Documenting BMI facilitates conversations about lifestyle changes

Dr. Maria Heck with patient Gypsy Boone Slaughter

Dr. Maria Heck of IHA Milan Family Medicine, believes in giving patients with high BMI achievable steps to be healthier.

Taking a patient’s vitals, including height and weight, are done at every visit. “As long as patients can stand or get out of a wheelchair we have their height and weight recorded,” she said. “Consistency at every visit helps take a lot of the thought process out of it.”

When patients are overweight, Dr. Heck aims for modest changes that patients can adopt.

“Most people know they’re overweight or obese,” said Dr. Heck. “Doing the BMI measure gives us a criterion point and opens up a discussion. I ask my patients what steps they are taking in terms of healthy eating and exercise. They may be just a few adjustments away from getting positive results.”

If patients aren’t taking steps to lose weight, Dr. Heck says she discusses healthy eating and asks the patient to go through an average day with her.

“If they seem motivated, I move on to a dietary discussion and show them how to make their calories count,” she said. “I do that by recommending whole foods and suggesting they avoid foods that are boxed or processed. I suggest they shop the periphery of the grocery store — the aisles where the produce, lean meats and dairy are.”

Small changes help affect risk factors for disease

Dr. Heck stresses that small, consistent incremental lifestyle changes can reduce risk factors for many diseases.

“For most people, exercise is the hurdle. It’s the first thing that drops off when we’re busy,” she said. “But I tell patients every step counts and I recommend they get a pedometer or a FitBit or download a free app on their phone. The goal is 10,000 steps a day more days than not. The goal is to get the BMI below 30. A BMI above 30 is when you see an increased diabetes risk, insulin resistance, high cholesterol and effects on blood pressure.”

Weight loss can be successful if you break it down into small components, said Dr. Heck. “Losing weight is a very daunting task. I tell patients that to lose a pound you have to be negative 3500 calories — approximately. You can do two things — count calories and decrease your intake by 250 a day and burn an additional 250 a day with a half hour of walking. Then it becomes more manageable to say you can lose a pound a week.”

Dr. Heck sees a significant number of patients who are overweight or obese. While she doesn’t recommend follow-up visits for BMI alone, many of her overweight patients also have high triglycerides, high blood pressure or other chronic issues.

For those patients, she will schedule follow-up appointments every three to six months.

Let patients see their progress

Dr. Heck likes to show patients the progress they’re making by scheduling lab work with their follow-up visit and letting patients see the trend on their medical records. “I always check vitals when they come in,” she said. “So, the electronic medical records will show a trend. If a patient with diabetes or high blood pressure has been exercising and eliminating fast food, for example, he or she can see a correlation between their vitals and their labs and blood pressure. It’s a good way to reinforce changes.” For patients who get discouraged because the scale isn’t changing, Dr. Heck tells them if they are exercising they are likely gaining muscle. She’ll ask, “Are your pants fitting better? You’re going to lose inches before you lose weight.”

Making lifestyle changes has many benefits. It helps patients feel better, said Dr. Heck. “The body has a huge capacity to heal itself,” she said, remembering a patient who she referred to hematology because of concerns about his bloodwork. The patient had been drinking four, 20-ounce diet pops a day and was encouraged to quit drinking pop, recalled Dr. Heck.

“When I saw him three months later, his chronic pain and headaches had gone away and the abnormal labs had returned to normal,” she said.

As a believer in lifestyle changes, Dr. Heck concluded, “Lifestyle changes are harder changes to make but the benefits are enormous. They have the least amount of negative side effects and they’re free.”