Small changes

I saw a patient recently who had gained 33 lbs since their last appointment. Thirty pounds is a significant amount of weight. And the reason for the weight gain should be discernible. So, we started talking about their diet. Now, this person was never lean, they had been overweight for many years but steadily overweight. They would weigh the same visit after visit, year after year. Now, in a short amount of time, they had gained an additional 33 lbs. Where and how? We started reviewing their diet, the amount of activity and exercise. We reviewed their medications, looking for anything that might cause weight changes. We talked about their job and how they do their work every day. Are they sitting more? Walking less?

The single most identifiable change was that the patient had moved and was now getting a McDonald’s Frappe every day on their drive into work. I looked it up. A medium McDonald’s frappe with caramel and whipped cream is 550 calories. 500 calories a day every day of the week would amount to gaining one pound every week. This is passive, insidious weight gain. It is slow and not always easy to see. In eight months, 32 weeks, they had gained 30 lbs.

It is that easy, shockingly easy.

To lose the weight, the patient must stop the frappe consumption and they must now BURN 500 calories every day to eliminate the stored weight they have packed on. They also cannot expect to lose the 30 lbs by Christmas. It has to be lost slowly and consistently though reasonable calorie reduction (NO McDonald’s frappes!) and daily exercise. One hour of walking at a brisk pace for 45 minutes will burn about 350 calories. Do that every day and you will lose LESS than a pound a week. Losing one pound of weight is hard work and it requires WORK. There is no magic. There is no short cut. There is no instant, Poof! course to being thin. And for the patient that has never been THIN, the goal is to be FIT.

September 2014