“The Latte Lady”

The Food Amnesia, “I need my energy” Story.

Once upon a time, not too long ago, actually it was last month (March 2008). I’m about to go into see a patient that I saw two months before as a new weight loss patient. Before I entered the room I reviewed her weight loss progress and noticed that she had lost only 1 or 2 pounds since she started at our clinic. I see that my other practitioners had seen her several times and have written long notes about her not following recommendations and I see mention of the “latte” word. One of my medical assistants sees me reading the chart and comes up to me and says, “Oh!!! You’re going to see the ‘Latte Lady’”!!! So, I guess this lady’s reputation precedes her. So, I knock and enter the room.

I have to describe to you what I see and observe. The best way to describe what I see is to describe this lady as a cross between Brittany Spears and Elizabeth Taylor. She is a mid-sixty year young woman that has been very well taken care of in every way, sitting in the exam room. I immediately feel that there is some tension within her body and she is holding one of my pre-printed food logs in her hand, like a 2^nd grader waiting to turn in her homework. On the table is at least a 32 ounce coffee from a local kiosk that has printed in vertical print, Java Detour. It is 4:30 pm.

I sit with her at our small table and begin to talk to her about how things are going and I can hear in her voice an immediate defensive tone and frustration. “ I just don’t understand why I am not losing weight”!!! “I’m doing what you and your Nurse Practitioners are telling me to do.” I said, “Well, let me take a look.”

She gave me her very basic, rudimentary food log. It had small scribbles that were barely legible with only calorie amounts listed (when we give a patient a food log assignment we want a few days of a complete food log to include total calories, carbs, protein, and fat. So we can really look, truly at what they are doing). I reviewed the days that she did have done (approximately 3 days) and all it had listed on the bottom was total calories and they were all around 600 calories. It wasn’t enough!!!! And it was LOUSY nutrition. She was starving herself. As I was talking to her and reviewing what she was consuming, my eyes glanced at the ‘Java Detour’ monster cup that was sitting between us. I saw her body tense up as if ready for battle.

I looked back at the food log to see if any of those Latte’s were mentioned in the food logs. I then pointed at the cup, her body tensed even more and she turned to face me, as if in full battle Viking fashion, as I asked her, “ What’s in there?”

Her immediate response was, “ I’m not giving up my Latte’s!!!!!” Her hand, with rings on every finger, circled the cup like a wagon train circling for an impending attack by Indians. I wasn’t asking her to give anything up, I just wanted to know what was IN IT. I said that to her and she said, “I’m not giving up my latte’s, I NEED my Latte’s!!

So, when someone is that ‘black and white’ and is so absolute, I ‘push’ them (figuratively). So, I again asked her what was in IT. Again, very defensively, she says, “It’s a NON—FAT LATTE”. So I said, “What does that mean?” and she said, “It’s a NON—FAT LATTE!!!” “OK, that’s greats” I said. “But still what does it have in it”?

She couldn’t give me an answer. She looked like a deer in the headlights. So I answered for her. “It has a whole bunch of SUGAR” I also asked her how much Nonfat milk her giant Latte has and she told me they put a bit more than 2 cups. I then educated her that 2 cups of nonfat milk has over 300 calories of sugar!!! She had no idea, we call that ‘FOOD AMNESIA’.

She got very defensive again and said, I won’t give up my Latte’s, I NEED my Latte’s.

(OK, Timeout, you need air and you need water but you don’t NEED Latte’s) So what do you think would be the obvious question to ask her?

So I asked, “Why do you NEED your Latte’s?” She replied almost in tears that she had to have her Latte’s to give her ENERGY. “I have no energy, the latte’s give me my energy. I can’t give up my Latte’s.” So, I continued to push, “why don’t you have any energy?”

She looked at me with a blank stare and didn’t have an answer. So I grabbed the very rudimentary food log that she had done and opened it to one of the partially filled in days and showed it to her and asked, “Why don’t you have any energy?”

I could see the realization in her eyes when, at that precise moment, she understood. She was not feeding herself enough energy and she was using the Latte as her energy source.

What I had not asked her yet was how many Latte’s she was having in a day?

The answer, FOUR, 300 calorie Latte’s a DAY. Everyday, Monday through Sunday. What does that equal, 1,200 calories a day. Oh, my, God!!!

Why Lose Weight?

The main reason to lose weight is for health, not appearance.

• Nearly 112,000 deaths per year may be attributable to obesity.
• The risk of death rises with increasing weight.
• Even moderate weight excess (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults ages 30 to 64.
• People who are obese (defined as having a body mass index [BMI] greater than 30) have a higher risk of excess death (they are more likely to die) from all causes, compared to people at a healthy weight.

Obesity is now recognized as a major risk factor for coronary heart disease, which can lead to heart attack. Some reasons for this higher risk are known, but others are not. For example:

• The incidence of heart disease is higher in persons who are overweight or obese (BMI greater than 25).
• High blood pressure is more common in adults who are obese than in those who are at a healthy weight.
• Obesity is associated with elevated triglycerides (blood fat) and decreased HDL cholesterol (”good”) cholesterol.
• Even when there are no adverse effects on the known risk factors, obesity by itself increases the risk of heart disease.

The consequences of weight gain are serious for other health issues as well.

• A weight gain of 11 to 18 pounds increases a person’s risk of developing type 2 diabetes to twice that of people who have not gained weight.
• Over 80 percent of people with diabetes are overweight or obese.
• Overweight and obesity are associated with an increased risk for some types of cancer including endometrial (cancer of the lining of the uterus), colon, gall bladder, prostate, kidney and postmenopausal breast cancer.
• Women gaining more than 20 pounds from age 18 to midlife double their risk of postmenopausal breast cancer, compared to women whose weight remains stable.
• Sleep apnea (interrupted breathing while sleeping) is more common in obese persons.
• Obesity is associated with a higher prevalence of asthma.
• For every 2-pound increase in weight, the risk of developing arthritis increases by 9 to 13 percent.
• Symptoms of arthritis can improve with weight loss.