Caring for my elderly patients is both a challenge and a delight. For one, most of them are so complicated that a medical intern would run screaming from the room. I, however, enjoy the layers of problems and solutions...this problems has led to that problem...and that problem's treatment will make that problem worse. Through years of experience we can usually find a happy balance between treatment and just letting nature take it course.

But these wonderful people are also (most times) lovely to care for. They are so thankful to be listed to and to have people caring for them. I have learned over the years that most 85+ year olds really just want quality of life and are not so hung up on length of life. I let them know that I get it and I often can see them visibly relax.

One important service that more families should take advantage of are Geriatric Care Managers (GCM). These are typically nurses or social workers who work with patients, families and physicians to navigate the complexities of caring for elderly patients. Whether it is moving an elderly parent close to an adult child's home, transitioning from home to assisted living or just optimizing the home situation so the patient can remain in their home longer.

There are so many questions that the GCM can answer that does not require my input. They can also help interpret symptoms, medical tests and results and often can be a shoulder to cry on for for both patient and child.

I have worked with several managers in the last decade. I have recently been working closely with Tracey Driscoll, RN of Transition with Care, out of the Concord area. We exchange emails and text messages several days a week about our mutual patient. Her advocacy for her patient is something to marvel at. The patient is doing very well, mostly because of the extra time that Tracey gives her and her family.

So if you are struggling to care for an elderly parent or sposue and find that you wish you had someone to do some of the leg work, coordinate with the physician or interpret medical jargon, then consider a Geriatric Care Manager. They can often make a very challenging situation much more manageable.

Obesity can simply be defined as maintaining an unhealthful level of excess body fat. The World Health Organization has devised a chart that will help you to determine whether or not you suffer from obesity. When a person does suffer from obesity, their body is unable to function properly; therefore, they may suffer from serious health risks.

The manner in which a person becomes obese can also be simply defined; obesity results when a person consumes more calories than they burn. And yes, our bodies do burn calories just by breathing and blinking our eyes, however, if we do not blink as many times a day as it requires us to burn all of the calories that we consume, eventually we will begin to gain weight; women more quickly than men.

There are many different things that factor into weight gain; our age, our gender, our genetics, environmental aspects, our physical activity, or lack thereof, illness, medications and possibly one of the most difficult to control are psychological factors.

 If you find the needle on the scale slowly creeping upwards, and begin to have difficulty, fitting into your own clothing, then stop buying new clothes with elastic waist bands and start paying attention to what you are eating and how much you are moving. Obesity does not happen overnight, yet it is often “overnight” that you wake up and wonder, just how it is, that you are now obese. It seems as though you may gain a pound or three, and then the next time you are brave enough to step onto a scale, those three pounds have mutated into fifteen pounds. At this point, we often tumble out of control until we reach a new level of obesity.

Finding a (concierge!) physician that can guide you along the path back to a healthy weight is not always an easy task. Remember that you are hiring a medical professional that will help you, not one that will degrade and scold you. You will want to find someone that is interested in your overall health care. You need them to be a kind and compassionate, yet a firm mentor, which is able to evaluate your current level of obesity and to determine just how and why it is, that you have become obese.

Once you have found your physician, you and he (or she)  will begin to establish a long-term, working relationship with the goal of helping you to lose whatever amount of weight is needed, to return you to your proper and healthier weight. This will not be easy, and this will not happen overnight, that is why you will need a physician that you, not only like and respect, but one that will take stake in you and your health.

So how do I work with my patients? By education and follow-through! Read on…

My first task is to determine the cause of a person’s obesity. I rule out reversible medical causes such as hypothyroidism, cushings disorder, and sleep apnea. I then look for and usually find the common culprits—poor food choices and lack of exercise.

I calculate a daily caloric intake based on sex and BMI and then devise a caloric distribution throughout the day that will obtain weight loss but will not cause uncomfortable hunger pangs. I push a diet plan with a high intake of lean protein and low in carbs. The three main meals should be 300-500 calories and  two-three are limited to snack 200-250 calories (high protein/low-fat bars or Greek yogurt).

I next pick a goal weight loss the first year of 15% of your current weight. This is usually obtained at an average weight loss of 1lb/week. Usually more comes off at first and then less and less as you approach your goal. So to lose 30 lbs. would take 30 weeks.

I also repeat several important teaching points:

Carbohydrates are ADDICTIVE! You will never feel satisfied with a high carbohydrate diet—your body will always want more and more. It’s like trying to keep a fire lit with only paper.

Cheese is NOT YOUR FRIEND! Although cheese has some protein content, it usually has a high fat content which is not going to help you lose weight.

Walk at least 30 minutes daily (or some other similar exercise) and add light weight lifting/muscle toning after the first ten pounds of weight loss.

Stay lightly hungry most of the day—when you are hungry…you are burning fat (but you need to have a high lean protein intake so you do not also burn your muscle protein).

Then watch the weight fall off. And if it doesn’t I find out why!

Being obese will put you at risk for many different health related conditions and illnesses such as; diabetes type 2, high blood pressure, high cholesterol, high triglycerides, cancer, cardiovascular disease, non-alcoholic fatty liver disease, osteoarthritis and even sleep apnea. All of these can be life threatening.

You are born with just one heart; obesity taxes that heart tremendously. It is easy to envision how obesity appears on the outside; we begin to see our bodies enlarge. What is not easy to see, is how our obesity affects the internal part of our bodies. You must know that fat cells are not just isolated on the outside of our bodies, just under our skin; they are also wrapped around and throughout our internal bodies, surrounding all of our organs. Imagining our heart and lungs totally encompassed in fat cells is not a pretty sight.

So, there is no better time than the present to take our own obesity, into our own hands and find a physician (maybe me) that is willing to consider treating all of you, not just your fat cells. And teach you why you are still “not at your goal weight” and guide you, day by day, minute by minute, to a healthier you.