The Importance of Being on the Same Page

No doctor is perfect. My guess is that orthopedic surgeons are as tired of talking about the importance of weight loss and exercise as I am to what seems to be deaf ears. Worse, it’s unprofessional to complain about other specialists[1], but my last two weeks have been a bit frustrating. 

  • Patient was seen two years ago with “mild arthritis” in a joint. She was told by two orthopedic specialists that she didn’t need surgery. Neither of them recommended physical therapy or for that matter, any movement whatsoever. Apparently that’s what she didn’t do–move (or so I’ve been told by a friend). Now she’s scheduled for a joint replacement having never been offered the option of physical therapy. I cannot help but think her inactivity accelerated her joint problem.[2]
  • I encourage my patients with knee and hip pain to exercise and especially to lose weight. If I send them to an orthopedist they come back to me and deny that the orthopedist recommended weight loss. I think they just didn’t hear what they don’t want to hear but many times, there is nothing in the referral note indicating that they were told to lose weight. 
  • Last week two patients came to me after they saw their orthopedic surgeons asking ME to send them to physical therapy. Why? Because the surgeon didn’t recommend it. 
Several years ago a friend of mine was sitting in an orthopedist office. After looking around the orthopedic’s waiting room, she began a diet and exercise program the next morning. She told me “Except for the athletes, every person over 50 in that office was at least 30 pounds overweight. How can you miss the message there?” At that time she was in her early forties. Now ten years later she has kept the 10 pounds she shed off and exercises at least four times weekly.

Day in and day out I understand how frustrating it is to try to motivate patients to exercise and lose weight. Many of my orthopedic colleagues DO emphasize these things and my sense is that they are improving in that regard. In a society where obesity is ever more the norm, we’ve all got to be on the same page to help patients make changes, especially if you are the expert in the patient’s eyes.[3] 
1. http://well.blogs.nytimes.com/2013/07/11/doctors-badmouthing-other-doctors/
2. http://www.mayoclinic.com/health/arthritis/AR00009
3. http://www.news-medical.net/news/20130411/Orthopaedic-surgeons-should-recommend-weight-loss-to-patients-prior-to-joint-replacement.aspx
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Weight loss

Sometimes the bane of my medical practice day is talking to patients about weight loss. I hate it. They hate it. I dread it. They dread it. My medical assistant tells me how a patient will get on the scale and sigh, then say “Dr. Nieder is going to yell at me.” Now truth be told I do NOT yell. But I do try to be consistent with my advice and not ever let an obese patient leave the office without hearing that they would be better off to lose weight. With the overweight patients I try to encourage them to stop gaining weight now before it’s too late.

It’s not as painful with the patients who understand that one can’t gain weight on air, that too much intake and not enough exercise is why they are gaining weight. And it is harder to lose it as the years mount up. In my twenties if I wanted to lose five pounds I would just not eat much for a couple of days. For the last ten years I’ve been battling the same ten pounds. Five pounds will disappear with lots of effort and the minute I let my guard down, BOOM, the pounds have returned. It’s very frustrating. Losing five pounds takes a month of concentrated effort and I HATE IT! It is unimaginable to think of needing to lose 100 pounds.

So I can commiserate with patients who are frustrated but what I can’t do is go home with them or go to the grocery store with them. Honestly, it would be a helpful and educational thing to do, for both of us. I stand in line behind 220+ pound people at Kroger’s and look at the contents of their baskets. What do I see? “White mushy bread??? 4 cases of soft drinks. Hot dogs (eeeww!) Whole milk. Hamburger helper. Canned vegetables. Cap’n Crunch (I LOVE Cap’n Crunch but I NEVER buy the stuff). Potato chips. No fruits or vegetables unless they are in cans, no whole grain anything, lots of processed foods and all dairy products are full of fat. Seriously?

Yes, it’s hard for me to lose those five pounds but I suspect the glass of wine in the evening, the french fries I had for lunch, the con queso I had for dinner last night or the peppermint bark cookie I ate for a late night snack may have contributed to the problem. Your hormones, your thyroid and your mother-in-law did not cause your weight gain. Your diet did. Your lack of activity made it worse, but it is what you put in your mouth that caused the problem. The sooner you can face that and move on, the easier it is on everyone. Tell me that you know you need to lose weight and that you are your own worse enemy and I can empathize. Tell me that you NEVER eat anything, that you’ve been starving yourself for years and it’s very hard for me to help you. No controlled study has ever backed up any claim that people gain weight on air.

People want a “kick start” with pills which occasionally I will acquiesce to. Nine times out of ten, this helps them to lose about five pounds and then they stall out, quit the pills because they are also not the quick fix they’d hope for and five months later they’ve picked up another five to ten pounds.

After 20+ years of practice I can agree that diets really don’t work. Only life-style changes do. Or sometimes, a gastric bypass or similar surgery. When patients ask what the best way to lose weight is, I tell them Weight Watchers because it is a lifestyle change. It is the most successful weight loss program I can attest to after all the years I’ve been in practice. People who stick to it, lose. Not 20 pounds a month. Sometimes not even five pounds. But consistently over months, the weight comes off. Add a good six days a week exercise program and suddenly people feel great and look great. BUT, it is HARD work. Very hard work. Of course most good things in life are hard work.

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