the department cardiovascular medicine at the Cleveland Clinic and I’m here with Kate Patton who’s a dietitian who spends a good deal of her time in our cardiovascular prevention clinic helping counsel patients about that diet and and and how to improve their heart health stock it’s a heart month and we have hi this year for heart month we’ve focused on obesity as a health problem and one of the things that so quite interesting as we did a survey. What I understand what attitudes of Americans are about will be seen heart health we found out that there are a lot of things that people don’t know people are worried about their weight but they don’t know what to do about it and there’s just a lot of lack of knowledge a lot of confusion about what to do. So you tackle this problem pretty much every day Kate so how do you start with somebody most people know they’re overweight how do you help him get moving toward a more heart-healthy weight. That’s a good question so I think I’m getting to know the patient and knowing their current eating behaviors is important and then try to just improve upon those things so making swaps and substitution and giving them ideas and suggestions but trying to work with them establishing goals realistic goals that they can achieve.
I’ll bet you get this question a lot which is you know I’m overweight. What diet should I be on sale how would you how do you answer that.I’m a fan of the word diets because I think that with the word diet has a start and endpoint right someone associates being on a diet they start they stop and then when they’re off then you know the way it just comes back on so I like to encourage people to change their eating pattern whether it’s the timing or the balance of their meals and think of it that way. So I’m gonna ask you a provocative question so what percent of the people that lose a substantial amount of weight regain. That’s a good question so it’s. I don’t know exactly on the top of my head but I’m getting gas close to fifty percent. Yeah, it’s pretty high I mean that’s what I read what the medical literature suggests so I guess one of the questions is what’s the strategy for somebody you know who knows they’re overweight they know that they’re having complications related to their heart or other things like diabetes.Yeah.So what’s the strategy to overcome that that kinda yo problem that so many people have. I think it starts with you know to understand you know the food groups and which foods have you know good nutritional value which foods to have good quality nutrient-dense calories from healthy fats good carbs good lean proteins and how to plan out a balanced meal in balance snacks but at the same time overall we need there to be a calorie deficit to support the weight loss. Yeah so you’re emphasizing a principle that I think is pretty important which is that there are no magical diets are there and there’s no magical everybody wants the easy way right okay if you just eat you know the Atkins diet or if you just eat this low-fat diet that somehow or other you’re gonna magically have the pounds melt off but it’s really about. Calories consumed and calories burned isn’t it.As.It at. Now we’ve tended and heart investments to hear emphasize the Mediterranean diet and I wouldn’t maybe you can share some of your thoughts about the Mediterranean diet what is it how does it work why do we think it’s the best approach. Sure so we think it’s the best approach because it’s been studied quite a bit so there’s a lot of good evidence to support that it reduces your risk for heart disease and it encourages the eating pattern that’s lower in animal fat but very rich and plant-based foods fruits vegetables whole grains starch as healthy fats from not send fatty fish and olive oil and still see no some lean animal protein too. It’s very high and sustainability isn’t it is you know one of the things I worry about my strong with my patients as you know often tell me well.
I was in the check out counter at the supermarket and I saw a little book there about the latest to do you know diet and they have I mean all the D. various names for these diets often written by people who are not digestion sign, yeah I do and they’re very restrictive you know they say oh you can only eat this not only that and it’s pretty hard to sustain but. It is yeah the Mediterranean diet does include all food groups so you still can have a little red meat if you know enjoy red meat you can still have some dare you can still have some ads but we just need to be that to be less frequent and we want this nutrient-rich food with lots of fruits and vegetables and whole grains to be that the base of the diet. And of course, it is very palatable. It is. I mean you know it’s I I can say this personally because it’s a diet that I eat and you know it’s been studied scientifically studied and shown to reduce the risk of heart disease in a very large study conducted in Spain and more than seven thousand patients which was a very impressive one of the things about the diet is that it does use olive oil and I take it that that’s something you do recommend to people do. Right yeah, I might mention that study house subjects were using extra virgin olive oil large portions now every day and calories are unrestricted and they still reduce the risk of heart disease. They did indeed and then of course that the diet was also rich in nuts right a lot of people are hesitant about this because in our notes are high in calories but they seem to work well well on these diets. Yeah well, I find patients often don’t realize how high in calories they are so I often have to encourage them to reduce their portion thereafter eating them is often too much so that’s an example of something that you know is nutrient-rich very good calories but to watch their portions. What is the biggest challenge you find in educating people?
About nutrition what are the barriers that you come up against that just make it hard for people to lose weight? I think I have just a lifestyle he you know whether it’s you know just ours. A fast-paced society so people you know don’t have time to cook so they rely on the fast food or they skip meals and just the fast-paced society of news and media they often hear many conflicting things and have so many misconceptions and them to struggle with applying really what’s best for them. You mention skipping meals on things I hear from patients and then maybe you can comment a little bit about this is that well I never eat breakfast Saudi much for lunch you know I don’t understand why am gaining weight if you could talk a little bit about this issue out of why that may not be the right strategy. Yeah there’s a lot of research that does support the eating the majority of calories later in the day is linked with obesity you know most of us then tend to be maybe are busy all day ignore those hunger signals eat a big dinner but were often resting and relaxing at night too so there’s no opportunity to burn off all those calories. There’s an adage and wonder what your thoughts are about it that says I eat breakfast like a king lunch like a prince and prince and dinner like a pauper is that a cell is not a sensible strategy. I think it is yes I agree with that. You know I see here this from selling any of my colleagues here you know often come racing into work in the morning and you know they have not had breakfast you know and of course what seems to happen when people do that is that they just pack in the calories in the evening, yeah if they can eat a good breakfast a healthy breakfast they may find that they can sustain themselves during the day and then not so hungry at night. I agree especially high protein diet to or high protein breakfast I should say you know is associated with controlling your appetite and your hunger and those cravings especially late in the day yes you don’t overeat. So a couple more quick questions you saw the survey that we did and I wondered if you know you had any thoughts on was there anything in there that surprise you what was FRAPH so a little bit the most surprising to you about how we. Yeah, I was surprised how few people. Knew about the Mediterranean diet and its association with heart health because especially the past couple years it’s been rated very high on the U. S. news you know report for healthiest diets yet so few people knew about it. Yeah, that was certainly I think surprise to me you know what I sensed from the survey is also that our patients were actually reluctant to talk to their physicians it was actually and I would have gas that you know very high fraction of patients that have a weight problem would approach their physicians for guidance and they seem to not be able to do this so that there. I think we’re dealing perhaps with some psychological barriers and I’m guessing that you encounter that a lot. I do yeah I think you know oftentimes in our doctors do refer patients but some patients come on their own too but you have to be you know ready I think you know to take that step to sit down with the dietician and and and make some changes. What we appreciate your your your briefing us on this huge public health problem as a cardiologist I know that we are struggling with the consequences are with the city and you know hi yeah I I think it’s important to know that you know we have this program that you’re part of the year at the Cleveland Clinic got our prevention team we have a prevention clinic that has people like Kate and others that will work with you on this and you know my encouragement to patients is that you note that had to take this on to have the courage to approach it recognizing it’s one of the hardest things you’re going to do but it’s not just that you’re going to live longer it’s so you’re gonna live better and you know we talked about the heart consequences but you know being obese very hard on the joints lot of orthopedic problems on diabetes many diseases are linked to obesity and in a day every day that you go on with the problem it gets tends to get worse so we’re here to help and we have people like Kate that are ready and willing and sympathetic and it will help you figure out how to get there.