Setting Realistic Weight loss & Physical Activity Goals for Metabolic Syndrome Patients
posted 08/25/03
The surgeon general recommends 10,000 steps per day, but 12,000-13,000 steps per day may be necessary for true weight loss.

Setting realistic, incremental goals for weight loss and physical activity can help patients succeed in their struggle with metabolic syndrome.

“Patients may think they need to lose 50 or 60 pounds. I set the goal initially at losing 5%-7% of body weight,” said Dr. Bessesen of the University of Colorado Health Sciences Center, Denver. “The goal for some may be not to gain any more weight.”

In a combined presentation, he and Dr. George L. Blackburn advised physicians to assess each patient's readiness for change before trying to alter health-related behaviors.

One way to motivate patients and encourage them to be involved in their own care is to say something like, “I think your diet and physical activity are putting your health at risk in the future. I'm here to help you change if you decide to do so,” Dr. Bessesen suggested.

“One of the problems with the metabolic syndrome is there are so many aspects to it,” he noted. It may seem daunting to address many of these issues in a 10- to 15-minute consult, but it's well worth it. Evidence suggests that early diagnosis and intervention lead to better outcomes, including a reduced risk for diabetes and cardiovascular disease.

Clinicians need to be tactful when approaching patients with a tool that has been an unfamiliar sight in medical settings—a measuring tape. Patients and physicians typically are unaccustomed to routine clinical measurement of abdominal waist circumference.

Central obesity—defined by an abdominal waist circumference greater than 40 inches for men and greater than 35 inches for women—is one of five criteria for diagnosis of metabolic syndrome specified in guidelines from the National Cholesterol Education Program. According to the NCEP, the diagnosis is based on meeting three of the five criteria, which also include fasting glucose (at least 110 mg/dL); triglycerides (at least 150 mg/dL); HDL cholesterol (below 40 mg/dL in men or below 50 mg/dL in women); and blood pressure (at least 130/85 mm Hg).

“Physicians are not accustomed to measuring this in clinical practice,” Dr. Bessesen observed. “When you do this, you have to train your office staff to do this in a manner that is comfortable for patients—they are not used to you coming at them with a measuring tape.”

Weight history also is important to consider because weight gain can be an independent predictor for metabolic syndrome.

Dr. Blackburn agreed. “If your patient has gained 5 pounds since the last annual exam, that is a real call to action. It's five times the typical annual weight gain,” said Dr. Blackburn, director of the Center for the Study of Nutrition Medicine, Beth Israel Deaconess Medical Center, Boston.

Setting incremental goals for increased physical activity also may increase the likelihood of success, Dr. Bessesen said. A recommended 30 minutes of daily physical activity may seem unattainable to some patients. Three 10-minute activities each day confer the same benefit and may be more realistic for some patients.

A pedometer is a relatively inexpensive way to measure physical activity and offer immediate feedback to patients. Patients who move 3,000-5,000 steps per day are considered sedentary. The surgeon general recommends 10,000 steps per day, but 12,000-13,000 steps per day may be necessary for true weight loss, he said.

A basic pedometer costs about $25. Doctors at Dr. Bessesen's institution prescribe them, and patients pick them up at the hospital pharmacy. Pedometers also can be ordered online at such sites as www.rx4betterhealth.com. Follow-up and encouragement are suggested so patients continue to use the devices.

Providing several options for behavioral change is advisable, as is giving patients take-home materials to reinforce the message. A patient's willingness to modify behaviors can be assessed in terms of these “stages of change.” A diet and exercise plan is not likely to succeed for patients in the earlier stages. An initial goal might be to move patients to another stage before implementing such a plan.

Precontemplation. The patient is not thinking about the consequences.
Contemplation. The patient sees barriers to change, and may say, “I feel terrible, but I can't change anything.”
Planning. The patient decides to pursue dietary change and/or increased physical activity.
Action. The patient tries interventions suggested by the physician.
Maintenance. The patient is making progress, which should be monitored regularly so goals can be updated.
Relapse. The patient regains weight after initial weight loss. Reward the patient for efforts, assess barriers to change, and consider trying other approaches.

Source: Diabetes In Control Dot Com.

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