Get Well, Not Hungry

A Metabolism, Diabetes and Weight Program

For people dealing with metabolic syndrome, type 2 diabetes and/or impacts of higher abdominal or over-all body fat, Dr. Roberts offers a program based on group medical visits.

How to Start – is summarized at the bottom of this page.

Video Visits for B.C. Residents – Visits by video (on your computer) are available, when appropriate, for people who are not able to come to the office regularly for appointments. This is for people living out of the Greater Vancouver area, for people who have significant mobility issues, or who for other reasons would find regular office visits a significant barrier to participation. Please call to discuss this, so the right arrangements can be made for your situation. In general, this will involve at least the first visit being at the office here in Vancouver. However, if travel is a barrier and if you have a family doctor who is willing to be in communication and supportive, we can discuss whether the need for the initial trip can be waived.

People who may find good benefit from this program include those who find themselves dealing with such medical conditions as:

  • metabolic syndrome
  • non-alcoholic fatty liver
  • pre-diabetes
  • type 2 diabetes
  • abnormal blood lipids, with low HDL and/or high triglycerides
  • medical reasons to recommend weight loss – according to MSP criteria, this means:
    • having a BMI over 30.0 (when the higher BMI is not due to high muscle mass)
    • BMI of 27 – 30 and at least one complicating condition

The goal is to provide people with information and support that they can put to good use as they look to improve and protect their health while managing these conditions. We are recognizing more and more that, when it comes to most long-term health conditions, the role the person plays in their “self-management” is vitally important. No amount of medication or surgery can equal the results that can come from combining appropriate good medical care with all the aspects of health practices that the patient themselves have direct control over.

It turns out that care provided in groups is a very effective option for people who are dealing with medical conditions where skilled and knowledgeable self-management can make a powerful impact.

Most people who live with long-term medical conditions understand that their day-by-day choices and actions are profoundly important to their quality of life now and in how their medical condition may develop over time. However, many feel frustrated and maybe confused by the buzzing cloud of conflicting advice they encounter. Many also feel frustrated by the results (or lack of results) or difficulties they experience when they take on the challenge of diet or lifestyle changes. Enough repeated experience with this can understandably lead to some people feeling discouraged about how much impact their self-care practices can even have on their medical outcomes.

Get Well, Not Hungry is designed to be a low-barrier, high “worthwhile-iness” program:

  1. come-as-you-are  Bring your current health practices with you. This is not a set program. It is a process of exploring different options to find what suits you, individually. This is not about suddenly up-ending your life when you leave the first session.
  2. initial commitment is 6 sessions  You can come to the first 6 sessions to learn about many options, without having to give up what you are currently doing or promising to make any certain specific changes. Of course, it is hoped that you will find several useful changes or strategies you wish to bring into your life.
  3. support is on-going  After the first 6 sessions, if you will be continuing the program, you can come for as long as it seems medically useful (at every second week or less often, determined individually).
  4. a whole-person, unique-person approach  All aspects of what you can do that affects your medical condition are considered – even the very process of being on a health journey and the process of considering, planning and implementing changes to your choices and routines. We consider sleep, circadian rhythm, various aspects of physical activity, mind-body health, problem-solving, tracking how your body is responding, and so on.
  5. medical pragmatism is the only “-ism” here  In terms of food, medically the goal is to help you find how to be a “pragmativore” – eating according to what works best over-all for your life in broad terms. This then has to be adapted according to your circumstances, goals, beliefs and values. Food is always about more than health, and is an important way we express our identity and values. Life is about more than health. The role of your health learning and practices is to serve your life, not take it over.
  6. side-step the hunger-induced derailing  When people start a new way of eating or other lifestyle changes intended to improve their health – very commonly (almost always?) they wind up under-eating in the first days or weeks. This can be completely unintentional and does not mean that the person was even intending to lose weight. Most often, though, it is intentional, based on the past idea that substantial weight loss (for those who have higher body fat amounts) was the most important goal of dietary strategies. Now we know that other dietary goals can be equally or more medically valuable. Dietary changes that don’t bring substantial weight loss can still bring tremendous benefit to people. So often people miss out on reaping the value of strategic changes in food intake patterns – because they started their journey with under-eating. Their appetite might “play nice” for the first few weeks or so, but will usually roar back to life with hunger and cravings some days or weeks in. Extensive amounts of research have made it very clear that reducing calorie intake by chronically forcing one’s self to eat less than what will satisfy your hunger is very rarely useful long-term (and may be counter-productive). The first strategy is, if possible, to “solve” the hunger, which means trying things and noticing how a person responds. (The thing that may solve a person’s excess hunger might not be anything about food – it may be something like getting more sleep or making a change to your medication.) This noticing-what-works-for-you is not going to work for someone who has just spent time under-eating and whose appetite and cravings are now exaggerated.
  7. side-step exercise as a barrier  Some people may be hesitant to start a program to help their health by changing their food or lifestyle – because they are concerned that they may be expected to take on a level of exercise that they don’t feel up to or are not ready for. They may even feel that there is no point in trying to make other lifestyle changes unless a substantial amount of exercise is part of the plan from the start. The good news is that increases in activity level can be made in careful, planned stages and major amounts or intensity of exercise can wait until there are other improvements in health. This can be a key strategic move for many reasons, not least because it is important to avoid exercise-induced injuries.
  8. come for the “it’s cheap”  All office visit fees are paid by MSP. There are no extra program costs. No purchases or special products are required to participate.
  9. stay for the companionship and the possible transformative journey  When you have a medical condition, taking on the job of learning about it and improving your health by your own efforts really can be a journey of personal transformation – beyond what may be accomplished in terms of health benefits.

Practicalities:

• Saturday and after-work (5:10 p.m.) groups available

• Referral is not required for those who will be attending the office (with some exceptions). Arrangements are individualized for those who are at a distance (from outside the Greater Vancouver area). Medical records are requested, such as recent lab reports and investigations.

• Eligibility is considered based on a person’s medical situation and on an assessment that the program would be suited to their needs. There is a Participant Agreement to sign. Learn More

• The eating choices aspect of the program is based on real food. People who are currently using meal replacement products or who personally have a strong preference for that treatment option are very welcome and we will work together over time, and as it suits the individual, to successfully transition to real food.

• The program has 2 phases:

  1. For the first phase, the person is asked to commit to a series of 6 group visit sessions, held once a week. This phase starts with an exploration of options and making plans for changes. There is no sudden start of major changes on day one, but a negotiation of choices over time.
  2. Following this, if the program seems like a good match and they want to continue, they join an ongoing group that meets every second week. People are asked to commit to attendance over at least 5 months further (at every second week or less often, determined individually). They have access to the group sessions as needed ongoing, according to their medical needs.

How to Start:

  1. Read further on this site, to learn more
  2. Consider the eligibility requirements (link to BMI calculator, Diabetes Canada)
  3. It starts with an Inquiry Phone Call to discuss if you may be eligible for consideration for the program. You can just phone or you can use the online calendar to book a specific time for your call (see info in the footer area at the very bottom of the page).
  4. If you are very sure you are eligible and would like to just go ahead, you can instead book an MSP Initial Visit. For that appointment, we will need you to have completed the Medical History Form.

Experiences of an MD offering a lower-carb or ketogenic way of eating in their practices (there is no one best diet, each person has their own needs and choices):

Brief clip of interview with Dr. Joanne McCormick of the U.K.:   LINK to clip   LINK to her website