7-and-a-switchblade

I'm a primary care physician in West Virginia. These two years have been horrible for my diabetic patients. I had a slew of patients over the last year who were experiencing rapid weight loss, enough to get me concerned for malignancy, but the real reason? Their A1c, which had been at a comfortable 6-7% for years and managed on oral meds, was now 12% or more. I have had to start dozens of people on insulin in just the last few months.

Working in the land of Mountain Dew and pepperoni rolls brings its own challenges, but outside of (and often in spite of) those come-to-Jesus moments (heart attacks, amputations, diabetic comas, etc.), it seems almost impossible to change the eating habits of... well, almost anyone. I still haven't found the magical combination of words to convince people to trade out soda pop and sweet tea for water and sugar-free beverages.

Out of the people who DO change, what have you found to be the impetus? What is the reason people cite when they decide to make healthier choices and focus on weight loss? Is there a common thread among success stories you could share?

Thank you so much for your time!

I put all my diabetic patients on low carb diets.

I give detailed literature on how to eat as a diabetic.

I offer one-on-one diabetic counseling to all diabetics.

I tour middle schools every year and teach kids why sugar is bad.

Believe it or not, people don't do everything their doctor tells them. If everyone ate the way I told them to, I'd be out of business.

That's mostly my strategy, usually I ask for a short diet diary, like 2 weekdays and a weekend day, and then focus on just one or two goals. Almost everyone here is all meat-and-potatoes, soda and sweet tea. I give my sweet tea addicts my home-made iced tea recipe and tell them how to slowly decrease the sugar content with every pitcher they make. For the soda drinkers, we make weekly goals, or set dates at which you're allowed to buy the next 12-pack. We talk about portion control and trading out some of the mashed potatoes for more broccoli, and exploring the freezer section for other kinds of vegetables they might like. Making one goal every visit seems to go further than nothing, but sometimes it's too slow, and often not enough.

Depends on what formulation you're talking about, and we're in WV here, 80% of my payer base is medicare/medicaid, almost no one can afford it. If you're talking Ozempic, then maybe. I do have a fair number of patients on it, and at high enough doses, it's even weight negative. If you're talking Wegovy, forget about it, I have had a 0% success rate getting it approved for anyone. And if you're talking Rybelsus, it's only the newest and Gucciest anti-diabetic on the market for a cool $700 / month. I can barely get Januvia approved for many.

> Look up the statistics on people going from obese to normal bmi.

Yup. People realize weight loss is hard but don't realize exactly how hard. Last figures I saw were something along the lines of 1/800 and 1/1400 for women and men, respectively, to go from a BMI of >30 to <25 and stay there for a year, without surgery. It's why the threshold for bariatric surgery is much lower than many believe it is, and why I get a lot of shocked expressions when I tell people that, while it might not be necessary right now, they'd qualify for it, if you are weighing over 200lbs and are on antihypertensives and antacids, you'd probably qualify for it.