Tuesday, September 30, 2008

Stress Eating

I know virtually everyone is reading the financial news with disbelief. Our paper wealth is dissipating before our very eyes as we watch our elected officials point fingers at each other. Many of you that had planned on retiring soon, selling your houses, etc are now facing more years of working.

At times like these, almost instinctually, we will start reaching for high-caloric food sources as some type of "treatment" for the stress and anxiety. Unlike valium or xanax, you do not need a prescription for chips or cookies. Also, we do not perceive those high-caloric food sources as potentially "addicting" such as the prescription tranquilizers.

I would estimate that more than 90% of people who have weight problems would consider themselves "stress eaters". Please log onto: www.stresseaterdiet.com and read Linda's blog abut weight loss and stress eating. Perhaps recognizing this pattern and exploring it more will allow you to avoid the stress eating pattern that will damage your weight loss efforts.

America is an incredibly resilient nation and we all just have to hang in there and things will most definitely get better. In the meantime, as mentioned previously, INVEST IN YOUR OWN HEALTH! Buy a good piece of gym equipment, hire a trainer, etc....your investment in Wall Street is now shown to be a very bad one....your investment in keeping you alive in a healthier and happier status is a much wiser investment.

Monday, September 29, 2008

The Sertortonin Plus Burke Lake Walk

Well, the sun did start coming out, the trail was not that muddy and about 7 of us did the 4.68 miles. For those of you who were thinking about coming but the weather held you off, please mark your calender for the third Sunday of every month at 9am Burke Lake Park....as the weather gets colder just check the blog or my office phone number about weather the walk is still on. Next walk: Sunday October 19 9am.

We actually bumped into a very nice woman who was at the park to meet with a walking group (not ours) and by mistake she wandered over to our group. We engaged her in conversation and she wound up walking with us. She was telling me about her recent cessation of cigarette smoking, and during the walk, I accompanied her in the back of the pack becasue her pace was limited due to the smoing and weight issue. At the very front of our group was a woman who has lost well over 100 pounds with our program. It was amazing to see just how much energy she had and the very fast pace she was able to do. As I was walking with the new woman, I was reassuring her that the smoking cessation and the weight loss will result in her having the same stamina/energy/endurance as the person who led our group and outpaced everyone else. As a physician, I was able to see in front of my eyes the "before" and "after" of just how weight issues affect exercise abilities.

Anyway, for those of you who did not come to the park, i sincerely hope that you did exercise yesterday at home! Remember....NO EXCUSES for not exercising regularly!!!

Sunday, September 28, 2008

Serotonin-Plus Invest In Yourself Walk

Okay...its not sunny....the birds arent singing....the park trail is wet...it was a late saturday nite, ESPN starts its football coverage soon, yada yada....lots of reasons why NOT to exercise. Well, let me give you one good one: Regular exercise will make you healthier, make you look younger and help you get to that weight that you want to be at. There will always be reasons we will find why NOT to exercise...why? because it doesnt feel good! Admit it...when you are running, getting that heart rate up, it doesnt feel nearly as good as sitting down, having a good meal, glass of wine and nice conversation.

Regular exercise requires making a commitment to yourself that you WILL exercise 3-4 times a week, not matter what else is going on. It is soooo easy to fall out of the habit of regular exercise and so difficult to get into it....

With that sermon, here goes: Posner will be at the park this morning at 845am at the mini golf area...I am leaving a telephone recorded message telling people the "formal" walk is off because of weather, but anyone who wants to join me, COME ON OUT!!! Put on the muddy sneakers, wear a baseball hat and some rain gear, but come on out!!! Let's show Mother Nature that she canot take away our commitment to be healthier and live longer. See you soon!

Saturday, September 27, 2008

Serotonin-Plus Walk and Exercise

Rainy Saturday but I think the forecast is better for tomorrow.

Please call: 703-866-4144 tomorrow morning if you have any doubt about the weather affecting the walk. We will meet at the minigolf area of Burke Lake park at 845-900, then go down to the amphitheatre area near the trail and then start the walk (or run). Again, this is not a race ....no pressure...just a fun walk to kick off our Fall "Get back to Exercise" theme.

Concerning exercise, as mentioned last week in one of the blog entries, please consider "investing in yourself"., i.e. if you do not have any good exercise equipment in your home consider purchasing a nice treadmill or a good elliptical machine..perhaps a rowing machine..whatever eqiuipment you would use. As the weather gets colder/darker, those of you who look at your exercise as an "outside" activity wll in fact start getting less and les exercise. Having equipment in your basement in front of a good tv set or stereo system allows you to exercise no matter what the temperature or darkness factor. I know these pieces of equipment are costly, but it is a GREAT investment in improving your health.

Please join us tomorrow!!!

Friday, September 26, 2008

weight loss and antiaging

Yesterday I received an invitation to speak at a meeting of the Anti-Aging Society in December. The conference is taking place in Las Vegas. I have been asked to speak about the usage of oral serotonin as part of a weight loss program. My first thought was this: Antiaging in Vegas? Booze, blackjack, staying up the entire night eating, drinking and gambling...this is a really good venue for anti-aging! No, just teasing...my first real thought was: Will I hit my 16 against the dealers 10, or should I take adventure of the surrender option they have in Vegas?

Okay, let me get serious now: my first thoughts were about the association of weight with the aging process. With excessive weight leading to the early development of diabetes, heart disease, fatty liver, sleep apnea, certain cancers and other serious conditions, clearly a detrimental weight results in more rapid "aging" process. Aesthetically, being overweight results in a person looking older than the chronological age.

At this conference, I am certain there will sellers of skin care creams, supplements of dubious merit, spa treatment machines that result in a more youthful appearance, etc. However, weight loss, probably more than anything else offered at this gathering is probably the most powerful "anti-aging" procedure/intervention that a person can do.

Thursday, September 25, 2008

Self-accountability

Yesterday we saw several patients who started our program, and for business travel reasons, family issues, etc. would up missing a number of appointments and came back in over a month since their last visit. A fairly significant weight gain occurred. We of course are not upset/angry or in any other way disappointed in the person. We do try to help the person self-analyze to find out what happens when they leave the weekly medical supervision that makes weight gain occur. Clearly, when we get distracted and lose focus, we start returning to old behavior patterns such as not planning our meals, not counting portions of foods, reaching for quick foods, doing distracted eating, etc. The result, of course, is the weight going right back up. Weekly, when someone comes for folowups, we of course weigh the patient, discuss the challenges of that week, provide encouragement and advice, etc. This "accountability" is a very powerful psychological motivator to keep "in the zone". On your own, this accountability becomes a "self" accountability and this oftens waivers in its' strength.

By writing this blog everyday, encouraging our patients to just come in and use our scale after they finish the formal weekly visits to our program, staying in touch with Linda via e-mail, or even coming in once every 1-2 months for an appointment, perhaps we can help you reinforce your self-accountability as this relates to your weight loss efforts. The long term success of your efforts can be enhanced by developing strong self-accountability systems. Keep that clipboard next to your scale and recod those weekly weights, analyze trneds, and then have a gameplan to do somehting about it if you see a rising pattern. You can ALWAYS pick up the phone or send us an e-mail if you need help. When you formally leave your weekly visits, you are still part of the Serotonin-Plus family. (Oops..did I just rip that one off from the Olive Garden commercial?)

Wednesday, September 24, 2008

weight loss..War vs. battle

When patients come in for their weekly visits and some weight gain occurred we try very hard to have the person understand that not every week willbe successful as that relates to losing weight. Due to business travel, personal stress, etc., sometimes focus is lost a bit and when that happens, a weight gain will occur. Remember that a weight gain for a week does not make you a "failure". Keep fresh in your mind the reasons as to why you want to lose weight, regather your forces and focus, and make the next week more aggressive. Remember that the "war" is an assault on the excessive weight that puts you at health risk and also makes you not feel good about yourself. Each day is somewhat of a battle, and some days the battle will not go completely in your favor. Thats okay..the big picture is the long term reduction of the weight and all the positive efects that brings with it.

Always try to keep very fresh in your mind the reasons as to why you committed yourself to losing weight. Oftentimes, our instinctual behavior patterns will make these reasons blur a bit, but if you can marshall those forces to keep the reasons clear and at the forefront of your minds, it will be easier for you to say "no" to the food items that will harm you.

Tuesday, September 23, 2008

weight loss and embarrassment

We have noticed over the years in our clinic that people will frequently cancel their scheduled appointments with the reason truly being that they gained weight that week and they were feeling embarrassed about coming in and having us see the gain. To some extent, the success of any weight loss program is "accountability" and when someone has an "off" week, there is some intrinsic fear that the doctor will be "disappointed" in them. Almost analagous to coming home with a bad report card and having your parents see this while you are standing there!

There will be many weeks in which the challenges of that week will exceed the internal drive to lose weight, and the scale weight will go up. This is compleetly understandable and certainly no one in our clinic nor should you be "embarrassed" about this. Weigth gain in any given week does not imply "failure" or "defeat". Rather, we all understand that thiese weeks will happen and all that it takes is a more aggressive adjustment the following weeks. When we get into big trouble on the scale is when we do not weight ourselves weekly or have no game plan for action based on the weight going up.

When you are in our program, the exact time NOT to cancel an appointment is when you had a chalenging preceding week. Coming to us allows you to get refocused, rejuvenated and pumped to get back on the aggressive weight loss mode. When not in our porgram, please make sure to chart your weight weekly and then have a gameplan as to what you will do if you see the weight going up.

REMEMBER OUR SEROTONIN-PLUS WALK/RUN SUNDAY SEPEMBER 28...9AM MEET AT MINIGOLF BURKE LAKE PARK......IF WEATHER IS QUESTIONABLE CALL: 703-866-4144 and a message will be on the recorder

Monday, September 22, 2008

Weight Loss and "Concierge" medicine

http://www.cnn.com/2008/HEALTH/09/18/ep.concierge.medicine/index.html

The above link discusses physicians that have opted to leave traditional insurance based medicine and instead, provide a more attentive, "concierge" type service to their patients. Same day appointments, access to their physician after hours via cell phone, weekend visits, etc. There is one catch: One has to pny up 1500 bucks a year "fee" for this service ON TOP OF all the other insurance premiums you are paying.

Why are physicians turning to this model? Not becasuse of greed...because of survival. A number of my colleagues are telling me that they cannot afford to pay their overhead and themselves a fair wage even with very busy practices. Insurance copanies have made it so difficult on these physicians, that their only choice was to get out of provate practice or turn to a different business model.

The insurance companies, as they have ben raising your premiums every year, have been lowering the fees they are paying physicians year after year. This has necessitated physicians trying to cram more and more patients onto their schedules which results in patients being made to feel like a "number". These same insurance companies will not recognize weight loss programs which of course, can save lives, lessen medication costs, etc.

Personally, I am very lucky i that I have not been participating with insurance companies for over 13 years now. We do see our patients the same day they are ill, people never feel that they have to "fight" for an appointment, I will see patients on Sundays and holidays, people get my cell phone number after hours, etc...but I do NOT ask people to pay any membership fee for these "concierge" services. This system has worked well for my patients and my office. Concerning our weight loss program, we will continue to always help you try to maximize your insurance benefits.

Congrats to you Redskin fans. They are surprising me. Giants had a close one yesterday...

Sunday, September 21, 2008

Understanding weight issues

Over the past week I have had several patients lament to me that they have friends and relatives who do not understand why it is so difficult to gain control of weight. Clearly, there are some people whose metabolisms are such that they pretty much eat what they want and have no difficulty controlling their weight. These people have no comprehension of what it is like to basically look at food and gain weight. I will provide the following examples: When you hear about someone who goes incessantly to casinos and gambles their life savings away, lose their marriages because of this, etc., is it easy to understand how they can let that addiction ruin their lives? Or, how about the alcoholic who has a great family, job, etc., but yet continues to drink alcohol excessively, winds up with a DUI and has other issues severly impact his/her life? The point here is that "addictive" behaviors are difficult to understand unless you are the one with that addiction. To some extent, overeating and the use of food as a "treatment" is an addiction as well. It is very difficult to break addictions on your own. In my medical practice, when I have an alcoholic asking for my help in discontiuing drinking, I ALWAYS advise a program because on one's own, the failure rate is about 99.999%. Overeating and the development of obesity similarly is an addictive process and obtaining help for this, either via our program, Weight Watchers or other is important and should not be looked at as some "weakness".

Saturday, September 20, 2008

Investing In Yourself

The stock market is tanking....real estate values keep falling....your intentions to retire comfortably are now being delayed because your paper wealth is evaporating.

You are going to need to work longer unless things turn around in the markets. To do so, you need to remain healthy and avoid serious medical illness that would disable you and prevent you from performing your daily activities.

What is a great investment? Answer: YOU!!! Invest in yourself. Spend the time and money to mmake sure you are healthy and will remain so. I cannot tell you how many patients of mine take take of everyone else and neglect themselves. Routine physicals, preventative testing such as colonoscopies, mammograms, etc, all can save lives. Weight loss will allow you to live longer in a better state of health.

Sometimes, I have patients lament a bit about expenditures on health care, but quite frankly, there is no better investment than spending money on keeping yourself alive and healthy. "You: will always be your best resource, and "You" need to be healthy.

Thursday, September 18, 2008

weight loss and the weekend

Okay...TGIF....work is almost over for the week. A long, difficult week in which you have seen your paper wealth dramatically drop as the stock market has been taking it's beating. Stress, frustration, some anger , etc. The temptation is to reach out for something that makes us feel better. On an immediate basis, the "things" that make us temporarilty feel better are "fun" things like alcohol, foods and sweets. It is very common to indulge in high-caloric foods when feeling stressed out. (Take our stress eating quiz at: http://www.stresseaterdiet.com/)

Remember that the food sources that may provide us an immediate "reward" ultimately are the ones that got us into a unfavorable weight situation to begin with and are NOT a true "treatment" for stress. Contrarily, these foods cause more weight gain which makes us feel even more stressed out.

Try to convert your stress feelings to more positive activites such as exercise and use this weekend to reflect on how you handle stress and what you can do to make your response more beneficial to your health.

weight and self esteem

We discuss many issues surrounding the psychological aspects of weight loss. Of course, for most people, the primary motivation for losing weight is the inproved health that accompanies the weight loss.

Yesterday, I saw a patient who has lost over 40 pounds, and she started tearing up from happiness explaining that her whole life has changed. Her happiness was not as much about her perceived improved health, but rather, the self-esteem improvement she has experienced. She went on to explain that when markerdly overweight, she would specifically avoid social situations with co-workers for fear of not being able to dress up well or present herself in a manner that others would find acceptable. As much as she tried not to think about "what others are thinking" she found herself becoming more and more distant and holing herself up at home.

Since the weight loss, she has been getting lots of compliments which have emboldened her to start going out again and after the first few times, she realized that she was "no different" than anyone else, and even seemed to attract more attention than others. This is why she was so happy.

Just an anecdotal story, but when I hear this type of self-improvement from weight loss, I feel great that our program is, in fact, changing lives on a number of levels. Yes, we love to see the lessening of blood pressure, improvement of diabetic control, etc....but to see the huge smile...really fun!!!

Wednesday, September 17, 2008

Weight Loss and Tailgaiting

I know I have brought this subject up before but yesterday I saw several patients that prompted me to emphasize this again: One day of very detrimental eating/drinking behavior can basically "undo" six days of aggresive dietary intervention. The patients who proved this once again lamented that they followed a very strict dietary plan for the entire week...except for football Sunday. They went to the Redskins first home game, and as tens of thousands of people do, they tailgated in the parking lot hours before the game. Going with the best of intents not to partake of the high-caloric food and alcohol sources that accompany the traditional tailgaiting event, after awhile, they got worn down and succumbed to the "herd" mentality. This resulted in excessive food and alcohol uage and the scale this week was not favorable. Six aggressive days wiped away!

Whether if be a football game, a family gathering, or another very special occasion, if you are in a weight losing mode, please consider limiting yourself to only small portions of the food and drink choices that you inherently know will damage your efforts. In the case of the football game, bring food sources that are conducive with your weight loss efforts or eat before going to the game. Planning and strategizing is essential to weight loss efforts.

Tuesday, September 16, 2008

"Good" vs. "Bad"

Many of our patients will come in for their appointments, and if they have experienced a week in which they consummed more calories than they would have thought prudent, there will be a statement such as "I have been very bad this week". Conversely, if they followed the dietary plan to the letter, this may be an opening line: "I was really good this week". (Word of the day: Banquet)

I believe it is important NOT to attribute being "Good" or "Bad" to the intake of food sources. There is a certain psychological issue/issues involved in everyone's weight problems, and we should not think of ourselves as evil human beings for eating a Three Musketeers bar. We are still the same "good" person whether we have had a difficult week in losing weight or had an aggressive weight loss week.

Looking at ourselves in the mirror and thinking we are "bad" leads to self-loathing thought patterns and a sense of being a "failure". These emotions are not compatible with the mindset necessary to lose weight and feel happy.

Whether you lost 5 pounds this week or gained 3 pounds, you are still a "good" person. All this means if you gained weight is that you eed to make better choices for your food intake and exercise patterns.

Monday, September 15, 2008

Can insurance cover this program?

Did you know that two thirds of Americans are either overweight or obese? The cost of obesity and overweight in this country is staggering. NIH shows that annual costs were about 117 billion dollars a few years ago and are rapidly increasing. (http://win.niddk.nih.gov/statistics/index.htm#econ). It is reported that 92 billion was spent for medical care for health issues for the overweight and obese in 2002.

As you know, in our weight loss program, we do not accept insurance but if you have health insurance you should try to use it. I wish all insurance companies were more progressive but with persistence sometimes you can get reimbursement. We give you a medical superbill that you can take and submit to your insurance company. I code it according to your health history. Since you have paid us for your visit, you should have the reimbursement sent directly to you. If you receive a letter from the insurance company and it doesn’t have a check enclosed, bring it into me (Linda) and I can investigate to find out what they need. Sometimes they need further explanation, a certain code or a letter of medical necessity that I can provide. Then it is a matter of just sending in the forms again. It may appear to be a tedious process but we have patients that do get reimbursed. If you have a PPO, most will allow you to have an annual physical. Many times, if people have not had one when they come into our program, they can use our physical to be reimbursed. I also suggest to try to get the weekly visits covered. Many times people have coverage for nutritional counseling which is an integral part of this program and the bills are coded as such.

Similarly, if you have a flexible spending plan, this program will qualify for that as well. Sometimes your plan administrator will provide a form filled that we must fill out or I can write a letter of medical necessity for you.

Sunday, September 14, 2008

When is the best time to exercise?

I have many patients ask me, “What is the best time to exercise, in the morning or at night?” Well, there are two schools of thought on that. Some experts think it is better to exercise in the morning because you will burn more calories during the day. Also if you include it into your morning regiment as you get ready for the day, you will always get your work out in. On the other hand, some experts feel it is better to exercise later in the day because it will burn the calories and carbs you ate during the day. In addition, if you exercise after work, it will help release the stress from the day resulting in less stress hormones being produced and consequently less belly fat. The only downside from exercising at the end of the day is that you may be too tired and decide to skip it. So, if you decide to wait until the end of the day, do not make any excuses and get it in whether it is a walk, a gym routine, class or at home regiment. In actuality, you should exercise when it fits into your schedule. I have some patients that have a hybrid: they exercise a little in the morning or at lunchtime and then workout again when they get home at night. The point of exercise is to burn calories, tone the body and increase metabolism and you will receive that benefit regardless of the time of day.

Remember it is best to get a mixture of both cardio and weight resistance training. You want to efficiently burn the calories with cardio by working within your target heart rate zone. Don’t go above it or you could burn precious muscle away. Also it is extremely effective to do some sort of resistance training, whether it is weight machines at the gym, dumb bells or bands. Resistance training will increase lean muscle mass causing an increase in metabolism. The lean muscle in your body burns many more calories than fat cells. Doing some sort of resistance training every other day will help you burn more calories, burn fat and sculpt the muscles. For women, I recommend lighter weights and more repetitions for definition without the bulk. Bulk will add weight to you. If you have ever seen women in the gym on the adductor leg machines using 150 pounds of weight and their thighs have muscle but are huge…that is why.

For those of you that see me weekly, you know I love to work out and I love weight training. It’s one of my personal interests. Last year, I felt stuck with my own routines and felt my progress was limited on muscle development. So, I decided to study to become certified personal trainer to help myself and to hopefully pass on information to help our patients. I usually do my workouts after work at about 8:00 PM or so as it helps me to release the stress from the day (and from working with Dr. Posner all day, just kidding)…For me, there are no excuses, after work I must immediately do my workout. I may not want to as I may feel tired from working the last 12 or 13 hours, but all I remember is how I feel after I am done and my car is on autopilot to the gym. As women, weight training can seriously give us the greatest boost in metabolism and it doesn’t matter at what age we start. We can reap the benefits at any age.

football sunday

Hi from St. Louis.....Linda wrote a GREAT blog yesterday about anger and eating...I sure hope the Giants beat the Rams today or I will be eating cheesefries at halftime....

Remnants of the hurricaine blasting st louis this morning..glad it is an indoor stadium ....soooo much rain...i feel like taking out my umbrella and doing my Gene Kelly impression

okay..here is Posner's gameplan to avoid the weight gain: i ran this morning....will eat brunch at the hotel before i go to the game but eat it kind of late so it is near gametime.......avoid the stadium stuff....i truly believe the stadiums have agenda to help our weight loss business...all that is served are high-caloric foods....perhaps a diet soda and maybe a pretzel....(hey..i am a sucker for those big pretzels) NO beer and NO nachos/cheesefries!!!

tonight, dinner at hotel BEFORE the airport..airport is about the same as the stadium....

so that is Posner's plan....and...GO GIANTS!!!!!

Saturday, September 13, 2008

Don't Let Anger Destroy Your Diet

Anger is a very strong emotion that causes stress to the body and to the mind. That stress also causes us to hold onto calories resulting in less weight loss if we are on a reduced calorie diet. Research shows that no matter how much you exercise or eat correctly, you are putting yourself at risk if you do not manage your anger. Anger causes a widespread negative effect on the body. Generally, if we react to this stress by eating, we have a double whammy, so to speak, causing poor nutrition and excess calories causing weight gain.

When we become angry, we may experience muscle tension, teeth clenching, higher blood pressure, chest pains, excessive sweating, chills, severe headaches or migraines. This is due to stress hormones being released. If people do experience chronic anger and it is not managed, more severe health issues may appear such as obesity, peptic ulcers, constipation, diarrhea, intestinal cramping, indigestion, heart attacks, strokes, kidney problems, and more frequent infections. Researchers have found the heart is affected by anger and can actually reduce the heart's ability to pump blood. Uncontrolled chronic anger can also have psychological effects resulting in depression and feelings of hopelessness, eating disorders, substance abuse and other self-destructive behaviors, and can cause significant changes in relating to other people.

When we eat in response to the stress of anger we are taking the anger out on ourselves and are actually punishing ourselves. We sometimes decide we don’t care about anything anymore, our weight or our health, etc. It is important to maintain nutrition when we become angry so we can manage our anger well. Always remember that with regard to eating we can limit our damage to ourselves. If we decide to give in to a high calorie snack, we can stop at one. But many times we say to ourselves, well I ruined it anyway so more chips or ice cream won’t matter. But it does. All of those calories add up and more weight is added to the scale. Just get right back on track with your diet, start to exercise to burn off those calories and forget about what you just ate.

Here is a listing of ways to begin managing your anger before it gets out of control.
• Exercise to release the anger- run or lift weights, punch a punching bag, do kickboxing
• Practice Deep Breathing – Begin with 2-3 minutes of deep breathing exercises
• Meditation -Relax and count to 30 blocking out everything that you see and hear.
• Call a friend to take your mind off your stress and to vent. If the friend is trusted ask for his/her opinion of the situation.
• Confront the one you are angry with and talk it out.
• Find something to smile about and laugh as laughter reduces stress hormone levels. Frequent belly laughter empties your lungs of more air than it takes in resulting in a cleansing effect - similar to deep breathing.

Friday, September 12, 2008

Weight and Diabetes

Yesterday we entered into our program a very wonderful lady who had recently been placed on an oral medication for her newly diagnosed diabetes mellitus. As all of you well know, diabetes, if left untreated, leads to early athersclerosis, causing heart attacks, strokes, blindness, kidney failure, peripheral vascular disease, and other life threatening diseases. The ramifications of diabetes can be ominous and it is a diagnosis that must be taken with the utmost degree of seriousness.

The incidence of diabetes is on the rise in The U.S. with the prediction that by the year 2030, almost 35% of the American population will have diabetes. If this is true, the amount of healthcare expenditures, lost time at work and other social/financial issues associated with this serious disease will change society as we know it.

Why is the incidence of diabetes climbing? The answer is the growing prevalence of obesity in the U.S. At our weight loss centers, we see an incredible and quick response to weight loss on the lowering of blood sugars. Moreover, we also see a number of people who start coming off their diabetes medications because of markedly improved control. There is no better initial response to a newly diagnosed Type 2 diabetes case then weight loss.

Have a great weekend!

Thursday, September 11, 2008

starting out...

Just wanted to remind eveyone that on Sunday, Sept. 28 at 9am we are meeting at the Mini golf area at Burke Lake Park for a walk/run around the lake...for those of you who have not been there, Burke Lake Park is off of route 123 in Fairfax Station There is a 4.5 mile trail around the lake and we will be meeting at 9...this is not a race so please do not feel you have to either walk fast or run...we are just trying to kick-off our pre-holiday season reminder for exercise after the summer. Sometimes people's activity levels fall off after summer ends and we want everyone to keep it up!!! Come out and join us...will be lots of fun...bring friends/family!!!

Yesterday we went to Ft. Belvoir to provide a health a wellness seminar about weight loss. The health activities' director used to have Weight Watchers come in but due to a waning interest in the attendees, Serotonin -Plus was invited to provide this lecture series.

Around the table I saw a number of people who were just starting out with their weight loss efforts. What I saw was an almost universal look of frustration and sadness. I felt that I needed to pump them up with my first talk dwelling on taking this "one day at a time"...establishing realistic goals, and learning to develop reward systems not based on food. Sometimes, when people are starting out, it seemingly appears impossible to reach the weight loss goals that people strive for. Most of you reading this blog have achieved lots of weight loss and you know that now you look at things a bit different than when you first started your efforts. Success breeds success. The point here is that if you know anyone who is about to embark on weight loss efforts, they need the positive support of friends and family to help them not feel that the task is impossible to achieve.

Wednesday, September 10, 2008

medications for weight loss

Often, when we have new patients enter the Serotonin-Plus Weight Loss Program (word of the day: phentermine) after I explain about using the prescription medication, phentermine and our serotonin supplement, I will frequently hear;" I used Phen-Fen in the past and it really worked. I lost lots of weight".

I can assure you that virtually every person who used the combination of phentermine and fenfluramine ("phen-fen") in the past (this was used up until 1997 when the FDA pulled fenfluramine off of the market because of associated heart valve dysfunction.) gained the weight back that they lost.

Why did almost 100% of patients who used this drug combination fail to maintain their weight loss? The answer: Medications do NOT result in permanent weight loss UNLESS there is an associated life style change/behavior modification PERMANENTLY. Obviously, if you are taking medications to reduce your appetitie, you will eat less and lose weight. But, when the medications are finished, the appetite will return and unless you have learned permanent life-style changes, then eating will increase and weight goes back on.

Medications can be used as a "jump-start" but by no means are the marquee feature of any permanent weight loss effort. In our program, we utilize phentermine because we want our patients to have a very aggressive beginning to their weight loss efforts because we have learned that losing lots of weight in the first month psychologically motivates the person to keep very aggressive in their efforts.

Behavior modification is very difficult, yet necessary for the long term control of weight.

Tuesday, September 9, 2008

setting goals

A subject we discussed previously, but worthy of bringing up again is the concept of setting realistic weight loss goals. "The charts" seem to always tell us that the weight appropriate for our height is an alarmingly low number. Furthermore, we tend to think back to the days in our 20's or 30's when we weighted a svelte weight and strive to reach that level again.

Certainly, as time progresses, it becomes more difficult to lose weight and maintain a very strict low number. Our metabolism and body type changes over time and what was once a "good" weight for us becomes a number which is truly not realistic. Moreover, aesthetically, I am not certain that we would like the "look" we have now that we had 30 years ago.

As you think about your weight loss goals, pick a goal which is realistic and also reasonable to maintain. If you ever want an objective opinion as to what would be a "good" goal for you, please stop by to say "hi" and we can provide you with an opinion. This, of course is free of charge.

Monday, September 8, 2008

weight and liver disease

Certainly in past postings I have discusssed the medical ramifications of obesity and at one point focused on childhood obesity. The main disease states linked to obesity are diabetes, heart disease, stroke, arthritis, certain cancers and prpensity for blood clots.

The following published report : http://www.msnbc.msn.com/id/26529310/from/ET/ describes a very scary disease in children and teens linked to obesity: liver disease.

When fat builds up in the liver, this can lead to scarring which ultimately becomes cirrhosis. A the end stages of this serious liver problem, the only "cure" is transplantation. (word of the day: Elvis) This article mentions that the rate of liver disease seen in the young will be rising exponentially and the availability of livers for transplant will not be abe to meet the needs.

As I mentioned in a previous blog entry, the life expectancy in the younger generation is less than their parents generation and this is the first time this trend has changed. Clearly, liver disease is yet another cause of this.

As a society, we must do a bteer job in helping our youth reverse this very dangerous obesity epidemic.

We must do a better job

Sunday, September 7, 2008

weight loss and looking younger

Good sunday morning..hope the weather did not disturb your weekend plans too much and certainly hope you didnt do the "hunker down" mentality of playing lots on the kitchen yesterday...

Over the past several weeks, i have seen some patients who enter our program who seem somewhat embarrassed that their main reason for being here is the desire to look younger, improve their confidence and self esteem, and otherwise feel more attractive.

The "politically correct" answer as to why someone should lose weight usually is the health answer: "I want to be healthier". To say "Iwant to look more attractive" sounds vain or otherwise superficial.

I strongly believe that people deserve to feel AND look their best and if in their minds, being thinner makes them happier with their own appeaarance, then this is a very good reason..as good as any...to lose the weight. So, if you ever feel ashamed of having a priority for your weight loss efforts be aesthetics, please do NOT feel this way.

Laughing..as an aside, on a whim last nite I took the gray out of my hair with one of those pharmacy bought hair coloring things...I do not look any younger but i sure do look like I had a close encounter with a shoe polish bottle!!!! If you see me wearing a baseball hat at the office, you will know why now....

Saturday, September 6, 2008

Stress Eating

Most people can relate to the concept of eating under stress. Whereas some people will reduce their food intake under stressful situations most reach for high-caloric food sources.

I am not certain how many of you have taken our stress eater's quiz. It can be found at: www.stresseaterquiz.com and www.stresseaterdiet.com.

Poor weather conditions such as today or snow days in the winter are hazardous for our weigth loss efforts because out of boredom we find ourselves wandering to the kitchen. try to be cognizant of this and spend time in the treadmill room as opposed to playi ng in the kitchen. Use "downtime" today to plan your week's meals.

Word of the day: hurricane

Friday, September 5, 2008

adjusting diet to activity

As I watched the football game last nite, I was reminded of several ex-NFL players that have done our program. When they were active players, they were working out constantly, but when they retired, their eating patterns never changed but yet their activity dropped trmendously. I think I read that the gold medal winner Michael Phelps eats over 10000 calories per day. If he continued to do that after he stops swimming, I think he will be calling us for an appointment.

Even if you are not a professional athlete, sometimes we get small ankle or foot injuries that prevent us from exercising. We must adjust our food intake to offset that lack of exercise . If not, we weill start gaining weight.

It is incredibly easy to eat lots of calories and hard to brun them off. Always try to look at this as a mathematical equation: calories coming in/calories burning off. Try to work aggressively on both ends of the equation.

Have a great weekend! (and see Skins fans, I didnt tease anyone about the game last night, did i?)

Thursday, September 4, 2008

Football season and weight

Okay: word of the day: (actually 2 words) GO GIANTS!

Now that is over with, you can see that your good doctor will not be reading medical journals tonight, but rather will be tuned into the first NFL game of the season, pitting the New York Giants vs. The Washington Redskins.

Okay, this is not a sports column, what is the connection to weight?

The answer is the eating and drinking behaviors of football fans during the season. Let's start out with those of you that attend games. Chances are very strong that you will find yourself in the parking lot 3 hours before kickoiff with a group of your friends and/or relatives having a feast of grilled meats, chips, beers, breads and sundry other high-caloric food items. The beer-drinking then extends into the ballpark with perhaps some ice cream or one of those really big pretzels. Concerning the people who watch at home, we again usually group with other people and provide all of the foods and snacks that accompany a football game. Once again, plentiful carbs and alcohol.

Separating the enjoyment of watching an intense football game from the high-caloric stress-eating foods associated with these gatherings is a very difficult thing. However, if you are in a weight -losing mode, this can basically ruin an entire week of otherwise smart eating behaviors.

I would suggest eating a well-balanced meal BEFORE the game and plan, and if you tailgate, to bring along some better food choices than nachos and beer. This gets back to my constant theme of PLANNING your meals and snacks and trying to avoid situations where all control is lost.

Oh...the Posner Prediction: Giants 24, Skins 7 (and if you are upset at me for this, and want to take it out on my car, I own that little mercedes sportscar in the parking lot with the license plate : SPDIET) Hmmmmm.....I better fess up on that one..that is Linda's car and she is an Eagles fan.

Wednesday, September 3, 2008

winter clothes

As the days start getting shorter and the temperature starts dropping, the summer wear of shorts, bathing suits, etc. will be replaced by heavier clothes, coats and other outerwear that will tend to "hide" our bodies to some extent. At our weight loss centers, we often see many patients enter our program in April and May, because as it gets warmer, the heavier clothes start coming off and people are concerned that their weight issue may be more noticable to others. One of the major motivations to lose weight is the desire to "look better".

With the holiday season not too far off, it would be great to get into the April-May "mindset" now, meaning that although it is not bathing suit season anymore, the improved health and energy aspects of weight loss should be a great motivator to continue your efforts. Americans gain an average of 7 pounds during the holiday season, and now is a GREAT time to motivate again to really watch the calorie intake and maximize your exercise efforts.

Consider in the privacy of your own home, occasionally trying on that swimsuit or summer dress, and seeing how well it is fitting. Even though we are moving away from that season, perhaps this will trigger the same motivational sensation that many experience in April/May as the time to shed the heavier clothes approaches.

Tuesday, September 2, 2008

School is back in session..be careful!

First, I hope to see those of you come into the office with your collection of August words of the day....if you have them, you get a cool surprise....

First September word of the day: School

Okay, so what about school? For those of you who are parents and your children are going back to school today, I wanted to remind you of the challenges involved concerning your focus on losing weight. Preparing them for going to school, then going to a full day of work, then off to a soccer practice or other after school activity, then home. Not much time to think about what is for dinner or even lunch for that matter. The tendency is to start doing "quick" things for meals, and what is quicker than a drive-thru fast food restaurant?

This becomes a very challenging time and requires you to use Sunday perhaps for 30 minutes as a "planning" day. Look at your week in advance and start plotting/planning out how you will handle the challenges of the upcoming week. Perhaps only a few days are challenging, but you ust think about this in advance because when we make decisions on the fly, they are usually not the best ones for keeping our weight under control. Also, as it remains darker later and turns darker ealrier, those of us who enjoy outdoor exercise may start finding less and less time to do it outside. Develop alternative indoor exercise plans to offset the less outdoor time.

The challenges exist but with the correct planning, you can indeed overcome these challenges and make your weight loss efforts successful!

Completely off subject but here goes: Do any of you Skins fans really think you have a chance at the Giants this Thursday nite??? Okay, I KNOW this will get some comments!!!

Monday, September 1, 2008

Weight Control on vacation

Good holiday morning! First, I want to thank Linda for posting some really good stuff on this blog while I was vacationing. Excellent insights!

Okay, some personal stuff about how I approach vacations as that relates to the scales. I went to a resort in Conneticut called Foxwoods. It is an Indian reservation and there is a new MGM Grand hotel that just opened several months ago. Wonderful new rooms..wonderful new spa and workout facility...wonderful new casino and WONDERFUL restaurants. One of the restaurants is a famous deli from Brooklyn, N.Y. called Juniors. They are especially known for their New York cheesecakes.

Okay: here was my approach: 1-every morning I went to the gym and ran treadmill, did some weights, pushups. 2-ate a pretty small breakfast of some type of protein 3-tried to walk lots during the day 3-lunch ...okay, was pretty negligent...corned beef sandwiches, potatoe pancakes, 4-dinner...no alcohol, lots of protein, some vegetables and carbs. allowed myself 2 pieces of cheesecake in 3 days.

Results: 1.5 pounds of weight gain in the three days.

Response: I will follow a modified Phase 1 dietary plan for this week and check the scale next Sunday.

This strategy works for me, meaning that on vacation, I will liberalize my food intake because to be honest, I understand completely that for almost everyone, part of the "fun" of the vacation are the foods associated with the place you go to,. To deny yourself everything will in fact take away from the global sense of fun you have. Pick and choose the things that you really want and perhaps eliminate some of the high=caloric sources that do not mean that much to you. Also, be sure to check that scale when you return and have some sort of forulated plan as to what you will do to bring the weight back down. We get into trouble if we do not check the weight or have no plan.

Have a great day!!!