I propose asking your patients two questions: What is it that you really want to accomplish with your life? How will having a healthier body help you achieve that?

When people are motivated by something positive, fulfilling, and deeply meaningful to themselves, like having a baby, the impetus to change is more powerful. The ability to postpone gratification is strengthened.

It really does not take a specialist to address some of the very basic issues related to weight management. The key often is to demonstrate the necessary empathy and understand that this is not “simply” a matter of eating less and moving more and that it is very worthwhile understanding the drivers of weight gain before jumping to “band-aid” solutions.

As I’ve often said before: obesity is a clinical sign, overeating is a symptom!

The art of medicine for a reproductive endocrinologist definitely includes life coaching, specifically with respect to things like weight loss and smoking cessation. Patients come to us wanting to become mommies and as such, have the rare opportunity to become fiercely focused and motivated. I often will talk with the patient for an hour reviewing their specific caloric intake, the scenarios which are the most perilous to them ( keeping that bowl of candy near her cubicle, watching TV with that favorite brand of ice cream every night, trying to regain work-day energy with those four sodas every day) and the reasons for their eating habits (“we grew up in a home where there were always cakes around”, “when I get stressed about my fertility, I find comfort in brownies”). We review specific strategies on what stepwise changes they can try with respect to exercise and consumption. There are also many patients with concrete medical disorders such as hypothyroidism and insulin-resistance which can be addressed with powerful results. When appropriate, patients also supplement my suggestions with an outside commercial weight loss program. All these components are centered around the constant reminder that as their BMI comes down to a more reasonable level, their chance to have a baby will get higher and come sooner. We set deadlines so that there are concrete goals to strive for, but we stay positive and flexible if they fall short, choosing then to reassess the situation and see what changes we can make to our strategy.

It didn’t take me getting any special training in bariatric medicine to pull off some amazing 30-40 pound reductions. I just took interest in it, learned from colleagues, learned from reading and mostly, learned by practice over time. In this manner, I function as would any primary care doctor. I acknowledge that we have it different given our opportunity to spend more than 10 minutes each visit AND we have the luxury of dangling a very potent motivating factor in front of the patient, namely her wish to bring home a healthy baby.

I sometime remind patients that I can always try to help them have a baby with or without their losing weight. However, the closer they can get to the optimal fertility BMI under 25, the less expensive it will be for them in terms of fewer IUI or IVF cycles and less money spent on fertility medication dosages. When patient are faced with very real personal financial consequences, they have the best motivations to getting healthier. The patients who have full insurance coverage for IVF, for example, will unconvincingly say to me, “OK, I’m going to try and lose 10 or 20 pounds, but can we get started with the IVF now anyway?”

Furthermore, I rarely refer patients to bariatric specialists until I’ve tried everything I can offer and surgery becomes the last resort.

And I agree with this post wholeheartedly. As physicians in almost any field, we can (and arguably we SHOULD) take an interest in honing our weight loss management skills.