Partnering with patients helps them adopt healthier lifestyles

Dr. Christine Jones and patient John Boyer

An interview with Dr. Christine Jones, Ann Arbor

How do you make sure BMI is documented for all your patients according to HEDIS?

In our office, it’s standard to obtain a height, weight, and calculated BMI at each patient visit as part of the vitals. The BMI value flows to the patient plan at least once yearly, with provider instructions to help promote healthy lifestyle modifications when necessary.

How frequently do you recommend follow-up for patients with high BMI?

For a BMI between 25 and 30, I like to see a patient every six to 12 months, especially if the person has medical comorbidities. If the BMI is 30 or higher, I try to follow up with the patient more regularly, every three to six months or as often as they need medical and emotional support on their weight-loss journey.

How do you approach conversations about losing weight?

I aim to establish a partnership with my patients. I encourage lifestyle modifications by way of a balanced, healthy diet and regular exercise program to help achieve weight loss goals. I often refer patients to mobile support programs like MyFitnessPal for calorie tracking, or FitBit technology to monitor steps. For certain individuals, the creation of a personal 60-second video on their smartphone is a very effective motivational tool. I request that patients record a brief video for their eyes only, stating why weight loss is important to them; it has to be something so powerful that the video evokes emotion, and often nearly brings them to tears. Examples include a desire to be alive for a child’s wedding, staying healthy enough to take the trip of a lifetime, or trying to avoid multiple lifelong medications or specific adverse health outcomes. On days where it is difficult to adhere to a diet plan, exercise program, or both, I ask patients to watch their video to remind them why their personal weight-loss goal is so important, which often allows people to stay focused and inspired by self-motivation.

How do you educate patients about long-term consequences?

My goal and approach is to empower patients to make healthy lifestyle decisions, and I serve as their accountability partner when needed. I educate patients about the potential long-term consequences of obesity, which can include metabolic syndrome, clinical diabetes mellitus, hypertension, cardiovascular disease, sleep apnea and a multitude of other health complications. By reviewing lab results and their potential implications with patients, and encouraging them to make changes that could minimize or eliminate the need for lifelong medication or serious interventions, most patients are enthusiastic about setting goals for weight loss.

 

You mentioned partnership earlier. Is it your goal to partner with your patients or for them to find a weight-loss loss partner?

At the end of a patient appointment or physical, if their BMI is greater than 30, I will often state that their primary health goal for the year should be weight loss. I offer to serve as their accountability partner if they wish to return for periodic weight checks, nutritional counseling, or vital sign evaluation and laboratory monitoring. I help them understand that I will encourage and congratulate their successes, and even support them through setbacks but, ultimately, I am only responsible for a minimal part of their weight-loss story; the rest is up to them and what they do after they leave the office. I have patients who have minimized their A1c values as though they were on insulin with clean eating and exercise, I have patients who have lost weight equal to that achieved with bariatric surgery without ever going under the knife. Each patient is different, and it is often a matter of saying the right thing to the right person at the right time that eventually resonates. Weight loss requires ongoing discussions with frequent revisions of goals and “reasons why” and attention to each small success.

Do you have any other thoughts or recommendations?

As a physician, my job is to promote healing and encourage patients to achieve wellness within a spectrum of evidence-based medicine and clean living. It is a privilege to work with people toward their weight-loss goals. Altering eating habits by avoiding “white foods” like bread, pasta, rice, potatoes, etc. and minimizing drinkable calories like juice, soda and alcohol are measures that can create dramatic change. Most people understand that it is best to shop the perimeter of the grocery store for health benefits, as well. One day at a time, the realization of small goals tends to have cumulative benefits and engender positive outcomes, which empowers patients to feel proud of their achievements and remain motivated to set an example for others.