Monday, January 30, 2012

Overweight Doctors Can't Do Weight Management?

Is it true? Well, it is all over the news! Physicians with a normal BMI are more likely to bring up weight loss and management to patients. At least according to a recent study in the Journal Obesity.

Well, I would pick an overweight Obesity Specialist over a normal weight Internist any day. Why? Most primary care doctors know absolutely nothing about weight loss. They know so little it is scary. In fact one medical weight loss franchise owner says "I learned more about malaria than obesity in medical school. I have yet to see one case of malaria."

He's right. That being said the study said normal weight physicians felt more confidence in their ability to counsel on diet and exercise. What I didn't find is whether the advice given was correct or not.

Put simply, when I lost weight using my specialized program I did gain confidence. By receiving education in bariatric medicine, I gained much more. More importantly I learned what works and what doesn't.

So is your physician overweight or obese? How are the managing your weight loss? Are you satisfied with your results?

Again, the true way to lose weight is to burn fat first. Plain and simple. Once you burn the fat, the weight is easy to take off!

Sunday, January 29, 2012

Are you not satisfied with your weight loss results?

I find that the end of January is always a tell tale sign for those patients who have been trying at home and online weight loss programs. We see many people disappointed with their results. These are various reasons for failure to progress.

With most of the non medically guided services I find some very good things. The first of these are support. Programs like Jenny Craig offer a weekly phone call and check in. This is very nice and useful. We find support program do help patients lose weight.

Here's what often leads to failure to lose weight.
1. Medical issues such as sleep apnea and no treatment. Sleep disturbance affects weight loss.
2. Medical issues such as endocrinopathy of adiposity
3. Lack of protein and macronutrients for nutritional ketosis and lean muscle support

Have you figured it out yet?

If you want to succeed partner with a physician. We have all sorts of strategies to help you lose weight. Further, you may need medical management to enhance further weight loss!

Friday, January 27, 2012

Weight Loss and Body Composition Testing!

Today we had a great day in the office. Why? We burned hundreds of pounds of fat. The best part of this is that we got to see a bunch of very happy faces.

In fact, patients who didn't lose exactly as much weight as they wanted, ultimately found out based on body composition testing, that they were burning fat and putting on lean muscle mass!

If you are not getting body composition testing, you are missing out. Often I find when people are trying over the counter weight loss programs, they get disappointed when they don't lose weight as fast as they would like. Well, it turns out, they may actually be doing much much better than what their weight shows.

Body composition is a much needed testing point for weight loss. It is important to do this for 3 reasons!

1. I want to see how well we are burning fat. If we level off, I want to ramp it up.
2. I want to make certain we do not miss a loss of lean body mass. We will increase protein then.
3. When patients don't lose so much weight, they could be actually be losing quite a bit of fat!

So, the teaching point is simple. If you are in a weight loss program, you should be getting body composition testing at least monthly.

Wednesday, January 25, 2012

Why protein matters in low calorie diets

From Healthwise. Why you should avoid Carbs and Eat More Protein!

The importance of protein within the context of low calorie diet cannot be underestimated. The use of
supplemental protein in the diet has several important functions.

Protein plays a major role in the structure and function of the body. It is an important structural
component of cells, hair and nails. It is an integral part of skin, bones, muscles, blood and connective

Without adequate protein, our immune systems wouldn’t function properly and our bodies would have difficulty producing adequate hormone levels. In fact, every metabolic function that occurs in the
body depends upon the presence of proteins called enzymes.

Even when not dieting, the proteins that make up our muscles are constantly being turned over. As
our caloric intake decreases, the body will begin using these proteins from our muscles to meet its
energy needs. Ideally, during dieting, the goal is not just weight loss, but rather fat loss and muscle
maintenance or gain.

For this to occur, our overall caloric intake must decrease while maintaining
adequate protein consumption. As muscle mass increases, so does one’s resting metabolic rate. This,
in turn, allows the body to burn more calories during rest, regular activities of daily living and with
exercise. Another benefit to a proportional increase in dietary protein is the increased satiety it provides.

Gram for gram, protein tends to satisfy and decrease hunger better than either fats or
carbohydrates. This helps improve a dieter’s chances of success by reducing the chronic hunger
that so often comes with calorie reduction.

Recommended amounts of protein vary depending upon one’s age, gender and current fitness and
activity levels. The suggested range begins at 0.8 grams of protein per kilogram of lean body weight
per day to upwards of 1-1.5 grams per kilogram of lean body weight for the very seasoned and muscular athletes.

As one begins dieting, a positive nitrogen balance can easily be maintained with the addition
of supplemental protein in the form of protein bars or protein supplements. This is a very good way to
ensure adequate protein while keeping total calories low.

In the context of an LCD diet or protein sparing modified fast, the reduction of carbohydrates has
equally important consequences. The hormonal changes associated with low carbohydrate diet include
a reduction in the circulating levels of insulin along with increased levels of glucagon. Insulin has
many actions, the most well-known of which is stimulation of glucose and amino acid uptake from
the blood to various tissues. This is coupled with stimulation of anabolic processes such as protein,
glycogen and fat synthesis.

Glucagon has opposing effects, causing the release of glucose from glycogen
and stimulation of gluconeogenesis and fat mobilization. Thus, the net stimulus would seem to be for
increasing muscle protein breakdown. However, a number of studies indicate that a low carb diet results in body composition changes that favor loss of fat mass and preservation in muscle mass.

According to G.L Blackburn's study carbohydrate apparently does not improve protein sparing. In
studies have shown that obese patients on a diet containing 40 grams of protein experienced
significantly better nitrogen balance than patients on an isocaloric diet in which 26 grams of
carbohydrate replaced some of the protein.

There is another theoretical advantage to omitting carbohydrate from a very low calorie diet. If a diet contains the minimum amount of protein needed to prevent loss of lean body mass, addition of carbohydrate adds calories and will therefore decrease the rate of weight loss.

In a recent randomized trial in 17 healthy obese women, a diet containing 1.5 gm
protein/kg ideal body weight was found to result in significantly better protein sparing than an isocaloric
diet providing only .8 gm protein/kg ideal bodyweight.' Patients lost weight at the same rate on the two
diets, but since there was less nitrogen loss on the diet without carbohydrate, it can be assumed that
more fat loss occurred than on the diet where carbohydrate replaced some of the protein.

What implications does this have regarding the choice of the protein supplements mentioned in the
protein discussion? It means that for the benefit of both the health and success of the dieter, the selection
of protein supplements should focus not only on the taste but on the nutritional composition of the

The best choice is to avoid higher carbohydrate, low protein supplements and to select
supplements that are higher in protein and lower in carbohydrate content. The conclusion would be
that for products that are relatively similar in carbohydrate content, the preferred choice would be the
protein supplement that offers a higher protein content and a taste that the patient find both pleasing and

Sunday, January 22, 2012

Phentermine Works! But see the MD!

There are a whole lot of people online who are searching high and far on the internet to get a prescription for phentermine. My advice? Go to a medically run weight loss program. Why?

Phentermine requires some monitoring.

Recently I saw a patient who was on Phentermine and Topiramate (a super common combination) for weight loss. When I asked how she got these, she sheepishly acknowledged that she had gotten these on the internet.

I then asked her if she had side effects, she said, "yes palpitations". I asked if she had a baseline EKG when starting the medication, she said no. We did one immediately!

Listen, I understand, there are a whole lot of doctors who poo poo weight loss medications. They are wrong and this could be dangerous. Why? Because it can drive patients to the internet for "no RX needed phentermine"

So, if you have been poo poo'd, fear not. There are doctors out there, who, if they think it will benefit you, will prescribe phentermine. Ideally make sure they are part of the American Society of Bariatric Physicians. Why would we prescribe it? Because it works! Alongside a great medical program you can achieve maximum appropriate weight loss.

There are side effects to this medication and they should be monitored by a physician who understands the medication. And remember, that internet site has not taken a hippocratic oath to first do no harm.

If you are in the Greater NYC area, call us!

What's in your tank? Why Burn Fat First?

Last year I set out on an adventure. You see, I was overweight. In BMI circles, I was bordering on obese. I discovered something amazing. Sure, I had lost weight before my wedding. I tried weight watchers, which allowed me to lose some weight and man did I look good at my wedding! But after the wedding, I put the weight back on.

Then after my first child and the daddy sympathy weight, I put on more. Then I launched my medical practice and put on more.......

You get the story.

So, about my discovery.

I found out what was in my tank and how to burn fat first. Using this knowledge I lost 20 pounds and have kept it off! To get an idea, 20 pounds was 10% of my body weight! For some of you, 10% is 30 or 40 pounds. Could I have lost more? Absolutely.

Did I need medications or nutritional supplements? No. But for many these help. Especially Phentermine and phendimetrazine. We use these at my weight loss clinic.

Did I need a meal replacement program? No. But for many it helps them keep it off! We use this at my weight loss clinic too.

Imagine if you went to pump gas and didn't have a gas gauge. You had no clue how much gas was going into the car. You would have no way to know if your car was full. Further, the only way you could stop is when the gas was pouring all over your nice new shoes.....

That doesn't happen right? Correct, some smart engineer created gas gauges. Then after too many people had their feet wet with gas, they then created automatic ctop switches for pumps. The pump stops pumping for you when the tank is full. That is exactly the problem with our bodies. There is no gas gauge and their is no automatic kill switch for our pump.

The problem with most weight loss programs and with online diet companies is that their technology and science is stuck in the model-T version of weight loss. Cut your calories and you will lose weight.

Well, it is much more scientific and medical than that. What you need is a 21st Century team.

I learned what was in my tank and then created the "Virgin Galactic" version of weight loss.

What's the first 2 steps of this dance?

1. Find out what is in Your Tank.
Everyone is different here. Believe it or not. Your tank size is NOT PRECISELY RELATED to your body size. You can try and estimate using equations. But unless you undergo technologically advanced medical metabolic testing using gas exchange, you will never know "What's in your Tank"

2. Burn Fat First
There were many times when I looked at my fat and was upset, then I came to view it as my friend. Accepting it as a part of me. Well, it IS NOT a part of me. It is a parasite sabotaging you, making you hungry, slowing weight loss. If you don't Burn Fat First, you will never lose weight long term. Further, you never reap the benefit of health if you don't burn fat first.

Over the course of this blog I will share weight loss tips, weight loss secrets and weight loss analysis. If you stick with me I will, in essence, walk you through our weight loss program. Unlike secret medical weight loss franchises that hide their "special sauce" or have fly by night felons in charge,  I will put it all out here on the internet, free to those who read along.

Come along for the ride, we are gonna have some fun helping you lose weight!