Questions

 

 
     Everyday we get questions from our patients and from those who want to lose weight who come to us for a consultation.  As much information as there is available these days, most people still either don't really understand the weight loss process, think they do, or have a misunderstanding about the process. Most people believe in order to lose weight a unique dietary or exercise process is required.  Hence, the formation of multiple "amazing" diets that purport to be the answer for the weight loss dilemma.  Keto, Intermittent Fasting, Adkins, Zone, Blood Type, and the list goes on and on.
 
     The same holds true for exercise.  Every week a new machine, device, or exercise regiment is touted to solve the excess body fat problem.  Every gym, every piece of equipment, every exercise type can be the answer.  Now, in all of these dietary and exercise programs, there is some great value.  They are all based on the science that we must expend more energy than we take in.  Each one of these plans provides a possible new and more palatable way to get the job done.  Certainly anything that makes dieting and exercising easier is welcomed.
 
     Today, we are going to take many of these questions that are asked us by our patients and get to real answers that hopefully will lead to a greater understanding of what and how to make changes that allow one to beat the genetic tendency of most people to gain weight.   Understand that excess body weight issues have a multitude of causes and to get to a lean and healthy weight takes an entire treatment plan.
 
     The Questions:
 
1.     Why do I lose and gain and lose and gain over and over?
 
     Remember that for most of us that struggle with long term weight loss, we are dealing with a disease process.  Obesity and Overweight syndrome is a genetic, metabolic, hormonal, and psychological disorder.  To beat it long term we have to correct the issues in each of these categories.  The genetics remain, but can be quieted when a long term proper eating plan, regular physical activity, metabolic and hormonal balance is achieved, and we modify our thinking about food, weight, diet, and body movement.  All of these factors must be consistently addressed for long term success and elimination of the loss/re-gain cycle.
 
2.     My friend and I perform the same exercise program 5 days a week.  We exercise together doing the exact same activity, intensity and duration.  She loses weight and I seem to be stuck.  How is this possible?
 
     Exercise is an amazing force to get our bodies leaner, more fit, and healthy.  Exercise alone will give us great benefits, but by itself will usually not cause us to lose weight.  I would take a close look at each of your diets.  That may be where the issue lies.  If calorie and diet intakes are similar, then a recently discovered phenomenon about exercise may be the problem.  Animal Studies have shown that  approximately 50% of the animals studied, including small animals like mice and rats, and  larger animals like dogs and chimps failed to lose weight with exercise.  This is a genetic issue.  About half of the population has a genetic makeup that makes the body respond to exercise with weight loss and the other half does not.  Both halfs benefit dramatically from exercise, but only half of us see weight reduction.  It is possible your genetics are different from your friends when it comes to exercise induced body fat reduction.  Don't give up the exercise as it will add years to your life and make your body more efficient at burning calories.  You will lose the weight and the exercise is the match that lights the fuel we eat.
 
3.     I like an alcoholic beverage several times a week?  If I stick to the lower calorie drinks, can I just count them as part of my daily calorie intake?
 
     You can count the calories in the alcoholic drink, but something more is happening in the digestion of alcohol.  We know that not all calories are processed the same in the body.  A gram of protein and a gram of sugar equal the same amount of calories.  To utilize the protein requires a series of chemical reactions to convert it to glucose.  This conversion takes extra energy consumption to perform.  The sugar calories move directly into the blood for use and take nearly no energy to process as fuel.  With alcohol, these calories must be processed in the liver.  One of the byproducts of alcohol metabolism is a backbone for fat production.  Our liver. cannot make fat and burn fat at the same time.  When we drink alcohol we slow our ability to burn fat.  I advise my weight loss patients to avoid all alcohol when they are in the fat burning phase of weight reduction and once they reach their optimal weight, they can count small amounts of alcohol calories as part of their daily caloric needs.
 
4.     Does our metabolism really slow down with age?
 
     Yes, our body goes through a growth phase early in life until around our late 20's called anabolism.  Energy needs and use are high as we are building cells, tissue, and organs.  After this period, we go through the remainder of our lives in catabolism which is a slow breakdown of our cells, tissues, and organs.  With this breakdown process we are utilizing less energy and fuel.  Though there are things we can do to slow this process, it is always occurring.  As we age, we become less physically active naturally.  We can certainly slow the process through adequate exercise and a lower calorie, healthy diet.  The aging process is accelerated by a  sedentary lifestyle, smoking, excess alcohol, medications and drugs, poor sleep habits, and a high carbohydrate and high volume diet.  The goal is to provide our body and its tissues with appropriate fuel and activity to make it as efficient as possible.  This will keep our metabolism as high as possible, even during the breakdown process.  Just to reiterate, yes our metabolism slows with age.
 
5.     I've heard from people that diet medication is dangerous. Even many Doctors say this?  Is this true or not?
 
     Any medication has the potential to have side effects and in some cases dangerous possible side effects.  The same is true of appetite suppressing medications.  There are however many misconceptions about these medications.  The stimulant appetite suppressants like phentermine, diethylpropion, and phendimetrazine are often combined with amphetamines.  Amphetamines have a moderate to strong addictive potential and are this classified by the FDA as Schedule II drugs.  The stimulant appetite suppressants are milder, much less if at all habit forming and are classified as Schedule IV drugs.  In my last 20 years of using these medications, I have never had anyone go through withdrawal or develop an addiction or drug seeking behavior with these medications.  Physicians often provide Schedule II Amphetamines like Adderall and Ritalin and lisdexamfetamine for children and adults with ADD.   Most doctors that do not practice bariatric medicine are unfamiliar with the medications.  They lump them together with amphetamines and tell their patients they shouldn't take them.  On the other hand, these same physicians offer no good advice or assistance to their patients regarding weight reduction.  They tell the patient that to get healthy they must lose weight, but aren't able to help them.  When I prescribe an appetite suppressant for a patient, we do blood testing and an EKG if they are over 40.  We check their blood pressure and examine their heart.  Monthly we check blood pressure, heart rate, and review any potential symptoms or side effects of the medication.  In 20 years of using these medications to help patients reduce weight, I have had only a few minor side effects that are easily managed with medication adjustments or changes.  Medications can be potent tools in the treatment of obesity and overweight syndrome.
 
6.     I've often heard that major weight problems are caused by hormone problems. Is this true?
 
     Hormone balance plays a role in our body metabolism and function.  If any of our hormones are in excess or a deficiency, our body will struggle to maintain a set weight.  The hormones most associated with weight problems are thyroid, cortisol, insulin, testosterone, estrogen, and progesterone.  There are many other hormones associated with our weight including ghrelin from the stomach, Leptin and adiponectin from fat tissue,  Other involved hormones are Neuropeptide Y, GLP-1, and Cholecystokinin.  Not all of these can be practically measured and assessed, however, we can optimize many of these that are out of balance including thyroid, cortisol, insulin, testosterone, estradiol, and progesterone.
 
7.     I eat only once a day and yet I can't lose weight and often gain weight. Why is this?
 
     Our body is processing fuel at all times.  We eat food and either use it right away or store it.  If we eat more than we use, we make fat.  If we eat less, we dip into our fat stores and use it for energy.  A problem occurs however when we only eat once or twice a day.  Upon awakening in the morning our body needs fuel.  If we do not give it fuel, it will break down glycogen to make glucose.   Our body however will put on the metabolic brakes to preserve its stored fuel as it senses a bit of starvation going on.  Later in the day when we eat a single meal, we consume way too many calories than we will utilize over the next few hours and our body must convert this excess fuel into fat stores.  A recipe for body fat production is to eat nothing early in the day and eat all of our daily calories in one or two settings later in the day or in the evening.  Our body weight is about what we eat, how much we eat, and when we eat.
 
 
When we learn more about our body and get our questions answered, we are better prepared to achieve results and complete our goal.  Never feel like a question is stupid or undeserving of being asked and answered.  If you have questions, feel free to email them to us on our website.  www.fastclinicalweightloss.com or via our Facebook page @fastclinicalweightloss

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