A little while ago I wrote to tell you about Dr. John LaPuma, a doctor and a chef who bases his practice at the Santa Barbara Institute for Medical Nutrition and Healthy Weight. During our interview, he told me he is able to achieve an extraordinarily high success rate with his weight loss patients. So I wondered what weight loss tools he can offer to Skinny Daily Post readers.
Well, part of this success lies in seeing very highly motivated patients. Half of his practice serves people who are obese or morbidly obese, with 75, 100, 150 pounds or more to lose. They want to reduce their dependence on medication or reverse disease and often say they want to achieve their goal no matter what it takes. So for them the game is survival rather than hitting a certain number on the scale.
LaPuma is very pointed about teaching the medical effects of diet and nutrition. “My patients are quite confused about what to eat and when and how,” says LaPuma. “They want honesty and accuracy.”
Their motivation pays off. “When they modify what they’re eating, they experience changes in their health,” he says.
These changes are measurable and progressive, and in certain ways, perhaps, more profoundly encouraging than the changes on the scale. People are always delighted to lose weight, but who hasn’t lost weight before? Dropping your resting heart rate, blood pressure, cholesterol numbers? Kicking Type II diabetes to the curb? A new and interesting game.
This program operates through four toolsets, says LaPuma: accountability, self-monitoring, individual design, and adequate activity.
“Accountability” for your actions, for sticking to your plan. Lapuma believes we need a coach who we can report to and get help from regularly. He doesn’t mean accountability to ourselves, or to a group. He believes the model that works best is one-on-one weight loss coaching. Coaches are not spouses or partners, coaches are not groups. He likes the idea of a coach who is a health professional specializing in weight loss, a dietician, for instance.
“In general, I find that groups are susceptible to group think,” says LaPuma. “Groups are good for a lot of things, but they can act more as a social cushion than as a responsible partner in weight loss. What you want is someone who will hold you accountable, who will help you get back on the straight and narrow if you’ve deviated from your plan.”
“Self-monitoring” is not a matter of clinging to your scale, but of monitoring your diet and exercise so you know you’re following your plan, and then measuring progress using other means. LaPuma coaches his patients to weigh in once every three months or so, so long as they’re following their eating plans. He recommends attending to dress sizes and blood pressure medication doses, the behavior of one’s belt, pedometer counts, the fit of favorite jeans as more reliable indicators of success.
“Individual design” for a diet is critical to his program. “There is no magic percentage of carbs, protein, fat, and alcohol,” says LaPuma. “It depends on you and how your body metabolizes calories, which is different for everybody.” LaPuma’s clinic administers a metabolic questionnaire that gives him a simple sense of how patients eat, what foods and patterns they favor, whether a patient will benefit from a more or less structured program. Physical examinations and lab tests help him set parameters for nutrition. These together with medical goals help his clinic form an individually designed diet.
“Adequate activity” is carefully worded to help patients focus on getting enough of any activity that will help make their bodies healthy. We know that means more than 300 minutes of activity per week. We know that getting a little sweat up during that time is ideal. It helps us lose weight, and is critical to maintaining our weight loss. Simple.
And that’s where it starts. Armed with all of these tools, LaPuma and his colleagues teach people to live differently, eat differently, cook differently. He shows them how to buy and prepare new foods. Nothing is left to guesswork.
Now, LaPuma’s practice is unique, of course, owing to his nature and interests. But what if it weren’t? What if other practices could borrow from this model for whole healthcare? I like to imagine that day.