Tony Hampton, MD, MBA, ABOM, CPE, Regional Medical Director Advocate Trinity Hospital Service Area, Advocate Medical Group, Advocate Healthcare And Dixie Jirak, Senior Consultant, Advocate Operating System, Advocate Healthcare
Tony Hampton, MD, MBA, ABOM, CPE, Regional Medical Director Advocate Trinity Hospital Service Area, Advocate Medical Group, Advocate Healthcare
In the age of smartphones and cellular technology, I know of few people these days willing to drive to an unfamiliar destination without the help of a GPS or directional App. Printed maps have worked for decades, but amazing tools like Waze and Google Maps now provide predictive information (predicated on evidence-based calculations) that guide us in reaching our locational goals.
"It is clear from the evidence that self-monitoring is a key component to reaching your weight loss goals"
The path we take to achieve our health-related goals should be just as straightforward. The research has been done and the tools are available. And the information we have access to provides needed insight to make evidence-based decisions regarding the choices we make. Case in point, research presented by the American Heart Association (AHA) Scientific Statement has been published as evidence-based interventions needed to promote physical activity and dietary lifestyle changes to reduce cardiovascular risk in adults. (Journal of the American Association, Circulation in 2010 by Artinian et al.)
Interventions recommended by this AHA study to deliver necessary change include: (1) setting shared goals, (2) scheduled and regular follow ups (with clinical teams, individual groups, or larger support groups), (3) long-term support (friends, family, peers), and (4) establishment a self-monitoring program. While all four interventions are critically important to achieve success, for the purpose of this article, we will focus on self-monitoring.
One compelling reason to include a self-monitoring program is that it reinforces the patient’s accountability. Particularly when coaching patients on weight loss strategies, we emphasize the importance of recording their daily macronutrient intake (fat, carbs, and proteins), and following a low carb, high-fat (LCHF) diet as recommended by many experts within the American College of Obesity Medicine.
Why do we concentrate on macronutrients as opposed to calories? The answer is simple: research proves that “calories-in” do not always equal “calories-out”, as the Law of Thermodynamics would suggest. Unlike a controlled lab setting, human factors which determine energy expenditure are plentiful, including the type of bacteria in our digestive system, hormone balance, genetics, and many others. And the macronutrient composition of what we eat makes a huge difference. For example, 100 calories of spinach will have a different impact on your body vs. 100 calories of cake. In general terms, starchy carbs are more likely to cause weight gain compared to less starchy carbs, fats, or proteins.
Back to self-monitoring. Whether patients choose to track macronutrients or calories, technology—such as a smartphone App—can play a key role in helping patients reach their goals. Not only does it reinforce the patient’s focus on his or her daily objectives, it provides important information on ideal nutrient ratios to realize those goals. For example, for our patients who select a ketogenic diet, we recommend the following macronutrient ratios:
Net Carbs: 10 percent (< 40-50 grams/day)
Protein: 25 percent (100 grams/day)
Fat: 65 percent (120 grams/day)
Imagine attempting to manage these ratios without using the technology found in an App? The average person would quickly lose motivation to perform these calculations on their own. While I encourage a low carb high-fat diet, I also try to individualize recommendations for my patients to choose from, like Ketogenic, Mediterranean, or DASH diets.
Although using a written log (or food journal) can work, studies reported in the Journal of Medical Internet Research and Obesity Research & Clinical Practice have found that well-designed Apps can be just as beneficial as any online resource or journaling, with many that include cloud back-up to prevent data loss. Other less sophisticated smartphone Apps are also available to simply count carbs to help lose weight. The point is, it’s up to each patient to determine their area of focus and choose the tool that supports their goals. If you’re searching for an App to become your personal coach, reminding you daily if you are on or off track, here are a few to consider:
CarbManager (FREE): We often recommend this App because it visually tracks macronutrients using a pie chart. It also allows you to track your overall weight loss, water intake, and exercise while providing access to a database with foods and their associated macronutrients and carb counts. With an upgraded membership, you have access to menus and other features.
DailyCarbPro ($2.99): In addition to counting carbs, this App allows you to track blood pressure, glucose levels, triglycerides, cholesterol levels, and medications.
My Fitness Pal (FREE): Who hasn’t heard of this popular App? Although it is primarily focused on calories (we prefer carbs), it does allow you to visualize the macronutrients as well. It has a large database with over 6 million foods and can be synced with other Apps like Fitbit.
There are many other Apps to consider but the big message is that use of technology may just be the missing piece in your weight loss journey. And keep in mind, success is not only about nutrition! It also requires exercise, reduced stress, and better sleep habits.
It is clear from the evidence that self-monitoring is a key component to reaching your weight loss goals. So make your life a little easier! And don’t be surprised when you find you’ve reached your desired destination a little sooner than once thought.
Hesham Abboud, MD, PhD, Director of the Multiple Sclerosis and Neuroimmunology Program and staff neurologist at the Parkinson’s and Movement Disorder Center at University Hospitals of Cleveland, Case Western Reserve University School of Medicine