Roberta’s Rant By Roberta Heale Associate Editor EBN, @robertaheale

A tv personality in Canada, Rick Mercer, is well known for his ‘rant’. Every week he’s filmed walking around outside in back lanes where he expresses his frustration about a variety of issues. Here’s his rant about people who don’t get the flu shot: http://bit.ly/1wdhAiW

I want to rant. I work at a community health centre once per week where I routinely care for patients with diabetes. Despite ongoing education about diet and exercise, most continue to gain weight and most are obese or morbidly obese. Very few are in target range for glucose or cholesterol, yet, the many also choose to stop their cholesterol medication (usually because of what they read on the internet). There is a great deal of confusion about appropriate lifestyle changes. All of this, and the clinic follows evidence based guidelines for diabetes education and management.

Knowing that confusion about diabetes care is not a unique to a few individuals, I can’t help but wonder what are we, as health care professionals, going to do? Looking at counseling for diet alone, it seems as if education about weight loss and healthy diets is like fighting a tsunami with a bucket. Obesity is rampant and growing (pardon the pun). People don’t appear to understand even very basic concepts, so how can we expect them to understand food labels, carbs, fat content, portion size, calories etc?

A research report released last week was splashed all over the news….every diet works  http://www.bbc.com/news/health-29031985    The issue is ‘for how long’???? The numbers show that people are not able to maintain changes in diet and exercise. The only successes appear to come from those who have received gastric bypass surgery. Has is come to this? Is the only way a patient can lose enough weight to get back into a healthy range through surgery?

We know a lot about disease processes such as diabetes, but we still know very little about what it takes for patients to make meaningful lifestyle changes. Until we know more, I’m going to give all of my patients a prescription for the following: Only eat ‘real’ food…fresh fruit and vegetables, lean meats, whole grains, nothing from boxes, nothing with added sugar or salt. No portion of meat, grains bigger than a closed fist. You can have a small sweet treat twice per week IF it’s made from scratch at home. Brisk walk for 20 minutes before each meal. Return to Clinic in 3 months for a review of progress. The hardest part will be to implement it myself.

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