Dr. Marisa Collins (biography and disclosures)
Statistics Canada 1 reports that more than ¼ of Canadians are obese. When those classified as merely overweight are included, 44.2% of women (5.6 million) and 60.1% of men (7.6 million) are deemed to be at risk for health consequences. Among the risks associated with excess weight are important chronic diseases such as type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis and some cancers.
BC Guidelines 2 recommend lifestyle management as first line intervention. Achieving and maintaining a healthy body weight is an important objective for patients and physicians alike. Physicians of normal weight may be more likely to provide recommended obesity care to their patients and to feel confident in doing so; 3 and patients may be more likely to take their advice. 4, 5
What I did before
Years ago, I found Weightwatchers groups to be a great patient resource – before they started flogging ‘product’. Regardless, group programs and nutritionists are not available in all communities, and most people can’t afford a personal fitness and diet coach.
This app changed my practice
Just in time for New Year’s resolutions, here’s an app to recommend to your patients and, perhaps, to make use of yourself.
If we want to lose weight we need to consume fewer calories than we burn. Learning how to do that is HARD – but it’s a lot easier with some handy computing power. Based on the principle that keeping track of what we do helps modify or affirm our behaviours, My Fitness Pal www.myfitnesspal.com offers a relatively easy method of maintaining a balance sheet on that simple but elusive equation: what goes in, must come out (in a metabolic sense that is). By my reckoning, My Fitness Pal meets BC Guidelines criteria that weight loss programs should encourage regular physical activity; be based on a balanced diet of e.g. 500-1000 kcal/day deficit; support an initial weight loss goal of 5-10% of the original weight; and recommend a rate of loss of no more than 0.4-1 kg (1-2 lb) per week.2
My Fitness Pal (MFP) bills itself as a calorie counter, diet and exercise journal. There are mobile apps for iPhone, Android, Blackberry and Windows phones, for iPad, and also an option rich website. Membership is free, as are the apps.
Here’s how it works:
Create an account (you can use a pseudonym). Be guided through creating your profile: weight, height, age, background activity level; then enter your exercise and weight loss (or weight gain) goals. MFP calculates a recommended daily caloric intake “Goal” for you.
Now start entering everything you eat, and the cardiovascular exercise you do each day. MFP makes it easy to do this in real time, with a searchable food database touted as holding 2.25 million food and restaurant items. Entries you make on your phone will synchronize with your web account and vice versa. The bar code scanner (on the iPhone app anyway) makes searching new items even easier. Likewise, there’s a cardiovascular exercise database.
To make food entries, simply search the MFP database or your own past entries (which can be sorted by Recent or Frequent categories). Create shortcuts with My Foods, Meals or Recipes. Modifying quantities is also easy. You had a large latte yesterday, but a small one today? Walked 30 minutes last night at a moderate pace, but only managed 20 minutes leisurely stroll today? MFP calculates the calories (consumed or burned) from the food weight/volume or exercise duration entered. The first week on MFP is more time-consuming because you are developing a database of your most common foods.
By monitoring calories (in and out) throughout the day, you gain real-time feedback. MFP displays how many calories you have left in your day (displayed in green) or if you’ve (literally) gone into the red on your goals. Along the way you learn what foods are your calorie culprits, and appropriate serving sizes become far easier to judge. Do you really have room for that second helping?
The app is devoid of advertising (unlike the website. Remember, it’s free).
What I do now
I recommend My Fitness Pal to my patients, with a brief demo and some tips:
- Keeping track can be very motivating.
- It gets easier to log, because the My Fitness Pal program remembers your foods and exercises.
- There are good FAQ and video tutorials.
- Make www.myfitnesspal.com the home page on your computer.
- Don’t obsess if you don’t find an exact food match. The wrong brand of Oatmeal Stout Porter probably has about the same amount of calories as your brand. (If you really want to, you can enter new foods (or brands) into the database using the website).
- You can choose fractions or decimals for adjusting portion sizes.
- The little “wrench” is used to remember a meal or copy it to another day.
- If you are achieving your daily calories balance but your weight isn’t changing as expected, then use a food scale and spoon/cup measures when it is convenient to do so. Estimates are just fine, but measuring is helpful for learning portion sizes.
- If you want to follow your macro nutrient intake, note that Nutrition Fact labels are based on a 2000 calorie/day diet. Also note that as many entries in the MFP database are “crowd sourced” and calories are the minimum user entry requirement, nutrient info may be missing. Read the FAQs for more info.
- There is a large online MFP community that is completely optional. There you’ll find some useful, and some misleading info as well. I advise my patients to be careful, and sensible.
- DON’T click the ads!
I offer to weigh my patient, calculate BMI, measure waist circumference – and I write these down for them. I also suggest a follow-up appointment in a couple of weeks.
I know of no systematic research into the efficacy of this app. I can report positive anecdotal experience of patients, friends and myself. The MFP program appears to meet BC Guidelines criteria 2 for recommendation.
BC Guidelines: For information on the diagnosis and management of overweight and obese adults, see http://www.bcguidelines.ca/guideline_obesity.html
Billing: Diet and exercise modification counseling (if CVD risk) are among the targeted clinical prevention actions that can be incorporated into a patient plan following a Personal Health Risk Assessment. For details on how to bill G14066: http://www.gpscbc.ca/system/files/GPSC%20Prevention%20Initiative%20Billing%20Guide-Revised%202011.pdf 6
I have no conflict of interest to declare.
References (Note: Article requests might require a login ID with CPSBC or UBC)
- Statistics Canada. Overweight and obese adults (self-reported), 2011. http://www.statcan.gc.ca/pub/82-625-x/2012001/article/11664-eng.htm#ft1 [accessed Dec 3, 2012]
- Guidelines and Protocols Advisory Committee. Overweight and Obese Adults: Diagnosis and Management, April 1, 2011. http://www.bcguidelines.ca/guideline_obesity.html [accessed Dec 19, 2012]
- Bleich SN, Bennet WL, Gudzune KA, Cooper LA. Impact of physician BMI on obesity care and beliefs. Obesity 2012;20(5):999-1005. (Request from CPSBC)
- McCrindle BW. Do as I say, not as I do: the new epidemic of childhood obesity. Can Fam Physician 2006; 52(3): 284–285. http://pubmedcentralcanada.ca/picrender.cgi?accid=PMC1479704&blobtype=pdf
- Reilly JM. Are Obese Physicians Effective at Providing Healthy Lifestyle Counseling? Am Fam Physician 2007;75(5):738-741. http://www.aafp.org/afp/2007/0301/p738.html?printable=afp
- GP Services Committee. Prevention Incentives. Revised 2011. http://www.gpscbc.ca/system/files/GPSC%20Prevention%20Initiative%20Billing%20Guide-Revised%202011.pdf [accessed Dec 7, 2012]