CPM Winter 2020 - 24

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lives. Admittedly there are times when due
Limit portion size. If the patient just can't need to limit portion size. Suggest patients
to dangerous health situations, serious effort seem to motivate herself to change what is ask the server to bring a take-out container
needs to be made to get significant weight eaten, then encourage her to decrease the when she delivers the meal, and immediately
off quickly. But for most of our patients, typical serving size to about 2/3 of what she put aside 1/3 to 1/2 of the portion from the
the effort should be toward helping them normally would eat. While less than ideal start - lunch for tomorrow! Decline the bread
clean up some eating habits and lifestyle from the nutrition standpoint, weight is basket, skip the appetizers and dessert, or at
choices so that over time a healthier weight bound to come off with less calories taken in. least share those things. Special warning for
is achieved and maintained. And similar to
AVO I D M A K I N G H AV I N G A those who have an expense account while
our wanting them to understand the issues "TREAT" A DAILY HABIT. Is it a birth- traveling for work: it's not their birthday!
behind their various medical problems to day? Have cake! If it's not a truly special It's just what happens to be for dinner since
address them at the root causes, our advice occasion, then skip dessert. In other words, they're not at home.
on diet should look at the facets of their lives encourage the idea that treats should be by
Now, we know the phrase, "Everything in
that contribute to their "weight problem." definition uncommon.
moderation." But I add to that, "Including
It's a shift from thinking about healthy
CONSIDER THE CALORIE CON- moderation," meaning, there are times
eating as something that's done for a time TENT FOR ALL THE BEVERAGES to celebrate and we should! Food can be
period then going back to what they really YOU'RE DRINKING. Soda, sweetened tea, a great part of celebrations. But all of us
want to do! Encouraging them to be a and even fruit juices can add tons of calories must remember to try not to eat like we'll
tortoise, not a hare is the idea: slow and to a meal or snack. Of course, those fancy never have the chance to eat that particular
steady wins the race, and no other area of coffee drinks are often loaded with sugary food again!
life demonstrates this more than the pursuit and fat calories with little nutritional value.
I was challenged recently by a statement
of nutritional health.
Encourage patients to opt for calorie-free from a dinner guest in our home who,
So our dietary counseling should look things like water, black coffee, or tea. Water despite enjoying the delicious dinner my
something like this:
can be flavored with something natural like wife had made, was leaving food on his plate.
AVOID SKIPPING MEALS. This lemon, lime, or another fruit for a no calorie Realizing he had served himself too much
seems to be especially true once the patient boost. Remind them that alcoholic drinks food, he apologized but said, "I don't want
the last memory of this wonderful meal to
gets past 40. Counter the "I don't like are not calorie-free.
breakfast." "I'm not hungry in the morning."
LOOK FOR IMPOSTERS. Packag- be discomfort from overeating." That's great
Often it's the scenario that the patient has ing can be very misleading. Granola and advice for anyone!

trained herself to not require food to get "nutrition" bars all look good - they're
going in the morning. It also may mean in a brown wrapper with a sun on it for
that evening snacking has blunted the drive heaven's sake! They've got to be good. What
to "break the fast." While there seems to be about smoothies? They're all natural, right?
benefit to a 12 hour fast, extending beyond Often these things are loaded with calories
that, or skipping meals means higher risk from sugar or other sweeteners that up the
of overeating at the next meal. Remind calorie content significantly while not really
patients that our bodies are not like cars providing great nutritional value.
that we load up with fuel and then draw on
it when needed. We need regular fueling to HUNGER. Suggest that patients evaluate
avoid the stress of starvation.
sudden hunger with this question: Am I
GO HEAVY ON THE FRESH FRUITS really hungry, or am I Sad? Lonely? Mad?
AND VEGETABLES. Lots of them. Col- Anxious? Stressed? At those moments one
orful foods are more likely to be packed with should take a breath and try to deal with
nutrients with less calories. Peppers, greens, that emotion rather than attempt to cover
fruit in its natural form, eggplant, tomatoes, it up with food acting as an edible bandage
avocados, etc., all exhibit the telltale sign that over those tough emotions.
they are loaded with good stuff: their color.
WHEN EATING OUT, FORE Suggest that they forego the starch of the WARNED IS FOREARMED. Since
meal and instead add two vegetables along restaurant food tends to contain lots of
with the meat. Or halve the typical starch fat and salt, this drives the calories and
serving and add the second vegetable. And fluid-retaining qualities up. While some
have something green every day.
choices are better than others, patients will
24 Winter 2020 Central PA Medicine

Dr. Richard Rayner is an experienced family medicine
and urgent care provider who leads Aspire's concierge
medicine practice, AspirePRIME, located in Harrisburg,
Pennsylvania. Dr. Rayner cares for a wide range of patients from newborns to geriatrics, helping them through
disease prevention, treating chronic conditions, as well as
addressing acute illnesses. He can be reached at rrayner@


CPM Winter 2020

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