Dr. Majid

Want to lose weight, quit smoking or drink less in the new year? There are things you can do to help ensure success. Dewan Majid, MD from Primary Care at Magee – UPMC discusses approaches to help reach your health goals.

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– [Announcer] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.

– It’s a new year. Are you making any new resolutions, especially when it comes to your health? Hi, I’m Tonia Caruso. Welcome to this UPMC HealthBeat podcast. And joining us right now is Dr. Dewan Majid. He is a family medicine physician at Primary Care at Magee — UPMC. Thank you so much for joining us.

– Thanks for having me. Pleasure’s all mine.

– OK, New Year’s resolutions. Coming off of the holidays, one of the first things everybody says is, “I’m going to try to lose weight.” Is this a good time of year to do this?

– I think any time’s a good time of year to start the weight-loss journey. It’s a new year, so it feels like a new time, a new hope for patients, and so it’s just a date that patients can start with on when they want to start their weight-loss journey. And then, from there, they can build onto it. So any date, really, like a birthday, anniversary, is a good date to start, but just like any other, New Year’s is perfectly fine.

– What are some of the conversations you have with patients in what you want them to be thinking about starting out on a weight-loss journey?

– I think the most important thing is understanding that it is a journey, that weight loss isn’t going to be something that happens over a short period of time. It’s not going to be two weeks and you’re going to lose X amount of weight, or four weeks and you’re going to look the way that you want to. But just taking the time to understand that you’re starting a journey and kind of discussing the expectations early on and then how to get to that final goal that they have.

– Is there a tried and true formula that you try to give to patients? Or is it really just assessing someone and figuring out, this might work best for me because A-B-C?

– I think every patient’s different, and the really nice thing about being able to, especially in primary care, being able to discuss with patients and figuring out where they are in their life and what strategies will help them. Generally, the rule is diet. A majority of your weight loss is going to come from what you take in, what you put out. And so watching your diet, as well as exercise, just to maintain healthy body weight while losing the extra pounds.

– Can you lose too much weight too soon? What’s sort of your thinking about fad diets? Are they good because then they get you started?

– So, it’s give and take. I think fad diets are fine up to a point. The hardest part about losing weight is just maintaining it afterward. So certain diets will help you lose 10, 15 pounds in two weeks, which is never the safest option. Usually, we like to recommend a slower weight loss, at least one to two pounds a week or every two weeks, just to get patients’ bodies more used to that weight loss. and it fits into your schedule, or you’re not having any cravings outside of it, it’s doable. But it is, again, having a very in-depth conversation with patients about expectations of that diet.

– And you already mentioned exercise, and that’s probably the second thing that goes with all of this. What do you say about how important exercise is? And what’s the simplest thing that you tell patients they can do?

– Yeah. I think with patients, the simplest thing that I like to tell patients is just become active. Everyone’s in a different stage of where they are with activity. The general consensus is getting at least 150 minutes of physical activity a week, which comes down to around like 30 minutes a day, but certain patients don’t have that time or can’t see where they can fit that time into their schedule. And so just having a discussion about getting active in any way, shape, or form, even if that’s just standing up from your desk a minute every hour or a couple of minutes a day, just to march in place or to do jumping jacks, something that’s easy to start off with and then building on top of that. A really good exercise is just walking. And so even if that means, especially for our health care professionals who are working in the hospital, just walking around the hospital and taking the stairs instead taking the elevator when they can. Just increasing the daily physical activity is a great way to start. And then, over time, once you build that physical activity, you feel more comfortable walking, you feel more comfortable just using the stairs, with getting up and moving, you tend to be able to add on top of that without having to take extra time for exercise.

– What’s the benefit to the body beyond weight loss?

– Yeah; I think the most important thing with exercise is it keeps you active. There’s been more than enough studies to show that exercise benefits with just general health, prevention of disease. And so, the more you’re active, the less likely you’re going to need medications for certain things, the more you can prevent heart attack, stroke, and feeling better about your every day.

– Next on the list is often smoking. So would you rather your patients quit smoking or lose weight?

– It’s very individualized. Obviously, the hope is that they do both. I prefer smoking cessation first. There’s been enough studies to show that patients who stop smoking, they may have a little bit of weight gain in the initial phases when they’re trying to deal with the cravings, but over the long period of time, it’s shown that smoking cessation has also led to weight loss. And so patients who have quit smoking, have been able to hold off on smoking for a couple of months, have been shown to have better weight loss than patients who’ve quit smoking and then have gone back to smoking or those who haven’t but have been trying to lose weight. We always talk about what can we do to help you quit smoking? And then once we get off of that particular addiction, then how can we work with the weight loss?

– And let’s give folks a sense, what’s involved in smoking cessation?

– It’s addiction management. The first thing is to figure out why patients smoke. So, some patients have been smoking for a long time. They just kind of got into the habit of it. There’s no specific triggers for why they smoke. They just kind of feel the need to smoke. Other patients, they smoke, and there are certain triggers for it, and so things like anxiety, stress can sometimes lead them to smoke a little bit more. And so understanding why they’re smoking is the first step to figuring out how to quit. Once we understand that, there are plenty of community resources available. So, there are stop cessation lines that they have, there are text messaging services, online websites. For some patients, they may benefit from things like the nicotine replacement, so patches, gum, lozenges. And then, other patients sometimes benefit from medication. So, the two big ones that you’ll hear about are Chantix and Wellbutrin tend to be the two big medications. And depending on what the patient needs, we discuss their options, and then we try to help them with their weight loss.

– And you would say that’s really the first step for anyone who wants to quit smoking or lose weight is to really have a conversation with their doctor?

– Yeah, I think it’s … the ability to quit smoking cold turkey is a thing. Some patients have been able to do it, but it’s not always that easy. Again, you’re fighting an addiction, and so although a small population of people may be able to do it, the majority of patients will quit, but then they’ll quit for a couple of days and then they’ll keep coming back. But at least, the most important thing is to have the conversation to see how ready they are to quit. Once they’re ready to quit, we can always talk about multiple options. I’ve had patients who benefited from just having the patch, from just having the gum. Some have needed the medication, but it’s been beneficial to them. And then discussing what’s the best option for them, how long they need to be on treatment for, how to mitigate those triggers.

– Is any science behind if you do something for X amount of days, you have a better chance of succeeding?

– I think in the past, I’ve read something about 30 to 40 days is how long it takes to build a habit or to replace a habit, in a sense. And so, that comes out to about a month. So for a lot of patients, it’s just discussing that you’ve had this addiction, or you’re obese, you need to lose weight, or you’re smoking, you need to cut down on smoking, and then talking about instead of thinking that everything can be done in 30 days, just building habits over time to help you quit smoking or help you exercise, eat healthier, going forward.

– So beyond smoking, drinking becomes the next one, especially coming off of a holiday season of party after party — maybe scaled-down parties now because of COVID. What do you say to patients about that? You often hear folks talk about “Dry January.” I’m done, I’m not going to have another drink. Does something like that typically work? What’s your best approach with patients for that?

– I think a lot of it is figuring out, what is their alcohol use? Some patients just use alcohol socially. So, they may just drink during social events, they may just have drinks during the holidays, but then during the week, during just day-to-day, they’re not really craving any alcohol. It becomes a problem when patients have, again, the addiction side of alcohol use, so they crave it. When they start drinking, they can’t stop drinking. They feel uncomfortable when they’re not drinking or they don’t have alcohol in their system. That’s when it becomes an issue and something to discuss about how to quit drinking. And these recent studies have shown that it’s okay to have one glass of wine a day. It’s not significantly detrimental to health, but over time, more drinking can affect just not only the well-known liver disease, but it can also affect your blood levels, immune system, and a lot of other functions in the body. And so, seeing where they’re at, what they’re willing to do, where they’re willing to cut down to. If they’re willing to completely quit drinking, we talk about if you’ve been drinking, say, three or four beers a day, cutting down day-by-day, or cutting down every couple of days, to two, to one, to every other day, and just spacing it out until you don’t need it as often. Obviously, we have programs for patients who have more significant drinking issues and then discussing whether or not those options are something to consider for patients who need it.

– And so, in general, for all of these, is there a thing of being too strict too soon? “I’m going to lose weight. I’m going to exercise. I’m not going to smoke. I’m not going to drink.” But, do you think that lowers the ability of success?

– I think it’s all motivation-based. And so, what is your motivation for doing what you’re doing? You’ll hear of success stories of people who’ve been able to quit everything at the beginning of the year. Usually, there’s something driving them to do that. For most patients, though, trying to do everything at once means that you may not be 100% percent on anything and it may feel like a failure, but the most important thing is you’re trying. And so, for my patients, I like to at least discuss that. Let’s start off with one thing, and let’s kind of move from there. So we started off with talking about weight loss as a goal for the New Year, and for most patients, I talk about first thing to do is just portion control. Maybe you’re not going to tart a restricted diet, or you’re not going to switch over to vegetarian, to vegan diets, to the keto diet, but at least cut down on how much you’re eating. And that’s something that they can handle. Also, discussing the ability to just write down how much of something you’re doing. So, a lot of patients tend to overestimate how much they exercise, underestimate how much they eat, and so writing everything down really helps you to visualize it and see like, “Oh, I did have two snacks between lunch and dinner, or I did have a heavier dinner than I needed.” And then cutting it down is a really good first step. And same thing with exercise. It’s just building, building everything bit by bit. So for exercise, you say, start with 10 minutes a day, or start with five minutes a day. Even just start with a minute a day of just get up and march in place, see how you feel. And then just building into it whatever you’re comfortable. Exercise doesn’t have to be in a gym. It doesn’t have to be just running or biking. It could be dancing. It could be anything else. And so finding what you enjoy and then just building time into that.

– And always good to start with a conversation with your doctor.

– If you feel the urge to start, start exercising as much as you can tolerate, start eating healthy as much as you can tolerate. But if you have any questions about how to do it in a healthy manner, if you have any questions about, “I’ve tried this before and it hasn’t worked,” or, “I just want to do it, and I want to do it right,” we’re always available. So definitely don’t hesitate to come find us, come talk to us. And then, I think talking with your provider about ways to just better your health is always a good start.

– Well, Dr. Dewan Majid, thank you so much for coming in and spending time with us today. We certainly do appreciate it.

– No, the pleasure was all mine. Thank you so much for having me.

– You’re welcome. I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

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