| Rx for Weight Loss -
05-03-2006, 08:45 PM
If your doctor is like most internists, he spends part of each day gently reminding patients they need to eat less and exercise more.
Think of his day and you get the whole, frustrating picture. No matter how many times he repeats these messages, statistics grimly remind him that he has his work cut out for him. After all, 30 percent of Americans age 20 and older are obese, and only 45 percent of adults are as physically active as they should be, according to federal statistics.
Yet a small but growing number of doctors are coming up with novel -- and successful -- ways to remind you that proper weight and exercise are key components of a healthy lifestyle.
For instance, Dr. Joseph Chemplavil, a cardiovascular endocrinologist in Hampton, Va., pays patients to lose weight -- $1 a pound.
And Dr. Charles Brackett, a physician at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., and his colleagues actually write prescriptions to exercise. Right on the prescription pad, he tells patients to get moving, tailoring the prescription to their condition, their health status and their capabilities.
"We're trying to get everyone to exercise," said Brackett, a fitness enthusiast whose passions include cross-country skiing and hiking. A poster in his office touts the value of exercise, and Brackett asks each patient if he or she is physically active.
If they are not, out comes the prescription pad.
"The idea of putting it in writing might make it more tangible to people," Brackett said. So does tailoring the prescription to the person's condition. For instance, he said, he might suggest that a patient who has had a heart attack walk a half hour a day, and share the news that studies have found that doing so could reduce the risk of another heart attack.
But before he writes the prescription, Brackett asks a series of questions that he hopes will motivate the patient to say, "I should exercise." If he can get them to acknowledge that out loud, he said, they are more likely to follow his Rx.
Brackett also has guidebooks available of nearby hiking trails and pedometers that patients can buy -- for $4 -- to track their progress. He conducts the program with help from the Upper Valley Trails Alliance, a project to promote physical activity supported by the Robert Wood Johnson Foundation.
Chemplavil asks his overweight patients to enroll in his "Dollar for Pound" program. They pay a $10 annual membership fee, and then get busy losing weight. At each visit, there's a weigh-in -- and maybe a pay-off.
The financial reward is small, he admits, but the health benefits aren't. He tracked a group of 150 patients who started the program in 2002, and 80 percent of them lost an average of nearly 9 pounds during the year.
What's the program's secret? "Any kind of new system (to motivate individuals) works in human behavior," Chemplavil said.
Perhaps many doctors don't realize the power the written words can convey.
Numerous studies have found that a simple suggestion from a physician to lose weight or exercise can have a big impact. In one recent study done in New Zealand, researchers assigned half of nearly 200 patients, ages 65 and above, to an activity program written in prescription form; the other half did not get the instructions. Those assigned to the prescription group also got follow-up telephone support for three months. After a year, members of the prescription group had increased their activity levels by about a half hour per week, compared to the control group. And, they said they felt better, too.
Brackett and Chemplavil are big believers in their programs. And the real payoff, Brackett said, is encountering patients who have taken his advice and reaped the health benefits.
"I get excited when I see patients who have lost 20 or 30 pounds and they are able to come off medications" for blood pressure, cholesterol or other conditions, he said.  | 
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