Saturday, February 4, 2006

Losing weight

Dr Dork is interested in weight loss. He is not a dietitian.

But many of his patients have obesity as a comorbidity of the conditions for which they see him. It often complicates treatment. It puts them at risk of diabetes, heart disease, certain cancers, among other things.

He often gives dietary and exercise advice to his patients. As should any doctor with a patient who has health problems due to their weight. This involves some finesse and delicacy, to say the least.

It is really up to the patient, of course. There is no miracle cure for this one.

Dr Dork knows it is hard work. He was once 30kg (66 lbs) overweight. He was working very long hours - that was his excuse.

At this time he changed career path, and decided to lose the pork. Despite still working 60-80 hr weeks, plus doing a specialist training program, plus doing postgraduate university study, he lost the weight in 5 months.

He changed his diet, and exercised for an hour 3 out of 4 days.

Dr Dork knows he is going on a bit...but this is a common problem.

Most studies show about 25% prevalence in the UK and Australia...and about 35% in the US.

Dr Dork has complicated views about dietary adjustments. He recommends monitoring calories as the primary intervention.

He believes in "outsmarting your body". Our brains live in the 21st century. But our physiognomy thinks we are still hunting mammoths.

If you eat lots of calories before you go to bed, your body will store them. It is thinking "I don't know when I'll next catch a mammoth". If you eat lots of calories at breakfast, you will generally use them to a greater extent. Your body is in active mode, not storage mode, during the day. Even if you sit behind a desk much of the day.

Dr Dork changed his main meal from evening to breakfast. It was hard for a few weeks. Then he got used to it.

When he has breakfast with his friends nowadays, they accuse him of "feasting".

But it worked.

It boils down to two things.

Eat less.

Exercise more.

Update: Dr Dork originally made the above comment in a discussion engendered by Dr Crippen at NHS Blog Doc in this erudite discourse on obesity management, and the dangerous allure of the chocolate digestive.

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