In theory, losing weight is simple. Eat less, move more, and the pounds will drop off. But if you’re obese, it can be a daunting task, emotionally as well as physically. Which is why there's no such thing as too much help. Sure, you’re the one who must do the hard work, but having a stellar team of experts by your side makes a world of difference. Think of these pros as your personal weight-loss cheerleaders.
Often, a nurse is the first medical professional you speak to about your weight-loss goals. As a registered nurse, Ashley Wood, B.S.N., often carries out the initial patient assessment. “When a person is obese, they can have other medical conditions that need to be treated and monitored while they are trying to lose weight,” explains Wood, who is based in Atlanta and is the author of Demystifying Your Health.
“It typically falls to the nurse to gather the information from the other professionals and relay it to the primary doctor overseeing the treatment plan. Each professional plans a key role in the process, but it’s the primary doctor who makes sure that all the components are working together, and it’s the nurse who makes sure that the doctor has all the information that they need to do this safely.” In other words, the nurse is often the glue that holds the whole team together.
If a person’s weight or inability to lose weight points to an eating disorder, a psychotherapist can be a crucial part of their dedicated team. Christine Schneider, Ph.d., from the Integrative Mind Institute in Kirkwood, MO, specializes in eating disorders such as Binge Eating Disorder (BED), which is the most common eating disorder in the U.S. People with BED repeatedly eat large quantities of food (often very quickly and to the point of discomfort), they feel out of control during the binge, and experience feelings of shame, distress, or guilt afterward, according to the National Eating Disorders Association.
“My role is to highlight the ways in which psychological factors such as self-hate, shame, and emotional dysregulation play into the choices a client makes over the types and quantities of food,” Schneider explains. From her perspective, one of the most important factors in obesity treatment is the way a patient attempts to use food to control emotions or communicate in relationships.
“Overeating can be used to soothe and comfort, to express anger at both oneself and others, and to maintain a role of needing care and comfort,” she says. “This can keep people at higher weights regardless of medical interventions. Once the patient can move towards greater emotional regulation and healthier relational strategies, they can be guided to healthier food choices that will be consistent over time.”
BMI and numbers on the scales aside, any weight-loss plan should focus on general lifestyle changes for the better, which is where an occupational therapist is a key player. “With weight-management counsel, I try to enforce that one must look at how they’re managing their lifestyle,” says Pooja Shah, O.T.D., an occupational therapist in Fullerton, CA. “Understanding lifestyle choices, emotional triggers, food habits, genetic history, and work and family obligations, plays a significant role in weight management.” Rather than set unrealistic weight-loss goals, Shah recommends setting smaller goals, such as staying within the prescribed calorie count, managing emotional eating, and increasing exercise time.
To give patients the best chance of meeting those goals and sticking to them in the long term, collaboration is key—and not only within the medical team. “Family members and coworkers can play a hugely supportive role,” Shah adds.
If a patient is morbidly obese (has a BMI of 40 or more) or has a BMI of 35 or more and is experiencing obesity-related health conditions, such as high blood pressure or diabetes, their physician may recommend bariatric surgery, such as gastric banding (reducing the size of the stomach with an adjustable silicone band).
The role of a bariatric surgeon goes way beyond performing the procedure, says Scott Cunneen, M.D., director of metabolic and bariatric surgery at Cedars-Sinai Medical Center in Los Angeles and author of WEIGHTY ISSUES: Getting the Skinny on Weight Loss Surgery. “I help the patient determine which procedure would be right for them and give them the information and encouragement it takes to keep the weight off long-term,” he says. “It’s crucial to ensure that our patients have the knowledge and understanding not only of what weight-loss surgery is and how it works, but what their own role will be in their initial and ongoing success.”
For instance, patients should know that surgery is not a quick fix or the easy way out, and should commit to what Dr. Cunneen calls “doing the work”: eating properly, becoming and staying physically active, and following professional advice for making major lifestyle changes.
Someone who plays a crucial role in guiding bariatric surgery patients through the pre-op and post-op process is a registered dietitian. “Our patients generally come to us with decades of mental and physical baggage relating to how their weight has affected their health and their lives, and they're looking for a long-term, permanent solution,” explains Rachel Lander-Canseco, R.D., a registered dietitian at PIH Health Hospital in Whittier, CA.
She supports patients in several ways: teaching weekly educational classes, leading monthly support groups, and seeing them in the clinical office before and after surgery. All these things combine to ensure patients have a safe, successful surgery and transition to a healthier, happier life.
Every Team is Different
Of course, every patient has their own (often-complicated) health history and their own specific needs. “Our patients may come to us with a complex web of medical histories, which means that specialists from a number of fields, nephrology to endocrinology to cardiology to mental health, need to be supportive and on-board for our patient’s weight-loss journey ahead,” explains Lander-Canseco.
Whether the outcome is surgery or not, the common thread throughout all aspects of patient care is an emphasis on changing mindsets and habits. “It’s that commitment that will ultimately determine successful long-term weight loss and maintenance,” says Lander-Canseco.