Over the years, Robert Kushner has seen many obese patients get "tripped up" trying to keep pounds off because they rely on fast food, juggle too many tasks and dislike exercise.
So Kushner, an obesity expert, began helping patients plan diet and physical activity around their lifestyles and habits.
"We don't necessarily put people on any specific diet; it really gets to what is their life, what are their struggles," he said. "We believe obesity care can't be inconsistent with culture, family or how you lead your life."
He recently suggested that a patient split meals with his wife when they dined out, rather than each having large portions or avoiding restaurants entirely. When the man said he was uncomfortable sharing a meal with his wife when the couple was out with friends, Kushner said to do it anyway.
"I said, 'It's a strategy that works whether you're with other people or not. . . . Be assertive,' " said Kushner. "I think people don't think about it because they just aren't raised to share."
The patient kept track of the foods he was eating, learning to avoid larger portions and fattening dishes. He has lost 15 pounds in six months, cutting about 500 to 700 calories per day.
More than a third of U.S. adults are obese, according to a 2015 report from the Centers for Disease Control and Prevention.
Kushner, who directs the Center for Lifestyle Medicine at Northwestern Medicine in Chicago, said he realized in the 1980s that obesity was a looming problem. He started combining diet, nutrition, exercise and behavioral changes into a plan for patients.
Since then, "what's changed is the maturity of the area, understanding more about the effects of stress and sleep on body weight, and some of the behavioral-change techniques have expanded," he said.
In addition to promoting good sleep habits and stress management techniques such as meditation, Kushner and his colleagues suggest bariatric surgery for patients with a body mass index of 40 or more and for some who are less obese but who have medical problems such as Type 2 diabetes, sleep apnea and heart disease. They also recommend medication for patients with BMIs as low as 30 who have additional medical problems or have failed to lose weight despite lifestyle changes.
While studies haven't generally proved that lifestyle changes are effective for weight loss, Kushner said patients often have trouble shedding pounds unless problems like stress are managed.
Kushner's approach proposes gentler, moderate changes. Rather than tell patients to cut out every unhealthy food they love, Kushner suggests focusing on alternatives with higher fiber and water content but fewer calories. (Think beans, vegetables, salads, fruits, broth-based soups and whole grains such as oatmeal.)
For the couch potato who finds exercise overwhelming, Kushner advises walking for short periods, building up to three 10-minute brisk walks daily to "boost your energy level and mood while you also burn calories."
He also suggests that dog owners walk their pet for 30 minutes daily rather than leave Fido in the back yard. Kushner found that dog-walking helped overweight and obese people lose weight in a study, and he wrote a book about it - "Fitness Unleashed!: A Dog and Owner's Guide to Losing Weight and Gaining Health Together" - with veterinarian Marty Becker.
"I call it an exercise machine on a leash," Kushner said. "It is a way for people to think about moving their body around in a fun way."
Most of his patients lose about 10 percent of their body weight (some more than 20 percent) after six months and keep it off during the program, Kushner said.
"Patients say they feel understood and more motivated as they are given personalized direction to make positive changes in their lifestyle," he said.
Kushner created a questionnaire to screen patients for traits that prevent weight loss - such as eating what's convenient rather than planning healthy meals or having an all-or-nothing mentality - traits that Kushner and colleagues found in a study to be strongly linked with obesity.
"Once you take the quiz and know your factor type, I can personalize a plan to help you lose weight and keep it off," Kushner said.
Another way Kushner hopes to help patients tackle obesity is by teaching medical students about treating and preventing it. He found in a recent study that the U.S. Medical Licensing Examination was focusing much more on diagnosing and treating obesity-related illnesses, such as Type 2 diabetes and sleep apnea, than on how to counsel patients on diet, physical activity, behavior changes, the use of medications and bariatric surgery.
But Kushner said his approach isn't only about weight loss.
"We know that as little as 5 to 10 percent weight loss will improve the health and well-being of individuals and can also improve blood sugar, blood pressure, the fats in your blood, arthritis or reflux symptoms, as well as your mood and energy level."
The Washington Post
Sat Sep 02 2017
Kushner said patients often have trouble shedding pounds unless problems like stress are managed.
Iran's supreme leader says Hamas leader's death will not halt 'Axis of Resistance'
The "Axis of Resistance", built up with years of Iranian support, includes Hamas, the Lebanese Hezbollah group, the Houthi movement in Yemen, and various Shi'ite groups in Iraq and Syria.
Putin says Russia willing to seek compromises between Iran and Israel
Russia is ready to help seek compromises between arch-foes Israel and Iran, President Vladimir Putin said on Friday, saying these would be difficult but possible.
What proposals will Russia push at the BRICS summit?
The proposal is also to establish a BRICS reinsurance company to allow uninterrupted shipment of goods and key commodities between members.
Indonesia's free meals plan in the spotlight as Prabowo readies for office
Prabowo calls the programme one of the main drivers of economic growth, eventually set to add an estimated 2.5 million jobs.
Astro AWANI's revamped English news website, AWANI International, launches on Oct 21
Astro AWANI's revamped English platform delivers in-depth global news and expert analysis to keep you informed on key developments.
Israeli strikes kill 33 people in Jabalia refugee camp in Gaza, medics say
Residents of Jabalia said Israeli tanks had reached the heart of the camp after pushing through suburbs and residential districts.
Liam Payne's ex-partner calls for media restraint after 'painful' death
Cheryl Tweedy used her statement to urge the media to remember they had a seven-year-old son, Bear, who could read the reports.
Analysts: Indonesia's strong MoF leadership team to boost investor confidence
Sri Mulyani Indrawati as head of Indonesia's Ministry of Finance is expected to instil confidence among investors.
Biden offers both a carrot and a stick to Israel as his term nears an end
Israel has frequently resisted US advice and has caused political difficulties for the Biden administration.
Putin says BRICS will generate most of global economic growth
Russian President Vladimir Putin will host a summit of the group in the city of Kazan on Oct. 22-24.
ISIS Malaysia's perspective of Budget 2025
An excellent rakyat-centric budget under the overarching principle of a caring and humane economy.
Budget 2025: Record increase in STR, SARA aid initiatives
The government will provide a significant boost to the Sumbangan Tunai Rahmah (STR) and Sumbangan Asas Rahmah (SARA) initiatives next year.
Budget 2025: EPF contributions to be made mandatory for foreign workers – PM Anwar
The government plans to make it compulsory for all non-citizen workers to contribute to the Employees Provident Fund (EPF).
What policies to expect from Indonesia's new President Prabowo
Prabowo will be open to foreign investment, his aide has said, such as by offering investors management of airports and sea ports.
Budget 2025: Govt allocates RM470 mil to empower women's participation in PMKS
The Women's Leadership Apprenticeship Program will be intensified as an effort to produce more female corporate personalities.
Israel sends more troops into north Gaza, deepens raid
Residents of Jabalia in northern Gaza said Israeli tanks had reached the heart of the camp, using heavy air and ground fire.
Indonesia ramps up security ahead of Prabowo's inauguration
Prabowo Subianto will be sworn in as Indonesia's president on Sunday with Vice President-elect, Gibran Rakabuming Raka, also taking office.
Immediate allocation of RM150 mil for local authorities, DID to tackle flash floods
Datuk Seri Anwar Ibrahim said this allocation is intended to address the recent flash floods that hit the capital and several major towns.
Budget 2025: Sabah, Sarawak to continue receiving among highest allocations - PM
Sabah and Sarawak continues to be prioritised under Budget 2025, with allocations of RM6.7 billion and RM5.9 billion respectively.
NFOF will be operational in November 2024 with funding of RM1 bil
PM Anwar Ibrahim said NFOF will support venture capital fund managers to invest in startup companies with RM300 million set aside for 2025.