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Elective Rotation: Health at Every Size

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Contact: Amy Marietta

Location: Varied

For my elective, I spent two weeks exploring topics related to obesity, its impact on health and wellness, and ways in which we can improve our approach to caring for patients of size as well as their health outcomes. In particular, I spent some time learning more about an approach called “Health at Every Size” which focuses on encouraging healthy behavior changes and self-acceptance no matter the size of one’s body.

1. I spent some time watching a series of video curriculum modules on this approach (available at http://haescurriculum.com/).

2. I also explored local resources for movement and healthy eating, by attending an Overeaters Anonymous meeting, auditing a Weight Watchers meeting, and shadowing Ashley, a nutritionist at “Healthy Steps,” a local medical weight loss program (http://www.healthystepsinfo.com/).

3. In addition, I conducted a short focus group with class instructors at the Northern California Center for Wellbeing (http://www.norcalwellbeing.org/).

4. Another valuable activity was attending the new patient bariatric surgery seminar at Wells Fargo center with Dr.Woodbury the first Saturday of the month from 12:30-2pm. Great info for primary care docs to help us educate our patients.

5. I also committed myself to taking the steps we encourage our patients to take- by keeping a food journal, practicing mindful eating, getting enough rest, and moving more- and kept a checklist of these goals to keep myself accountable- it’s harder than we think!

To work with the Healthy Steps team, contact Dr. Woodbury first- his contact info is available on our medicine team list.

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Obesity Elective

From: Kayla Flores Tindall

I mostly wanted to get more comfortable addressing obesity and metabolic syndrome in our patients as it is so common and often not directly addressed. I visited the Center For Wellbeing and got a tour and description of their programs and services and available scholarships. I spent several days at the Healthy Steps Lifestyle center shadowing the dieticians. There they do body composition analysis, address life stressors, movement and movement goals, and discuss a meal plan. Occasionally people are put on a ketogenic diet but most are instructed on a whole food, Mediterranean based diet that limits grains to one serving of whole grains a day. They tailor the meal plan to the person's resting basal metabolic rate. With the exception of starchy vegetables, they encourage unlimited vegetables. I also witnessed guided meditation and encouragement around mindful eating as well as appropriate water consumption. Most importantly, they have frequent regular check in with patients. I read a basic and thorough AAFP article on obesity so I was better educated prior to doing some panel management during which I called patients on my schedule in the coming months with increased BMI. I explained that as part of an elective I was reaching out to patients with medical conditions that can be influenced by body weight and asked if they were interested in achieving a healthier weight. All replied with an enthusiastic yes and gave us the opportunity to discuss healthy breakfast, sugar sweetened beverages, and programs like CWB and healthy steps. PHP covers healthy steps metabolic weight loss program so referred many and helped to spread the word about the referral process so our PHP patient with obesity and metabolic syndrome could get help in obtaining a healthier weight. I have already seen someone in follow up that I referred on that "panel management" day and she was excited to tell me all about the program and the changes she had made in her lifestyle. I definitely increased my comfort in acknowledging and addressing this with my patients.