Over the years, Robert Kushner has seen many obese patients get tripped up trying to keep weight off because they rely on fast food, dislike exercise and find themselves stuck juggling too many tasks.
He recently suggested that a patient split meals with his wife when they dined out, rather than each having large portions. When the man said he was uncomfortable sharing a meal with his wife when the couple were out with friends, Kushner said to do it anyway.
I said, Its a strategy that works whether youre with other people or not, Kushner says. I think people dont think about it because they just arent raised to share.
The patient kept track of the food he was eating, learning to avoid larger portions and fattening dishes. He has lost nearly 7kg in six months, cutting about 500 to 700 calories per day.
More than a third of adults in the United States are obese, according to a 2015 report from the Centres for Disease Control and Prevention. In Hong Kong, the Centre for Health Protection estimates that almost 39 per cent of the population aged 18-64 are overweight or obese, while 21 per cent are obese.
Kushner, who directs the Centre for Lifestyle Medicine at Northwestern Medicine in Chicago, says he realised in the 1980s that obesity was a looming problem. He started combining diet, nutrition, exercise and behavioural changes into a plan for patients. Since then, he says whats changed is the maturity of the area [of study].
I call it an exercise machine on a leash. It is a way for people to think about moving their body around in a fun way
Robert Kushner on dog walking
Understanding more about the effects of stress and sleep on bodyweight, and some of the behavioural-change techniques have expanded, he says.
In addition to promoting good sleep habits and stress management techniques such as meditation, Kushner suggests bariatric surgery for patients with a body mass index (BMI) of 40 or more. He also suggests surgery for some people who are less obese, but have medical problems such as type 2 diabetes, sleep apnoea and heart disease.
He and his team also recommends medication for patients with BMIs as low as 30 who have additional medical problems or have failed to lose weight despite lifestyle changes.
While studies havent generally proven that lifestyle changes are effective for weight loss, Kushner says patients often have trouble shedding kilos unless problems like stress are managed.
Kushners approach proposes gentler, moderate changes. Rather than telling patients to cut out every unhealthy food they love, Kushner suggests that patients focus on eating alternative foods that are high in fibre and water but contain fewer calories. (Think beans, vegetables, salads, fruits, broth-based soups and whole grains such as oatmeal.)
For the couch potato who finds exercise overwhelming, Kushner advises walking for short periods, building up to three 10-minute brisk walks daily to boost their energy level and mood while also burning calories.
He also suggests that dog owners walk their pet for 30 minutes a day rather than leave Fido in the backyard. Kushner found that dog walking helped overweight and obese people lose weight in a study, and he wrote a book about it Fitness Unleashed!: A Dog and Owners Guide to Losing Weight and Gaining Health Together with vet Marty Becker.
I call it an exercise machine on a leash, Kushner says. It is a way for people to think about moving their body around in a fun way.
Most of his patients lose about 10 per cent of their body weight (some more than 20 per cent) after six months and keep it off during the programme, Kushner says.
Patients say they feel understood and more motivated as they are given personalised direction to make positive changes in their lifestyle, he says.
Kushner created a questionnaire to screen patients for traits that prevent weight loss, such as eating whats convenient rather than planning healthy meals. It was these traits that Kushner and his colleagues found in a study to be strongly linked with obesity. Once you take the quiz and know your factor type, I can personalise a plan to help you lose weight and keep it off, Kushner says.
Another way Kushner hopes to help patients tackle obesity is by teaching medical students about treating and preventing it. He found in a recent study that the US Medical Licensing Examination was focusing much more on diagnosing and treating obesity-related illnesses, such as type 2 diabetes and sleep apnoea, than on how to counsel patients on diet, physical activity, behaviour changes, the use of medications and bariatric surgery.
But Kushner says his approach isnt only about weight loss. We know that as little as five to 10 per cent weight loss will improve the health and well-being of individuals and can also improve blood sugar, blood pressure, the fats in your blood, arthritis or reflux symptoms, as well as your mood and energy level.
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