching the scale trend downwards encourages one to closely follow the prescribed diet. After several years this enthusiasm wanes and slowly the weight comes back. This of course does not happen to all patients, but for those that experience weight regain there are steps that can be taken to slow or halt weight gain and encourage the restart of weight loss.
When patients first approach me about their need to lose weight, I always ask if they know why they have gained weight. Although patients may not realize it, this one question helps me to identify how much insight they have into their own health. Sometimes patients can tell me exactly what has caused their weight gain, while many others seem to have no idea how this has occurred. Then my next step in getting patients back on track is to ask them about their previous day’s meals. This will often give me insight into their daily routine. Often foods of little nutritional value have managed to work their way back into their diet. Associating a ‘caloric value’ to these foods can be impressive and informative to patients. To help improve awareness I also ask patients to start a comprehensive food journal. These are reviewed at follow up visits to see if the suggestions and substitutions that have been made have been effective. Food journaling can often encourage more healthy dietary habits and point out behaviors that may be keeping patients from their goals. The most common problems I see are increased amounts of processed foods, excessive carbohydrates, liquid calories, increased portions and more frequent dining out of the home. I also ask about added calories such as salad dressings, catsup, gravies and butter and attempt to make more palatable substitutions to remove these often high calorie foods. I also ask patients to include additional information into the food journal such as emotional eating, boredom eating and mindless munching to look for additional eating triggers.
I also provide general recommendations and guidelines for dietary selection. Getting back to planned meals each day, eating protein with each meal and improving vegetable consumption can often get patients back on a healthier track. Patients often report that protein makes them feel full. As satiety is important to weight loss and weight maintenance, this helps patients feel more satisfied between meals. I also generally recommend that patients decrease the amount of processed wheat products, potatoes, corn and corn products, rice and sweets in their diet. Last but not least, I recommend against liquid calories. The addition of fruit and vegetable juices, fancy coffee drinks, smoothies or protein shakes just adds calories to one's daily intake. So although popular, beware of these extra calories.
At the patient encounter I also take the opportunity to review the patient's medication list to determine if any of the medications prescribed are known to have a side effect of causing weight gain. I can usually make some sort of substitution recommendation to the medication list that is known to be more weight neutral.
Some patients will request a weight-loss medication prescription such as phentermine to assist with weight loss. I closely monitor patients not only because they are on the medication but also to improve their accountability. This also may improve weight-loss. There are new medications on the market for weight loss such as Qsymia® and Belviq®. These medications have to be closely monitored by your physician.
If you are experiencing weigh regain, make an appointment to see your medical team. They can help you to refocus, reengage and restart the weight loss process to ultimately be more successful at life-long weigh control.