Dear Dr. Roach: In a recent column, you said, “I don’t find simply telling people to eat less and move more to always be an effective therapy.” What do you suggest to patients wanting to lose weight?


Dear C.N.: The vast majority of patients I see who are overweight know they are overweight, and have tried unsuccessfully to lose weight. Often, they have tried multiple different types of diets, sometimes having success in the short term, but then having gained it back. “Eat less, move more,” while correct, doesn’t address the issues that are important for many people.

Although some of my colleagues will disagree with me, I look at the issue differently. I recommend that people choose a healthy diet. There are many healthy diets, and people can choose what they like, but I recommend plenty of vegetables, some fruits, and good-quality protein sources such as legumes or nuts and lean meats or fatty fish for those who eat them; processed foods, especially starches and processed meats, should be avoided. Along with these dietary changes, which are modest for many people, I advise increasing exercise, from wherever the person starts (within reason). My rationale is that “losing weight” often seems unattainable to people; however, eating better and exercising more feel like they are within one’s control. There is no doubt that people will be healthier with a better diet and with more exercise.

It is true that over a long time, most people who make those dietary and exercise changes will lose weight. But the primary goal is to improve health, even if the weight doesn’t come down.

Some people, especially those with medical problems due to their weight, need more-intensive intervention, and I am fortunate to have colleagues in weight management, both medical and surgical, for those who need it.

Dear Dr. Roach: My husband just got a diagnosis of multiple sclerosis. We’re not thrilled, but it could have been worse. He is older than I am — in his 70s. A few people have said that if you are going to get MS, it is not as bad when you are older. Is that true? What is his prognosis?


Dear N.W.: I am sorry to hear about your husband. There is no good age to get this diagnosis. MS is the most common demyelinating disease of the nervous system. The myelin is a covering around the nerves, which protects them and speeds impulses. Without myelin, nerves cannot properly perform their function of communication. The myelin is destroyed by the body’s own systems, by an immune system that mistakes myelin for an invader.

It used to be thought that people who got MS at a younger age had a slower rate of disease progression; however, more recent studies have shown that age itself is not a strong predictor of the course of the disease. Similarly, being male was thought to predict worse outcomes, but that no longer seems to be the case.

It is very hard to predict how MS will progress in any given individual, as the disease can range dramatically. Some people have only a single episode in life (sometimes called “benign MS,” about 15 percent of cases). However, the most common is relapsing-remitting, with times of normal function interspersed with acute attacks. Finally, there is progressive disease, which can start right away (primary progressive MS) or after a period of time of relapsing-remitting (secondary progressive). About 12 percent of people have malignant MS, which leads to a need for assistance walking within five years.

MS is a complex disease, and I can barely scratch the surface of it here. There are many types of symptoms, but most people have at least one of the following: eye symptoms, numbness or weakness in a specific body area and terrible fatigue.

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