To aid patients in losing weight, think small.(Clinical Rounds)

COLORADO SPRINGS -- When it comes to helping patients manage overweight and obesity, the best strategy is to focus on small, concrete, readily achievable goals, Dan Bessesen, M.D., said at a meeting of the Colorado Chapter of the American College of Physicians.

Behavioral scientists insist that the key to lasting behavior change is mastery of a series of modest but measurable goals, added Dr. Bessesen, head of the section of endocrinology at Denver Health Medical Center.

He suggested ways to address the obesity epidemic in a busy primary care practice, including these:

* Put a BMI in every patient's chart, and measure waist circumference selectively. The strongest recommendation contained in the most recent update from the U.S. Preventive Services Task Force is that every adult should know his or her own body mass index and its implications for disease risk. Waist circumference is most helpful in those with a BMI of 25-34.9, since in that range a waist circumference greater than 40 inches in men or 35 inches in women indicates higher disease risk than in a trimmer-waisted person of the same BMI.

"One strategy in your office would be to train your check-in staff to do a BMI in every patient, and when the BMI is 25-35, you have them do a waist circumference," Dr. Bessesen said. "When people lose weight, the waist circumference can be one of the first things to move. It can then become something that makes the person feel like they're making some progress."

* Be realistic about treatment options. Diet and exercise typically provide a modest 3%-5% weight loss; that's medically useful in terms of reduced risk of diabetes and other chronic diseases, but most patients want to lose much more. Drug therapy on top of diet and exercise gives an additional 5%-8% weight loss. Surgery yields a 20%-30% long-term weight loss, but with substantially greater risk than diet, exercise, and drugs. Explain that whatever the patient decides to do to lose weight, it will need to be done permanently--or at least for as long as the patient wants to keep the weight off.

* Read some popular diet books. "I used to resist diet books. I kept them at arm's length. I thought they were for people who are stupid and gullible. It's always dangerous to think that way. Now I realize they're being bought by people who want something more intensive than I can give them in 10 minutes, and they're finding it in a book. Who am I to ...