Usually, when a patient comes into my clinic, whether they’re referred to me by a physician or by a friend, the first thing that happens is a consult. I discuss the program with the patient, find out a little bit about them and we see if the program is a good fit for them. If it is, I make a few recommendations of things they can do to get a jump-start on the program before their first appointment.
Now obviously, if you’re reading this blog, I can’t tell you what weight management program will be a good fit for you or make individualized suggestions. But, I can tell you the things you need to do to get started.
SEE YOUR PRIMARY CARE PROVIDER
In my clinic, a patient’s first appointment is always with me. In that appointment, I conduct a physical exam to ensure that the patient is healthy enough to get started with our weight management program. This happens whether the patient is an eighteen-year-old with a BMI of 24 looking to improve their knowledge of nutrition and avoid the “freshman 15” or a sixty-five-year old with a BMI over 30 and multiple chronic health problems. There are no exceptions.
Guess what? You need to have an exam before starting a weight management program too. I don’t care how healthy you think you are. You need an exam. In the best case scenario, it’ll count as your annual visit (and you hopefully won’t be back that year); in the worst case, it’s one extra visit but you’ll have peace of mind going forward with your dietary and activity changes.
Usually, your primary care provider will be best equipped to carry out this exam. Specifically mention to your PCP that you’re looking to lose weight. Your PCP will then discuss their recommendations in regards to diet and exercise and may even be able to refer you to a medical weight management program for further advice. If you see a specialist of any sort, I would also recommend asking your PCP if you need to consult that specialist in regards to dietary or activity changes.
Don’t forget that weight loss and management is not just a physical journey, but a mental and emotional one as well. If you are currently seeing a mental health professional, mention that you’re starting a weight management program. Often, this will help them support you better during your program. If you are not seeing a mental health professional but are experiencing mental or emotional problems (especially symptoms of anxiety or depression), talk to your PCP. They will be able to refer you to the best-equipped individual to assist with these issues. This support can only help you as you move towards your weight management goals.
2. FIND OUT YOUR BMR ESTIMATE
BMR is an acronym that stands for Basal Metabolic Rate. This is the number of calories you would need to live if you laid in bed all day and didn’t move at all.
Now you’ll notice that I tacked on an “estimate” to that term. That’s because the only way to directly measure your BMR is by using a piece of equipment called an indirect calorimeter. This is typically a pretty expensive device, so it’s not common in clinics. Any other process used to determine BMR is a prediction. Even equipment like an InBody body composition analyzer (which we use in our clinic) that determines your muscle mass, water weight and fat mass uses a mathematical formula to calculate your BMR. If you don’t have access to a body composition analyzer, look at an online BMR calculator, but keep in mind that these are estimates. Some may be more inaccurate than others and they typically overestimate.
To determine the number of calories you need per day to maintain your weight, you’ll need to figure out your TDEE or total daily energy expenditure. Most individuals work desk jobs that don’t require a lot of activity. Because of this, most people would be considered sedentary. Don’t get worked up about this—remember that it’s due to the nature of your work. We’re not factoring exercise into this equation for a reason. For a sedentary individual to calculate their TDEE, they need to multiply their BMR by 1.2.
So if you have a BMR of 1500 calories, your TDEE would 1800 calories per day. You’d need to eat 1800 calories per day to maintain your current weight. Pretty simple, right?
Again, always keep in mind that these are estimates. But you have to know roughly where you’re starting in order to know where to go. Which brings me to one of my favorite analogies about calories.
If I asked you right now exactly how much money you had in your bank account, could you tell me? Some people probably could. But most people have a rough estimate. They know if they have enough money to buy groceries. They’d know if they had enough to pay their rent or mortgage. They would definitely be able to tell you if they had enough to buy a brand new Ferrari.
Your daily calorie expenditure is like your bank account. You may not know exactly what you burn in a day, but you need to have a pretty good idea. So while using BMR estimates may not be ideal, it does give us a starting point.
3. START LOGGING
And no, I’m not referring to cutting down trees. Here, we’re talking about food logging with a special focus on calories. I know. You hate logging calories. It takes too much time. You don’t see the point.
That’s only because no one ever explained it to you.
There’s one point to logging: self-awareness. You have to know what you’re eating and how much you’re eating in order to make any sort of adjustments to your program.
Say you go on your program without logging for a week. At the end of the week, you’ve lost weight. How do you know what you did right? The reverse is true if you’ve gained weight after a week. Without a log, how do you know what to change?
The answer is: you don’t.
There’s also evidence out there that simply the act of logging your food changes what you eat without any conscious effort. Basically, because you’re logging, you’re more likely to make healthier choices.
So how do you start logging? You can do it with any number of smartphone apps or websites online or with pencil and paper. If you want to get started on weight loss immediately, most apps will set a calorie goal for you by asking how much weight you’d like to lose per week (this should be somewhere between 1-2 lbs for safe weight loss), but again, remember that this is an estimate. If you’re logging with paper and pencil, you’ll want to start with a goal that’s about 200-250 calories beneath your TDEE to lose 1-2 lbs a week (the other half of your caloric deficit will come from activity, but that’s another post entirely). For the majority of patients I’ve seen, this places them somewhere around your BMR. But, the numbers are not as important as your mindfulness regarding your current eating behaviors.
We’ll be discussing my app recommendations and ways to obtain accurate information for paper and pencil logging in another post, but when you’re getting started, your main goal should be to record what food you’re eating, an estimation of how much you ate as well as the number of calories per serving in each food. Apps will typically do all of this for you. With paper and pencil logging, most of my patients have found that starting with the food name and calories per serving helps them to ease into the process. Other data like portion estimates and carbohydrate content can always be added in once you’re comfortable with the basic process.
4. PREPARE FOR THE LONG HAUL
Weight management is a 90% mental game. I tell all of my patients this. You have to realize that staying focused on the program is mental work. And it’s not “one step and done.” It’s a process and one that we’ll be discussing in depth in subsequent posts here. But, you do need to get started.
Start off by thinking about why you want to lose weight. Is it for your health? Is it for your spouse or your family? Is it for your own self-confidence? It doesn’t matter what your reason is, but keep it in mind as you begin your program.
In my clinic, we follow program structure recommendations from The Obesity Society, The Obesity Association, The National Heart, Lung and Blood Institute, the American Association of Clinical Endocrinologists and the NIH. These recommendations suggest a year long program with between fifteen to twenty-six visits in that time. This may seem like a long time, but I have found it absolutely necessary. This gives patients time to A. absorb the information and education given, B. modify their attitudes towards eating and exercise and C. implement long term behavior change.
So, don’t expect all of this to occur overnight. Remember it is a ongoing process. But, if you do the work, the changes will come with time and you will evolve.