When Treating Obesity, Discuss the Holidays — Before, During and After

It’s not unusual for people who have excess weight or obesity to have many barriers to overcome in managing their weight. In my experience, the holiday season can be a big barrier. For much of the world, holidays are associated with food; not just food but an overabundance of food. And for many, the weather is cold at this time of the year, which doesn’t help with being active.

I have worked with patients on a regular basis who were losing weight using lifestyle changes, medications, and/or bariatric surgery. Then, during the holiday season, I don’t hear from them until after the first of the year. It may be soon after the January 1st or even years after that date. When I do hear from them, they have regained the weight they lost. Some take that long to come back because they are embarrassed. They blame themselves and feel like a failure.

Rather than be judgmental, I ask them: What happened, what got them off track? I’m often told it was the holidays. They got off track and couldn’t get back on. Some stop their medications during the holidays, thinking, “I’ll resume them after the holidays,” but they often don’t. Then, they feel like a failure. I make sure they get the message from me that they are not failures.

I often tell them about The National Weight Control Registry (NWCR), established in 1994 by Rena Wing, Ph.D., Brown Medical School, and James O. Hill, Ph.D., The University of Colorado, the largest prospective investigation of long-term successful weight loss maintenance. The NWCR is tracking over 10,000 individuals who have lost significant amounts of weight and kept it off for long periods of time. Most of the people had failed keeping off the weight they lost several times before they were successful. They kept trying different ways to lose the weight and keep it off until they were successful. It is highly individualized, but it is possible. I let them know there is hope for them. I explain the pathophysiology and recommend they live and learn from past experiences.

I also discuss prevention of weight regain from the first visit on. I teach them to look at their weight history, what have they been successful at and what have been their barriers. Knowing this, together we can design a personalized plan that includes weight loss but also weight maintenance.

Since a lot of patients struggle during the holidays, I start the discussion any time of the year and we visit it often. Holidays don’t just happen from October through January, but all year long. “It’s always something!” However, I admit, I do make sure to revisit it starting in October and continue through January.

Lessons Learned:

• Discuss prevention from your initial visit with patients who need to lose weight. This includes both of us understanding the patients’ histories of what has and has not worked for them. Also, teach them the physiology of obesity, the various approved treatment options for weight loss and weight maintenance.
• Teach patients not to blame themselves. Give them hope and tools to help them lose weight and keep it off.
• Check out Dr. Alpana Shukla’s interview re: Food Order. Recommend your patients eat protein and vegetables before eating carbs. It can make a difference!
• The lessons learned from my patients who are struggling to lose weight and keep it off are many, more than can be discussed in this article, but DiabetesInControl is committed to share more information with you to help you help your patients. Stay tuned.

Joy Pape, FNP-C, CDE
Medical Editor, DiabetesInControl

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