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Focusing on Nutritional QUALITY vs. Quantity

Oct 19, 2010

How many patients do you see that are successful at losing weight, but gain it back? The goal of the nutrition plan is weight loss, and as long as that is occurring, the patient feels rewarded. If their weight loss slows, stalls or rises do they accuse themselves of lacking willpower or of being lazy?

An absolutely delightful patient made an appointment to see me recently due to frustration with her weight. She lost weight on a program two years ago to prevent diabetes, only to gain it back. She claimed it was due to laziness on her part, and unwillingness to spend time in the kitchen preparing food. She is a mother with several children still at home, a full time job, and a dedicated singer in a local and very successful singing group. Now, that does NOT seem lazy to me! Her blood glucose values were rising as was her frustration with herself and her own self management. But the topic always seemed to go back to the regained weight.

Nutrition counseling for patients with pre-diabetes and diabetes so often focuses on weight loss as a primary goal. The patient and provider’s goal is to achieve weight loss to decrease insulin resistance, make movement easier, and to reduce both blood pressure and lipid values. When the weight loss fails, the perception is the diet has failed, and continuing on seems somewhat nonsensical.

I have spent many hours contemplating this challenge, as I am sure many of you have as well. Perhaps the concept of weight loss as the primary goal is flawed. Even though there is efficacy for weight loss, the long term success rate is abysmal. Perhaps the goal should be more basic.

What if the nutritional conversation started with increasing fruit and vegetable intake? Or something else that the patient really has control over.. Perhaps how to incorporate whole grains, starting by mixing them ½ and ½ with white (sandwiches with 1 side whole grain and one side white; noodles ½ and ½ whole grain and white).

What if we provided healthy menu ideas that take little time to prepare in a busy household? What if we talked more about quality than quantity? What if the focus was eating and exercising for health rather than weight loss as the primary target? Would the outcome be different?

Five years from now, would the patient berate themselves for not eating fruits and vegetables? In the long term, would the patient be more successful at achieving their healthy eating goals? Perhaps instead of gradual and continual weight gain, weight stabilization or loss might occur anyway. Have you considered this approach?

What are your thoughts?


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  1. Nov 15, 2010

    I totally agree on the focus on adding veggies and fruits. They are lower in fat/calories and higher in fiber, therefore more filling. Once this habit develops they end up replacing higher fat snack foods that can increase insulin resistance. Come on...Carrots, celery, cuke slices and cherry tomatoes and a piece of fruit are fast foods! Add a little container of humus and you've got an easy meal to throw in the cooler. I tell my patients to just purchase a small veggie tray at the grocery and grab a little of this and that from the tray and throw it in a baggie. There's fast food then there's healthy fast food! This is a message that can also help as a prevention measure and I would love to see this message promoted on a broader level.
  2. Oct 28, 2010

    Thanks Carla for your blog-I agree that focusing on the negative's while trying to loose weight is counter productive. It helps if the patient sets the goals-stating what change they would like to make and then focus on increasing fruits/vegetables/lean protein & healthy grains. By making small changes in meal planning & exercising the benefits are great and patients do not get as frustrated or burned out.
  3. Oct 20, 2010

    I tend to agree with you, Carla. I support patients' weight loss goals but tell patients who are frustrated that we do diabetes by the numbers, and that weight is not the most important number. Achieving one nutrition goal at a time can go a long way toward long term control. The ones you listed are excellent. Thank you for your article.

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