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Host:  Steven Nissen, MD, Chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic

Description:  Dr. Steven Nissen talks with Kate Patton, Med, RD, CSSD, LD, from our Preventive Cardiology Clinic  about our recent survey showing that while most Americans (88 percent) understand that there is a connection between a healthy heart and a healthy weight, most aren’t doing enough – or anything –  to combat their own weight issues.   Kate and Dr. Nissen talk about suggestions on how to do get started on a heart healthy eating plan, strategies to keep weight off, what you need to know about the Mediterranean diet, barriers to healthy eating and losing weight.

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Healthy Weight Equals Healthy Heart

Podcast Transcript

Announcer: Welcome to Love Your Heart, brought to you by Cleveland Clinics Sydell and Arnold Miller Family Heart and Vascular Institute. These podcasts will help you learn more about your heart, thoracic, and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Dr. Nissen: I'm Dr. Steve Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, and I'm here with Kate Patton, who's a dietician who spends a good deal of her time in our cardiovascular prevention clinic, helping counsel patients about diet and how to improve their heart health. It's Heart Month, and this year for Heart Month, we've focused on obesity as a health problem, and one of the things that's quite interesting is we did a survey of people to understand what attitudes of Americans are about obesity and heart health. We found out that there are a lot of things that people don't know. People are worried about their weight, but they don't know what to do about it, and there's just a lot of lack of knowledge, a lot of confusion about what to do. So you tackle this problem pretty much every day, Kate?

Kate Patton: Yes.

Dr. Nissen: So how do you start with somebody? How do you start with somebody? Most people know if they're overweight, how do you help them get moving toward a more heart healthy weight?

Kate Patton: Sure, that's a good question. I think getting to know the patient and knowing their current eating behaviors is really important, and then try to just improve upon those things. So making swaps and substitutions and giving them ideas and suggestions, but really trying to work with them, establishing goals, realistic goals that they can achieve.

Dr. Nissen: I'll bet you get this question a lot, which is, I'm overweight, what diet should I be on? So how do you answer?

Kate Patton: Yeah, I'm not a fan of the word diet, because I think that with the word diet, it has a start and end point. Someone associates being on a diet, they start, they stop, and then when they're off, then the weight just comes back on.

So I like to encourage people to change their eating pattern, whether it's the timing or the balance of their meals, and think of it that way.

Dr. Nissen: I'm going to ask you a provocative question. What percent of the people that lose a substantial amount of weight regain it?

Kate Patton: That's a good question. I don't know is exactly off the top of my head, but I'm going to guess close to 50%.

Dr. Nissen: Yeah, it's pretty high. That's what I read, what the medical literature suggests. So I guess one of the questions is what's the strategy for somebody who knows they're overweight, they know that they're having complications related to their heart or other things like diabetes? What's the strategy to overcome that yo-yo problem that so many people have?

Kate Patton: I think it starts with understanding the food groups and which foods have good nutritional value, which foods have good quality, nutrient dense calories from healthy fats, good carbs, good lean proteins, and how to plan a balanced meal and balanced snacks. But at the same time, overall we need there to be a calorie deficit to support the weight loss.

Dr. Nissen: Yeah. So you're emphasizing a principle that I think is pretty important, which is that there are really no magical diets, are there? Everybody wants the the easy way. Okay. If you just eat the the Atkins diet, or if you just eat this low fat diet, that somehow or other you're going to magically have the pounds melt off. But it's really about calories consumed and calories burned, isn't it?

Kate Patton: It is. It is.

Dr. Nissen: Now we've tended, in the Heart and Vascular Institute here, emphasize the Mediterranean Diet, and maybe you can share some of your thoughts about the Mediterranean Diet. What is it? How does it work? Why do we think it's the best approach?

Kate Patton: Sure. We think it's the best approach because it's been studied quite a bit, so there's a lot of good evidence to support that it reduces your risk for heart disease. It encourages a eating pattern that's a lower in animal fat, but very rich and plant-based food. Fruits, vegetables, whole grains, starches, healthy fats from nuts and fatty fish and olive oil, and still, some lean animal protein too.

Dr. Nissen: It's very high on sustainability, isn't it?

Kate Patton: It is.

Dr. Nissen: One of the things I worry about and I struggle with my patients is they'll often tell me, well, I was in the checkout counter at the supermarket and I saw a little book there about the latest diet, and they have all the various names for these diets, often written by people who are not dieticians, I might add, and they're very restrictive. They say, oh, you can only eat this or you can only eat that, and it's pretty hard to sustain.

Kate Patton: It is. The Mediterranean Diet, it does, it includes all food groups. So you still can have a little red meat if you enjoy red meat, you can still have some dairy, you can still have some eggs, but we just need that to be less frequent. We want the nutrient rich foods with lots of fruits and vegetables and whole grains to be the base of the diet.

Dr. Nissen: Of course, it's very palatable.

Kate Patton: It is.

Dr. Nissen: I can say this personally, because it's the diet that I eat and it's been studied, scientifically studied and shown to reduce the risk of heart disease, in a very large study conducted in Spain in more than 7,000 patients, which was a very impressive one. One of the things about the diet is that it does use olive oil and I take it that's something you do recommend to people.

Kate Patton: I do. I mention that study, how subjects were using extra virgin olive oil, large portions, every day and calories were actually unrestricted and they still reduced the risk of heart disease.

Dr. Nissen: They did indeed. Of course, the diet was also rich in nuts.

Kate Patton: Right.

Dr. Nissen: A lot of people are hesitant about this because nuts are fairly high in calories, but they seem to work well on these diets.

Kate Patton: Yeah. Well, I find patients often don't realize how high in calories they are, so I often have to encourage them to actually reduce their portion. They're often eating them, often too much. So that's an example of something that you know is nutrient rich, very good calories but to watch their portions.

Dr. Nissen: What is the biggest challenge you find in educating people about nutrition? What are the barriers that you come up against that just make it really hard for people to lose weight?

Kate Patton: I think just lifestyle, whether it's just our fast paced society so people don't have time to cook, so they rely on the fast food or they skip meals, and just the fast paced society of news and media. They often hear many conflicting things and have so many misconceptions and they just struggle with applying really what's best for them.

Dr. Nissen: You mentioned skipping meals. A lot of things I hear from patients, and maybe you can comment a little bit about this, is that, well, I never eat breakfast and I don't eat much for lunch. I don't understand why I'm gaining weight. Maybe you could talk a little bit about this issue of why that may not be the right strategy.

Kate Patton: Yeah, there's a lot of research that does support that eating the majority of calories later in the day is linked with obesity. Most of us maybe are really busy all day, ignore those hunger signals, eat a big dinner, but we're often resting and relaxing at night too. So there's no opportunity to burn off all those calories.

Dr. Nissen: There's an adage, and I wonder what your thoughts are about it, that says eat breakfast like a king, lunch like a prince and dinner like a pauper. Is that a sensible strategy?

Kate Patton: I think it is. Yes. I absolutely agree with that.

Dr. Nissen: Yeah. I hear this from so many, and even my colleagues here often come racing into work in the morning and they have not had breakfast. Of course, what seems to happen when people do that is that they just pack in the calories in the evening. If they can eat a good breakfast, a healthy breakfast, they may find that they can sustain themselves during the day and they're not so hungry at night.

Kate Patton: I agree. Yeah. Especially a high protein diet too, or high protein breakfast, I should say, is associated with controlling your appetite and your hunger, and those cravings, especially late in the day, so that you don't overeat.

Dr. Nissen: A couple more quick questions. You saw the survey that we did and I wondered, was there anything in there that really surprised you? What was perhaps the most surprising to you about what we found?

Kate Patton: I was surprised how few people knew about the Mediterranean Diet and it's association with heart health, because especially in the past couple of years, it's been rated very high on the US News report for healthiest diets, yet so few people knew about it.

Dr. Nissen: Yeah, that was certainly, I think, a surprise to me. What I sensed from the survey is also that patients were actually reluctant to talk to their physicians. I would have guessed that a very high fraction of patients that have a weight problem would approach their physicians for guidance and they seem to not be able to do this. So I think we're dealing perhaps with some psychological barriers, and I'm guessing that you encounter that a lot.

Kate Patton: I do. Yeah. I think oftentimes, doctors do refer patients, but some patients come on their own too. But you have to be ready, I think to take that step, to really sit down with the dietician and make some changes.

Dr. Nissen: Yeah. Well, we really appreciate your briefing us on this obviously huge public health problem. As a cardiologist, I know that we are struggling with the consequences of obesity, and I think it's important to know that we have this program that you're part of here at the Cleveland Clinic, our prevention team. We have a prevention clinic that has people like Kate and others that will work with you on this.

My encouragement to patients is to take this on, to have the courage to approach it, recognizing it's one of the hardest things you're going to do. But it's not just that you're going to live longer, it's, you're going to live better. We talked about the heart consequences, but being obese, very hard on the joints, a lot of orthopedic problems, diabetes. There are many diseases that are linked to obesity, and every day that you go on with the problem, it tends to get worse. So we're here to help and we have people like Kate that are ready and willing and sympathetic, and we'll help you figure out how to get there. Thank you for watching.

Announcer: Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Please subscribe and share the link on iTunes.

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