One of the most popular New Year's resolutions is to lose weight. As a nurse practitioner (NP) whose practice focuses on bariatric medicine, I see an upsurge in patients eager to lose weight this time of the year. When you consider all the diet and exercise resources in the market today, weight loss can be a time-consuming conversation. Advising patients became even more cumbersome when, just last year, the Federal Trade Commission found four products (including Sensa) guilty of misleading consumers.1 Given the complexities, how do we effectively direct our patients toward healthy weight loss?

In today's healthcare system, the provider is forced to see a large volume of patients in a fairly short visit. Where does a provider find time to thoroughly discuss healthy weight loss? Considering that weight loss might be an encompassing solution to a patient's larger health problems, I challenge us, as holistic providers, to look at the whole picture to ensure healthy, holistic weight loss.

Detoxing

Benefits of detoxing include a healthier digestive system, decreased inflammatory markers that can cause bloating and water retention, and initial weight loss due to a healthy elimination diet. There are many nutritious detoxing regimens available as well as harmful treatments. It is our role as NPs to use evidence-based research and educate patients on choosing a safe, effective regimen. This includes a nutritious plan incorporating vitamins and minerals in addition to increased hydration, healthy eating, and regular elimination.

Undiagnosed medical conditions

At times, we are confronted by a frustrated patient who has followed every plan in detail but has not lost weight. This is an opportunity to explore possible underlying, undiagnosed medical conditions.

Of course, we are familiar with hypothyroidism and the subsequent disease process. However, lab tests can now help identify underlying food allergies, including milk, wheat, and gluten sensitivities. If not addressed, these issues could cause intense exasperation to a diligent patient. In addition, hyperinsulinemia, even without a diagnosis of diabetes, could cause great difficulty with weight loss. Insulin levels should be closely monitored.

Other basic diagnoses and lab values are also commonly overlooked but should be addressed to assist in weight loss. Anemia with low levels of hemoglobin, hematocrit, and/or vitamin B12 could hinder patients from exercising, for example.

Lifestyle

We should also consider our patients' stress levels, daily routines, and sleeping habits. High stress levels can lead to elevated cortisol secretion, which is highly correlated to weight gain. In addition, sleep apnea and insomnia have a reciprocal relationship with obesity. The patient's relationship with food and "emotional-" or "stress-eating" should also be carefully assessed. This unhealthy association must be addressed for any regimen to have long-term success. A referral to counseling, psychotherapy, or even Overeaters Anonymous (http://www.oa.org) can help bring these issues and the root cause to light. (Weight Watchers can also be helpful: http://www.weightwatchers.com.) A mental health regimen can then be developed to complement the patient's weight loss.

Successful planning

It is important to know your patients' successful attempts at weight loss as well as regimens that failed. Build a simple program emphasizing key points from their previous success. Meet patients where they are and educate them on proper eating and exercise habits. Follow up with each patient closely. Hopefully, your patients' successful weight loss will lead to healthier future visits and many more happy years to come!

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