United States Army Veteran Michael Smith has a great deal to be proud of these days. He walks a mile every Saturday, he can collect his groceries from the store without waiting for the electric cart to get him around, and most importantly, he doesn’t need to sit and take a break while his popcorn pops in the microwave. He recalls a time when he could not do any of this and further, he was unable to drive or collect his own mail.
Veteran Smith has been over-weight his entire life and he needed to lose 100 pounds before enrollment in the military.
After an injury at work resulted in early retirement, his weight started to increase rapidly due to his limited mobility. His unhealthy weight gain worsened his medical issues, and he was advised to pursue weight loss surgery. He did not think that surgery was a good choice for him, but he reluctantly began the process of necessary preoperative evaluations when his wife unexpectedly passed away. Being unable to drive and severely limited with activities of daily living, he found himself essentially homebound.
Because of these multi-factorial events, he was hospitalized at the local VA hospital during the pandemic, and after stabilization of his medical problems he was moved to the VA St. Louis Health Care System rehabilitation center. He continued to be extremely weak, needing assistance from others to do basic tasks such as sitting at the edge of his bed.
For any meaningful attempt at recovery, it was clear that his weight would have to be discussed and addressed with him. After sensitively and respectfully discussing how most of his medical issues could be traced back to his unhealthy weight, OMA member Dr. Monu Khanna was able to use the pillars of obesity medicine to design a treatment plan for him. “To recognize the possibilities and assist him in a manner that had not been possible earlier with a focus on his nutrition, physical activity, sleep, and stress levels were a game changer. Slowly but surely, he started losing a few pounds every week, and more importantly, he was able to reverse his diabetes and effectively decrease his overall medication burden,” states Dr. Khanna.
Our nation is sick. More than 93% of the United States population are either overweight, have obesity or have an obesity-related medical condition. Unhealthy weight is the root cause of most of the chronic medical conditions and a weight loss of as low as 3-5% total body weight can lead to improvement of medical conditions such as diabetes, hypertension, heart disease, gout, fatty liver, and the reduction of risk in developing certain cancers.
Veteran Smith’s success using OMA’s Pillars included:
Nutrition: Prior to his admission to acute care, Veteran Smith was not a big eater. He was knowledgeable in terms of his nutritional needs, and he knew he had to prioritize protein and vegetables in his diet when at home. With additional help from his dietitian, he opted for double meat portions with meals during his rehabilitation stay but he stayed clear of bread, pasta, breakfast cereals and sugars.
Activity: From a bed bound state, Veteran Smith was gradually able to progress and start sitting up followed by ambulation with his wheeled walker. Over the combined three months stay in the rehabilitation center, he engaged with the therapists and improved upper body strength, started wheeling himself into and out of the gym and began ambulating. “I still can’t forget the smile on his face when he first walked 200 feet, which he had not done in 15 years, and he had lost hope he ever could. He had pride in his accomplishment, and he realized how different his health trajectory now looked,” states Dr. Khanna.
Behavioral changes: The focus on healthy habits for managing stress and sleep are extremely important for weight management. Embracing restorative sleep and recreational activities such as bowling and playing bingo while in the rehabilitation center in addition to socializing with peers brought him immense joy. He self-directed his free time by watching TV, reading, and talking on the phone with his friends.
Deprescribing: On admission to the rehabilitation center, Veteran Smith had a long list of medications he was taking that were not weight-neutral. As he was tapered off both short and long-acting insulin, his weight loss became easier. He needed lower doses of his antihypertensives and diuretics as well. He no longer needed to take any of his diabetes medications, and he was ecstatic the day his scale provided validation that he was 250 lbs. lighter than his heaviest recorded weight.
Today he continues to do well and lives his best life, each day, one day at a time. He has a positive outlook, and he is inspired to help others. Last year, he crossed another milestone: for the first time since the late 1990s, he was able to visit the gravesites of his deceased children. To learn more about Veteran Smith’s story, visit https://www.youtube.com/watch?v=x9PDtwmoJu0
There are many lessons to be learned here, but we know that life happens and there can be weight regain. There is a reason that obesity is a disease and that it is defined as chronic and recurring. Getting Veteran Smith back on track with repeat evaluations, encouraging the use of anti-obesity medications if needed, and reexamining his current lifestyle will be some areas of focus now. The last time I saw him in office, he did not use the accessible ramp, and he instead chose to walk the flight of stairs with just a quad cane. He remains dedicated to his goal of losing half of his body weight.
“Freedom is never given, it is won” whether for your country or from your illness. Wherever you receive health care, discuss weight management options with your medical provider to find a regimen that works best for you.