Controlling intake and increasing activity (dieting and exercise) are very difficult, and it is important for physicians to understand that some patients may have to do much more than others to maintain a healthy weight. There are windows of opportunity when radical behavioral changes seem to work. For example, after a diagnosis of diabetes or myocardial infarction, patients are often highly motivated to undertake behavioral changes. Unfortunately, the amount of weight loss by nonsurgical approaches rarely surpasses 15 percent from baseline weight. Table 6.2 provides some guidelines for improving adherence to dietary changes. It is important that physicians not take nonadherence to their suggestions personally and criticize patients when they don't achieve their weight goals. After validating the difficulties that their patients face, it is important for physicians to focus on identifying obstacles and help their patients design a plan to succeed the next time.
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I already know two things about you. You are an intelligent person who has a weighty problem. I know that you are intelligent because you are seeking help to solve your problem and that is always the second step to solving a problem. The first one is acknowledging that there is, in fact, a problem that needs to be solved.