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Dynamic Chiropractic – March 1, 2014, Vol. 32, Issue 05

Weighing in on Weight Loss

Simple suggestions to help your patients and expand your practice opportunities.

By Elizabeth DeRobertis, MS, RD, CDE, CDN

If your practice trends anything like the U.S. population, you are probably noticing over two-thirds of your patients could benefit from weight reduction, particularly if their main complaints include chronic back or joint pain.

In addition to your own treatment plan, addressing weight management can prove to increase trust and retention within your practice, and offer more comprehensive care to your patients and overall community. In addition, it could introduce additional revenue, making it a win-win for both you and your patients.

Starting the Dialogue

Holistic wellness is key to addressing weight management. Pain level, flexibility, sleep and other factors you assess all impact your patients' ability to live healthier overall. You have a unique opportunity to serve as a lifestyle coach each time you interact with your patients. If you're looking to address weight management, here are some tips that can offer the support patients need to make a big difference in their lives.

1. Choose Your Language Carefully

Studies suggest doctors may use language that sounds critical or judgmental when it comes to weight / weight loss, which may make patients feel embarrassed about coming back for their next visit. One approach seen to be beneficial in weight management is "motivational interviewing." This approach focuses on creating an environment of acceptance whereby patients can verbalize their own motives for changing a health-related behavior through conversation with their health care provider.

weight loss - Copyright – Stock Photo / Register Mark Studies suggest patients guided using motivational interviewing techniques are more adherent to a prescribed program and demonstrate better weight-loss outcomes. Bottom line: You need to meet them where they are and play off of their own motivations for changing their behavior. Numerous resources are available to learn more about motivational techniques, including

2. Foster a Commitment

Ask your patient how they feel about their current weight. This is an easy way to start the conversation, and they actually may end up taking the lead and opening up. As they do, this is a great opportunity to create a plan with them, figure out who will be their support network, and get them to commit to a new and improved lifestyle.

3. Watch the Calories

The popularity of fad diets and various news reports regarding new weight-loss studies make it hard to know how to guide our patients. A common thread for weight loss is to address calorie reduction. One of the most effective strategies to help your patients achieve a calorie deficit is to identify the extra calories in their eating routine. Then you can collaborate to create a customized plan that will replace high-calorie foods with lighter alternatives.

Remember, it is important to take into account your patient's lifestyle and routine to make sure the plan is manageable and sustainable in the long term.

4. Help Them Keep a Log

Food diaries are the most helpful tool you can encourage your patients to use. You can offer food diaries from your office, and have patients record their food intake and review it with you at each visit. Another option is to have them use apps through which they can track their intake online and receive calculated calorie / nutrient intake daily.

The key to keeping a food log is to have your patient do it as they go, instead of in hindsight, to avoid the inaccuracies that come with "selective memory."

5. Consider Meal Replacements

For obese patients, consider having an option to sell meal replacements in your office to help them to stick with a more formalized and structured weight-loss program (see revenue-building opportunities below). Meal replacements have more than 30 years of research and hundreds of studies to show their effectiveness. Choose a plan that offers a combination of shakes, bars and other packaged foods to optimize the likelihood of long-term adherence to the plan.

Many plans call for one "real food" meal per day; this is helpful because it gives your patients the ability to plan one meal that fits with their schedule (e.g., dinner with family or business lunch in a restaurant).

6. Track Their Weight

Have your patients weigh in at each visit. The accountability of knowing they will get on the scale is often the most important part of keeping someone focused and on track.

7. Talk About Appetite Control

When someone goes too long without eating, they go off track and end up overeating. You can highlight the idea behind small, frequent meals as the strategy of eating something every few hours to stay in control of appetite. You also can offer portable options in your office, such as all-natural foods, snack bars or other weight-management tools (see revenue-building opportunities below).

8. Promote a "Safe Food Environment" at Home

Ask your patients about their most tempting foods (AKA "trigger foods") and what needs to change. Provide practical advice about setting up their food environment at home, such as limiting the availability of trigger foods, and organizing cabinets and drawers in a way that makes it easy to obtain healthier foods and hard to reach / be tempted by less healthy options.

9. Discuss the Nutrient Density of Different Foods

Help patients get the most "bang for their bite" by helping them learn what holds them over and what ends up being a trigger. Most people feel satiated longer after eating a meal / snack containing both fiber and protein, as opposed to just carbohydrates, so it is important to have the right balance in each meal. For example, a 100-calorie bag of almonds may hold them over much longer than a 100-calorie bag of cookies.

10. Give Tips to Burn Calories

Promote regular activity by recommending exercises that are the best, safest and most comfortable for your patients. Work on problem-solving techniques and simple changes that will help patients burn calories and support their weight-management goals. In addition, highlight the fact that regular exercise, even something as simple as walking 30-60 minutes per day, in one of the best predictors of long-term weight maintenance.

Revenue-Building Opportunities

As you begin to assess your patients' interest level and commitment to weight management and holistic wellness, you may find these goals quickly expand the time you are spending with them. Instead of trying to meet all of these needs on your own, consider relying on other networks and resources. This not only helps you meet your patients' needs more efficiently, but could expand your practice and scale your revenue. Here are a few suggestions:

Nutrition counseling: Network with registered dietitians (RDs) in your area and interview to find practitioners who share your philosophy on wellness. Registered dietitians are nationally recognized experts on nutrition and diet counseling, and can not only help you create weight-loss success stories, but also help you expand your services for patients with comorbid conditions needing lifestyle support, such as heart disease or diabetes.

There are a number of arrangements that could build revenue in your practice, but most common are those whereby your practice offers individual consultation, a package of consultations or group classes delivered by the RD. Choose price points that are competitive with your patient base while still allowing both you and the RD to profit through revenue sharing.

Body composition and metabolism measurement: Depending on the demand within your practice, you can look into devices that provide more accurate information about a patient's body composition or calorie needs. These reports have become increasingly popular and effective in further personalizing weight-management goals.

Metabolism measurement and body composition scale companies offer accurate instruments you could buy for your practice. Once procured, you could provide each of these tests and subsequent reports for an additional fee.

Meal-replacement services and coaching: There are several organizations that offer distribution opportunities through health care practices, with impressive outcomes for overweight or obese patients. At least one offers an opportunity that pairs free health coaching in coordination with delivery of the program. You receive turnkey tools for your practice to implement, complete with ongoing coaching tools and home meal delivery. Not only will you acquire the skills and knowledge to help people get on a path to "optimal health," but you also will receive financial rewards through a compensation plan.

Referral networks: Partner with local businesses to receive a percent of revenue for referrals, or simply receive more traffic to your practice by participating in cross-promotion activities. Examples of synergistic partnerships include yoga / fitness studios, RD private practices, primary care practices or local grocers. You can offer coupons or promotions to these establishments, and referrals can be tracked when the coupon is presented to your partner businesses for redemption.

With an eye for overall wellness, be sure to align yourself with partners that promote the weight-management and overall healthy-living practices you support. That said, some partnerships could involve rewards for your patients for successfully reaching certain goals or milestones (e.g. 20 percent off at a local clothing store for the first 10 pounds of weight lost).

Meaningful products and tools: You can become a wholesale distributor of products you stand behind and offer them as part of the patient experience in your practice. As a wholesale distributor, you will get the opportunity to purchase products at a lower per-unit cost and then earn a percent margin with each purchase. Aside from the revenue upside, this approach offers convenience and greater adherence to care plans if you stock your practice with products and tools you believe will support your patients' goals.

Elizabeth DeRobertis, a registered dietitian and diabetes educator, has a master's degree in clinical nutrition from New York University. The director of nutrition and wellness services at Scarsdsale Medical Group in N.Y., she is a nationally recognized speaker on diabetes and weight management, and is frequently quoted in the media including national television shows, publications and websites. She is also the co-creator of HungerShield, an all-natural appetite-control drink mix.

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