Weight Reduction: Tips from the Doc

Weight loss: Why is it so hard to do and what can be done?

Obesity is a disease located in the hypothalamus of the brain. Unfortunately, it’s like treating high blood pressure in the 1960s, we understand the lifestyle changes but only have a few medicines. Many drugs are in the pipeline.

The problem is that 70% of the nation is either overweight or obese. Arthritis, diabetes and sleep apnea are sky-rocketing due to obesity. Obesity is an actual disease as evidenced by inflammation in the hypothalamus of the brain. The brain fails to receive the hormonal input that causes one to feel full.

It is hard to lose weight because metabolism slows and the hunger hormone, ghrelin, increases.

The key to losing weight is taking action by setting up follow-up appointments with your physician, dietitian and/or weight loss psychologist. Form a team and stick with it! Portion control works better than exercise but both are important factors.

Weight Watchers remains the most successful weight loss program according to clinical studies. The power of the group is motivating. 

Remember to keep a food journal, exercise daily or every other day, weigh each day and wear a pedometer. Aim for 10,000 steps daily, bring the right foods into your house and eat only when you’re hungry. A great snack is air popped popcorn (not microwave or theater popcorn) with a little olive oil. It is a whole grain, gluten free and quite filling and can even be used as a meal substitute (no more than once a day).

The MyPlate approach increases satiety and decreases waist circumference even at 1 year. Essentially, you have a plate of food that is divided into quarters and includes whole grains, vegetables, fruits and proteins. 

What is the best lifestyle change to lengthen your life? 

It’s the Mediterranean diet, which consists of lower carbs, olive oil, fruits, vegetables, fish, whole grains and a little alcohol. Basically, you are reducing white rice, pasta, white potatoes, sweets, chips and bread. 

Sugar and processed foods increase weight, elevate the risk for cardiovascular disease, double the cancer risk and heighten the risk of dementia. 

This approach reduces dementia, cancer and heart disease!  

Wow, so the father of medicine, Hipoccrates, was right. The best medicine is at the end of your fork. Ok, maybe they didn’t have forks back in those days but you get the idea.

Losing weight can preserve your memory, reduce arthritis, cure sleep apnea, prevent diabetes, decrease cancer and lessen heart attacks. 

Interestingly, a Nov. 17^th 2005 NEJM study showed in a 1 year study that a weight loss drug alone resulted in an 11 pound weight loss. An intensive lifestyle modification program consisting of 30 meetings yielded nearly a 15 pound weight loss. 

The drug plus eight 15 minute counseling sessions done by an MD helped patients to lose 16.5 pounds. Finally, the combo of intensive lifestyle modification plus the drug resulted in over a 26.5 pound weight loss.

If we extrapolate, perhaps Weight Watchers plus a medicine can be an effective strategy.

Another interesting strategy is just add fiber to your diet. Fiber can have many beneficial effects upon the body. In a small 8 week study from Nutrition Journal 201615:86, 10.5 grams of soluble fiber or psyllium reduced HbA1C by 1% (as good as a drug to lower sugar), improved the cholesterol and resulted in nearly a 7 pound weight loss. 

So you could take a teaspoon of Metamucil=psyllium 3 times daily and lose weight. At the very least, you’ll likely improve blood sugar and cholesterol.

Let’s debunk a myth for just a moment. You must eat breakfast, it is the healthiest meal of the day. Breakfast doesn’t help you lose weight or help you live longer. It is your option if you wish to eat breakfast. See BMJ Jan. 30^th 2019.

Newer medications (Belviq, Qsymia, Saxenda and Contrave) and surgical procedures can also be beneficial. All of these weight loss medicines create a sense of fullness and help one lose about 5% of total body weight, but the results can vary. The chart gives a quick overview.

The side effect profiles are low, but these agents can be expensive so utilize the coupons provided by your health provider. 

Such medicines are indicated if you are obese (a BMI of 30 or higher) or if you are overweight (a BMI of 27-30) with a cardiovascular risk factor such as diabetes, smoking, high cholesterol or high blood pressure. BMI stands for body mass index and charts are numerous on the internet.

If you have a BMI of 35 or more (morbid obesity), then you may need to consider a procedure.

Commonly, gastric sleeves are being performed. By simply making the stomach smaller with this laparoscopic, surgical procedure, significant weight loss can be realized. This surgery carries the same or less risk than a gall bladder operation. It is indicated for individuals who are obese, especially if there are additional cardiac risk factors. 

You can lose up to 50% of your excess body weight. So if you  should weigh 200 pounds but you actually weigh 300, then a gastric sleeve procedure can help you lose an additional 50 pounds. According to Ann Intern Med. 2018;169(11):741-750, here are the percent weight loss for gastric bypass, gastric banding and gastric sleeve procedures:

• 1 yr. 31% 25% 14%
• 5 yrs. 25% 20% 10%

Gastric bypass has more side effects but results in more weight loss. Also gastric surgery likely reduces cardiovascular death in half according to JAMA 2018 Oct 16; 320:1545. Additionally, according to JAMA 2018 319 (3) 279-290, the overall mortality is significantly lower in each surgical group compared to no surgery.

By the way, get Weight Loss Made Really Simple by going to this link: https://doclipkis.convertri.com/lifesavers-newsletter