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News February Resolutions: How are your New Year’s Resolutions holding up?

By Russell Herring, DNP, FNP-BC, CSCS

It’s February, and we’ve already had weeks below zero. It’s a leap year, so if this February is anything like last February, we get to look forward to an extra day of record cold temperatures and historic snowfall. Are your workdays like mine, and you can easily transit from Sunday afternoon to Saturday morning, having escaped direct sunlight for the entire work week? Arriving to work before sunrise on Monday morning, and punching out after sunset on Friday afternoon? It becomes easy to get into a rut, and extremely difficult to climb back out.

Am I the only one who is pale and grumpy?

I’m certain we each have personal evidence of the 80% of New Year’s Resolutions which fail (Luciani, 2015). Is 2020 still the year when you’re going to focus on you? Are you still eating a tightly controlled course of fruits, vegetables and lean meats? Are you still going to the gym 3, 4, 5 days each week? Are you meditating for at least 15 minutes every day? Has dry January come to a crashing halt?

Sitting in my exam rooms, we talk about health history, current problems and goals. It’s always a very back-and-forth conversation as we try to compile decades into a single hour visit. I warn my new patients that I can be blunt – sometimes in the extreme. I warn them that I am the provider who is going to tell them the ugly truth, but that I promise to help them work through it – whatever “it” is. Reactions vary.

I warn patients about my preferred problem-solving approach. Some may call it “lack of tact”, but I prefer to think that we’re just getting to the point. I also like to think that I can tell when this approach will result in a less than therapeutic relationship, in which case I can, and do, tone it down. However, most patients have told me they prefer a frank conversation.

I tell the patient that their BMI (body mass index) has transcended from obese, to morbidly obese (BMI above 40). I admit that I’m not for everyone, but I’m ok with that. People choose primary care providers for many reasons. Patients know, but it’s one of those societal norms – the things we know but don’t talk about, which have invaded the exam room.

In primary care we see patients every week whose weight has caused orthopedic aches and pains. Lower back and knee pain seem to be the most common. I’ve seen patients with back injuries that qualify for surgery – if the patient were lighter. I’ve seen patients who’ve been referred to bariatrics by neurosurgery so they might lose enough weight to qualify for back surgery. Talk about being painted into a corner. A surgery to qualify for surgery.

I’ve seen grown men shed veiled tears about not having enough money for a gastric bypass to qualify for a lumbar fusion.

We talk about counting calories. We talk about activity trackers on these modern, fancy smartwatches – which research shows should help (Pourzanjani, Quisel & Foschini, 2016). Some patients have only weight-related musculoskeletal concerns, and have remained as active as possible – and relatively healthy, aside from knees or back complaints.  They want to walk, they want to be able to hunt in the fall. After being told to lose a hundred pounds before qualifying for back surgery, it’s difficult to maintain hope. Other patients have blood pressure and blood sugar problems, in addition to painful bodies. They can have half a dozen chronic problems to address along with any attempt to safely lose bodyfat.

I think the wet eyes represent feelings of hopelessness and helplessness. Patients feel as though they can’t effectively exercise or live the life they want because of pain, which worsens their weight, which worsens their pain. The help they need, they can’t afford, which means nothing can be helped.

They’re stuck.

I tell them, yes, being told to lose 100 pounds is a bit of a slap in the face, but Rome wasn’t built in a day. I tell them that I wish their other providers had elaborated on their weight loss goals, but have to agree – they have more than 100 pounds of excess bodyweight. That said, I tell them that we’ll work on 5 pounds, then 10, then 20 and so on. I tell them their back and knees will appreciate the reduced bulk.

The tears are drying.

I tell my obese patients that I will do just about anything that is safe and legal if it helps them get their weight down. All providers want to help their patients in whatever capacity we’re able, if it means we don’t have to treat hypertension, diabetes and cholesterol later in their lives. Sometimes these other diseases already dictate our options for treatment. Uncontrolled high blood pressure and cardiovascular disease can limit safe exercise options and eliminate some options for medications. I talk to my obese patients about better exercise modalities for larger bodies. Walking in the pool, inclining a treadmill or a recumbent bicycle – exercises which provide support and limit the concussion on painful joints. I have at least one patient who walks against the current in the river pool at a local gym several times each week. Inclining a treadmill and simply walking uphill increases the difficulty at the same time it decreases the vertical drop and concussion through knees.

I ask all my patients if they exercise. If there is a pause, the answer is no. The pause is usually preparation for justifications and excuses. Many jobs are physically demanding, which I accept wholeheartedly, but few are physically demanding the way the American Heart Association defines it. Few jobs require sustained moderate exercise intensity for 150 minutes per week (heart.org, 2020). I ask my patients if they track their calories. The simple act of journaling food improves weight loss, even if the test subjects aren’t told to change their diets (Acharya, et. al., 2009).

Talk to your provider about calories in versus calories out. Talk to them about the First Law of Thermodynamics (you may both have to Google it). Talk to them about the best diet for your health. There are mountains of mis and disinformation about diets, but some diets are certainly better than others. Talk to your provider about healthy goal-setting. Talk to your provider about food journaling.

Talk to us about how to get and remain healthy.

About Russell Herring, DNP, FNP-BC, CSCS

Photo of Russell Herring, DNP

Russell Herring, DNP

Russell R. Herring, DNP, joined the Great Falls Clinic in 2018 and is among the newer healthcare providers in the State of Montana. He works alongside Drs. David Engbrecht and Dr. Carey Welsh in Family Medicine at the Great Falls Clinic Northwest location. Russell specializes in diagnostic, preventive, and therapeutic healthcare and treatment plans for acute and chronic illness, and in education and guidance of patients regarding disease prevention and health promotion. He is currently accepting new patients at the Northwest Clinic, 1600 Division Road, Great Falls. For more information or to schedule an appointment, please call 406-268-1600 or visit www.gfclinic.com.

References

Acharya, S. D., Elci, O. U., Sereika, S. M., Music, E., Styn, M. A., Turk, M. W., & Burke, L. E. (2009). Adherence to a behavioral weight loss treatment program enhances weight loss and improvements in biomarkers. Patient preference and adherence3, 151.

“heart.org, 2020” https://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_448770.pdf

Luciani, J. (2015) Why 80% of New Year’s Resolutions fail. U.S. News and World Report. Retrieved January 19, 2020 from: https://health.usnews.com/health-news/blogs/eat-run/articles/2015-12-29/why-80-percent-of-new-years-resolutions-fail

Pourzanjani A, Quisel T, Foschini L (2016) Adherent Use of Digital Health Trackers Is Associated with Weight Loss. PLoS ONE 11(4): e0152504. https://doi.org/10.1371/journal.pone.0152504

Meet Our Providers

Becky Wozniak, DNP

Clinical Research

Family Practice

Andrew Blackman, MD

Orthopedic Destination Center

Orthopedics / Orthopaedics

Russell Herring, DNP

Family Practice

Andrea Withey, RDN

Diabetes / Nutrition Services

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