Much like in primary care medicine, treating patients as a Registered Dietitian hinges upon creating a rapport with patients in an attempt enable them to make the necessary health modifying changes. Treating a person with obesity is much like treating a person with a substance use disorder. The patient is the sole individual in the driver’s seat and makes all of the choices that determine their success or failure. Getting a patient to “buy in” to a healthy eating pattern, just like eliminating drug use, takes significant time considering barriers to compliance. For treating obesity, barriers include long-standing untreated psychological coping mechanisms, time, financial barriers to eating healthy, social climate, and affordable access to qualified healthcare professionals. Physicians and many other practitioners simply do not have the time to elicit the necessary changes in their patients without appropriate support staff.
In my experience as a dietitian, even if time is taken by typical physicians to steer patients toward healthier eating habits, minimal nutritional advice is given. What little guidance is provided usually only includes following certain caloric restrictions or my personal favorite, “don’t eat anything white.” Much more is necessary to make changes in the arena of weight management.
Another challenge that compounds the time issue is that there is so much diet information accessible to the public that may or may not be true, accurate, or safe. There are so many pop culture fads that it is impossible to keep up. Physicians and other outpatient health providers already have to manage the changes in their respective fields, but adding in the world of nutrition makes an already time-pressed existence even more hectic and inefficient. With such challenges and barriers, how can the healthcare team begin to impact the billion dollar problem of our country’s obesity epidemic? It starts with using appropriate resources, every day, and with every medically appropriate patient.
Working as a dietitian for 10 years in various health care settings has provided me with opportunity to experience the power of a team-based approach. I have seen where the synergy of physicians, dietitians, nurses, physician assistants, health coaches, physical therapists, personal trainers, pharmacists, and licensed clinical social workers working together can yield much success when treating obesity, diabetes, and other nutritionally-focused chronic diseases. Obesity and diabetes lead as one of the most costly issues in our healthcare landscape and 75 percent of the United States population is categorized as overweight or obese. Addressing this issue head on should be a priority in any primary care practice.
Regularly making referrals to dietitians for overweight or obese patients is only the first step toward addressing the problem of obesity. The need for multidisciplinary metabolic centers is much needed. While these centers exist in some parts of our country, comprehensive obesity care centers are lacking in the areas of the country that need it the most such as Louisiana and Mississippi.
As I experience what it is like to be a medical student, I see how little nutrition education is given in preclinical years to future physicians. While there are progressive schools that offer more nutritional education for their medical students, the vast majority of healthcare schools just do not have enough room in the curriculum to train their students as dietitians as well. They should not need to. The resources are out there and we just have to know how to use them.
The first step is to reach out to the state and local dietetic associations to see what resources are available for dietitians interested in working in obesity. Visiting local chapter meetings to network with dietitians is also a way to build resources. Speaking from experience, physicians do not often reach out to find dietitians are not receptive or available to have the much needed discussions. These lines of communication must be initiated by healthcare leaders, because it is the leaders who are shaping the healthcare landscape.
After seeking out qualified dietitians who are willing to design customized weight loss programs for patients, there should be support staff and health coaches to handle the weekly follow ups. After working with bariatric patients for 4 years and owning my own weight loss clinic, I have seen the best success in treating obesity comes with establishing non-judgmental rapport with patients and offering frequent follow ups to help patients stay on track. This does not have to be with a dietitian or a physician; a certified health coach is often all that is needed to remind patients of their goals for success.
For any healthcare professional, learning advanced motivational interviewing techniques and using them daily is the best approach to helping noncompliant patients. Simply referring out is not enough. The healthcare system must have open communication with all parties involved in the treatment of obese patients to ensure accountability and progress. These simple strategies are just the beginning of what needs to be done to effectively treat obesity, and are strategies that can begin to be implemented today.
Rebecca Markway Lee, RDN, CSOWM, LDN completed her dietetic internship at North Oaks Health System in Hammond, LA, and obtained her registration and license as a RDN, LDN in 2008. She became a Board Certified Specialist in Obesity and Weight Management by the Commission on Dietetic Registration (CDR) and received a Certificate of Training in Adult Weight Management in 2010, as well a Certificate of Training in Childhood and Adolescent Weight Management in 2017. Rebecca worked for East Jefferson General Hospital in the inpatient clinical and outpatient settings, including the EJGH Wellness Center and Corporate Wellness Department. In 2012, she began working with the bariatric population and Ideal Protein Weight Loss Method at Northlake Surgical Associates. She opened her private practice, True Body Nutrition LLC in 2016. With her business partner, Katherine Bridges, she then opened a business geared toward providing childhood obesity prevention programs to preschools, True Body Kids LLC. Rebecca is current a second year medical student at William Carey University College of Osteopathic Medicine, where she is currently enrolled as a second year medical student. Just this year, Rebecca received approval to undergo a longitudinal research study aimed at discovering interventions to prevent the rise of obesity.