Notes from a Doctor's Practice

This is the most common question I am asked these days.

1. Identify Your goal and enlist your primary care doctor for help. A successful weight loss program should lead to weight loss of more than 5 percent of initial weight within 3-6 months. Because long-term weight reduction is so difficult, it is important to have as much information and support as possible before starting. Your Internist or your Family Doctor can help you find the best plan.
2. Which diet to start? There are many published studies showing that low-carbohydrate diets (Atkins, South Beach, Zone, Sugar-Busters etc.) work better than low-fat diets for short term weight loss. This is important if you are looking for a jump start. Weight Watchers has the best published data for long term and sustainable weight loss. Very low calorie diets (medically supervised liquid diets for example) have fallen out of favor and I don't recommend them because yes, you will lose weight but in my experience you will put it back on.
3. How much exercise do I have to do? Start with a brisk walk (this means a light sweat and breathing harder than would allow you a cell phone conversation) 30 minutes 3 times a week. Increasing that to 50 minutes 5-7 times a week is your goal. Then incorporate this into your life: take stairs instead of elevators, walk the short distances instead of driving. Bottom line: You must move around more if you are going to sustain any weight loss you achieve.
4. I've been trying diet and exercise for 6 months and nothing has happened! This is the time to talk to your doctor about medication options. You will hear and read about many options but the only two medications that are effective and approved for weight loss and are safe for long term use (more than 6 months to a year) are Meridia (Subutramine) and Xenical (Orlistat). Both work for an average of 10-20 lb weight loss at 6 months and both have their own sets of side effects that need to be followed by your doctor. Remember that Ali is just over-the-counter Xenical, and is half the dose of the prescribed medicine (60 mg three times a day as opposed to 120 mg three times a day). And most studies were done on the prescription strength version. Phentermine works and is available for short term use (less than 6 months) but because of side effects and addictive potential it is NOT recommended for long term use. Metformin, Byetta, Wellbutrin, Topamax and Zonegran are medications used for other purposes that also have a bonus side effect of weight loss but are not yet indicated for weight loss purposes alone (stay tuned on those).
5. When should I ask about gastric bypass? If the above steps have not resulted in successful weight loss and you have a BMI > 35 or a BMI of 30-35 with other medical conditions you should learn about the bariatric surgery options. The gastric bypass procedures range from the less invasive Lap Banding procedure to the standard Roux en Y procedure. In the right hands the laparoscopic Roux en Y has the best results. Your healthcare provider can tell you more about this. There's no question that the surgical options work, but only consider it as an option after your best 6-12 month effort with the above listed options.
6. There's more? This already isn't easy, but there is additional work required on your end. You need to change your behavior. In some ways this is the hardest thing to do but here are some tidbits. Pay attention to what triggers you to eat: the place, emotions, people you are around, time of day, etc. Drink a sip of water between each bite and eat slowly. Reward yourself with something other than food (manicure, shopping, etc). Learn to be assertive and say no when friends offer you certain foods. Keeping a diary may help you sort out the behavior that leads to bad eating habits.

Dr O.