The year before last, my patient Kevin had a heart attack. Last year, he lost 18kg using the products of ‘A Big Weight Loss Franchise®.’ But last week, he was 5kg heavier than when he started!
I seem to be having a lot of conversations with patients about weight loss. We really want them to think about being fitter – many are only concerned about being fatter.
People, including health professionals who should know better, promote one fad after another. It is frustrating to see our patients lose weight, only to find that after some months they are bigger than before they started – and with less cash in their pockets.
It is no surprise that any diet people choose seems to work initially.
The book “Perfect Mess” describes the series of studies undertaken at the Hawsthorne plant of the Western Electric Company. These studies demonstrated that worker output improved when any change was introduced. Even meaningless changes had an effect – like turning the lights up and then later turning them down. People tend to work harder when they know they are being observed. It is the clipboard that matters most.
Successful weight loss, of course, as our colleague and GPSpeak medical editor Andrew Binns points out, requires the motivation to commit consistently to healthier choices.
It’s a pity it’s not as easy as Dr Rudi’s diet – “Eat less” or even the advanced diet “Eat less, do more”.
It requires sustained behaviour change.
I have been trying to track down a picture book I once owned about a land in which the king had to be able to jump to the very top of the castle. When it became time for the king to retire, he sought someone who could take his place. One little boy started at the bottom, and jumped one step by one step till he reached the top. In time, this wise boy became the new king.
In the collaboratives we have learnt about successful change management – incremental change, measuring what you’re doing, being systematic, being creative.
I am sure that using these principles we could collectively come up with a GP-based program that promoted genuinely healthier lifestyle changes, as well as sustainable weight loss.
We have excellent baseline resources to use like Lifescripts, Andrew’s series of articles in GPSpeak, and a lot of collective knowledge about behaviour change. Of course we will call our program by some fancy name. I’ll use FancyName® for the time being for illustrative purposes.
I imagine it works like this.
Kevin has heard of FancyName® and comes to see us, his GP, about weight loss. We chat about aims and goals and enrol him in the GP collaborative healthy lifestyle program, FancyName®.
We perform some baseline measurements and then give him a FancyCard®, which has on it the one change he is to make that week. This change is easy.
Perhaps week one he has to measure his weight each morning and night. (He finds his weight varies enormously – the lesson being that he shouldn’t take any notice of small fluctuations up and down and that weight is not the best way to monitor health and fitness).
He returns next week and sees the practice nurse, who gives him a pedometer and another FancyCard®, which suggests that he measure his steps each day.
When he sees us in week three we give him a new FancyCard® that suggests he have a fibre cereal each morning.
(I’m not an expert on weight loss, unlike Andrew, who has written ‘The Expert’s Guide to Weight Loss’. I think that there were three key factors shared by people who successfully lose weight – they have breakfast each morning, exercise every day and have a low fat diet.)
Week four he has to increase his steps by 1000 each day. Week five we introduce the concept of low GI foods.
Anyway, you get the idea. Our patient jumps to the top of the castle one step at a time.
Collectively, we produce a hundred or so simple steps that patients can adopt incrementally to achieve lasting improvements in their lifestyle. We use this program to manage these patients systematically and proactively, using our practice teams, including exercise physiologists and dieticians. We support their gradual adoption of changed behaviours. Instead of talking to them at length about fat intake, energy balance, low GI foods etc, we give them one simple task each week. We measure how they go, and how we go, and share information on what works well, and modify the program with this shared data.
I’m sure many practices already have such a program. I know that Tintenbar has an excellent activity program.
Anyone up to making suggestions for our collaborative effort? What should the real name of FancyName® be? What would you recommend for the weekly changes that go on the FancyCard®? I’ll collate the responses and share them. Email email@example.com.