Happy New Year,,,One Last Nag

I wish all of you a very happy, healthy and safe New Year...Let's look forward to 2009 being a MUCH better year. Remember at all times: If you have your health, you truly are fortunate no matter what the stock market has done, no matter what horrible world news is in the newspaper, no matter who the latest politician is that has been caught doing something bad. It takes one serious medical illness to put all of this into perspective. Do everything possible to keep you and your loved ones in as best health as possible.

I look forward to being a part of your quest to make 2009 a healthy and happy year! All the best!

losing weight over the holidays

One of the patients I saw yesterday had a very successful weight loss week despite the holiday festivities. I asked her the "secret to success". Her answer: Take only small tastes of the high-caloric foods and not large portions. Also, pick the few items that are most desirable to you and have small portions of those, but leave the other high-caloric foods/desserts that are not as appealing to you completely untouched. Also, she recommended that because there are fewer hours at work during holiday weeks, she scheduled more exercise time. The patient also expressed lots of happiness that she decided to embark on weight loss before the holidays as opposed to packing on the pounds and doing the New Year's Resolution thing.

Alcohol is a major barrier to effective weight loss and if, on New Years Eve you have a choice of doing booze or doing a good dessert...opt for the dessert.

weight loss and patterns of behavior

Please take some time this week and write down all the behavior patterns you can think about that derail your weight loss efforts. Do you skip breakfast? Do you not plan your meals in advance? Are you a nighttime snack person?? Do you have a glass of wine every nite??? Write down everything and anything you can think about that may play a role in hindering your weight loss efforts and make a conscious decision to start intervening with these issues. Your list may have 20 items, 10 items or 100...if you can see exactly what the issues are, then perhaps you will be better positioned to permanently do something about them.

Okay: Posner movie reviews: Clint Eastwood's Gran Torino: EXCELLENT Merly Streep in Doubt: Excellent


Football weekend: Giants positioned to go all the way again...if the Giants win the Superbowl anyone reading this blog that e-mails me at: serotab@aol.com and sned the mesage "Go-Gmen" will get taken out to lunch by me and Linda.

weight loss and supplements

The FDA issued warnings covering over 20 Over-the-counter supplements that are being sold for weight loss. Some of these supplements (made out of the United States) actually contained the same chemical as the anti-seizure medication Dilantin.

You cannot turn on your computer without being inundated with ads for "magic pills" that purport to cause massive weight loss with little effort on your part. Buyer beware! Not only what you are buying with probably not help, but you are putting yourself in harm's way.

Anything that sounds "too good to be true" usually is, and certainly, as this relates to weight loss, it ALWAYS is. We developed and sell a supplement, but you will never hear us say: "take this pill....do nothing...and weight will come off". Long-term weight loss always has to include a dietary and exercise component, and supplements may be adjuncts to this effort. However, check out the supplement and its ingredients carefully and make sure there is some sort of safety track record associated with its usage.

Balmy weather...weird... this makes people get sick...we always see in my medical practice a spike of respiratory infections when the weather turns warm over the winter....time for a run at the park and then on to NFL Sunday....have a great one!

Post Holiday Left Overs

First, thanks Suzanne for imparting further strategies for planning out holiday meals so as to have healthy choices available. Lots of candy and cookies around the house from gifts...PLEASE be very careful to NOT mindlessly ingest these items over the next week. It is so easy to just pick up one or two snacks and think it will not harm your weight loss efforts but, cumulatively, these high-caloric food sources will be deleterious. If you are off today, make some time for exercise. Personally, since I got Tanner The Dog, I feel guilty about exercising indoors so I have felt compelled to take him outside for runs. As I am getting older, I find myself hating the cold. I went out this week and bought some heavy duty hats, sweatshirts, gloves, etc to protect me from the cold. If you do not have inside equipment or belong to a gym, then your exercise will need to be outside. If you did not get holiday gifts that were related to exercise, consider exchanging something for outside exercise garb. Have a great day !

Happy Holiday

I wish all of you the very best of health and happiness.

What does a Jewish doctor do on Christmas morning? 1-Look for Christmas movies on television 2- Take Tanner the dog out to Burke Lake Park for a run 3-see a movie at the theatre 4-just had to attend to a patient with a bad sore throat 5-try very hard not to write anything about losing weight on a holiday that is meant for everyone to enjoy the love of their families and not worry about calories for one day....

i will get back being a pain tomorrow!!! laughing...have a great one!

Happy Holiday

We have all been hit with horrible financial news over the past number of months. Yes, all of our "paper" wealth has taken a major hit and the newspapers daily deliver us worse news about the financial future...the values of our houses, the deteriorating job market, etc.

As you spend time this holiday season, enjoying your family and loved ones, focus on the "real" wealth that we all (hopefully) have and that is the love that exists in our circle of family and friends. Furthermore, health is truly our major resource, because no matter the value of our house or our stock market portfolio, if we do not have good health, these other things matter little.

Have a great Christmas eve and I wish all of you the very best of health and happiness

Staying Healthy

As you are enjoying the company of your friends, family and loved ones, give special thanks, if you have relatively good health, for the fact that you are there in a pretty good state to enjoy your family time. In my internal medicine practice, I see many cases of people who have the sudden onset of signficant medcial problems that have a good chance of shortening that unfortunate person's lifespan. There will be less Christmas dinners for that person to enjoy their families. It is sad.

What shortens a person's lifespan? Heart disease, diabetes, cancers.

What contributes to the development of heart disease, diabetes, breast cancer, pancreatic cancer, colon cancer? Obesity

Losing the weight is certainly going to help you aesthetically, but for living life to the fullest and being there to see you children and grandchildren grow and florish, there is no better thing you can do for yourself. Life often is a series of choices. Choosing to be there with your loved ones over impersonal high-caloric food sources or alcohol is, in my opinion, a better choice.

Big Push.....

Okay: 10 more days till the New Year.....try very hard to NOT let the next 10 days really turn your scale in the wrong way. Make a conscious effort to enjoy the love and festivities of the holiday season and not start going back to old habits. If you are receiving gifts of calories for the holidays (cookies, fudge, brownies, Godiva, etc) and you are trying to lose weight, turn around and give them to someone who does not have a weight issue. These food sources are NOT comfort and are NOT your friend. Anything that makes you less healthy and less happy is NOT a "treat".

As you are planning your Christmas day or Eve meal, make certain to have lots of healthy choices for those around you who are also trying to lose weight.

You will be VERY happy January 1 if you see that the scale has not given you bad news because you are paying attention now!

GREAT game last nite!!!!! Giants looked like a Superbowl team again. Congrats to you Skins fans....they played an excellent game....really bottled up Donovan.

choosing wisely at meals

At restaurants there are lots of "accompanying" things that make for a much higher calorie count...the bread that comes out with butter, the before dinner alcohol-containing drink, the side dishes and the dessert tray that is then presented.

Picking and choosing the "right" parts of the restaurant meal can go a long way in helping your dietary efforts...give up the cocktail....leave the bread alone....and....order that really good steak or lobster....but have a vegetable as opposed to mashed potatoes...and....the dessert tray??? it is not worth it and react to your senation of satiety...there is no way you are still hungry at that point!

Finding partners...

As January approaches and most people have as their New Year's Resolution weight loss, it would be great to find others who may want to join forces on a quest for significant and sustainable weight loss. Do not be afraid to approach family or friends who also have a weight problem and offer up some type of "partnership" on the effort. Perhaps exercising together, planning meals and strategy, some healthy "bet" or competition...something that will make your weight loss efforts seem easier and perhaps more fun.

Okay...I have an idea: for anyone of you reading out there that has an interest, write me an e-mail: serotab@aol.com and I will start keeping a list of people interested in "teaming up" and I will pass on contact numbers...or...post a note on this blog with your contact e-mail.

Having "company" during your weight loss efforts can boost the results for everyone!

Winter Weather Advisory and Weight

It has been very nasty outside..dark, cloudy, rainy....it seems many many months ago that the birds were singing, sunrise was bringing warmth and the flowers looked beuatiful. Those morning, it was a great chance to take a walk or jog outside. Now? forget about that! dismal, dark and cold. We feel like rolling over in bed and staying asleep.

Exercise levels are prone to drop off and if we do not adjust our eating, weight will start going up instead of our desired loss.

During these months, it will be very helpful to have in a warm, well-lit basement, exercise equipment which will allow you to get that exercise in. Yes, belonging to a gym is great, but if you know your personality is such that you will have trouble getting up, dressed and to the gym before work, then home equipment is your answer. Putting this equipment in front of a tv set to provide entertainment will make the exercise time go by easier.

weight loss and happiness

Over the past several weeks I have seen a number of patients who have demonstrated, almost in a linear correlation, a marked improvement in their happiness that has paralleled their weight loss. When these patients first started our program, their mood was bordering on the clinical depression side. After signficant weight loss, the mood problem reversed completely, with an almost elated sensation occurring.

The improved physical appearance, higher level of confidence, more energy, positive feedback from friends and relatives, etc....all of these contribute to a person being happier when they lose weight. Coming off of medications for diabetes, hypertension, hypercholesterolemia and other medical entities associate with weight problems is yet another reason for improved happiness.

Yes, on an immediate basis, the ingestion of a dessert can make us happy...for a bit. BUT, weight loss will make a person happy for much longer.

An Idea to Help With These Next Two Weeks...

Everywhere you turn for the next several weeks there will be high-0caloric food and drink choices staring you in the face. You will have people all around you ingesting alcohol, cookies, chocolate and other food and drink choices that will derail your plans to lose weight.

Here is a suggestion: Take the time to sit down with a piece of paper and write out a list of those food and drink sources during this holiday time that will sabotage your efforts to lose weight. These items may include egg nog, Godiva chocolate, Cookies, etc. If you generate a list of 15 or 20 items, then strike out 50-75% of them and put them as "completely off limits". Allow small portions of the remainder. In this way, you will reduce the amount of calories you will take in but at the same time allow yourself some of the holiday food and drink sources that will allow you to not feel totally deprived.

Chart that Weight!!!

I know I have recommended this previously but I REALLY REALLY everyone should do this and if you have not done so, DO IT TODAY!!! Keep a chart on a clipboard next to your scale at home and record your weight weekly on that chart. If that weight ever goes up by 10 pounds more than when you left our program, please pick up the phone and call us. We can bring you back into the program for 1 or 2 weeks and help you refocus.

If you do this, there is NO WAY you can gain back 20, 30, 40 or more pounds.

PLEASE do not be embarrassed if you have gained weight back. It is incredibly difficult to maintain weight loss, and it is common to need help. W e are here for you.

TV Commercials and Weight

While watching football yesterday (dismal day for the G-Men and Skins) I was amazed to see the plethora of commercials touting huge portions of food for a relatively inexpensive price. From the "5 Dollar Foot Long" Subway commercials to the "Panormous" Pizza Hut commercials to the "555" Dominos commercials...it seems as if you can get lots of calories for a relatively small amount of money.

Corporate America is great at showing us tasty looking foods on commercials (do you notice though that in real life, the food never looks as good as in the commercials???) and then hitting us with an "Offer we can't refuse".

Do we really need a foot long sandwich as opposed to a 6 inch one??? It is that important to get three Dominos pizzas (with one topping each) as opposed to a less-caloric meal?

If you are in a weight losing mode (and if you are reading this then my guess is that you are) then please think carefully before picking up that phone and dialing your local pizza delivery place....the deal sounds good, but your scale will not like it!

Helping other's weight loss efforts

There is no question that you have friends and/or family members who are trying to lose weight. Having support in your efforts and providing support for others will go a long way in helping everyone. Such things as having "healthy" choices available when you throw a party, not giving (as a show of love and caring) baked goods or candies as holiday presents and perhaps organizing a weekly walk, discussion or other type of support function to help everyone stay focused will help everyone lose weight. You want your friends, family and loved ones to be as healthy and live as long as possible. Why, if they are overweight, would you provide high-caloric gifts? You will be hurting them. Many other alternatives for presents are available...gift coupons for movies, massages, etc.

Posner's Picks for today include: Tampa over Atlanta, Cincy over the Skins (sorry Skins fans for that one), Jets over Buffalo and Carolina over Denver.

A Great Theme...Making a Choice

This morning I had a patient tell me that she went to a function that had a great buffet line and she was able to not damage her weight loss efforts by repeating this line over and over to herself:

"The food will not taste as good as my weight loss will feel"
"The food will not taste as good as my weight loss will feel"

I did love that line because this, in fact, sums up the choice that we make when we decide to lose weight: We know the high-caloric food sources taste really good, but we also know that when we lose weight, we feel more confident, have higher energy levels and overall feel much better. So, if we cant "have it all", which route should we choose? We can either continue to do lots of the high-caloric foods that provide temporary happiness or lose weight, whiuch will help us live longer, feel better and look younger. A great choice is the latter!

Antiaging and Weight Loss

Hi once again from Las Vegas...one more day at the antiaging convention than home tonight....

I delivered a speech yesterday morning about the use of oral serotonin supplementation in a medically supervised weight loss program. I was surprised to learn that most physicians who have "Anti-aging" practices do not have formal weight loss prgrams in their offices.

Once again, the concept of "internal aging" vs. "external aging". Being overweight, and developing a number of the associated medical syndromes....hypertension, diabetes mellitus, arthritis, atherosclerotic heart disease, etc causes a markedly increase in "aging" of the internal organs. As the "outside" can be getting aestheic help, such as botox, surgical procedures etc to make us physically look younger, if the inside is aging rapidly, big problems wwill occur.

Aside from the "anti-aging" that our organs will go through as we lose weight, at the same time, our external appearance becomes more youthful as well.

Back in NOVA tomorrow!

food choices, weight loss and being out of town

Good morning from Sin City...In case you ever arein doubt about splitting 8's when the dealer has a "10"....my advice: DON'T DO IT.

Okay...now to business....I have noticed a dramatic difference in the size of the people in Las Vegas who choose to eat at sit-down restaurants as opposed to the buffets or food courts at the hotels. It seems that there are many more overweight people choosing the buffets or the "fasr food" choices at the food courts. When I have been at the sit-down restautrants, the % of people with weight problems drops off.

I have discussed this before in the blog but will bring this up again: A long term strategy for weight loss will include NOT putting yourself in situations that will create problems in controlling your caloric intake, and most definitiely, buffets and food courts will test the strength of our resolve. Especially the buffets...they are all advertised as "ALL YOU CAN EAT". Try to pick good places to sit down, take your time and enjoy a meal that offers a number of high protein and vegetable choices. And no doubt, unlike a buffet where we all tend to make multiple trips to the food bar, at a sit-down restaurant we will be served one plate.

I am talking at an antiaging convention this morning and perhaps I may come back looking 10 years younger. (Or perhaps not)

Aging and weight loss

I am off to Las Vegas today to talk at an antiaging conference about obesity and aging. The "outside" of us, i.e. the aesthetic appearance is dramatically altered by weight loss. Our patients who lose significant amounts of weight look up to a decade, if not more, younger. It is amazing to see the physical change and how much more youthful someone appears after weight loss.

"inside"...i.e. the internal organs are also considerably helped by weight loss. The heart, joints, lungs etc are incredibly improved by losing weight. These organs and joints will allow us to live longer in a healthier state.

There are many reasons to lose weight and certainly from an "aging" perspective, it is incredibly helpful to shed those pounds.

Will write you from Vegas!!!

Weight Loss and Dogs

Tanner, my new yellow lab, is a really, really sweet dog. Very obedient, attentive and not too hyper...and...has not done anything bad in the house yet! He loves to run outside...I had him out for a number of walks and runs over the weekend. I run daily on a treadmill when cold, but in addition to the treadmill workouts, I found myself doing lots more exercise BECAUSE of the dog. So my point is this: IF you are an dog lover/liker, and do not have one now, aside from the companionship and love you will get back, getting a dog will FORCE you into more exercise. Having to walk the dog, getting up a bit more early to do this, or even running with your dog will have you burning off more calories. If you cannot have a dog for any reason, then PRETEND you do...teasing of course, but what I mean is set that alarm earlier, get up and walk yourself (no leash required) or go on that treadmill or elliptical machine. Exercise is a vitally important component of any sustainable weight loss initiative.

Restaurants and weight loss

Last night at dinner my son, who is trying to lose some weight, offered this advice:

Toward the end of dinner, when he is feeling not hungry anymore, he purposefully puts his napkin on the plate to signal the waiter/waitress to remove the plate. There may be some potatoes or other food sourses still left, but Brian told me that if the plate remains there, he will find himself still picking at the remnanst almost absentmindedly. If the plate is removed, he cannot do this.

The other issue certainly is the "dessert tray". Who truly feels any "hunger" at the end of a restaurant meal to then have a high-caloric dessert???

By removing the pre-dinner alcohol drink, the bread that is brought to the table, a high-caloric side dish and the dessert, you can save a thousand calories and still have a great time!

On a non-weight loss note: New do for your doctor!!!a 2-year old yellow lab....Tanner....VERY sweet and athletic....

Thanks!

Our 20th Anniversary party was so much fun last night !!!

For those patients and friends that showed up, I want to thank yoo very much for taking time from your busy schedules to help us celebrate.

For those patients who could not make it: I want to thank you very much for allowing me to take care of you and your family's medical needs.

For my staff of uniquely intelligent and caring people: Thank you so very much for setting this function up and cleaning the office when it was finished.

For my family: I want to thank you for so much support during these 20 years.

Today is my first day of the next 20 years! A little older (alright, lots older) but still lots of energy and enthusiasm!!! I promise...back to weight loss issues tomorrow....

20th Anniversary...some reflection

Okay, if today you are tuning in for some advice about weight loss, sorry....your doctor is in a very reflective mood and today's entry will not be about weight loss.

Twenty years ago I opened my doors to start an internal medicine practice. My family and I moved to Northern Virginia in the summer, 1988, and I had just ended my U.S. Navy obligation as an internal medicine physician in Jacksonville Florida. I joined an internist in Mt. Vernon, and after three months, realized I did not want to continue in his practice. It was a very typical-for-that-time type of solo practice where the doctor would round at the hosipital before hours, see patients in the office from 9-4, and then round again. Quickly, I saw this was not for me: patients waiting hours past their scheduled appointment time, hospitals and nursing homes constantly paging you, admitting patients through the emergency room who had no physicians...all of this was not what I envisioned when I left the Navy to become a private practice doctor. I decided to open my own practice, and at that time, I had two small children, Ellen worked as an assistant county attorney and we had moved into a house that was way more expensive than our house in Florida.

On December, 5th, 1988 I opened my office in Burke and had three patients (all from the old practice) my first day and none the second. I had a total of 7 patients my first week. I was moonlighting at a military outpatient clinic called 'PRIMUS" in Burke, and every patient I would see I would hand them a card telling them about my new practice. I would give lectures at libraries at night to try to meet new patients as well. With great support from my family, I have now had the great fortune of completing 20 years of providing medical care to the wonderful communities of Burke, Springfield, Fairfax, Fairfax Station and the surrounding areas. Over the 20 years I have had hospitals open up pracitce right near my office with lots of marketing bucks behind them, but we still maintained a wonderful, viable practice.

I remember seeing old clips of Lou Gehrig giving his speech to Yankee Stadium, one of his lines was 'Today, I consider myself the luckiest man in the world...." The guy was dying at the time.
Today, I do consider myself one of the luckiest men in the world. The great thing for me is that I am not dying and I get a chance to keep doing the things that make me feel so lucky. I want to thank each and every one of my patients who chose/and keep choosing me to help them with their medical needs...both past and present patients. I know that sometimes when patients come into my office, they ssee weight loss signs, bottles of pills, and other signs that suggest that Dr. Posner is moving in other directions. Let me assure you that at no time during any of these other efforts have I ever not answered your weekend calls, concerns, etc. as this relates to my internal medicine practice. The best way of showing my gratitude is to continue to be the type of doctor you can count on 24/7, 365 days a week to be available to you either in person or by phone. Thank you for a great 20 years!!!!

How To Navigate Around The Holidays...

Several patients came in yesterday who had great success during Thanksgiving week in their weight loss efforts. In common, this was their plan of action: they decided not to deprive themselves of any particular food source (excpt alcohol) that was around the table, but they took only "tasting" portions of the different foods. From the mashed potatoes to the stuffing to the sweet potatoe casserole, small spoon-sized portions were tasted. This action seemed to result in not feeling completely "deprived", which is a terrbibly frustrating sensation.

Both patients did'nt lose lots of weight this week...about 1.5 pounds, BUT the important point is that they had a great Thanksgiving holiday, were able to partake of the variou food sources and did not feel deprived.

As the Christmas parties start abounding, consider that strategy to help your weight loss efforts.

Treating 5 pounds like 50....

Yesterday I had two patients return to us who had previously done great in our program. Both lost around 50 pounds about a year ago. One person that came back gained back all 50. The other gained 5.

Both were somewhat embarrassed about coming back, but I reassured them that we understand completely how hard it is to maintain weight loss, as we are so naturally built to be a weight gaining organism. As much as we stress that there is no "finish line" when it comes to weight loss efforts, psychologically, we are always looking for that finish line so we can start going back to some of the old, more fun, eating behaviors.

Anyway, for the patient that gained 5 pounds, perhaps 1 or 2 visits to refocus, give some pills, and the person is right back to where he wanted to be. In the case of the 50 pound weight gain, this will take months (again).

Point here is treat the 5 pounds as urgently as you would treat the 50: If you do not allow more than 5-10 pounds to go back on before you make an aggressive move (calling us, on your own, doing phase 1, etc) then there is no way you can allow yourself to put back on 20, 30 40 or more pounds back on.

Serotonin, sunlite, seasonal affective disorder,weight

Another dark, cold morning...also, getting darker so much earlier at nite. Do you notice that sometimes your mood tends to be less "up" during the winter months? ("Seasonal Affective Disorder") Also, do you find yourself eating more carbs during the winter?

Here is, in part, a chemical explanation of this: Serotonin is made inside the brain from the amino acid tryptophan. When sunlite hits the retina, this makes the brain make more serotonin. During the winter months, when there is less sunlite, the brain is making less serotonin. The person is then compelled to eat more tryptophan to try to help the brain have more substrate to make more serotonin. Unfortunately, the tryptophan is present not just in chicken and turkey, but large amounts are found in sweets and carbs. These sweets and carbs carry with them lots of calories resulting in weight gain.

How do you break the cycle??? Some people use special lighting (very popular in Alaska) in their households. For a number of our patients, the oral serotonin supplementation helps dramatically with Seasonal Affective Disorder. There are also a number of people in my medical practice who require "SSRIs" (selective serotonin reuptake inhibitors) such as Prozac and Zoloft during the winter months. The problem with the antidepressants though is that they only raise serotonin at the mood (Serotonin-1-A) receptors and not the serotonin receptors involved with appetite and cravings.

Enough biochemistry this morning! Have a great day and.....countdown is 4 more days till our 20th Anniversary Patient Appreciation Nite....December 5th, 5-730 Pm!!! PLease join us!!!

Keeping track...

This past week we put several patients back into our program who had previously lost well over 40 pounds during their initial program but unfortunately over a number of months, put every pound back on. Embarrassment delayed them from picking up the telephone and calling us, but eventually they decided they needed our help again.

First, nothing to be embarrassed about being a normal human being.. As I tell each and every patient entering our program, we, as humans, are built to be a weight gaining species. Lest you doubt that, ask yourself whether when you "crave" food, are you craving high-caloric foods such as ices cream or chocolate, or are you craving broccoli? Is a "reward" for a long day at work a glass of wine or a glass of water? When we gather with friends, is it at a gym to exercise or is it at a restaurant or someone's home to eat and drink? The answers herre are obvious, and explain why, in part, we have such difficulty maintaining our weight loss. The botton line is that for most people, there is nothing fun about giving up food and drink sources that we love. We will do it for short periods of time (dieting) but not for long periods (life style change).

Keep that chart next to your scale and weekly, WRITE DOWN the weight and the date. If that weight ever goes more than 10 pounds from when you left our program, CALL US!!! If you follow this recommendation, there is no way can someone go out there and put back on 30, 40, 50, etc. pounds. We will catch it at 10, and only a few weeks of refocusing will be required to help you get that weight back down and we can help you figure out how the 10 pounds happened and what you can do to perhaps avoid this.

Different subject: Sorry Skins fans...I think Portis being hurt, even though he played, damaged the Skins efforts. They are still in the playoff hunt!

"Bread..I Need Bread..."

Okay, yesterday I did NOT do something I always tell my patients to do...and that is PLAN their meals in advance if a challenging day is expected. Okay..here is my story: Yesterday, after office hours, we drove up to New Jersey for a family member's surprise party. The first surprise was the traffic on the Jersey Turnpike. Bumper to bumper for the entire way. The trip, which should have lasted 3.5 hours turned into a 7 hour nightmare. None of us ate lunch, anticipating a relaxing stop for some small food enroute and then dinner at 8PM. Because of the excessive traffic, we would up not eating much of anything , and we were all starving by the time we had to throw our clothes on and get there in time for the surprise. As we had to get there 1/2 hour before the birthday guest of honor, a bar was open, but no food When the waiter brought over the first bread basket after the surprise and then we finally sat down for the meal, it was devoured in seconds. "Bring another please!!!"

We/I did not do the planning necessary to ensure that we would not resort to reaching immediately for the carbs. We should have brought snacks in the car anticipating a possible travel problem and then we would not have felt so hungry before dinner.

Plan your day in advance to ensure that you do not skip meals and wind up "starving" later. I need to follow my own advice!!!!

"I Have To..."

Yesterday I saw a patient who had a somewhat difficult weight loss week and apparently their family has a tradition where on the day after Thanksgiving, Christmas cookies are made...lots of them. The patient told be that "I have to make these cookies." Unfortunately, the patient not only made the cookies, but a number of them were ingested.

I want to touch on the mindset that somehow we are compelled or forced to do something that will damage our weight loss efforts. I have had patients who travel tell me that at business dinners "I have to have a glass of wine". Or, "they brought in lunch and I had to have sandwiches and chips."

If it is family tradition to bake cookies after Thanksgiving, by no means am I suggesting that you break tradition (unless most family members are overweight in whcih case I would ask you to consider changing traditions). I am suggesting that you take ownsership of your OWN actions. Whether it be baking, but not easting the cookies, or going to a business dinner and ordering a non-alcoholic beverage, these choices are under OUR control, not someone elses. Yes, being in the environment of baking cookies or being around people socially drinking willl tempt us to do the same, but we can all exert control of ourselves. It is a matter of changing the mindset that "I HAVE to.." to "I CHOOSE to..."

Have a great Saturday....and....any Skins fans wanna bet your doctor about tomorrow's outcome???? GO G-MEN!!!

Thanksgiving "Leftovers"

Oops...as Suzanne pointed out....next Friday is December 5th and that is most most definitely the day of our anniversary party...5pm till ??? Karioke....hear the staff sing!!! (and we get to hear YOU sing!!)

Lots of food left over from yesterday's feast/ Take stock of what you wrapped up and put in the fridge...if it is protein, great job and enjoy the remains of that turkey, ham, etc. If you put away the remnants of that apple pie, sweet potato casserole, etc., be very careful NOT to start snacking on these. Tendency is to take small little spoonfuls, thinking we cannot possibly damage our weight loss goals by just taking a little. But you and I know, that "little" turns into a lot.

As my son Brian aptly pointed out to me last night, lots of these blog subjects are being repeated, but I do think it is important to keep hammering home certain points. The next few weeks can be treacherous to your weight loss efforts...it would behoove you to not dig into the leftover high-carb foods.

Have a great time shopping!!!!

Happy Thanksgiving!

I want to wish all of you a very happy and healthy Thanksgiving. Enjoy your family, friends and loved ones.

I am off to the tennis courts (hey...burn some calories so I can eat a bit more and not damage the scale!).

Few hints: stay away from the alcohol, do only "sampling" tastes of the traditional high-caloric stuffings, breads, potatoes, etc, load up on those proteins, and really only taste that pumpkin /apple pie IF you feel hunger....

And please dont forget...next Friday..December 20 from 5-??? 20th anniversary patient appreciation nite......please stop by!!!!!!

Thanksgiving Eve

This is my favorite holiday of the year. Gathering with family,, friends, loved ones...watching football, eating the traditional foods, going outside and throwing the football around...all of these activities are incredibly fun. For me, as well as all of my patients out there that are "Type A's" that run around like crazy all the time, the day gives me time to take a pause and realize just how important family is and the incredible need to stay healthy to be able to enjoy, for years, your family. The stock market, politicians, business issues, etc....all of these are truly much less of a priority than being able to gather with your family on happy occasions.

Yes, we all want to lose weight so we can look great, look younger, have a higher aesthetic appeal to ourselves and others...but the very most important reason to lose weight is so that we can become healthier, avoid heart disease, diabetes and certain cancers that are linked to obesity. As you look around your Thanksgiving table tomorrow, think of how sad it would be for you if you could not be with your loved ones..and think how sad it would be for them if you were not here to enjoy the holiday. I do not mean to bring any morbid thoughts into a joyous holiday occasion...I just want you to embrace life and do whatever you can do to stay here longer.

Weight Loss Initiatives Before the Holidays

We have had several patients recently who came in for consultations to learn more about the program. All decided to start the program but in common, they voiced the feeling that they should start AFTER the holidays. Already knowing the true reason behind that decision, I asked each of them their rationale. Basically, it came down to not wanting to "mess up" their holidays. Although the intellectual part of our brain tells us that weight loss is a VERY GOOD thing...making us healthier, more confident, etc., there exists the almost universal feeling that "dieting" is basically sacrifice and deprivation. We will be giving up "fun" activities and substituting strict eating behaviors. If we go into a holiday season "dieting" we will have a much less fun holiday. Therefore, why not start January 1???

This is the mindset that we try very hard to change. Anything that makes us overweight, puts our health at risk, and makes us feel less confident is not a "good" thing. A concerted effort to lose those pounds, look younger, rid yourselves of medications, and live longer/healthier is a very good thing. Why wait one more minute to begin a new lifestyle? The holidays bring you and your loved ones together. This is what the important thing is. Ingesting thousands of needless calories should not make this family time any more special. Losing that weight will allow you to spend more Thanksgivings and Christmases with your family. Obesity will cut your life short.

The start of your new, healthier lifestyle should start NOW. There is no reason to delay this!

Cold, dark winter and weight loss

Before I begin talking weight control, I want to point out my football picks from yesterday.....not bad, huh????

If you will be asked asked by your spouse/family member/friend what you want as a present for the holidays, please think fitness. It has been a very cold November and it seems as if this winter will be indeed a very cold one (so goes the global warming thing). Getting outside to do your walks or runs will not happen as frequently as summer time. It is definitely not fun to be out there bundeled up trying to exercise in the dark.


A warm, well lit basement withan elliptical, treadmill, rower or some other machine in front of a tv set provides a much better climate-controlled environment to exercise. For long term weight loss purposes, routine exercise is a vital component, but if we take months off from this because of weather issues, then our goals will not be reached as readily.

A gift of health for you in the form of exercise equipment or $$ towards a purchase is a great gift. Perhaps the gift of life!

Matching Food intake to activity levels

Football Sunday...Giants play Arizona...Redskins Seattle.. Eagles--Ravens... Posner's Picks: Giants 33-27 Redskins 17-13, Ravens 20-10

We have put several ex-NFL players thru our program. All were morbidly obese. In their pkaying days, they were used to consumming a tremendlous number of calories, but at the same time, they were also practicing and working out extensively. When they stopped playing football, they did not curtail their eating habits, yet activity dropped off significantly. Moreover, the aging process slows down metabolism resulting in another reason for the marked weight gain.

The bottom line is that we all must pay attention to our slowing metabolism and decreasing activity levels if our current life situation does not allow for aggressive exercise. If we do not adjust our eating patterns accordingly, weight gain will ensue. In college and high school we all probably ate much more food than now as well as perhaps drinking more alcohol. But we were younger and were more active, (in most cases).

It does come down to a simple math equation: calories coming in vs. calories being burned off. Working on both ends of the equation is important for long term success.

Have a great Sunday!!!!

weight loss and confidence

This morning I was seeing a wonderful husband/wife couple that have been very successful in our program. They have lost lots of weight and one of the great byproducts that occurred has been a marvelous increase in confidence for both...personally and professionally. Concernign professionally, going into meetings has been with a higher level of confidence and people around them can "feel" this. This will translate into a more compelling presence at meetings which may result in a better outcome. Having a higher level of confidence and self esteem is a wonderful byproduct of weight loss. When we feel better about our personal appearance, it is easier to be around people. Yet another great reason to keep your weight loss goals aggressive!

Shopping for Thanksgiving

This weekend many of you will be shopping for the food that you will prepare for Thanksgiving. The traditional foods such as turkey, ham, etc provide lots of protein, but the "peripherals"...i.e. the stuffing, potatoes, breads, desserts etc will be the challenge. As I tell anyone that enters our program, we do not expect anyone to NOT partake of some of the tradtional food sources a holiday brings. However, try very hard to not "over-indulge" on these sources. Perhaps make a list of the 10 food or drink items that would be detrimental to your weight loss efforts and only buy/have around the house 5 of them. When you shop, try to make sure you have choices that will be tempting, yet less caloric. Perhaps one of the dessert choices can be a sugar free jello with a low caloric whip on top. This is surfe to bring in 600 less calories than apple pie and ice cream.

Following this holiday in the next weeks will bring even more opportunities to sabotage your weight loss efforts, so please consider starting now by reconciling your desire to have a great loving holiday with your family, friends, and loved ones and stil maintain your quest to live longer and be healtheir and happier.

The Big Apple

Good morning from Manhatten! The city has an energy unmatched by any other I have been in. I couldn't help but notice that there seemingly is a higher % of people here overweight than in the D.C. area. Not that I was counting overweught people but my generalized impression was at the restaurant I was in that I was seeing more overweight people that I do at the D.C. restaurants I frequent.

Perhaps it is the stress and "rushing" that are endemic to a very large crowded city. The more time someone commutes to work, drive in traffic, etc., the less time to plan meals and more likely to make quick easy food choices....slice of pizza...pretzel at the stands etc.

We all only have a certain amount of time per day to focus on a number of issues that confront us everyday...children issues, other family maters, work commute, issues at work, etc. The more time we need to attend to the essential daily activities, the less time we have to focus on our own issues. Planning our meals, not making fast choices, finding exercise time...all of these are important for long term weight loss.

New York Trip and Potholes

I am leaving this afternoon for a very brief business trip to New York and I will be facing lots of potholes. I am not referring to the ones in the road. I am talking about the dietary potholes that get us into a weight issue. New York is the land , for me, of pretzel stands, delis with those huge corned beef sandwhiches and knishes, and incredible restaurants. Everywhere you turn there is an opportunity to devour thousands of calories.

Posner's plan for not doing too much damage? First, eat something before I drive lest I am tempted to stop at one of those rest stops on 95 that offer the very healthy choices of Roy Rogers burgers, Sbarros pizza or hot dogs and fries. Make sure i do wake up early in the morning for a workout at the hotel gym. When I do venture into the Carnegie deli, allow myself that corned beef sandwich but NO side dishes such as their potatoe pancakes or potatoe knish. Absloutely NO cheesecake right after that meal, but later at nite, if I am in a cheesecake frenzy, allow myself two forkfulls. NO stopping for a pretzel at that stand with the hot chestnuts UNLESS I only had protein and vegatables for dinner. Also, if it is not too cold, walk to the places I need to get to instead of a cab.

Please feel free to share your ideas as to how NOT to gain weight when you enter the land of dietary potholes.

An Inspirational Story

Yesterday I saw one of our patients who has lost a total of 85 pounds. She informed me that she is now training for a half-marathon. This half marathon is for people who are wheelchair bound.

When she first entered our program, the patient was still able to transport herself without any aid whatsover from her chair to her automobile. However, it did seem quite difficult becasuse of her weight problem. Yesterday after her visit, I observed her do the car transfer steps, and it was amazing just how much easier it seemed for her.

She now smiles lots during here visits, looks about 10 years younger than when she started, and clearly, is able to do many more things with less effort. Her fortitude, determination and accomplishments before our program were amazing. Brilliant, successful at work, etc. She brought those same traits in her quest to lose weight, and although she cannot walk, she is one of our most successful weight loss patients. A true inspiration!

the Big Push...

11 days till Thanksgiving and then weeks of holiday parties, family gatherings, gift exchanges etc.

Now is the time to be very very vigilant in your weight loss efforts. This is a perfect week to go to Phase 1 for one week and not allow any fruits or carbs in. We all will be challenged in many ways over the next 6 weeks, so use this next 1 1/2 weeks to be especially diligant.

You know the feeling of looking in the mirror in January and feeling remorse that you allowed yourself to put much weight on the previous year. Do not wait until January to start doing the work necessary to make you happier and healthier. Start doing it NOW!

Reminder: We hope you can attend our 20th Anniversary Patient Appreciation Nite on Friday, December 5, 2008 5-730. We will of course have lots of healthy snacks!

Serotonin-Plus in Rhode Island and Mass.!!!!

Good morning...tennis match over..Giants at 1 PM.... GO G-MEN!!!!!

We have finalized the terms of helping a group in Rhode Island and Massachusetts open up the Serotonin-Plus Weight Loss Program to their patients. I am very happy to see that our program, which has been helping lots of people in the D.C. area can now be brought to people outside of our area. The Agape Medspa owners, Paul and Mona have done some weight control programs before, but they felt that our program could produce superior safety and efficacy reuslts to their patients. It was very important to us that if we did expand our program outside of our area, that we worked with groups that truly had theiur patients' best interests in mind. There are so many weight programs out there that are all about "making money". Buying meals, supplements, etc....so many programs are geared to basically get people to spend lots of money. After our meetings with Paul, Mona and their very fine staff, we are convinced that their group will in every way live up to the high standards we set for ourselves here in our clinic.

Melissa Gosselin will be training their staff so I want to reassure everyone that Linda and I have our commitment right here in our clinics. As a matter of fact, I know that on a daily basis Linda answers your e-mail questions, and even when you stop your formal visits here, we want to be your support and resource to help you achieve and maintain your weight loss goals.

I am very proud of the Serotonin-Plus team for developing a program that now is heading north!!! Paul and Mona met a number of patients yesterday and it was really great to hear all the wonderful stories our patients were telling them. Thank you so very much for allowing us to help you in your quest for weight loss.

Identifying your "Potholes"

Potholes are things are cars drive over ruining wheels or rims. When it comes to weight loss potholes, I am referring to the behavior patterns that we fall into that get us into weight problems. Some of these potholes are obvious.."Doc, at nite when I watch television I always get some ice cream from the fridge.." "I miss breakfast and get really hungry at lunch..." " I have no time to exercise..." Lots and lots of potholes, and as we step into each of them , our chances for achieving and maintaining our weight loss goals are diminished.

I encourage all of you to get out a piece of paper and pen and jot down your "pothole" list. Try to think of each and every behavior pattern that leads to unwanted weight gain. Then, on the other side of the sheet, write down potential solutions. If you identify your potholes, there is less chance of stepping into one!.

As an aside, switching from pothole lists to "Bucket Lists" (good movie), here is one thing on my bucket list (something I want to do before i kick the bucket): I want to see the sunset on a tropical island in the pacific.

The Economy and Weight Loss

Yesterday I had a patient who was laid off from work, and he experienced a significant weight gain in 1 week. Due to stress of thinking through his financial issues and quest for new employment, he was at his computer constantly, and unfortunately, had at his side high-caloric food sources. His intake of these snack foods was a reaction to stress and although he immediately recognized that this eating behavior wasn't helping any of the reality issues, it seemed that he could not stop this.

Remember at all times that stress-eating does not solve anything...it only adds to some negative feelings and low self-esteem. When interviewing for new employment, looking your best will only help your chances. Taking ownership of what you are ingesting is difficult, yet looking in the mirror and telling yourself "I Control what I put into my mouth" is an important step. If there is extra time in your schedule because of a down employment cycle, convert some of that time to aggressive exercise. Sweating and getting the heart rate up help dissipate stress and the bonus is that you will look healthier. Additionally, as I have mentioned previously, due to the stock market collapse, we will all need to work for more years than expected, so being healthier is important to keep us at work and not, god forbid, hospitalized or otherwise physically unable not to work.

Additionally, as we all are at a computer daily, make it a rule that you never will eat any food sources while at your computer. Distracted eating will only worsen a weight problem.

Support and weight loss

We had a physician visitor in last week from Arizona who is contemplating bringing our program to his very busy primary care practice. He shadowed me and Linda on a few patient visits and I was gratified greatly to hear our patients voice some very positive comments about our program. Universally, everyone he spoke to said that they felt positive support from all of us...nurses, front staff, Linda, and me. Even if there was a difficult week, they still felt there was no "value judgement" or negative attitude given to them.

Positive encouragement is a very important aspect to helping someone lose weight. Whether it be your spouse, your friend, child...maintaining the positive environment is a vital component to long-term success. We have a number of people to this day who feel comelled to cancel their weekly appointment if they gained weight. They know inherently that no one here will admonish them or make them feel bad about this. However, there is some psychological desire to be successful in front of others, most notably the doctor they are paying. These are the exact weeks we need to see the patient and help them through the issues that are making their weight loss efforts difficult.

Stay positive and realize that not every week will show aggressive weight loss. In every war, there are battles that are lost, but if we maintain the energy and positive support, we will have many more successful weeks than we will less than successful!

The Recession and Weight Loss

I read the Washington Post every morning and over the past number of months, there had not been one issue that doesnt hold doom and gloom. From the stock market swoon to reading stories about how companies that have received bailout aid from US (remember...it is our taxes) continue to hold retreats, lavish their CEOs and waste money. I believe I talk for most of you reading this blog that no one comes to our "aid", meaning that we all work hard, earn our money, and we all find the necessity to not spend more than we earn. And if we did, there would be no one handing us money to "bail us out".

So, what does this have to do with weight loss? The answer is two fold: first, when under stressful situations such as the current economic times, the tendency is to start doing stress eating. This of course solves nothing, other than making us less healthy. It sure doesn't change the state of affairs. Secondly, it is clear that you and I will have to work longer than expected (laughing...perhaps I meant "you", not me, cause I will only stop working when they have to cart me outta here horizontal..I love this place) and we better make sure that we do not have a heart attack stroke or some other serious illness that will prerclude us from working those extra years. Putting weight on because of stress eating will lower our life expectancy and certainly put at risk our years of work futuristically.

Check out Linda's blog at: www.stresseaterdiet.com It has some excellent insights that may help you ward off the compunction to stress eat.

Sorry for the pessimistic entry this morning but I was just reading about another AIG issue. If I had a donut here I would eat it, but I don't so off to the treadmill I go.

cookie diets

I was talking yesterday to a medspa owner in Massachusetts who has previously run a weight loss program based around a franchised "cookie diet". At the risk of having a lawyer contact me about defamation, I will not name the cookie diet involved (there are several out there) but for this medspa owner, the diet plan failed miserably. I started internet researching "cookie diets" and found lots of diffeent ones.

I am laughing because once again, marketing hype is a huge part of the weight loss market. Things that sound eccentric, unique, etc. tend to get lots of press. One of the "Cookie Diet" companies was featured on the Today Show, national magazine covers, etc.

Pardon my New York vernacular, but here are my thoughts on "fad" diets and programs...BULLSH__. Marketing experts know exactly how to get people to take out their wallets when it comes spending money on weight loss....make something sound easy, simple, no-brainer and fun. Eat cookies!!! Or..in the casse of the prepackaged foods, their tv commercials show brownies, lasagna etc. I love seeing the ex-football players in the tv commericals that show how much weight they lost and then on Sunday, you see these same guys on the sidelines looking more obese than ever.

Recurrent theme, but here goes again: There is no easy shortcut to losing weight and maintainign that weight loss. You cannot eat cookies as the cornerstone of your weight loss program. You need to maximize proteins, minimize carbs and alcohol. You need to bump up your activity levels. This is the hard truth It is not cookie BS.

Football and Food

Okay...sorry Eagles fans but my G-Men sure looked great last nite...

During the football games yesterday we had some backed pastry puffs that contained some meat, potatoes and other high-caloric items. As I was watching the games, I could not stop eating these things one after another after another. I was intently watching the games, completely distracted in my eating pattern, and wound up eating much more of these things than i should have.

Point here again: NO DISTRACTED EATING!!! I should never have puth those things up nor ate them during a game. Posner did the thing that he rants and raves about to you in this blog!!!

How do I make up for it? Today I will be incredibly strict in my food intake and Mondays I usually do not exercise but today I may go down to the treadmill during Monday nite football....laughing....and not bring down pastries as I watch!

Vacations and weight loss

I had a patient visit yesterday with a gentleman who was in Hawaii for over a week, had not been to the office in 2 weeks, and before he stepped on the sclae, i was expecting a weight gain. He is a very good and fun guy and previously informed me that on vacations he liked to have some good drinks and fun food. To my surprise he lost 4 pounds since his last visit. I asked him to advise anyone going on vacation how to lose weight and still have a great time and this was his advice:
1- Drink alcohol perhaps heavily the first day or 2, then stop or signficantly reduce the alcohol consumption you normally would have done

2-keep portions underr control

3- step up your exercise...most places have great gyms or spas...use it!

4- Limit the high caloric desserts, fruits etc...do not eliminate them..just watch the portions.

Vacations are challenging..no doubt, but if we do not go into it with the mindset that you are "being let out of jail", right choices wil be made to maintain steadfast in ytour weight loss progression,

Excuses

On a daily basis, there will be reasons why your weight loss efforts can be derailed...travel where significant time is in the airport, conferences were meals are provided by the sponsor, family trips to visit relatives, holidays and birthday celebrations, stressful times at work....

You have two choices: 1-Let the environment contol you and have a "give up" mentality i.e. "it is not my fault, I had no choice" or 2- YOU CONTROL THE ENVIRONMENT, i.e. despite adversity, you make the right food choices and do not succumb to the natural forces that make us eat and drink high-caloric foods.

For long term weight loss success, you need to adopt the latter attitude, not the former. The environment will not adapt to you...you need to adapt to the environment. If you know you will be at a conference where all there is are sandwiches and chips, bring your own lunch to the event...when you are under stress, convert that time to more exercise to dissipate the stress, not turn to glasses of wine.

This is not easy...I never said it is....but taking control of your actions and environment can be done successfully.

How does your life change with weight loss?

Although everyone are unique and different individuals, there is some commonality to the reasons why people want to lose weight. The obvious long-term goals are to be healthier, take less medications, avoid significant medical problems such as diabetes, heart disease, arthritis, etc. From the "aesthetic" standpoint, looking younger, being more attractive to ourselves and others, finding renewed confidence and heightened self-esteem are also motivating factors. Getting back into clothes that did not fit anymore and being able to shop for more stylish outfits are also a benefit of losing weight. Regaining energy is yet another clear result of losing weight.

Your life does change significantly when you lose weight but sometimes we forget about the major positive effects. When we think "dieting" we equate that with sacrifice and deprivation...giving up "goodies and treats" and basically punishing ourselves. We fret that we will not be able to enjoy family gatherings, vacations, birthday celebrtaions etc. We cannot wait for the diet to "be over" so we can with glee, start going back to the old, "fun" behaviors.

Concentrating on the reasons as to how your life will significantly change for the better as you lose weight is an important mental exercise that you must go through to help you sustain your motivational forces. Are those 2 glasses of wine a night really worth risking the development of premature atherosclerotic hearts disease or diabetes? Is it really worth feeling that you have to hide your body from others by avoiding summer swimwear? Is it really worth feeling lower confidence and self-esteem?

Try to focus on all of the positive outcomes that will accompany your weight loss and this may help allowing you to stay "in the zone".

Three weeks till thanksgiving...

This is a very important time to get very "strict" in following your plans to lose the weight you would like to lose, because three weeks from today we enter the most difficult time of the year to achieve weight loss...thanksgiving thru new years.

Realizing that in several weeks, you will on a weekly basis be going to parties, gatherings, exchanging gifts, etc., it will be almost impossible to remain very regimented during this time.

NOW is the period to be especially focused and NOT take in food/drink sources that will hinder your weight loss efforts.

Remember: December 5, 5-730 pm at our office...2oth Annual Patient Appreciation Nite!!!! Much fun, HEALTHY foods and Karioke!!!!

Maintaining your weight loss

I Had a woman return to our program yesterday after she gained 5 pounds in one month. She had originally entered our profgram in anticipation of her daughter's wedding, and proceeded to lose over 30 pounds before the wedding date. She reached her goal and felt/looked fabulous. After the wedding, she started slowly going back to some old behavior patterns, and when tracking the weight, decided that at 5 pounds, it was time to come back in for a "tune up".

The story above illustrates two things here: First, the concept of a psychological "finish line". When someone is striving to lose weight for an event whether it be a reunion or a wedding, after that date comes and goes, the person will mentally cross that finish line, and feel that he/she can now "take a break" and start returning to some old eating/drinking behaviors. Secondly, the monitoring of weight allowed this person to stop the gain at 5 pounds and not the entire 30 she had worked so hard to lose.

To maintain weight loss, one needs to try as best as possible to maintain your newly found patterns of planning and eating, and the monitoring of your weight is crucial to know at what point you may need a jumpstart help for a few weeks. If the above mechanisms are followed, there is no way that a person can gain back all the weight they have lost.

Stress eating

No matter what the outcome of the election is today, remember that ingesting lots of calories will not: 1) change the outcome if you are not happy with the results 2) make you feel better tomorrow morning about the outcome 3) positively effect your long term goals

Stress eating is a constant theme that we have discussed previously, but there is much angst that surrounds a presidential election and today will not be an exception. Some people are more "into" the election than others, and will tend to be hanging on every word tonight uttered by the numerous news anchors and talking heads/pundits. If you are in a weight losing mode, please do not starta distracted eating pattern, meaning ingesting popcorn, nuts, chips and other small, high-caloric repetitive food sources as you watch. You will consume far too many calories without even knowing it.

Linda writes a great blog at: www.stresseaterdiet.com and I would strongly encourage you to read this daily, especially today.

Whether your candidate wins or loses, please remember that at all times your health is the most important issue, because no matter what happens politically, if you fall ill to a devastating illness, you will not care for one minute who is President.

Election and weight issues

Please do not expect an endorsement in this entry. I very very much try to stay away from political discussions with patients. What I feel about politicians, my political beliefs, etc. are not pertinent to my wonderful job of keeping you and your families healthy. Quite frankly, what Oprah Winfrey, Sean Penn or Chuck Norris believe is of no interest or swaying factor to me either. What I will admit is that I am neither "Democrat" or "Republican". I believe that every election has candidates that need to be evaluated on a number of issues and I will not vote one way or the other becuase some "party" tells me to vote a certain way. I also believe the "system" is very flawed in that hundreds of millions of dollars need to be raised to run a successful campaign. How much does either candidate "owe" to special interest groups and others based on their donations? Okay...now to weight loss....what does this all have to do with the election? As we all read about the financial meltdown, the rapidly growing deficit, etc., the question comes is to how we will "pay" for healthcare in the future? With the growing obesity epidemic, espeically in children, the futuristic health of America will continue to deteriorate with morbidity due to diabetes, heart disease, cancers, etc. increasing. The resultant strain on our financial system will be enormous. We are now already seeing a higher and higher percenatge of America's expenditures going to healthcare and this will worsen over time. Whichever candidate is elected, it is incumbent upon our elected officials to make preventative healthcare a priority. As all of the war news, financial news, election news is taking center stage, the looming devastation financially and otherwise due to the obesity epidemic is not going away. Who will pay for all of this needed healthcare associated with obesity? Our children? They are the very ones that are going to be suffering from unchecked childhood obesity. As physicians keep seeing their income eroded by managed care rates, how easy will it to find a doctor who cares and is competent? We are heading for some very difficult times on a number of fronts in this country, but we will all be better as a nation if we are healthier and can keep working. Sorry for the doom and gloom note here today, but we all need to think abouit these issues, especially the people we elect.

"I Wish I Could Go Back To College..."

There is a hilarious Broadway musical called "Avenue Q" and in this show, the actors all walk around with puppets that are the main characters. One of the show songs is called "I wish I could go back to college" and in this number, the chatacters (most of whom are in their mid 20s-30) lament that life was easier and more fun when they were all in college and their parents were paying for eveything.

One of the lines from this song was:

" But if I were to go back to college...

I would sit in the quad

And say "Oh my God!"

All the kids are so much younger than me..."

What the heck does this have to do with blogging about weight loss? Okay..here goes: I am in Williamsburg VA this weekend with my family and last night after dinner at a pizza/sub place we went to a bar near the college of William and Mary. The kids were so much fun to watch...lots and lots of beer, wings, other drinks etc being imbibed, and yet, most of the students appeared thin. I started thinking that at that age, most of us ate pizza, subs, drank beer after beer, and yet we had no difficulties controlling our weight. Over time, we started eating and drinking less, yet weight became more of a struggle.

The slowing of metabolism is subtle, yet over time, we find ourselves putting pounds on because we do not initially adjust our eating/drinking to the slowing metabolism. If I ate and drank what I saw these kids doing in a consistent manner, I would be over 220 pounds for sure. Adjusting our eating and alcohol usage as we age is a very important part of not developing a signifcant weight issue over time.

I went back to my alma mata Binghamton State University several years ago and gave a lecture about serotonin and weight loss to their biochemistry department. It was so cool to see the college campus again...memories drifted in like a breeze on a balmy summer day. I wish I could go back to college...I would sit in the quad....and say "Oh my God"...The kids are so much younger and thinner than me"

socially responsible acts for helping obesity

Suzanne posted a comment yesterday in response to my rant about Halloween candy. She said there was a Fairfax dentist who was "buying" back Halloween candy from kids, and then the kids could use that money to buy toys or something else of value to them (hopefully not equity stocks or REITS from their new york brokers).

I loved that act...the dentist had a plan to do his part to lessen the risk of the high-sugar candy on the children's teeth, but at the same time, was lessening their caloric intake.

What can we all do to be socially responsible as this relates to helping the nations largest health concern, obesity? At the Thanksgiving table, we should ensure there are tempting, NOT high-caloric choices that allow any overweight children and adults to still partake of the bountiful buffet of food, but it is not all mashed potatoes and apple pie. Christmas and New Years, do NOT give to overweight relatives and friends gifts of high-caloric candies, cookies, cakes, etc. as a show of love and caring. You can think of creative gifts that will not make them less healthy and increase their chances of an earlier death. Actively discuss your or your loved-ones's weight problems and bring the entire family in to discuss what actions may be taken to help reduce the risk of great harm to the affected person(s).

If we all thought of socially-responsible acts to help the problem of the obesity epidemic, perhaps it would not be an epidemic anymore!

Candy and Elvis

Happy Halloween....for those patients of ours that choose to wander by our office this morning, be prepared to see Elvis come to life....in the form of a middle aged male doctor thinking he looks great in the jumpsuit....Viva Las Viagra...oops..I mean Viva Las Vegas....Don't worry, if you cannot make it in for this spectacle, we will take pictures and have them prominently displayed at our VERY SPECIAL Patient Appreciation Nite scheduled for Friday, December 5 from 5-7pm. (Autographed Elvis pictures will be on sale).

Okay...please remember that the nation's largest health concern is childhood obesity and if you plan on giving our Reeces Pieces, Butterfingers, etc. tonight, you are not exactly helping the problem. PLEASE consider non-caloric treats...such as party favors or some other "treat" that children will perceive as fun, safe but yet not high-caloric. Or, perhaps, some lower calorie "treat", such as a packaged fruit.

Also, as I have made my case previously, do NOT decide to either ingest your left-over candies or partkae of your own cildren's collection from your neighbors. These smal high caloric sources will completely wipe out all the hard wotk you have done this week. If you are going to do a chocolate, go out and buy some expensive Godiva...do not do the cheap stuff.

At all times, rememeber your quest to be healthier, happier, look younger etc...these are the reasons WHY you want to lose weight....do not let the little saboteurs we call "treats and goodies" take us away from this great mission.

weight loss and family

I had a new patient come in yesterday who told me that her major motivation for weight loss was that her young daughter was starting to become overweight and as her mother, she felt obligated to be more of a "role model". She told me that at night, upon returning from work, to relax, she would have several glasses of wine, and her daughter commented on that. This struck a nerve, and the mother decided it was time to eliminate alcohol and show her daughter a healthier way of eating as well.

To an extent, we are all role models to our family, friends, students, patients etc. No matter what your profession or area of specialty, there are people in this world who "look up to you". Does this mean you have to be "perfect" in your eating behaviors, clothes choices, the way you conduct your life? Of course not. But, isn't it a good feeling when your children, family, co-workers, etc. positively comment on your "healthier" appearance? Isn't it a great feeling to know that you are setting some sort of "example" in a positive way? Obviously, as this relates to weight, it is our own self esteem, health, appearance etc. that are affected by our own eating/drinking choices, and we truly are not responsible for other peoples actions. But, very very cool to know that someone decides to become healthier by following our example!

weight loss and credibility

Yesterday I was asked by a patient why I ran daily, and I honestly asnwered that when I run daily I can eat more and not put on weight. I further explained that for credibility purposes I feel it is important for me to not be dispensing weight loss advice to my patients if I was overweight. I then thought back to the first year we had the program (2002) and Linda and I went to our first meeting of the American Society of Bariatric Physicians. This is the organization of physicians whose specialty is medical weight loss. Linda and I were aghast to see that over 75% of the physicians there were overweight. We both thought how weird that is to have a specialty in weight loss, yet the physician could not control his/her weight.

When I was an internal medicine resident at Portsmouth Naval Hospital from 1981-1984, 4 of the 5 staff cardiologists and 3 of the 4 oncologists were cigarette smokers. These were physicians whose patients lives were ruined by cigarette smoking, yet the physicians themselves did the same lethal behavior pattern.

By no means am I a "model" for my patients...I eat too much pizza, I sometimes skip meals, I eat lots of carbs sometimes...any of you out there that have bumped into me at a restaurant and have seen my plate can certainly tell stories! But, I do get up early every day and run 5 miles...I do avoid alcohol...I rarely will order a dessert after dinner...and most definitely part of my motivation to keep my weight stable is that when I am in front of you, I do not want you to think to yourself: "yeah, you tell me this doc, you tell me that, you dont practice what you preach!!"

Your weight loss as a "threat" to others

I have had a number of people tell me as they are successfully losing a lot of weight that spouses and friends will almost intentionally try to sabotage their efforts to lose even more weight. The person is told, even when he/she clearly has many more pounds to lose, "you don't need to lose anymore!" and then the spouse or friend attempts to lure the person into eating high-caloric food sources.

Is it possible that your weight loss threatens some peeople around you? Does yor spouse fear that you will become much more attractive to others? Do your friends feel that you will get much more positive attention and they will get less? How is it possible that the people closest to you and love you the most will try to derail your efforts to look/feel your best?

I truly do not think it is intentional sabotage. To an extent, your efforts to lose weight, showing control and discipline along the way, does, in fact, make other overweight people feel embarrassed that they cannot do the same. When that dessert comes at the end of a meal, if EVERYONE partakes of a high-caloric dessert, it must be okay, right? However, if one or several people profess that they are in a weight losing mode and need to not eat dessert, than others around them will not have as much fun ordering the double chocolate cake. Concerning spouses, to some extent, a number of people will feel threatened when their spouse draws positive attention from the opposite sex when walking into a room.

I am not certain much can be changed about people's emotional response to your weight loss efforts, except to point out that it probably is not intentional, and you should not become angry at anyone. Calmly, but firmly, telling those around you why it is important for you to lose the weight, and your gratitude for having them help and support your efforts may help them chnage their behaviors and therefore make it easier for you to progress in your efforts.

Setting short term and long term weight loss goals

When someone enters our weight loss program, we ask them on their entry sheets to list a "goal" weight loss in total and then a separate 12 week goal. I have discussed this previously, but I will do so again: Make sure your total weight loss goal is reasonable and practical and most importantly, MAINTAINABLE. We will have great difficulty getting back to our college weights (I weighed 155 pounds, had Neil Diamond hair and drove an AMC Hornet) so that is not a reasonable goal. There is no question that if someone were to pay you a million bucks to get to your college weight, you could do that. But, once the money was delivered, there would be little chance of maintaining that weight.

Concerning a short-term goal, challenge yourself to reach that, meaning that you must take into account your gender, age, height and previous "low" number. Obviously, being male, younger, more obese, etc. will result in more weight loss in the short term. Patients that weight over 300 pounds coming into our program can lose over 40 pounds in 12 weeks with us, but if someone was 5 feet 2 inches, 170 pounds and 60 years old, a mch more reasonable expectation would be 20 pounds in those same 12 weeks.

We can help you establish goals in the short term and long term, and this does not require coming back into our program or entering the program if you have never been here. We do offer free consultations and we would be happy to help you establish realistic and maintainable goals for yourself.

Weight loss and sleep apnea

Over the past several weeks, I have seen several patients that have told me that their snoring at night has markedly decreased as they have lost weight. Snoring is an obvious annoyance to the person you share a bed with, but medically, this could be a sign of a potentially dangerous disease. i.e. sleep apnea.

Sleep apnea patients experience many episodes of oxygen desaturation at nighttime which can lead to serious heart disease and/or cardiac dysrhythmias. The patients will also experience significant daytime somnulence. For the patient that complains of snoring and daytime fatigue, a physician will order a sleep stuyd that demonstrates the oxygen desaturation that occurs, confirming the diagnosis of sleep apnea. A continuous positive airway pressure machine ("CPAP") is then prescribed.

Excessive soft tissue around the neck can cause this obstructive sleep apnea and weight loss can greatly improve the situation. Yet another great reason to lose weight!

eating and boredom

A rainy saturday...events cancelled, activities postponed...lots of home time. Boredom sets in (hey, you can only watch just so many reruns of Friends) and you find yourself wandering over to the fridge to see whats begging to be eaten. Hmmm..how about the Halloween candy that is in your cubbard not opened yet??? Is it calling you by your first name?

Whether it be a snow day, a rainy day or any other adverse weather condition that places us for long periods of time in our homes, we must be careful not to give in to the temptation of treating our boredom with eating high caloric food sources.

If you have exercise equipment in your house, try to use this "down" time for more caloric burn-off. Do not venture over to the refrigerator for snacks in bewteen meals. Certainly, avoid small repetitive food sources such as nuts, popcor, trail mix, etc.

And if you go out to a movie theatre, NO POPCORN!!!

Have a great Saturday

Building "wiggle room"

Another weekend upon us...Friday nite party??? Saturday college football gathering??? Sunday NFL football party or tailgating??? Lots of opportunities to reach for high-caloric food sources and derail all the efforts you put in this week. Remember: Thanksgiving, Christmas, New Years almost upon us!!! The holiday season is probably the most difficult time of the entire year to lose weight. You know the "usual" drill...you put on 8-10 pounds over the holidays, January rolls in, you get on the scale and say to yourself."New Year's resolution..I am going to lose weight". Start now!!! be EXTRA aggressive in your efforts over the next several weeks so when the holidays are upon us, we will be able to eat a bit extra and not worry too much that we destroyed months of good weight loss work. Do NOT get into that Halloween candy you may have already bought on sale. Also, remember for next week that childhood obesity is probably the most important national health issue at this time, so was it really a good choice to buy Three Musketeer bars to give out to any overweight kids ringing your doorbell???

On another note..PLEASE put on your calenders Friday, December 5th, 2008 from 5-7. We are celebrating our 20th anniversary of providing medical care to the area! This is a very special day for the staff and me. Please join us for some really great holiday fun...and yes, there will be some high-caloric stuff there but also healthier stuff. We are bringing karioke in again which was way too much fun last year. I certainly hope that you are able to stop by that evening!

Weight loss and Libido

A very senstive subject that is very difficult for patients to bring up to their physicians is sexual dysfunction. For males. there is a distinct difference between the desire for intimacy (libido) vs. the inability to achieve an erection (erectile dysfucntion or "ED"). Medical problems such as diabetes, athersclerotic heart disease, and adverse medication side effects may cause either or both sexual difficulties.

Obesity in and of itself is a very large contributor to both problems as well and we have found that when male patients lose significant weight, both libido and performance improve dramatically. Perhaps some of this is psychological, as our self-esteem, confidence and ego improve tremendously with weight loss.

On the female side, we have had many reports of libido increase on the serotonin supplement, and it is not clear to me as to whether it is the weight loss itself or serotonin enhancement that provides the libido increase. Perhaps it is both.

In any event, whether female or male there is no doubt that weight loss can enhance and enrich sexual performance and desire. Yet another reason to count those calories and realize that those "treats and goodies" such as cookies and chocolates can be sexual milk-DUDS.

Exercise and weight loss

This week it has been very apparent to me that the change in season to a darker, colder time period adversely impacts on caloric burn-off for many people. In the program, a number of patients tell me that "walking" is their exercise, but they do this outside. On a balmy morning in the summer, it is easy to set your alarm early, put on shorts and enjoy the birds singing as the sun rises while you are walking. Now, it is dark, cold and the birds are packing their bags for points south. Who wants to walk outside? A warm bed sounds much better.

The point here is that equipment for your house in the form of a treadmill, rower, exercise bike or elliptical machine can be very helpful to allow you to still get up early and get some exercise in. Place the equipment in front of a tv set and watch the morning news (oops..forget that...stress eating may result...put on AMC and watch a good old picture instead). Climate control, lights and a distraction in the form of a tv show allows you to still burn off calories during these darker/colder months. Getting up, getting dressed, bringing a change and going to a gym is lots more work. Please do not get me wrong...gym membership and utilization is great. However, I have had some patients recently who have told me that they have gym memberships but never use the gym.

Yes, equipment for the house costs precious $$$, but remember our new theme here: "INVEST IN YOURSELF". We all will need to work years longer now, and need to sustain our health. Investing in the stock market was a loser. Investing in yourself is a winner. An exercise program will go a long way in keeping us healthy.

Holiday Season Approaching

Probably the time period from Haloween through New Year's is the fastest time perioed of the year. So many events..gaterings. From Halloween parties to Thanksgiving celebrations, office Christmas paarties, friends holiday parties, our own family gatherings and then New Years Eve festivities. All of these will be taking place in basically an 8 week period. There is no bigger challenge to your weight loss efforts than this time of year.

How do we approach this holiday season and not gain 10-15 pounds? First and foremost, try to keep alcohol as minimal as possible. Also, although gratiously accept thje gifts to you of brownies, cookies, holiday candies, etc., turn around and give these bac to someone who does not have a weight issue. Take these next several weeks to really work hard on your weight loss efforts to build in some "cushion" for those few pounds that may sneak on during the Thanksgiving thru New Years time period. Always try to pay attnetion to your hunger signals, and when ata large Thanksgiving or Christma feast, stop eating when you in fact feel "full". Take very small tastes of the very high-caloric foods as opposed to larger portions.

Linda has generated some holiday mealplans, so please check our websites and stop by the office.

It would be great to get to January 1, step on the scale and smile as opposed to saying "oh, no..New Years resolution time!"

Halloween and Weight Loss

First issue: My staff and I all dress up for Halloween even during the work day so Friday, October 31, we will be here in from 730 am till 12 noon so if you want to see Elvis come back to life in the form of a middle aged doctor, please feel free to stop by.

Did you buy the candy yet to give out to your trick or treaters? If so, my question to you is: "WHY?" Keeping food items of temptation around the house for prolonged periods of time is not a great idea. If it is in the house and we feel stressed out, we will feel an urge to open one of the bags and indulge in the very food sources that perhaps caused the weight problem to begin with.

Also, are there perhaps "healthier" snacks to purchase to give out on Halloween? With the childhood obesity rate climbing to alarming proportions and the life expectancy of the younger generation being less than their parents, our decision to give out less caloric sources of "treats" is a very socially-conscious decision.

As opposed to looking at high-caloric, low nutritious food sources as "treats and goodies" but rather as saboteurs and killers will hopefully help you avoid purchasing them and giving them out.

weight and "set points"

I often have patients ask me whether there is some predetermined "set-point" that a person's weight will go to no matter what they do in the short term. If that person "diets" the weight will go down but then over time, the weight seems to drift back up to the number that has been present previously. No matter what that person does in the short term, the weight always seems to go back up to that overweight number that prompts the person to feel frustrated.

I propose to you this: Behavior patterns are the "set point", not the number on the scale. What I mean by this is that people develop behavioral patterns that become ingrained and although in the short term many people can alter these behavior patterns, the long term change in behavior is difficult. As this relates to weight, if in the short term, a person lowers carbs, exercises more, reduces alcohol consumption, etc, the weight will drop. However, if over time, the person reverts to old behavior patterns as that relates to eating, the weight goes back up.

So the point here is that there is no weight"set point", but rather there are behavioral "setpoints" that are difficult to change. For long term weight loss, it is the behaviors that must change permanently. Easy to do? Of course not. Can it be done? ABSOLUTELY

Back from Boston

Okay....I was there for several days so I now find myself saying.."Paaaahhhhk the caaaahhhhh"

Had a book signing at the Natural Products Expo yesterday and it was fun. Lots of people from overseas were at this convention and there was much interest in our serotonin technology.

As I was talking to people who came by for a book, I started thinking again about how our body chemicals can contribute greatly to our health and conversely to disease states. Specifically concerning weight issues: metabolism, cravings, the need for food when we are under stress, the feelings of when we feel "full" (satiety) vs. hungry...all of these have a chemical contribution. We inherit these chemicals just like we inherit the genes that dictate eye color, height and hair color. When we come from families that seem to have many overweight people, there clearly is a genetic predisposition for this to occur in us and our children.

We do have to "play the hand we are dealt" and when it comes to weight issues, if we inherit a genetic predisposition to be overweight, we are forced to be that much more aggressive in our efforts. By no means is it a predestined outcome that the obesity is going to be present regardless of what we do. Balacing the chemicals that contribute to some of this issue (sucha s serotonin of course) can be helpful in our efforts. It was lots of fun for me yesterday to meet new people and explain the development of our serotonin technologyu and the formulation that Linda and I developed.

Have a great weekend!

Last Day in Beantown

Yesterday I attended a conference in Boston called the Natural Products Expo. This is the second largest trade meeting of the natural products industry. This is a very large conference and many of the booths are from companies that sell dietary supplements, natural foods, etc.

As I was walking up and down the aisles of the display booths, it became apparent again to me yesterday how many companies sell "weight loss " supplements making it seem that just by taking their pill or powder, one is able to easily lose weight. At the booths, I would engage an employee of these companies and innocently ask questions (I did not identify myself as a physician who practices weight loss for fear of having them not do their usual shpiel) about how their "miraculous" product works. The explanations I received were often ridiculous from a scientific standpoint.

I know I have written this theme before, but it struck me so hard yesterday that I felt the need to bring this up again: To lose weight and keep the weight off, there is NO SUCH PILL ALONE THAT WILL MAKE THIS HAPPEN WITHOUT A LIFESTYLE CHANGE. Not our Sertonin-Plus, not the myriaqd of pills I saw being sold yesterday, not anything already on the market.

As you are all doing this effort, you of course realize that planning your meals, limiting your portions, reducing your carb intake, avoiding alcohol and snack foods...all of these aforementioned activities are not in a pill form. Supplements (of course our Serotonin-Plus is the VERY BEST!!!) can be an adjunct to these efforts, but stand alone, do not be duped into believing there is a magic pill out there. Yesterday I saw too many companies that made it seem this way.

New England and Cookie Diets

We visited a medspa in Massachusetts yesterday that was interested in implementing the Serotonin-Plus Weight Loss program into their spa. Seems that they have tried a number of "weight loss programs" that have not worked very well. The owner was lamenting that his most recent venture was a "Cokkie Diet" program in which patients would buy 75 dollars a week worth of special cookies. They would also pay 80 dollars a week for their visit. Most of the patients were dissatisfied and left the program . The owner is now stuck with 10000 dollars worth of inventory of cookies that have a 35 day shelf life.


Once again, it is our strong feeling that meal replacements, fad diets etc. are NOT a long term strategy. To lose weight and keep that weight off, one needs to learn how to behavior modify with "real" food...not prepackaged meals, bars, shakes or cookies.

By the way, New England for seafood??? The restaurants in our area are MUCH better than here,

Hi From New England

Thanks to Linda for providing a great blog ths morning...Your Doc is meeting with a hospital today in Fall River, Mass. to discuss implementing our Serotonin-Plus Weight Loss Program in their bariatric center. They offer surgical procedures but not a medically managed program.

Surgery is the answer for some but not many. We have many people that enter our program who have a surgical procedure and then gain back lots of weight. Why? The answer is that surgery truly does not provide beahvioral modication. Over time, people revert to old eating behaviors and the weight goes back on.

The long term success for weigth loss requires behavioral modification and life style changes. With any type of bariatric surgery you must still provide behavioral guidance and support.

Cold up here!!! Brrrrrr! (This ex-Nuuu Yooorker has developed southern blood!)

Dining Out-To Cheat or Not to Cheat?

Dining out can be a challenge for anyone whether we are watching our weight or not. There are so many choices. Americans dine out more than ever. And portions are larger than ever. Restaurants, however, are more accommodating to health and diet needs than they were in the past. Really think about the food you are going to choose and ask yourself if the calories and setback are worth it. Here are some tips that might help you in making choices when you do eat out.

• If you are busy and eat out often, avoid considering dining out a special occasion. When we think of dining out as a special occasion or celebration, we tend to overeat and indulge in foods that we may not otherwise eat.

• Budget your calories throughout the day: if you know that you are going out to eat for dinner, try to reduce your intake at breakfast and lunch so you can "save" some of your calories for when you dine out.

• However, you may want to have a small snack to help curb your appetite before dining out to help you avoid eating too much at your meal.

• If you know where you will dine out, look up the menu (and nutrition information, if available) online and decide what you will eat before you get to the restaurant. This way you are in control to choose a lower calorie, lower fat meal option and are not overwhelmed by the menu options and careless about eating healthy when you arrive at the restaurant hungry.

• Split your meal with a friend or family member. Most restaurants serve portions that are two to three times what we need! Otherwise, have the serving staff put half of the meal in a to-go box before it is brought to the table.

• Avoid all the extras, as these calories add up quickly: bread and butter on the table, sweetened drinks, appetizers, side items and desserts. Instead focus on a healthy balance of lean proteins, low fat carbohydrates and fruits and vegetables.

"Taking a Break"

On a number of occasions, we have had patients that have spent many months with us doing a great job in losing much if not all of the 100-plus pounds that they needed to lose. At a certain point in their efforts, especially when the weekly loss slows down on the scales, patients will sometimes say 'I need a break". The question is "break from what?"

The answer is that mentally, the choice to lose weight necessitates a constant need to plan meals, count portions, consciously give up the food and drink items that put us in a weight problem to begin with, and focus your attention and efforts on your weight efforts. All of these requirments are not easy at all ; especially when we feel stressed from other personal or business matters. Food and alcohol is a form of treatment for these stresses and at certain points, your efforts to lose weight become stressful as well. There is just so much stress anyone can handle at one time, and when you are dealing with many issues at once, sometimes we feel the need to "take a break" from focusing on weight loss.

At times like these, I ask my patients to sit down and write out on a ledger the important reasons as to why they want to lose the weight and then on the other side, write down the culprits that derail their weight loss efforts. Are the two glasses of wine at nite really more important than developing diabetes and risking kidney failure or blindness? Does the popcorn nuts or ice cream after dinner rate a higher priority than looking older than your age?

These are the mental machinations that one needs to go through when the mental fatigue sets in and you are thinking about "taking a break" from your wonderful goal to lose weight and be happier and healthier.

On a completely different note, the Giants were dismal last nite and the first patient that teases me this morning about that ugly game last nite will get the largest needle we have for the blood test.

Exercise and weight issues in females

The following article: http://news.yahoo.com/s/hsn/20081010/hl_hsn/mentalbarriersblockobesewomenfromexercise

shows in a study that overweight females avoid exercise for several reasons including self-consciousness, fear of injurt, minor aches and pains.

A viscious cycle is set up when a person is overweight...lack of exercise because of the obeisty worsens the weight problem further, resulting in even lesss ability to exercise. Conversely, when one starts losing weight, a positive cycle is set up: when the person starts losing weight, there is less pain when exercising, less self-consciousness about being seen in work-out garb etc. This increasing exercise will alloow the person to lose even more weight.

Please do not hesitate to contact us for recommendations for exercise no matter what yourweight is. Embarking on an exercise program will pay off huge health dividends for you.

Changing topics: Football..no gloating from me about the Skins....their two wins on the road were amazingly surprising ...yesterday was a trap game...they will be okay...Tonight...GO G-MEN!!!!