Healthcare

Firstly, from the clinical perspective of the practising internist, it must be noted: There is no avoiding the fact that affected patients need to consume more calories than they take in. This unavoidable negative energy balance can never be achieved in everyday life simply through more exercise. Calorie intake must be restricted through a conscious, balanced but thoroughly enjoyable diet. As an internist, I emphasise that losing weight with my mental support as a doctor means embarking on a long-term project like a marathon. After months or even years, once we have reached the goal we have set together, there is no time limit to maintaining the weight we have achieved. Maintaining this weight can only be achieved by making permanent changes to a healthy lifestyle. All diets are useless in the long run and only lead to the dreaded "yo-yo effect"This means that in the long term, patients gain even more weight than they were already overweight before the diet.

One balanced diet with lots of salad and vegetables and less fruit in comparison is important. You don't necessarily have to be a strict vegetarian or even vegan, but a plant-based diet is scientifically proven to be the healthiest and, in my clinical experience, the most effective for losing weight.
If you don't want to give up meat, eating food of animal origin 1-2 times a week may be sufficient (so-called "flexitarians"). Fish and poultry are preferable to red meat from a health point of view.

Particularly healthy are Vegetables include broccoli, cauliflower, kale, Brussels sprouts and pulses. Fruits include dark berries such as blueberries and raspberries. Nuts, especially walnuts, and wholemeal-based carbohydrates are highly recommended.

In addition, fibre such as a tablespoon of wheat bran, psyllium husks or ground linseed can be consumed daily with sufficient liquid (1 glass of water, tea etc.) to maintain a healthy microbiota (bacteria in the gut).
Food supplements (vitamins, trace elements) are only indicated in special life situations: Folic acid (400 micrograms per day) should be taken additionally if you wish to become pregnant and in the first trimester of pregnancy; if you are vegan, you need to take vitamin B12 (5 micrograms per day) in the form of capsules or drops. All other intensively advertised vitamin and food supplements are unnecessary for a balanced diet and are sometimes associated with a risk of damage to health.

In order to be able to better assess how many calories common foods contain, I provide my patients with the "Chip list" of the general practitioner and diabetologist Dr Klas Mildenstein (http://chipliste.de, can also be ordered as a leaflet from the pharmacy with the central pharmacy number PZN: 2 58 76 18 at your own cost of around 6 euros). I would like to emphasise that I do not receive any financial benefit from this recommendation.

One chip corresponds to 100 calories, with the chips for different foods being freely interchangeable depending on the patient's taste. Patients are given an indication of the quality of the food in terms of a healthy and balanced diet via yellow, smiling chips (healthy food) and red, sad chips (less favourable or worthless). A so-called exercise chip list gives an idea of which types of exercise burn how many calories for how long. I agree a certain number of chips with my patients, for example 17 chips (i.e. 1700 calories), which they consume daily, whereby additional chips can be "earned" for eating through exercise.

Some of my patients additionally and complementarily use Intermittent fasting I follow the 16/8 method, i.e. you usually eat 2 meals within 8 hours followed by fasting for 16 hours. In practice, this means that, depending on their preference, my patients either eat breakfast (fasting between dinner and lunch the next day) or skip dinner (fasting between lunch and breakfast the next day). It has not yet been conclusively proven scientifically, but there are indications that intermittent fasting also has a positive effect on pain perception (e.g. musculoskeletal pain), blood pressure control and irritable bowel symptoms.

In addition to a healthy and balanced diet Regular exercise not only for additional calorie consumption, but also to improve your general condition: at least 2 times, ideally 3 times a week a Endurance sport for 30-60 minutes. Jogging is the most time-efficient activity because it can be done right outside your front door at very flexible times. Alternatively, cycling (at least 1-1.5 hours), swimming (250 - 1000 metres), walking (5-15 km), dancing (1-2 hours) or a combination of these are recommended. All of this is only effective if the "sweat is flowing". Another important principle is: it must be enjoyable in the long term, otherwise you won't keep it up.
In my experience, my patients develop a real need to run, for example, after 4-6 months, i.e. if running is not possible for 14 days for some organisational reason, they no longer feel "comfortable in their skin", which is then "blown away" with a round of jogging. Regular endurance sport has a demonstrably positive effect on the release of neurotransmitters (popularly known as "happiness hormones") in the midbrain.

I encourage my patients to take an active role in the ongoing control of excess weight and its elimination. This includes, for example, self-measurements of weight, but also of the often elevated blood pressure after initial guidance from our medical assistants (MFAs). Printed Excel files of runs with distance and time are also important as documented therapy.
This data generated by my patients themselves is of great value for my medical documentation of the course of therapy and I regularly scan the printout they bring with them into my electronic patient file. In my experience, the active involvement of my patients in their therapy and documentation - also under Use of mobile technologies such as smartphones - lead to greater reliability in the implementation of the therapeutic measures previously agreed.