Do you remember that game you used to play as a child called You’re Getting Warmer, You’re Getting Colder?  Or perhaps you knew this activity as something called the Hot or Cold game.  Anyway, as you may recall, the premise of this child’s game is that someone hides something and then you search for it.  And, while you’re looking, they help you find it by telling you if you’re getting closer to the object or farther away.  As you may remember, they do this by using phrases like you’re getting warmer, you’re getting hot and you’re burning up as you’re nearing the object.  On the other hand, they would let you know when you were going in the wrong direction as well with phrases like you’re getting cool, you’re getting colder and you’re freezing.

With that child’s game as our reference point today, let me ask you to consider the following question.  When it comes to losing weight and living the healthy life that you dream about, are you getting hotter or colder in your pursuit?  Since we are at the beginning of a new year, I think it’s the perfect time for those of you in search of weight loss and healthy living to do a little honest soul searching and determine which direction you are currently traveling.  Because the direction you are currently going will dictate the destination you eventually arrive at when you reach the end of 2020.  So, if you’re getting colder regarding your desire for weight loss, perhaps today is the perfect day to make a course adjustment.

I started thinking about this search for healthy change while rummaging through some old files in my office.  I ran across a story in one of my files that I used to use as an introduction to many of the speeches and workshops that I used to give regarding creating healthy change in your life.  Even if you’ve heard a version of this story before, it’s definitely worth another look because it makes a great point about how to go about finding what you want in life by looking in the right direction.  With that said, let me share an abbreviated version of this story with you.

Steve, returning home very late from a long business trip one evening, finally turns down his street and approaches his home.  As he begins to make the turn into his driveway, he notices his neighbor Bob out by the curb crawling around under the streetlight on his hands and knees. Well, being the friendly, helpful and neighborly type of guy that he is, Steve parks his car and walks over to see what his neighbor is up to.

He says “Excuse me Bob, but I couldn’t help but notice you on your hands and knees out here by the road crawling around under this streetlight.  I thought that maybe you had lost something and that I could help you find it”.  Bob looks up and says, “Thank you so much Steve. I’ve lost the keys to my house and I can’t get in without them. I’ve been out here for a couple of hours now and I just can’t seem to locate them so I would greatly appreciate your help”.

Steve then says “Well show me about where you dropped them and I’ll get down on my hands and knees and help you search”.  Bob replies “I dropped them in the bushes up by the front door”.  Well Steve scratches his head, gets this puzzled look on his face and says inquisitively, “Now Bob, if you dropped your keys in the bushes up there by the front door, why in the world are you out here under the streetlight looking for them?”  And Bob says, straight faced and without a moment’s hesitation, “Because the light is so much better out here”. 

I can practically hear you all groaning right now.  Please know, however, that it’s not a laugh I’m looking for here and I don’t tell this story because it’s belly busting hilarious.  I tell it because it demonstrates, in a rather humorous way, a very important point.  A point that I learned from my own life experience as well as from many years of doing psychotherapy with people.

That point is this – when trying to create change, looking for the answer where the light is good is what most people do most of the time.  However, the truth is that the most helpful, meaningful and life-altering answers are usually found back in the bushes where they are a little harder to get at and the light isn’t as good – if you follow the analogy.  In the terms of the Hot Or Cold game that I mentioned earlier, Bob was freezing cold and was never going to find his keys looking under that streetlight.

The same analogy can be drawn regarding your desire for weight loss in the New Year.  The key to making that happen in 2020 lies within YOU.  It’s time to stop looking for that perfect diet, the ideal time or waiting for some magical remedy that will somehow transform you because you will never find the weight loss and healthy life that you seek by looking for the solution outside yourself.  The key to healthy living and successful, long-term weight loss is truly an inside job that must come from within you.  Losing weight and creating a healthier life takes a laser focused and unrelenting effort on your part.  It demands that you dig deeply into yourself and create the mindset that finds failure simply unacceptable.  It demands that you love yourself and desire the goal enough to walk the walk even when you don’t feel like it.

So, with that said, let me leave you with this question.  Will this be another year of looking where the light is good and, as a result, letting the pathway to healthier living grow colder?  Or is this going to be the year that you step away from the comfort and security of what you’ve always known and feel the warm glow of progress?

Wishing you Great Health,

Dr. John H. Sklare

The Inner Diet

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I can hardly believe it’s the New Year already.  It seems like it was just last week that we were celebrating the beginning of 2019 giving further evidence to that age old adage – time flies!  As a matter of fact, I always see this celebrated event – the end of one year and the beginning of another – as an annual and powerful reminder of the passage of time.

There is just something magical and extraordinary about this yearly time marker that symbolizes the end of one thing while, at the same time, signifies the beginning of something totally new.  The image of a relay race comes to mind as one runner ends their leg of the contest and, while still in full stride, hands off the baton to the next runner who continues running the race.  In this analogy, New Year’s Eve is the flashpoint in your personal life journey where the baton is symbolically handed off each year from the old you to the new you.

Of course, in your real-life journey, you don’t have the benefit of fresh legs of trained teammates to pass the baton to because you must run each leg of this contest yourself.  So, if you consider each year of your life as one leg of the race, let me ask you this question.  How happy are you with how you’re running the race of your life so far?  Are you ready to receive the baton from 2019 and are you prepared to run with it full-throttle toward the finish line in 2020?  What I’m trying to address and focus on here today is the continuity that you need from year to year to achieve your heartfelt goals.  This symbolic baton can be anything that you wish to change, improve or start in the New Year.  We typically refer to these goals, aspirations and new behaviors as New Year Resolutions and they are typically centered around thoughts and actions that will improve your life in some way.  Two of the most common yearly resolutions are to lose weight and to start exercising but the sky’s the limit when it comes to making verbal commitments to resolutions for the New Year.

So, with that said, here is my primary question for you today as you think about what this New Year will ultimately mean to you, your life and your health.  Are you going to simply and mindlessly just celebrate the passing of one year and the introduction of another year OR are you ready to flip that switch inside your head, take charge of your life and start closing the gap between who you are and who you truly want to be this year?  If you’re still with me, here’s what I recommend.

I suggest that you make 2020 a serious year of action, progress and change.  For example, just think about what an incredible year this would be if you really put your mind, heart and soul into losing weight and getting healthy this year.  Heart, soul and a relentless goal-oriented effort is what it takes to create real change in your life because, when running this race, nothing really happens unless YOU make it happen.  And this is the ideal time to start making it happen because the desire, mindset and motivation for change is typically strongest at the beginning of each year.

So I hope that you all hear my clarion call today and give some serious thought to what it is that you want to accomplish in 2020.  For most of you reading this today, I know that weight loss and healthy living are a top priority in your life at the moment.  I hope that you capitalize on that desire for wellness by making this THE YEAR where you finally grab that health baton, lose that excess weight and run the race of your life in 2020.  If you take my advice and choose to do so, 2020 will truly be a magnificent and transformational year to remember!

Wishing you Great Health,

Dr. John H. Sklare

The Inner Diet

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The Centers for Disease Control and Prevention reports that more than 100 million U.S. adults are living with diabetes or pre-diabetes which often leads to diabetes within 5 years.¹  Of those diagnosed with diabetes, 90-95% of them are Type 2 Diabetics as opposed to those with Type 1 Diabetes or Gestational Diabetes.

This disease has traditionally been thought of as a chronic, long-term disease that people have to live with for life. While not a cure, recent research has begun to indicate that with weight loss and intensive long-term lifestyle modifications, some people with type 2 diabetes can experience remission.²   Health practitioners with a thorough understanding of the disease and the most effective dietary and behavioral treatments are positioned to positively influence this trend and those they serve with type 2 diabetes or pre-diabetes.  In addition, with 2/3 of the American population designated as overweight, such treatments can also benefit the overweight patients you likely serve in your practice every day.

It has long been understood that people diagnosed with diabetes either don’t produce enough insulin or don’t properly use the insulin their body produces.  Insulin is one of the most powerful hormones produced by the body (pancreas).  It is an important part of metabolism.  Insulin is responsible for converting glucose (from ingested macronutrients and stored fat) into energy and distributing this energy to body cells.  Insulin also helps the liver, fat and muscle cells store glucose that is not immediately required by the body so it can be utilized for energy later.

The great thing about insulin is that it is a hormone that can be controlled for most through their nutritional intake and other specific behaviors.  Dietary recommendations over the years has varied and often confused the lay population.  However, a recent analysis by Nita G. Forouhl and colleagues indicates that common ground on dietary approaches for the prevention, management and potential remission of Type 2 Diabetes can be found.³

 This common ground includes the understanding that weight loss/weight management is critical for metabolic health.  Additionally, dietary quality such as avoiding processed foods, refined grains and foods high in sugar, while increasing intake of quality protein sources and vegetables as well as taking into account personal, cultural and social factors is preferred.

Integrating weight management and supportive treatment for type 2 diabetes can be a great fit within any chiropractic practice.  Such integration supports overall patient health, low back pain treatment, improving or eliminating inflammation and brain fog, effectiveness of adjustments among others.

Based upon research and experience working with thousands of patients, here are 3 ways you can positively impact your patients with type 2 diabetes and those that are overweight.

1.  Don’t avoid the weight management conversation:Your patients know, like and trust you and rely on you for quality advice that positively impacts their holistic health.  Provide them with information that will help them with their weight management efforts and support the treatment plan for those suffering from type 2 diabetes.  Any weight management conversation should include the following components at a minimum:

• Nutrition: Recommend a nutrition plan that will lower their insulin requirements and result in controlled insulin levels.  This generally includes a diet low in carbohydrates and refined foods that includes quality sources of lean protein.  Do your own research as well regarding nutrition and type 2 diabetes and be open to what you find.  There is a great deal of evidence that diets lower in carbohydrates that include adequate amounts of quality protein are beneficial.  In fact, prior to the development of exogenous insulin as a treatment for diabetes in 1921, the treatment was dietary management including a diet comprised of 5% carbohydrates, 20% protein and 75% from fat.⁴   You will find many variations of this today as well as much research and support for intermittent fasting.⁵
• Lowering stress levels: When people with type 2 diabetes are under emotional or physical stress, their blood sugar levels can raise which results in the need for more insulin.  Controlling stress can help avoid such glucose swings and improve insulin level stability.
• Exercise: Physical fitness has been shown to lower blood sugar levels, improve overall health, avoid complications through improved blood flow and glucose utilization as well as improve mental outlook.  Start with small goals and increase from there.  Begin by having your patient’s track their steps and increase up to 10,000 per day.  Then integrate resistance training for an increase in lean body mass.  Improving lean body mass throughout their weight loss journey is important for supporting their metabolism which is critical for long term weight loss success.
• Quality sleep: Research has found that insufficient sleep (specifically duration and quality) increases risk for development of type 2 diabetes.⁶  Insufficient sleep, like stress, can cause cortisol levels to rise.  The result is higher levels of glucose in the blood, an increase in appetite and a craving for high calorie foods.  In addition, lack of sleep adversely affects the desire to exercise for many people.  The recommended amount of sleep for adults is at least 7 hours and poor quality sleep can be evidenced by not feeling rested or repeatedly waking up throughout the night.⁷      

2. Consider offering a quality weight loss program within your practice. Any successful medical weight loss program must include specific easy-to-follow nutritional instruction, patient engagement and accountability, ongoing support and integration of the behaviors that support long term weight management. These can be created in house and offered on-site with supporting online patient interaction for convenience or integrated through a turn-key program offered through a reputable 3^rd party.

3. Partner with bariatric specialists as appropriate. Overweight patients need your services.  Reach out to bariatricians and/or bariatric surgeons and investigate ways to partner or at the very least refer patients to each other for optimal holistic care.  You could even consider offering a satellite weight loss program within your office that includes a shared revenue model.  Integration of high quality protein products can also add an additional revenue stream.  It is critical to make sure whatever products you select tastes great, is not offered at other ‘big box’ retailers and can be combined into a program that enhances patient weight loss efforts.

 Integrating one or more of these strategies can not only improve the health of your patients but add additional revenue streams to your practice.  The key to success is keeping the patients’ needs top of mind, practicing what you teach and enjoying your journey along the way.

 *First published in Chiropractic Economics Magazine Filed Under: 2019, Health, Wellness & Nutrition, issue-5-2019

Karol Clark, MSN, RN is the best-selling author of How to Add Medical Weight Loss to Your Practice: 7 Steps to an Enjoyable Business, Healthier Patients and Increased Profitability and owner of Weight Loss Practice Builder.  She has over 20 yrs. of experience working with surgical and non-surgical weight loss patients and assisting physicians build an enjoyable weight loss practice. She partners with Nutritional Resources (d/b/a HealthWise- www.healthwisenri.com) for creation of educational programs/articles for weight loss practitioners.

¹ https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

²https://acpinternist.org/archives/2018/05/diabetes-remission-through-diet-may-be-doable-with-support.htm

³Forouhi, N.G., Misra, A., Mohan, V., Taylor, R., Yancy, W. (2018). Dietary and nutritional approaches for prevention and management of type 2 diabetes. BMJ 2018;361:K2234. https://www.bmj.com/content/361/bmj.k2234

⁴https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/

⁵Fung MD, J. & Moore, J. (2016) The Complete Guide to Fasting: Heal your body through intermittent, alternate-day and extended fasting. Victory Belt Publishing, Las Vegas.

⁶Knutson KL, Ryden AM, Mander VA, Van Cauter E. Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Arch Intern Med 2006;166:1768–1764.

⁷ https://www.sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times

Today I want to talk to you about the 3 key ingredients, as well as some secret sauce, that goes into creating a successful weight loss practice. This is a little bit of a simplified version. But, these are things that are required (mandatory) in order for you to have a practice you can enjoy.

The first ingredient is clarity. What I mean by clarity is what you want your office to look and feel like. It’s clarity around the staff you want inside your practice that’s representing you. It’s clarity around the services you want to provide, and to what clients. You can’t just be the weight loss physician for everybody. You’ll be more successful if you get more specific when it comes to your marketing and the services you provide. You can do this in a sequential order.  For example, you can start with a medical or surgical weight loss program and then add in other aspects to the services you offer.  Having a clear view is really important for you. It’s also really important to communicate that to your staff so they know exactly what the goal is for that overall clarity.

The next key ingredient is action. We all may know what we want, but unless we actually take some action toward attaining that, we are just spinning our wheels. I don’t mean the type of action where you’re just throwing money into a money pit. I mean concentrated action that relates back to the goal you want to accomplish (clarity). For example if you were going to be someone who wanted to focus on cash pay sales, you want to make sure your actions are supporting what it is with someone who is seeking cash pay surgery or cash pay products. If you are someone who is research based and you want to attract people that can fit specifically into your study, you need to make sure you have clarity around that including the people in your office and you are actually attracting the people you want to work with for that study. Often when I talk to practices they’ve gone off on all these different tangents, and they haven’t remained focused on the clarity of what their larger goal is. If it’s simple then it’s going to get done. Clarity around your major goal and actions that lead toward that major goal is critical.

The third key ingredient is patience with your staff and with your goals. Patience is really hard for me. I want everything yesterday. That’s how our society is. Think about all the patients that come to see you and want all their weight gone immediately. It’s one of those things you just have to be patient with. I’ve been fortunate to build practices with my husband or other physicians. Things do tend to move along in a fairly quickly order.  But it’s because we have those right things in place and we’re not just throwing our money at the next shiniest object that comes along. Having that focus is really important.  It takes patience. You’re not going to have a ton of retail sales overnight.  You’re not going to have the group of ideal patients you want to work with overnight. You’re going to have to be patient. That’s what leads to the transformation of a practice you can really enjoy. The secret sauce that goes along with that is really having a passion for whatever is that you’re doing. I just spent some time last week at Obesity Week. It involves a lot of different entities. I could see those people who had passion. I’m talking about people who are really passionate about what they’re doing.  I also saw people who were really burned out, whether it is lack of support or lack of success in their business. Or maybe they’re burned out from having too many patients. I could see a dichotomy as I talked to so many people.

These are the ingredients that will help you build a successful practice and will help you enjoy the practice.  Create that momentum for yourself, your employees and your practice. Combine that true clarity along with actions, and having patience along the way. Then add in that passion for what it is you want to accomplish. Those are the things that are going to help create that success for you.

If I can help you in any way, please reach out to me at Karol@WeightLossPracticeBuilder.com.

Karol Clark, Weight Loss Practice Builder

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I can hardly believe that the holiday season is nearly upon us and Thanksgiving is just around the proverbial corner.  I hope you all have plans to spend some quality time with your loved ones over this holiday.  For me, that’s one of the most important aspects of Thanksgiving.  It’s traditionally a time when families gather together, enjoy each other’s company and share a traditional meal with those you love the most.

If you’re lucky enough to be able to spend time with loved ones and family, I hope you truly enjoy and cherish this joyful occasion.  Many people simply take this festive time of gathering for granted because they tend to repeat this wonderful annual act of coming together year after year without interruption.  For others, however, I know this day will be a bit more difficult if not downright painful.

For example, it will be difficult for those of you who have lost a loved one and will have to deal with that empty seat at the table this year.  Having been there myself, I know how heart wrenching this situation can be.  It will also be hard for those who are in the military or those who have a loved one in the armed forces who is away from home on this holiday, in service of this great country.  It will be difficult as well for those who are estranged from a loved one due to misunderstanding, pride or pure stubbornness.  If you happen to fall into this last category, I encourage you to be the healing agent this year and consider reaching out and using this occasion to close the distance and make amends before the opportunity  no longer exists.

Even though Thanksgiving is one word, I suggest you can bring a deeper meaning to this occasion if you break it apart and think of it as two words…Thanks Giving!  Instead of viewing it as a proper noun, this year I suggest that you view it and embrace it as a two word action verb.  In other words, instead of simply enjoying a festive time with friends and family, make it a time to truly give thanks for the many blessings you have in your life.

As an example, there are many things that I’m thankful for.  So, in the spirit of giving thanks, I’ve chosen three to highlight here that I consider the trifecta of things that I appreciate most.  In case you don’t know, trifecta is word used in horse racing that refers to successfully picking the top three finishers.  Well, even though I’m not a betting man, this term seems to fit my mission here very well today.  So, with that said, what follows are the top three picks on my gratefulness list this year.  I think I’ll call this my Thanksgiving Trifecta:

• Health:

Having watched people very dear to me struggle with illness and disease in recent years, I have learned firsthand to greatly value and appreciate my health.  When all is said and done, there is really nothing more precious in this life than your health.  I hope that my simply mentioning it will motivate some of you to take your health more seriously and invest in your physical body and emotional well-being more responsibly.

• Love:

This one is truly a two-way street as I see it.  I’m thankful that I have people in my life that I deeply love and that there are people in my life who deeply love me back.  When you have love coming and going in both of these directions, you have created a wonderful balancing act that enriches your life as well as the lives of those you love.  To love and be loved is one of our most basic psychological needs and provides a powerful wellness inoculation that both heals and nourishes.

• Work:

I am also very grateful for the work I do that occupies a good portion of my time and allows me the pleasure of helping others.  I tend to live by a guiding principle from the late motivational speaker Zig Zigler whose message was – The best way to get what you want out of life is to help others get what they want.  Not only is work necessary to create revenue in order to enjoy life and pay the bills but more importantly it gives you a reason to get up each day, provides meaning to your life and greatly contributes to your sense of value and well-being.

So, today I simply hope that I succeeded in helping you to think about Thanksgiving in a slightly different way this year.  I hope that I have encouraged you to embrace this holiday in a more personal and much deeper way than usual by sharing with you a few of the things that I am most grateful for.  With that said, I wish you all the best that life has to offer and hope you all have a wonderful and joyous Thanksgiving Day!

Wishing You Great Health,

Dr. John H. Sklare

The Inner Diet®

Dr. Sklare partners with HealthWise, NRI as a resource for weight management professionals who are interested in adding a component to their program that addresses emotional eating.

Download HealthWise Thanksgiving Day Survival Guide for Weight Loss

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Most people who want to lose weight know that protein is needed while dieting but many people do not know how protein helps in weight loss and aids our bodies in many other ways.

Protein is one of a complex group of molecules that makes up your hair, nails, bones and muscle. Simply put, protein helps tissues work the way they should.

Here are a few facts about protein and how it helps the body to reduce weight and keeps the body functioning the way it should:

1. Energy Restoration: Carbohydrates and fat are the top sources for getting energy but when you are running low on calories like during active weight loss, protein is what helps to restore your energy.
2. Muscle Building: Protein is what helps you from losing too much muscle mass when dieting and cutting calories.  It also helps those who are looking to increase muscle mass by lifting weights.
3. Bone Strength: Getting the right amount of protein during weight loss is important to prevent losing your bone strength. Bones need to be strong when on a weight loss plan as exercising plays a big role in weight loss and physical activities can lead to falls/breaks.  This is especially important for aging patients as it can help to prevent osteoporosis (bone loss).
4. Reduces Appetite and Cuts Cravings: Studies show that protein is the most filling of the macronutrients which means you need to eat less to feel full. More protein especially in the evening can keep the dieter satiated and prevent them from eating high carb foods that are not appropriate for weight loss.
5. Increases Metabolism: A high protein diet increases metabolism (the rate that the body uses calories). When protein intake is higher, the body burns more calories even at rest.  Keeping a consistent increase of protein intake during weight loss maintenance can also help the dieter from gaining the weight back.
6. Immune System Support: Because proteins are made up of amino acids, they play a large role in the immune system. Adding protein to the diet can help in turning disease fighting cells like T-Cells and B-Cells into germ fighters.  These cells look for and kill harmful cells that enter the body.
7. Heart Help: Studies have shown that protein aids in reducing high blood pressure. Also, studies have reported decreases in LDL or bad cholesterol.  Two very good reasons to increase protein intake.
8. Heals Injuries: Protein can help the body heal itself after an injury.  This is because of its ability to form the building blocks of tissues and organs.  Protein reduces inflammation and repairs tissue at the site of the injury.
9. Nutrient Transport: Proteins act as vessels that carry vitamins, minerals, sugars, cholesterol and oxygen through the blood stream and into the cells and tissues that need them.  Some proteins also store nutrients like Iron to provide a back-up supply when needed.

A  higher protein intake is important not only for successful weight loss but for keeping the body functioning at the level needed to ensure; adequate energy, muscle and bone strength, immune system support, heart health, injury prevention/repair and transportation of vitamins and minerals to cells and tissues in the body.

Visit healthwisenri.com for a complete list of over 200 high quality protein products for professional weight management programs.

Sources:  healthline.com/nutrition/10 reasons to eat more protein; Benefits of Protein Web MD/ webmd.com/men/features/benefits-protein#1; The Importance of Protein/HealthWise

Image from Pixabay

Most of us wouldn’t think of eating a 24 oz steak every day but that is about the amount of protein a

190 lb man needs to support good health. Thankfully, one doesn’t need to consume a huge steak every day but can get protein from multiple sources throughout the day that are much healthier. Additionally, current research is showing that eating too much protein at one time can have adverse effects. Protein comes from many sources in our diets. There are the more obvious ones like meat, eggs and dairy, but it is also present in the fruits and vegetables we enjoy. We need to take all sources into consideration when looking at total protein intake.

Protein, carbohydrates and fat are the macronutrients that make up our diet. To achieve weight loss, we change the amount and ratio of these to create an imbalance. This must be done in a manner that will preserve lean muscle while causing fat loss. If muscle mass is lost, our calorie needs decrease and it is more likely that the muscle will be replaced with fat. In ketogenic diets, this is achieved through lowering the intake of carbohydrates and carefully increasing protein intake to create the imbalance needed to put the body into the fat burning state of ketosis. A mild state of ketosis is ideal for weight loss and can be maintained until the desired weight loss is achieved.

The amount and timing of protein intake in this process is of particular importance to maintaining the ketogenic state and to reduce hunger but also to ensure preservation of lean muscle mass. If too little protein is consumed or if it is not consumed often enough, the body will come out of the fat burning state as it works to conserve stores of energy (fat). When too much protein is consumed it can have harmful effects on both the musculature and other systems.

“When too much protein and too little fat and carbs are consumed, your cells burn protein for energy. This can create an acidic environment in the body, which triggers calcium (a base) to get pulled out of bones to neutralize the acid. Muscle also tends to weaken in an acidic environment, which increases the risk of injury and premature aging. And when protein is burned for fuel in place of the carbs you’re not eating (your body’s preferred fuel source), it’s essentially wasted, because it’s not available to maintain and repair your muscle and other lean tissue.” (Sass, 2019)

Spreading one’s intake of protein throughout several meals during the day will stimulate 24-hour protein synthesis. (Mamerow MM, 2014) A smaller, measured amount of protein eaten at regular intervals has also been shown to be more effective at reducing hunger even when fewer total calories are consumed (Paddon-Jones D, 2008).

About 30% of daily calories should come from protein for weight loss. (Castaneda & Fetters, 2019) Bariatric (weight loss) products are designed to allow intake of protein 4-6 times per day while working to lose weight. If the goal is 1200 calories per day then 360 of those calories should come from protein which has 4 calories per gram. This means a person can consume 90 grams of protein per day. Taking into consideration other sources of protein such as spinach, eggs and meat, one will probably want to consume about 60 grams of protein from nutritional products. Bariatric products are designed with about 15 grams of protein so one can have 4 of them during the day thereby spreading protein consumption out to ensure more efficient protein synthesis and greater satiety. This model for weight loss has been proven to not only be effective for healthy weight loss but has also been shown to result in less weight gain once goal weight has been achieved. (Sass, 2019)

If one uses a protein product with substantially more protein, one must also limit the number of times protein is consumed or risk a dangerously elevated daily protein intake. The recommendations are to consume 0.5 to 0.8 grams per pound of body weight per day. A person weighing 190 lbs should consume 95-152 grams of protein a day. The lower limit would be for someone who is moderately active while the upper limit would be for someone wanting to bulk up. Few would recommend the upper limit long-term because of the issues created by too much protein consumption. Even at the mid-level of about 124 grams per day, one will only have about 70 grams of protein to consume through protein products if also including eggs, meat and vegetables in the diet. Even when looking to maintain weight and maximize muscle regeneration, it is best to spread the consumption of the protein throughout the day. A person in this category would be able to enjoy five 15-gram products to maximize their absorption and satiety while also minimizing their caloric intake.

When deciding which protein products to include in any diet there are numerous considerations including taste, availability, convenience and overall nutritional profile. While there are many protein products on the market today, most are designed only to deliver protein in a convenient package that will sell to the mass market. These products are not designed for weight loss and will often have the wrong ratios of macronutrients that are needed for weight loss and muscle preservation. It is good to remember the adage “Buyer Beware” when looking at a protein supplement on-line or on a store shelf.

If you like this article, you may also enjoy Know Your Proteins.

References

Castaneda, R., & Fetters, K. A. (2019, August 29). How much protein do I need? U.S. News. Retrieved September 6, 2019, from https://health.usnews.com/wellness/food/articles/how-much-protein-do-i-need

Mamerow MM, M. J. (2014). Dietary protein distribution positively influences 24-h muscle protein synthesis in healthy adults. J Nutr., 144(6):876–880. doi:10.3945/jn.113.185280

Paddon-Jones D, e. (2008, May 01). Protein, weight management, and satiety. Am J Clin Nutr, 1558S-1561S. doi:10.1093/ajcn/87.5.1558S

Sass, C. (2019, September 5). Can I have Too Much Protein When Trying to Lose Weight? Retrieved from shape.com: https://www.shape.com/healthy-eating/should-you-eat-more-protein-lose-weight

Westerterp-Plantenga MS, L. S. (2012, August). Dietary protein – its role in satiety, energetics, weight loss and health. British Journal of Nutrition, 108, 105-112.

If you’ve been thinking about adding weight loss services to your practice or taking your weight loss program (and profitability) to the next level, now is your chance to make that a reality.  Below are 7 steps that have been shown to effectively do just that.

1. Have a Passion for Helping Others Lose Weight and Improve Their Health

There is no denying the fact that if you love what you do, you are happier and much more effective.  It doesn’t even feel like ‘work’.  Rather, your passion creates joy, motivation and positive outcomes with faster results.  This may sound a little surreal or unrealistic, but it is so true!  You can’t fake passion.  When you are passionate, your actions are much more believable and inspirational.  This is especially true when it comes to building a successful weight loss program.

Let’s face it, weight loss is hard!  So, having a practitioner that is passionate about helping others lose weight and improve their health is very important.  If it’s not you, don’t stress it – the passion can also come from your employed clinicians and/or staff.  This passion (and overall vibe) will differentiate you from others who may be building a weight loss business for the wrong reasons.

2. Practice What You Preach

It is easiest to coach people to success when you are successful yourself.  It also feels congruent when your personal values match your professional values and goals.  This can bring extreme enjoyment and peace.  I am not saying you need to be perfect, but I am saying that you should be able to walk the talk and practice what you preach.

You wouldn’t seek financial advice from a company that just went bankrupt just as you wouldn’t likely seek health advice from someone who isn’t somewhat healthy themselves. There is the thought that misery loves company and if your practitioner is “in the same boat” they will better understand, but that’s not the way to the path of improvement.  Similarly, in any sport, it is better to play with those more skilled than you – that’s how your game improves and how you challenge yourself to get to the next level.

Another natural outcome is that your level of accountability for your own health usually becomes more intense when you are providing weight loss services.  As a result, you are healthier, happier, driven and more creative.  When you feel your best, you tend to bring out the best in others.  Positivity and great results are contagious!

3. Surround Yourself with GREAT People and Treat them Well

As you build your business, you will drive yourself crazy (and limit your success) if you try to do everything yourself.  You must surround yourself with a competent, loyal, self-directed and motivated team.  This includes your key employees along with your advisory team (corporate attorney, accountant, investment advisor, marketing specialist and coach/mentor).  You may have a desire to cut corners here to save money.  However, in the long run, you will actually spend more money due to staff turnover and potentially costly mistakes or “spinning your wheels” while getting nowhere fast.

I am one of those people who like to figure everything out and do it myself because then I know it is done right (or so I thought).  I used to micro-manage my team (which drove everyone crazy) and then I started to delegate…with trepidation.  Something I should have done a lot sooner.  You see, I found that by micro-managing, I was limiting the creativity of our employees, discouraging them from problem solving, limiting their ability to grow and preventing myself from becoming a true leader.  To make matters worse, I was spending little quality time at home with my husband and 4 children because I was so “busy”.  While the business was still doing quite well, another outcome was stagnation of business growth and less joy.  I micro-managed because of my perfectionist personality and because of fear…fear of losing control and discovering that someone else might do it better – crazy I know!

Once I trusted the wonderful team we had built and challenged them with desired outcomes instead of tasks, they rose to the occasion…and are much happier.  They work hard and we reward them accordingly.  This has afforded me the opportunity to build 3 additional businesses and actually relax knowing that processes and people are in place to keep moving in the right direction with a focus on stability, growth along with above average patient outcomes and satisfaction.

4. Build Systems

Systems create calm from chaos and service consistency that patients and staff both appreciate.  Effective systems also create predictability for your business and extra time for you.  You need them!

The top systems that need to be in place include, scheduling (patient & staff), clinical documentation, patient education, retail sales, marketing, financial, patient outcome tracking, patient testimonials and office patient flow for each practitioner.

Systems simply mean that you have an organized set of procedures in place that can be easily performed to create predictable outcomes and utilized for staff training as necessary.  These systems need to be documented and updated regularly.  I find it is easiest to review them at the end of the year and anytime throughout the year when your ‘flow’ is disrupted which is usually caused by the constant of change.  No need to take this on alone.  Your staff is the best one to document what they do each day.

5. Be Intentional

We are creatures of habit and usually don’t like change.  So often you may go about your day doing the same things even though your actions aren’t creating the outcome you desire.  You may feel stuck and simply used to doing things the way you always did them.  And frankly, that feels comfortable and safe.

You also are extremely busy or overwhelmed and taking time to really think about what you want personally and professionally isn’t possible with your schedule.  Or so you believe…

No one can do this for you, but it is critical to your success and happiness.  If you don’t know where you are going, you can’t be intentional about your day to day activities and before you know it, years have passed by and you just continue to be in the same rut.  And one day, you may regret not pursuing what you really want and deserve.

Believe me, I fought this for a long time and wouldn’t have succeeded in building a number of successful businesses unless I overcame my fears and reasons for procrastination.  I also worked with a coach to help me break out of my rut and create my vision.  In addition, I shared this with my husband.  He is a great sounding board and helps to support my vision/actions.  This method also works for our children as well.  We like to break it down this way:

• 3 Year Vision – My ‘Why’ or motivation. I describe exactly what my life will look like in 3 years from a personal and professional perspective.  I write this in present tense as if it is 3 years from now.
• 1 Year Goals – My ‘What’ I have accomplished over the next year. I write this in present tense as if it is one year from now.
• 90 Day Strategy – My ‘How’ to accomplish my goals. I list my ‘Top 3 Projects’ along with the most important 4-8 actions that will get me where I want to go.
• This Week’s Actions – My ‘Now’ actions that relate to my 90 day strategy. I revise this weekly and then make sure the actions are incorporated into my schedule that week.

I document this in one table with 4 boxes and keep it in front of me each day to keep me focused and ‘Intentional’.  This is key for me because if my actions are intentional (deliberate, conscious, done on purpose), I see progress.  Otherwise, I let others drive my schedule by constantly volunteering, putting fires out and being ‘busy’ instead of accomplishing my weekly actions…which contribute to my top 3 projects…which lead me to attaining my goals…and living the life I envision and desire.

6. Don’t Be Afraid to Add a Retail Store

I used to think retail felt a bit weird.  We are healthcare providers and the thought of sales felt terrible.  We dabbled with a very small store (literally in a closet) and soon I realized that the products we carefully selected actually improved patient outcomes.  I discovered that they loved having products available to them and that our retail store helps to build a stronger relationship since it keeps them coming back.  Believe it or not, our retail store generates $480,000+ gross revenue each year.  And, once you have a wonderful retail manager (again surrounding yourself with great people) with systems in place you don’t have to be the salesperson.

Key considerations for a successful nutritional retails store is selection of the best products, putting effective systems in place, creating effective (simple) marketing campaigns for product promotion and monitoring your return on investment.  Retail doesn’t have to feel salesy.  You are actually helping your patients get better results and adding another revenue stream into your practice.  If they aren’t purchasing quality nutritional products from you, they are purchasing them from someone else.

7. Learn from Your Experiences (success & failures alike)

Just like long term weight loss, business success and life is a journey that is experienced minute to minute and day to day.  We need to take it one day at a time and learn to enjoy it more.

In your practice, you will experience success and failures.  These lay the foundation for positive growth – if you let them.  I try to view failures as a learning experience and then move on.  I encourage you to do the same.

Learning from your past can be hard to do.  You may think your past defines who you are today.  The reality is that your past does not predict your future.  Only you have control over your destiny.

Karol Clark, MSN, RN is the best-selling author of How to Add Medical Weight Loss to Your Practice: 7 Steps to an Enjoyable Business, Healthier Patients and Increased Profitability and owner of Weight Loss Practice Builder.  She has over 20 yrs. of experience working with surgical and non-surgical weight loss patients and assisting physicians build an enjoyable weight loss practice. She partners with Nutritional Resources (d/b/a HealthWise- www.healthwisenri.com) for creation of educational programs/articles for weight loss practitioners.

Obesity is one of the pressing global public health concerns. It is commonly associated with several co-morbidities and can be treated effectively with a high protein, low fat and low carbohydrate diet for successful body weight loss and maintenance. It is extremely important to ensure the quality of protein used in a calorically restricted diet will provide the necessary amino acids to maintain muscle mass and overall health in subjects. The quality of the protein in such diets is typically defined by its ability to achieve defined metabolic actions¹. Conventionally, the protein quality has been associated with the composition of amino acids to satisfy the demands for synthesis of protein as measured by nitrogen balance in humans. The understanding of protein’s actions has expanded beyond its role in maintaining body protein mass into increasingly complex roles for protein and amino acids in regulation of body composition and bone health, gastrointestinal function and bacterial flora, glucose homeostasis, cell signaling, and satiety¹.

Protein Quality Assessment

In 1991, the Food and Agriculture Organization of the World Health Organization (FAO/WHO) introduced the Protein Digestibility Corrected Amino Acid Score (PDCAAS) which is the internationally approved and recognized method for protein quality assessment². Briefly, PDCAAS is based on the combination of an age-related amino acid reference pattern that is representative of human requirements plus estimates of the digestibility of the protein³. The amount of potentially limiting amino acids in the test protein is compared with their respective content in the appropriate reference pattern, identifying the single most limiting amino acid that determines the amino acid score. The current consensus is that meeting the minimum requirements for lysine, methionine, and tryptophan, the most limiting amino acids in poor quality proteins, determines the amino acid score which is then corrected for digestibility giving the PDCAAS value, which is assumed to predict net protein utilization³. The PDCAAS method has now been in use for over 25 years⁴. Basically, the PDCAAS value is derived as the amino acid score which is multiplied by the percent digestibility.

Quality of Selected Protein Sources Used in HealthWise Products

HealthWise products are typically designed with 15g protein per serving (30% DV) with different combinations of protein sources based on how they influence the product attributes including taste, texture, functionality and mouthfeel. At HealthWise, we follow strict quality guidelines to ensure our products are produced with the highest quality protein possible. Our products are designed to maintain a balance of essential amino acids to ensure complete bio-availability. For instance, products that contain protein with PDCAAS <1.0 are typically combined with other sources of complete protein to obtain the desirable amino acid composition to ensure optimal nutritional benefit.

To learn more about HealthWise products and our production process, view our brand video here:  View our Brand Video

References:

¹ Westerterp-Plantenga, M. S., Lemmens, S. G., & Westerterp, K. R. (2012). Dietary protein–its role in satiety, energetics, weight loss and health. British journal of nutrition, 108(S2), S105-S112.

²  FAO/WHO. Protein Quality evaluation in human diets. Food and Agriculture Organization, Food and Nutrition paper 51. Rome, Italy: FAO/WHO, 1991:35-6.

³ Millward, D. J., Layman, D. K., Tomé, D., & Schaafsma, G. (20 08). Protein quality assessment: impact of expanding understanding of protein and amino acid needs for optimal health. The American journal of clinical nutrition, 87(5), 1576S-1581S.

⁴ Boye, J., Wijesinha-Bettoni, R., & Burlingame, B. (2012). Protein quality evaluation twenty years after the introduction of the protein digestibility corrected amino acid score method. British Journal of Nutrition, 108(S2), S183-S211.

Everyone’s weight loss journey is different. However, there are certain needs of human biology that are a constant, and sleep is one of them. The body heals, cleanses, and rejuvenates itself during a daily seven to nine hours of sleep. That sleep time is also essential to regulating appetite and food cravings. Without it, you’re hungrier, less satisfied with your food, and prone to cave to your cravings.

Sleep and Appetite

Hormones are your body’s chemical communicators. When your stomach starts to empty, it triggers the release of the sleep hormone ghrelin. However, when you haven’t gotten enough sleep, the body releases higher levels of ghrelin, which means you’re hungrier even if your energy needs stay the same.

The other half of appetite control revolves around satiety, and sleep comes into play here too. During sleep deprivation, that’s anytime you get less than seven hours of sleep, the body reduces leptin, a satiety hormone that makes you feel full. When you put more hunger with less satiety, you’ve created the perfect equation for overeating.

Curbing the Cravings with a Better Night’s Rest

The sleep-related appetite changes don’t stop at hunger; they extend to food cravings. Food causes a pleasure response in the brain. Without enough sleep, high-fat foods and those packed with sugar cause increased pleasure in the brain’s reward center.

Studies have found that sleep-deprived people will choose snack foods with 50 percent more calories and twice the fat in comparison to when they’ve gotten a full eight hours of sleep. Eating healthy can already be a challenge, and adequate sleep is the kind of help that will fuel better food decisions.

Building Healthier Sleep Habits

Sleep can and should be your health foundation. Better sleep starts with habits and behaviors that cater to the body’s sleep needs.

• Eat for Sleep: The body uses recognizable patterns of behavior to regular the release of sleep hormones. Eat meals at around the same times and at consistent intervals throughout the day. You can also help by avoiding foods like caffeine and heavy, fatty foods within three or four hours of bedtime.
• The Set Up: Everything about your bedroom should support good sleep. Cool temperatures, a quiet atmosphere, and complete darkness are simple ways to help your body relax. Your mattress can be a big factor as well. It should support your weight and sleep style. If you share a bed with a partner, a mattress that actively reduces motion transference can help you both sleep better.
• Schedule and Routine: Set a bedtime and keep it. Consistency helps the body recognize when to release sleep hormones. Add a bedtime routine to help you transition from awake and active to calm and relaxed. Routines train your brain to not only release sleep hormones but to appropriately respond to them.
• Turn It Off and Dim It Down: Technology is great, but it can get in the way of sleep. The blue spectrum like that from electronic screens can suppress sleep hormones. Turn off your screens two to three hours before bed and try to bring down light levels in the evening. The better you can follow the natural progression of sunlight, the better off you’ll be.

Conclusion

Successful weight loss needs adequate sleep. Not only will it help you in your weight loss journey, but it fully supports an active lifestyle and balanced diet. Habit changes may be in order, but once in place, better habits create the building blocks for more energy, better food choices, and achieving your goals.

Source: Guest Blogger, Ellie Porter, Managing Editor of SleepHelp.org

To learn more about HealthWise nutritional products and diet plans for your weight management practice, contact us.