Imagine you could go back in time as the Titanic was setting sail and change its course only one degree southward. Long before it would have reached the fatal iceberg, it would have been well into safe waters.

In most patients’ lives, there are icebergs waiting: heart disease, cancer, diabetes, as well as the cumulative effects of stress, smoking, bad food choices and a lack of exercise. How can you help them make small, long-term changes early enough to steer clear of danger?

Health — The New Definition
“Health doesn’t simply mean the absence of disease,” said Charles D. Sands, PhD, of Samford University’s Exercise Science and Sports Medicine Department.

St. Vincent’s dietitian Susan Stone concurs. “Wellness means taking responsibility for taking care of yourself, not just reacting to illness. It means balancing mind, body and spirit. Doctors are one of the biggest motivators for people to call a dietician. Unfortunately, they often come to us after the fact — when they are already overweight, or have heart disease or diabetes. If we can work with physicians who identify a family history of cholesterol, obesity and related diseases, we could have an opportunity to intervene before problems become advanced.”

A Team Approach
For patients who need more guidance in losing weight, getting in shape, stopping smoking or dealing with stress than can be provided in an office visit, referring them to other credible resources can make the physician’s job easier and improve the patient’s chances for success.

“More and more professionals recognize that a team approach is beneficial in helping patients make changes and to reclaim as much of their health as possible if they have already encountered problems,” said Sands. “An MD, pharmacist, exercise physiologist, clinical psychologist and dietician should work together.”

Stone added, “There are very few people who don’t have to manage their weight in their adult years. People tend to think other people don’t have to, but that’s not the case. In general, the challenge for physicians is to guide patients away from fad quick fixes and toward credible sources of nutrition and fitness information.”

Dr. Douglas Heimburger, professor of Nutrition Sciences and Medicine at UAB, said, “After the holidays, patients will be thinking about the extra pounds and looking for practical ways to address them. Incremental changes usually work better than trying to do too much at once. Practice a new habit till it’s a part of your life, then add another one. Long-term changes are more effective than a resolution to go ‘on’ a diet they will be ‘off’ of soon.”

He added, “Between all the talk about low fat and low carb there is a lot of confusion. Our ‘Eat Right’ program teaches patients to think about energy density — what volume of food do they get for how many calories? Then we look at the big picture, including activity for weight management.”

Most local hospitals are associated with nutritional and exercise programs, and some also offer or work with wellness facilities in the community that can be a resource for patients who want to make wellness a lifestyle.

“Saint Vincent’s One Nineteen Health and Wellness has a fitness center, a nutritionist on site and everything from a spa to diagnostic imaging,” Stone said. “We also offer a regular program of wellness education, healthy cooking demonstrations and talks by physicians. The focus in February is heart health, and in summer we have a cooking camp for kids.”

Questions and Answers
When patients are thinking more about wellness, physicians are likely to be hearing more questions about nutritional supplements that always seem to be in the news.

“Some, like niacin to reduce cholesterol, work very well, and others less so,” said Heimburger. “You may also be hearing about cinnamon or chromium for blood sugar, ginger for motion sickness, garlic and red wine for the heart, and hoodia for weight loss. Extra vitamins are also an issue. Some in megadoses seem to be less safe than we once thought. In most cases, a basic multivitamin is the best choice, perhaps with a little extra calcium or vitamin D where indicated. It’s hard to keep up with all the media reports. What’s important is to know what your patients are taking, and where to go for reliable information on nutrition news.”

Susan Stone suggests www.Eatright.org.

“It’s the American Dietetic Association Web site. It usually responds quickly to reports in the media. It may take a little digging around as reports with different findings come out, but it’s one of the most credible sources for nutritional news.”

January 2008