New Brunswick family doctor Dr. Jeffrey Levine weighed 400 pounds when he became a contestant on "The Biggest Loser," the TV reality show back in 2005.
"I lost 103 pounds in the 12 weeks I was on the show and another 50 when I came home," he told a conference of about 200 physicians and medical students on Wednesday at the University of Medicine and Dentistry of New Jersey in Newark.
Levine, a 50-year-old father of four daughters, teaches at the UMDNJ's Robert Wood Johnson Medical School in Piscataway.
Losing weight reversed some serious health problems. But what really pleased him is what it did for his patients. He's comfortable now talking to overweight and obese patients about the benefits of nutrition and exercise. "I think they decided I was practicing what I preach."
Levine shared his own experience tipping the scales to urge his audience of med students and doctors to find ways to engage in the uncomfortable conversation about weight with their patients.
"What I usually ask a patient is 'How do you feel about your weight?' His goal is to gauge whether or not the patient is ready to address the issue. If the patient feels "OK" about the weight, Levine might say, "I am asking because based on your measurements, you are at higher risk for certain conditions. I see your mother had diabetes and I want to reduce that risk."
Conversation starters also begin when patients come to his office "with joint pain or a breathing problem that they don't associate with their weight. So I address the problem. I say, 'It may be your weight.'" If a patient seems ready to make lifestyle changes, Levine will ask "what is about your weight that bothers you? What is your goal? And that opens the door for people to be more comfortable talking about their weight."
Losing weight is difficult, and keeping the pounds off is a lifelong struggle. Doctors need to focus on prevention, and intervene to help overweight patients before they become obese, Levine said. This takes time. Levine said he may spend a half hour with a patient who is seriously engaged in eating healthy, exercising, keeping a food journal, and adopting new habits. Most doctors could easily see three patients in the time it takes to counsel an overweight patient, he said.
Medical schools now provide nutrition education to med students, but most doctors practicing haven't been educated in how to screen overweight and obese patients, or how to design weight loss strategies that will fit into the individual's lifestyle, Levine said.
Approaches to obesity need to be incorporated into residency programs, he said. "Most residents see obesity as a major risk but they are uncomfortable addressing it." Even more disturbing, "residents may become very negative toward patients who are obese. It takes more time to examine them, and they have more problems." Doctors need to learn to listen to their patients to find out "what are their goals, what have they tried, what are the barriers, what are the triggers for eating."
Levine also helps with the different challenges they need to overcome. For some, it's a lack of time to cook nutritious meals or to exercise, or a lack of nutrition knowledge: Levine said he sits down with patients and teaches them how to read food labels.
Like most people who've lost weight, Levine has gained some of those pounds back. "I consider myself an obesity survivor because every day I have to make a conscious effort about what I put in my mouth and to get my butt out of bed and do something physically active and to do things that make me emotionally well."
Levine's slide show included pictures of the skinny kid and young man he was up all the way through medical school. That all changed when he began his residency training.
"Every third night, we worked 36 hours straight. And what did our hospital do to reward us? In the middle of the night they would open the cafeteria up. Hamburgers and hot dogs that had been sitting in the grease since lunchtime, chocolate bars, potato chips and soda. And we'd all get together to talk about who was having the most miserable night."
Levine said he ate to stay awake. "Then I'd go home and we had a newborn and a two-year-old and there was no way I was going to go out and exercise. With the combination of work, lack of sleep, poor eating habits and lack of physical activity, I gained 70 pounds my first year of residency."
Levine said he consider himself a "food addict" who has struggled to break the habit of using food to deal with stress and lack of sleep. "I learned that food was not just good to eat when I was hungry, food was good to help me when I was tired, when I was stressed, to help me concentrate. I literally became addicted to food, food became my drug."