Keeping It Off

Posted December 30, 2011 by Dr. G
Categories: Addiction, General Mental Health, Obesity, Psychiatry in the Media

Tags: , , , ,

I found this NYT article yesterday about the difficulty of successful weight loss, and finally finished reading it today. I have been interested in this topic recently–the science behind weight loss. Partially I’m interested in this because there is increasing evidence that obesity has underlying biological factors that contribute to its epidemic; i.e. obesity is more like a disease, not a choice. The article is fairly long, but some of the more interesting points I found were the following:

1. There are hormonal changes after weight loss (lower peptide YY and leptin, higher ghrelin) that make it hard to keep the weight off (i.e. someone who used to weigh 150 pounds and now weighs 120 pounds, is different than someone who naturally weighs 120 pounds)

2. Some people have specific genes that make them more predisposed to eat higher calorie foods, and make it harder to lose and keep weight off

3. People who successfully keep weight off are the minority of those who try to lose weight, but they all have specific consistent habits, including tracking their food and exercise, weighing themselves daily, exercising daily, eating breakfast everyday, watching less TV, and not “cheating” on holidays and weekends

4. After weight loss, you are more susceptible to cravings than before (and this is shown on brain MRIs in research, and is some of the evidence behind obesity having similarities to addictions)

5. Knowing some of these things can help to improve ways of losing weight

Now after read this article I feel a bit more informed. It is easy to tell those who are obese to eat less and exercise more. While these tenets are still the core of achieving weight loss, we are starting to learn that not everyone has the ability or the genetics to do this things as effectively or efficiently. That being said, it’s not a reason to give. It may just be that we need to start approaching weight loss for people in a different light, for example slowing it down rather than speeding it up. Another reason to avoid those infomercials late at night!

Good luck and as always feel free to leave comments or feedback!

Obesity Counseling to be Paid for by Medicare

Posted December 1, 2011 by Dr. G
Categories: Obesity

Tags: , ,

Recently I have become interested in the obesity epidemic plaguing our country. I’ve actually been interested in obesity and co-morbid psychiatric illness since residency, but recently my interest has been revived. I read that Medicare is going to be reimbursing health care practitioners for obesity counseling and screening. My initial thought was that this is a positive step in the right direction. But the cynic in me began to wonder–what does obesity counseling exactly consist of? Who will be administering this counseling? Will it be nurses, doctors, nutritionists, or psychologists? What data is available that tells us this will actually work?

Currently, the art of “counseling” is already in danger of becoming an extinct entity, as a result of changing insurance reimbursements, which tend to be better for psychiatrists who prescribe medications rather than psychotherapy. This has influenced the state of psychiatry training programs, which have begun to deemphasize training for therapy, favoring instead a focus on psychopharmacology and biology. This has its pros and cons, as with anything, but has turned psychiatrists partially into pharmacists. I find it unfortunate.

But back to obesity counseling. Usually now, when obese patients see their doctors, they hear a lot of the same information over and over again–that obesity leads to hypertension, diabetes, strokes, heart attacks, shorter life expectancy, and so on. To deal with obesity, patients are told to eat healthier and to start exercising. Well, no kidding! All of this information is now readily available anywhere online and is not news to people. So what makes doctors think that repeating this information will all of a sudden get a patient to lose weight? It doesn’t. Which leads to no change, which in the long run, makes doctors become pessimistic, believing none of their patients will change. So they start treating the diabetes and high blood pressure, ignoring the underlying obesity, and it turns into one big never-ending cycle.

I hope this is not what “obesity counseling” will consist of. I hope that what doctors and other health care practitioners start learning is that motivational interviewing and motivational therapy is the way to get patients to start changing. We have to allow patients to tell us why they want to change, not us tell them why they need to. People only change when they are ready to. We need to start learning how to get patients to get closer to that point. It’s easier said than done.

Group Everything Is Better

Posted November 6, 2011 by Dr. G
Categories: Uncategorized

Hi everyone! Sorry I’ve been MIA for the past few weeks. I have been busy with work, and also busy with taking care of myself. I started back up in the gym, and yesterday ran a 5K with a friend of mine. Training for even 3.1 miles is hard when you haven’t run in a few months! Luckily I had been working out so it wasn’t too bad.

Tonight I wanted to bring up the topic of relying on groups for motivation to do what you want, partially because that’s what I have been doing recently. There is a reason that AA (Alcoholics Anonymous) and Weight Watchers work for people. There is evidence that group programs such as these are some of the most effective ways to stay sober and lose weight (respectively of course!). Working in groups is useful for a number of reasons, including being held accountable by others, feeling responsibility for others’ progress, and seeing other people’s progress as an inspiration for yourself. It is helpful for people to get advice from those who have been in their shoes, in order to overcome the obstacles that come with any journey of self-change.

Lately I have been trying to work with others (such as running with friends) in order to accomplish some of my own goals. Having someone else doing the same thing as me keeps me motivated to keep up my progress, which is not easy when I am by myself.

I would encourage that anyone out there who wants to improve themselves in any way–whether it is recovery from mental illness, beating an addiction such as smoking, or wanting to get in better shape–to consider trying it out with other people. You might be surprised at how much more you can accomplish!

Happy mental health! Next post will be much more timely than this one!

Really Destigmatizing Mental (and Medical) Illness

Posted October 1, 2011 by Dr. G
Categories: Depression, General Mental Health, Multiple Sclerosis

Tags: , , ,

Recently I was asked to speak with a large group of resident physicians after one of their colleagues committed suicide the week prior. It was a hard discussion to have for a couple of reasons, including the fact that I had never done such a thing before. I had, however, gone through the same experience when I was in residency training–a colleague committed suicide when I was in residency as well. It was an event that impacted those that knew him, as well as those that did not. This is sadly a topic that is not discussed much–depression and suicide in physicians. Part of the difficulty in confronting this issue, is of course that doctors have a hard time asking for help for their own mental health. However, doctor’s rates of depression and suicide are higher than the general population–but on the other hand they have lower rates of cardiovascular disease.

One of the things I have personally struggled with during my training in medical school and residency, was dealing with depression. Unfortunately, although I was in a psychiatry residency, talking openly about being depressed was still a no-no. What it will take to destigmatize depression is being able to discuss it openly. So although it is hard, I will start in this forum. I have been depressed in the past. Finally after some time, at the encouragement of a friend years ago, I sought really good help for myself, and now I am a completely different person than I was back then.

I was also diagnosed with multiple sclerosis six months ago. This is another issue I have been struggling with, but in the past couple of months I feel I have been able to get a good handle on it, in particular by managing the things I still have control over. One of the things that I have learned though, is that I have an easier time talking to friends about having MS; I never talked that openly about depression. I was worried what others would think of me, that I would appear weak, and so on. I felt that way despite knowing so much about depression and why it happens, how it’s treated, and how it affects people. It has been a struggle dealing with all my health issues, but I’m so glad I’ve had the determination to do it. That being said, I’ve needed a lot of help along the way, and for that I’m grateful too.

If you think you might be depressed, tell someone. Ask for help. If the situation were reversed, wouldn’t you help the person asking? It’s hard to manage these things alone. Happy mental health everyone!

Taking Time For Yourself

Posted September 26, 2011 by Dr. G
Categories: General Mental Health

Another common phrase that’s easier said than done, right? Well, I think sometimes these sayings are out there because they have some truth to them. Today I took a random vacation day off. I’ve been working for months now with a couple days off for travel, but was realizing that it was starting to feel a little Groundhog Day for me. So here I am. This morning I went to the gym (which ironically is at work!), picked up some things at the grocery store, and took Harrison for a nice walk in my neighborhood. Yes, if you click on his name, you’ll find he takes after his owner–he has his own blog as well!

Anyway, not only do I get a shortened workweek, but I feel a little bit relaxed to be able to miss the Monday madness that inevitably happens each week. I plan to do a little cooking, and of course watch some of the judge shows (yes I know they’re all probably fake but I love them!), and catch up on a couple of bills.

If you have the luxury of being able to use a vacation day here and there just for yourself, not traveling, then I would highly recommend it. Just the idea of prioritizing yourself can make you feel better. Although it doesn’t seem like it would make a big difference, the benefits are great! Happy mental health.

Everyone Needs Help Sometimes

Posted September 21, 2011 by Dr. G
Categories: General Mental Health

Tags: , ,

The title of this post is something that’s often said to people who are having a hard time accepting help. Of course this statement is easier said than done. It is difficult for people, in particular independent people, to even acknowledge that they need help with something, let alone ask for it. I see this in the hospital at work with sick patients all the time, but it also happens in our day to day lives. Personal example: I recently hired a personal trainer. For me to outsource a task that in the past I have managed myself, was very difficult. I wondered why I wasn’t strong enough to address my health on my own. Well, whatever the answer to that question is, the more important issue at hand is that I get healthy one way or another. Hence, the trainer.

In any case, asking for help doesn’t make someone weak; truly I think it makes them strong. For someone to humble themselves enough to say “I need help–will you help me?” means that person is able to put aside their pride in order to meet a need. I don’t feel that I am incompetent because I need an expert’s help. I am good at what I do, and others are good at their job. And in cases of asking for a friend or family member’s help, I think it’s always important to remember that if the situation were reversed, you would be happy to do the same.

Just some food for thought–happy mental health!

Doctors Should Stop Wearing White Coats

Posted September 8, 2011 by Dr. G
Categories: Forensic Psychiatry, Psychiatry in the Media

Tags: , ,

I stopped wearing my white coat regularly about four years ago. I get questions from people at work about it all the time. Most commonly I get asked why it is that I don’t wear one. I admit, it might be easier for me if I did–and occasionally I will put it on, usually for an important meeting, or when I want to have a more authoritative role with a particular patient. A white coat makes a physician more recognizable as a doctor, and has big pockets, so a doctor can carry his or her important papers, reference books, and of course their cell phone.

That being said, I absolutely hate wearing my white coat. I have two of them, and find them to be a terrible nuisance. They get ring around the collar after one wearing, the smallest size could house a small football player, and can cause someone to be 10 degrees warmer, especially in a hospital where the air conditioning is unreliable, and the heat too high.

Also, and definitely most importantly, white coats are disgusting, and I mean that in a clinical way. White coats have been banned in the U.K. since 2007. While it is not clear whether the bacteria on white coats actually causes more infections in patients, to me it doesn’t matter. It gives me one more reason to not wear my white coat. Wearing one doesn’t make me a better doctor.