May 26 2022

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The use of patient-centered strategies and a collaborative strategy with Registered Dieticians could help in the creation of customized nutritional interventions for the treatment of overweight, according to a panelist on the Obesity Medicine Association Spring Conference.

“The cure for obesity isn’t easy and we require an entire community to assist our patients on the process … you cannot do it by yourself.” Ethan Lazarus, MD, FOMA, director of the Clinical Nutrition Center, president of the Obesity Medicine Association and delegate of the AMA at the time of the talk.

Lazarus E, Winchester E. Making a diet plan that is customized to the needs of your patient. Presentation in: Obesity Medicine Association 2022 Digital Experience from May 18-21 2022 (hybrid gathering).

Before making a decision on a nutrition program, Erin Winchester, RDN, a dietitian nutritionist at the Clinical Nutrition Center and a professional chef at the Cordon Bleu Institute, asks the patient about the changes they think they can make in a way that is easy, simple and consistent over a long time. Patients and their providers must keep an eye on the fact that the diet plan may change over time and will vary between patients.

“You aren’t marrying to this lifestyle,” Winchester said. “We can always alter our diet.”

There are a variety of established diet plans, including the Mediterranean diet ketogenic diet paleo diet, intermittent fasting. There isn’t a requirement to recommend just one diet plan. The combination of many options can be considered based on what is most beneficial on the person, as per Winchester.

Lazarus and Winchester described the four simplified food plans they employ within the Clinical Nutrition Center. They use customized advanced, advanced, modified speed along with meal substitution. Plans can be altered to suit the individual needs of each patient.

Individualized program

The personalized program is the most flexible and consists of an “exchange” kind of nutrition intervention. This kind of program might be more appropriate for those who wish change only a few aspects of their diets, according to Winchester. It focuses on portions of various food categories. The calories consumed in this diet is generally higher than 1,200 per day.

Advanced program

The advanced program is more restrictive than the individual programme, Winchester said. It consists of a lower intake of carbohydrates (70 to 100 g daily) as well as protein (80 100 to 120 g daily) and non-starchy vegetables, dairy products and fruits without other starches, a low-fat diet and a specific goal for consumption which is usually approximately 1,200 calories per day.

Modified speedy program

A modified fast plan focuses on protein (80 100 to 120 g daily). It also reduces the consumption of carbohydrate down to less than grams daily. This program does not include fruits and dairy products, and usually utilizes a meal replacement that is only a portion of the time. The total amount is between 800 and 1,000 calories a day for the majority of patients.

Meal replacement program

The program utilizes meals that are designed to satisfy 100% of suggested daily allowances for micronutrients. It does not contain protein shakes, Winchester said. Typically, the program establishes an calorie goal of between 800 and 1,500 calories a day, based on the patient’s BMI. Most of the time, patients consume an adequate dinner that includes lean protein and vegetables that are not starchy as well as meal replacements during lunch and breakfast.

Patients following a more intensive diet, like the complete meal replacement program are likely to eventually change back to more normal food items, as per Winchester. Variety of foods is best expanded in a gradual manner while evaluating the total calories consumed daily. Support, treatment with accountability, regular exercise, and regular treatment are essential to keep expanding the variety of food choices to sustain the weight loss.

Teamwork-based approach

The Clinical Nutrition Center Lazarus usually requires his patients visit a dietician who is registered prior to any scheduled sessions with Lazarus.

“By at the point they go to my … they’ll already have a good idea of about what they’re in for This isn’t fresh information.” Lazarus said.

The more intensive treatments are, the greater reduction in weight the person can be able to achieve, as per Lazarus. But, the lower intensity plans provide more options for patients to select from. When a patient embarks on a journey to lose weight the more intense diet plans can be added alongside medication, in order to meet the desire to lose weight.

But, “how we start matters,” Lazarus said. Discussion of goals with patients could influence which treatment plan is implemented first.

Furthermore the longer appointments (30 hours or greater in a visit, instead of 15 minutes) has allowed Lazarus be able to “actually be able to treat” patients, instead of just prescribing drugs. Communication is frequent through telehealth or in person.

A registered dietician working in an office isn’t needed to design a comprehensive nutritional strategy, Lazarus said. Patients are monitored by other team members who are skilled like social workers, nutritionists or nurses, as well as outside-of-office referrals. The majority of patients visit at the Clinic Nutrition Center on a ratio of 3:1 of three visits with a registered dietetic and one appointment with a doctor to monitor their medical condition. The visits may be spread apart as the treatment program develops.

“You can treat your patients using the resources you have available,” Lazarus said.