Viewpoint

Garbage In, Garbage Out

Larry E. Patterson, MD
From The Chief Medical Editor

We most often attribute that phrase to the world of computers — bad instructions produce bad results. However, we might want to consider the same application in regard to our patients and their nutritional status.

Consider Susie, a patient who's only 42 years old. Morbidly obese, her diabetes had begun to ravage her retinas. While amazing advances in retinal diagnosis and treatment have occurred over the last few decades, I thought maybe it was time to address the etiology. When I asked what she was doing to treat her diabetes, she proceeded to show me a very long list of medications. Some were intended to reduce blood glucose levels, others to treat her hypertension and high cholesterol levels, some to help with sleep apnea, and others to treat the side effects of all of the previous drugs.

“No” I replied. “What I'm asking is, ‘What are you personally doing to treat the cause of your diabetes?’” She looked confused. “Are you aware of anything you are doing that might increase your risk of diabetes, as well as most of the other diseases you and your doctor are fighting?” She thought about it for a moment, then sheepishly pointed to her belly. “You mean what I'm eating?” she asked. Bingo.

I have similar conversations every week with patients, with a good number swearing that no doctor has ever suggested to them that they lose weight, or even modify their diet. While I'm pretty sure this is often a case of selective memory, I have spoken with and routinely find that my friends in general medicine are tired of preaching to the masses and being consistently ignored. Unfortunately, they find it's easier to just prescribe pills. But it's certainly not the best thing for the patients, much less for the skyrocketing cost of medicine.

Recently, it's been fashionable to say that diets don't work. That's nonsense. Of course they work. It is true, however, that they don't work when you stop them. I'm not referring to the wacko internet fad diet of the week. I'm talking about a healthy, balanced lifestyle and diet that is sustainable. Most of us are on some type of diet whether we realize it or not. I'm fairly slender, but that's thanks to a balance of diet and exercise. Fifteen years ago I went on a cruise and, boy, did I get my money's worth. I gained 10 pounds in just one week!

As part of our special issue on retinal topics, we've devoted a whole article to the subject of the ophthalmologist's role in nutritional counseling. In article “Ophthalmologist as Lifestyle Guru?”, you can read and learn ways in which you can include this in your practice. I know it's hard to find the time, but it's needed. This month, one of my patients came in for her yearly visit, and I noticed something looked different. She smiled and, with obvious pride of accomplishment, said, “I lost 40 pounds since you saw me! Your talk last year really made an impression on me. Thank you so much.”

No, you don't get paid extra for giving a few extra minutes of nutritional advice. But the rewards, while not consistent and sometimes infrequent, are really worth it.