Post 70 The Dietitian's Tale

 My patient came through the door, waddled into the room, then slowly, and with a sigh, eased himself into the chair.  It groaned under his weight and I feared for its safety.   One look at him told me he was obese, but the protocol insisted that I had to calculate his Body Mass Index, and chart it for his records.   The measurement would be the base-line against which his efforts at weight loss, and my success as a dietitian would be measured.

 ‘Let’s have you on the scales,’ I said without much
   Some inner instinct told me that this man had little interest in reducing his weight.   The chair groaned again as he levered himself to his feet.   He struggled to the scales.   He weighed 101 kilograms (15st 12lbs).   By this time, he was slightly short of breath, so I gave him a moment to recover before asking him to stand against the wall to be measured.   He was 1.67 metres tall (5 ft 6 ins).   I plotted the readings on the conversion chart; his BMI was 36! That made the diagnosis of ‘obesity’ official!

 I see hundreds of overweight patients every year and I confess it takes quite an effort to sound spontaneous and enthusiastic when repeating the same advice over and over again.   However, his health and life expectancy would be greatly enhanced if he could be persuaded to lose weight, so I determined to do my best; I would give it my best shot.

 I started by warning him of all the dangers of obesity; high-blood-pressure, strokes, diabetes, heart attacks, arthritis, and so on.   I always lay considerable emphasis on the fact that all these conditions can lead to an earlier death.   He listened politely, though without showing a great deal of interest.   Then we discussed the many ways in which his obesity affected his day to day lifestyle; his reduced mobility, his breathlessness and the wear and tear on the joints in his feet, legs, hips, and spine.   This seemed to claim his attention a little more.

 ‘Are you saying that if I lose weight, my knees won’t trouble me as much?’ he asked.

 ‘That’s exactly what I’m saying,’ I replied.  ‘With every step you take, your entire body weight is carried on your knees. Obviously, with less weight to carry, your legs will trouble you less. You will be less breathless as well.’

 The fact that he was now showing a little more interest encouraged me to up my game.

‘There are so many ways to lose weight,’ I enthused, ‘and so many programmes available to help you along the way.’

 Most dietitians I know, at this point in the consultation, start to talk about dieting.   Clearly, this is important, but my view is that dieting is usually seen in a negative light by patients.   My own preference is to begin by enquiring what activities or hobbies the patient enjoys, such as walking, swimming or cycling, to see whether these can be encouraged.  

 On this occasion, I found my patient was football-mad and I was able to inform him of a programme of walking football that had recently been introduced at the local gym.  Now I felt I had him; he was enthusiastic and motivated.   Perhaps my earlier negativity had been misplaced; maybe I might have success with this patient after all.

Inevitably, I moved on to discuss his diet.
   As expected, it was not a healthy one. Chocolate cereals, buttered toast and marmalade washed down with sweet tea at breakfast, a couple of Mars bars and crisps for lunch, then sausage or fried fish with chips for his evening meal.   By this time, however, the consultation was going well.   I had my patient’s attention; he was positive, motivated and enthusiastic.   He declared he would give his all to the diet and exercise regime I’d prescribed for him.

 Pleased with the way things had gone, I wished him luck and arranged a follow-up appointment for him.   Then I gave myself a well-earned pat on the back; I’d gee’ed myself up at the start of the consultation and it was going to pay dividends.

 ‘Thanks so much for your help.   I’ll see you in two months then,’ he said as he left.   ‘I shall have lost two stones by then.’

 ‘That would be great,’ I said, though I knew that even for a determined individual, this would be a tall order. ‘Particularly remember that processed foods and sugary drinks are to be avoided. There are ten teaspoons of sugar in every can of Coke.’ I added as a parting shot.

 ‘I will, I will,’ he assured me.


 Actually, I didn’t have to wait two months to see him

 We saw each other at McDonalds during lunch. He had a Big Mac burger, French fries and a large Coke in front of him, and as it happened, so did I!

 Thought for the day

The first law of dietetics seems to be; if it tastes good, it’s bad for you.

                                                                                    Attributed to Isaac Asimov   1920 - 1992

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