Thursday, April 30, 2009

weight loss on vacation

I would like to relate a good story I heard from one of our patients yesterday. She came back from a vacation having LOST almost 4 pounds, and of course, this is not the ususal result after a vacation. I asked her how she did it.

First, she went to a resort spot which was NOT an "All-Inclusive" meaning that the family would pay for each meal. Second, she brought with her a collapsable cooler and went to a market and bought low caloric yogurt. cheeses, and some other easy protein choices. She further explained that she would fix her own breakfast and lunch following very carefully the dietary plan, but then allow herself and to enjoy a dinner at one of the resort restaurants. In this way, she did not feel deprived in that her dinner meal was at a restaurant, yet she did not need to succumb to the higher-caloric meal sources for breakfast and lunch. She also explained that this actually saved her lots of money as well.

Of course, bringing coolers, shopping for food, etc. is "work" and when on vacation, we are trying hard not to work. However, this is just one way of doing it. I have had another patient tell me that before the trip he made a list of all the food/drink sources that would harm his plan to lose weight that he would usually do on a vacation, and he scratched through 50% of them. He allowed himself to do "1/2" of the usual, and he returnmed having gained no weight. Usually, vacations would mean 4 pounds of weight gain for him previously\.

The point here is to THINK about it before you go on vacation. Check out the resort's restaurants' menus online, and plot which restaurants would be best to go to. Avoid buffets as best as possible. You can have a great vacation and not derail your plans to be healthier and happier.

Wednesday, April 29, 2009

weight loss and socioeconomics

Yesterday we had a young female patient come in with a small child with her, and she was here for a consultation about our program. When Melissa provided the information about our program, the woman was very interested, but when the cost of the program was outlined, she said she couldn't even come close to affording it.

Clearly, a personalized weight loss program such as ours should not be only for people who have enough disposable income to afford it, but yet, what is the answer to this dilemma?

First, insurance companies should be REQUIRED to offer coverage for at least part of a medically supervised weight loss program. These companies have been doing nothing more than dramatically increasing premiums, denying coverage to those people with preexisting medical problems, cutting fees to physicians and forcing doctors to change their prescribing habits. Isn't it time that the government stepped in and mandated that these companies become more aggressive in their contribution to reduce the nation's largest health concern. Believe me, there will be tens of thousands of times more deaths this year in the U.S. caused by obesity-related diseases than the swine flu.

Secondly, perhaps some of the monies that have been going to flying AIG executives around the country, bailing out companies that have been incompetently managed, etc. can be diverted to health clinics in poorer areas that can offer weight loss and other preventative care to people who cannot afford it.

We have been investigating bringing our program out to Native American reservations, as the obesity rate is incredibly high in that population. Our program can be taught to other medical people, and does not need a nice suburban office space to provide the services. We are exploring how we can perhaps package our program and have it delivered through other providers at a much lower cost to people who cannot afford the services we provide in Burke.

Anyway, sorry for this relatively angry rant this morning, but I feel very bad when someone who really wants to do our program does not have the resources to pay for it. Obviously, it is not fair for us to give some people "discounts" or free programs, other people pay full price, etc. I would greatly appreciate your comments on this discussion...feel free to post on our chat at: www.spdiet.com or write me at: drposner@spdiet.com

Tuesday, April 28, 2009

"buddying up"

Yesterday we entered a number of people into our program who came in as couples...a mother/daughter and then friends. Having support along the way is very important, and clearly, having a relative or friend start their effort at the same time can be quite helpful. It is difficult to embark on a weight loss effort when everyone around you is not paying attention to calrie counts, not planning exercise time, etc. Having one or several people who are on the same mission as you will help your efforts.

Please do not be embarrassed to seek out people to work out with, discuss recipes , exchange ideas as to how to make it more fun to lose weight. With Americans having a 67% overweight rate, I know there are people at work, church, family members etc. who want to lose weight.

Your good doctor turns 53 today. Do you notice that the older we get, the less excited we are about our birthdays???

Monday, April 27, 2009

hot weather, fluids and weight loss

First of all, thank you Suzanne for the very nice comment yesterday...for those of you who did not read the comment, Suzanne was very complimentary about the daily blog and said that she could almost hear my Nuuu Yooork accent voice in her head saying the things I am writing...and that is EXACTLY what I want to do (minus the annoying accent), which is to get into my patients' heads daily with stuff to think about...because once again, if we stop thinking about issues, we go automatically back to old behaviors and the weight starts going back on.

It has been very hot outside and during the warm/hot months we tend to drink lots more fluids. Some fluids overtly are harmful to our weight loss efforts....non-diet coke, pepsi, beer, etc. As we ingest these drinks we know full well that they will impact on our weight loss efforts. However, have you seen the caloric count on a large glass of ornage juice??? Cranberry or other fruit juices??? VERY HIGH!!! Water, flavored waters such as Propel (grape is my favorite and they are now a corporate sponsor...laughing...teasing!!) Please get used to checking the nutritional labels on every drink that you take in other than plain water and if the caloric count is not 20 or below, switch to a different drink. At Starbucks or any other coffee place that sells the iced drinks, be careful of the calorie count...ask them what is the amount of calories that are in the drink you are ordering. Paying attention to these "small" details can really add up!

Sunday, April 26, 2009

One full year of blog entries

I noted that today is my 365th blog entry. A full year of writing my thoughts, my obeservations, and abstracts from our patients' experiences that may be helpful insights along the way of trying to lose weight. Recently, I have become quite militant in querying my patients as to whether they are reading this daily. When the answer comes us a "hummm, well, I try..." I cut them off and say..."you know...i am writing this pretty much every day (please excuse yesterdays travel day as a miss) so I expect my patients to read it every day!

Okay, before you go off thinking how full of himself Posner is that he expects his writings to be amazing, life-altering, revelation-provoking prose, let me just say this: One of the things I have learned from seeing thousands of patients atempting to lose weight, is the more they think about their challenging issues, the more successful they will be. As soon as we stop thinking about it, we will revert to old behavior patterns, and you and I know those are not good patterns for losing weight or keeping your weight off. To lose weight, one must think, plan, organize, face the challenges, etc. I am trying to use this blog to get into my patients' heads everyday...just giving them a thougth or two that may provoke them to think more about their strategy for controlling their caloric intake that day if not that week. When you are in your formal visit stage of our program we see you once a week, have a weigh-in, discuss that weeks challenges, etc. You feel accountable and you feel the support. When you leave the program visits, we want you to feel that same senastion of support and accountability. Between my blog and my staffs chat room with daily entries from Robin and Joanne,we are trying very hard to stay with you on this...even when you leave your visits. This is what separates ourt program from all the others out there...we are offering support systems that are part of what you already paid for....no memberships, additional fees, etc.

So, that explains why Posner jumps on you when he finds out you log on daily to the internet but do not take the 1 minute to read the blog and chat. These can be incredibly helpful for your long term weight control..make use of them please!!!! Please feel free to post comments, make recommendations for subjects etc. I/we would LOVE to hear from you. Now, on to my next 365 days!!!

Friday, April 24, 2009

recognition of the need for weight loss

Good morning again from Orlando....the lecture went very well yesterday...audience seemed to be connected and interested..from the podium I didn't see one person snoring.

After the talk, I spoke with a number of doctors attending the antiaging convention and I was particularly interested in a discussion I had with 2 nurse practitioners who own annd operate a wellness center in Louisiana. These very nice NPs told me that the state medical board very carefully scrutinizes any practice doing "weight loss" and in that state, NPs do not have the authority to write prescriptions for weight loss medications. Even in programs that do not use prescription anorectics, the state audits and monitors very carefully anyone advertising "weight loss" services. The situation is such that very few practitoners in that state want to get involved in a formal weight loss program because of fear of the state regulators sanctioning them.

When you read studies that show the most "unhealthy" states with the highest obesity rates, Louisiana is near the top. What would possibly be the motivation of the state government to frown upon medical professionals trying to actively intervene with the obesity epidemic? Something seems amiss here. The point however is that one of the reasons why America as a whole is losing the war on obesity is because of ineffective government involvement, and in the apparent case in Louisiana, even throwing roadblocks up. With the current Preisdent's emphasis on access to medical care for everyone, perhaps local, state and federal health agencies can start focusing on one of the major issues that will lead, if unchecked, to higher percentages of heart disease, diabetes, cancers etc ...and that issue is obesity.

Thursday, April 23, 2009

weight loss and looking younger

This morning I will speak to physicians who are attending the American Academy of Anti-aging Medicine meetings in Orlando. We noticed that this is the only "weight" discussion occurring the entire 4 days of seminars. Most of the talks are about aesthetic procedures..liopdissolve, injection therapy, natural hormones, etc. Once again, from an aesthetic standpoint, looking younger (significantly) almost always accompanies weight loss. I am thinking about so many of our patients who appear to drop years (even decades) when they finish their formal visits with us.

It is important to remember that you do not have to spend thousands and thousands of dollars trying to look younger. If you are overweight, making signifcant progress in reaching your goals will make you look so much younger. How many of you can really believe that I am 73 years old? (Laughing....okay....I really am turning 53 and trying desparately to look no older than 52)

Wednesday, April 22, 2009

weight and airports

Good morning from Orlando...The American Academy of Anti-Aging conference starts today and if I perchance find the fountain of youth I will drink lots from that fountain and will reward those of you reading this blog with some sips.

Yesterday at Dulles airport I saw a gentleman riding an escalator down a very large decline and then watched him proceed to climb up the very large amount of stairs from which level he had just come from. The journey seemed pointless but then I realized that he was actually exercising. I thought this was very cool. Rather than sit at the bar watching ESPN and downing a beer, sitting at the Sbarros and consuming a pizza or standing on line at the Haagen Daz ice cream place, he elected to wait for his plane by burning off calories rather than consuming them. He took an opportunity to convert "downtime" to caloric burn-off time with no need for gym clothes or exercise equipment.

Take a step back and analyze your trips to see if there are similar opportunities to take "downtime" and make use of it for helping your weight loss efforts.

Okay, I have not put a little contest in this blog for a bit so here goes: winner(s) will get a free bottle of our Serotonin multivitamin and your name will go into a drawing to win a Collector's Edition Serotonin-Plus "Just Lose It" exercise shirt. Here goes: (NO INTERNET HELP!!! YOU ARE ON THE HONOR SYSTEM!!!) The Three Stooges...Moe, Larry and Curley....name the LAST names of them all!!! Nuk, nuk nuk....(you people under 40 have no chance!!! laughing)

Send your answer to: srangbar@spdiet.com

Tuesday, April 21, 2009

weight loss and age

We have a number of people currently in our program who are way into their 60s and 70s. Their results for the most part have been astounding. This made me think of bringing this subject up: It is NEVER "too late" to embark on a weight loss objective. When most people progress into their 60s, the joints are starting to wear down some redulting in degenerative arthritis. Knee, back and hip pains are very common. Losing a substnatial amount of weight makes this situation much better and can delay, if not obviate, the need for knee replacements.

Psychologically, let's never forget that no matter what our age, self-esteem is an important issue. Losing weight makes a person feel better about being around others, and self-esteem improves. It is so much fun for us to see the changes in mood when someone achieves significant weight loss. The overall persona changes for the positive.

From a physical and psychological standpoint, weight loss is a great thing no matter what your age.

Monday, April 20, 2009

weight loss and support

Last week I saw a patient who told me her week was difficult because she traveled home and her family weas putting out lots of food sources that were not conducive with her dietary strategy and hardly any foods that were compatible. I asked her if she had told her family prior to coming out that she was on a weight loss effort and she said "no". I asked why, and her reply was something to this effect: "I didn't want them to know that I was trying to lose weight because if I am not successful, they will look down on me as a failure because I have tried so many times before..."

I tried to convince her otherwise, meaning that a family that loves their relative will want that person as healthy as possible. Supporting their weight loss efforts would be the most likely response. The point here is you should not be embarrassed, ashamed or otherwise in any way "clandestine" about your efforts. Be very forthright in telling your family an d friends that you are very exciteed about losing weight and you would love their help in this quest. When travling to other people's homes, if they know you are on a weight loss effort, I would bet they would have some healthier choices at the dinner table for you. Your friends and family could be a hge support for you and a great resource. Do not hide your efforts..tell them! They wil be happy for your choice and will do their best to help.

Sunday, April 19, 2009

Looking Younger

I am presenting at the American Academy of AntiAging Medicine meetings in Orlando at the end of this week. I am discussing how the 3:4 defense is better than the 4: 3 in NFL football. No, just seeing if you were paying attention. I am discussing weight control. The physicians attending this conference specialize in "anti-aging". For most people, this usually means the external changes that may occur...wrinkles, skin changes, hair changes etc. Clearly, internal aging means the development of atherosclerosis, degenerative joints and other maladies that seem to occur as we age. As I was reviewing my slides for the talk, it once again drove home the point that there is nothing that more powerfully "anti-ages" the internal organs than weight loss. So many disease processes that lessen our life span or produce morbidity are realted to weight issues. It is amazing to also see the external anti-aging that occurss with weight loss. Our patients look incredibly younger than when they started when significant weight loss occurs.

Saturday, April 18, 2009

weight problems and disease

This morning Ellen, Brian and Stephanie have raised money and are doing a walk in Montgomery County to support Multiple Sclerosis research. A great cause...I have a number of patients in my practice who have MS and the serious cases can be life devastating.

There is not a week that goes by that I do not see advertised some 5K or 10K run/walk to raise awareness/money for some very wonderful causes. Breast cancer, heart disease, diabetes, AIDS, etc. These disease processes can severely impact lives and finding new preventions/treatments can be an amazing positive impact on society.

I do not believe I have seen a walk/run that raises awareness/money for the obesity problem in America. Obesity, which leads to many of the diseases I listed above, is the major contributing cause to diabetes, heart disease, stroke, etc. Why are there no walks/telethons/money raising events that specifically name "obesity" as the cause? The reason: most people do not believe that obesity is a "disease", but rather an issue that is under someone's control. Hey, all the overweight person needs to do is "stop eating/gorging", right??? Why should there be fundraisers to benefit a cause that is clearly a personal issue? Well, my answer is this: Yes, obesity IS a disease and no, it is not a simple decision on a person's part to choose to be obese. There is not one obese person out there that wants to be this way. Whether it be environmental, chemical, familial or other contributions, someone is not making the choice to be obese. Further research would be increibly helfful to identify neurochemical alterations that could be made or psychological counseling techniques that would have a long-term effect on reducing weight.

Hmmm...after writing this, I have an idea. How about Serotonin-Plus sponsors a walk to bring recognition to Obesity being a disease? As part of the sponsorship, we would provide free weight loss programs to perhaps a number of people who could never be able to afford our program. I will discuss this idea with Melissa, Sonita, Jess, Kerri, Donna, Joann and the rest of the staff to get their imput. Check this blog for the date we will do this!!!

DON'T FORGET....PATIENT APPRECIATION DAY TODAY 10-2!!!!!!

Friday, April 17, 2009

weight loss....multidimensional approach

First, we have a GREAT weather weekend approaching, espeically Saturday so for those who like to do their exercise outside, you have a great opportunity.

Yesterday, the TV producer from WUSA (channel 9) interviewed me at the office and lots of the focus was on the serotonin supplement. I tried very hard to get the point across that a long term weight loss strategy needs to be multidimensional...yes, our serotonin supplement can help the process, but there is much more needed. Such things as planning meals and shopping for the food sources that you need to have available, incorporating exercise as part of the strategy, making a conscious decision to avoid alcohol and small repetitive food sources such as nuts, and other interventions. are all part of the weight loss process. I know that we would all love to have a "pill" that would make all of this planning and enactment of a strategy obsolete, but neither our serotonin pill or any other out there will substitute for the multidimensional approach needed for a long-term weight loss result. As I tell all of our patients coming into the program: The gaining of weight requires no thought or work behind it..do what the body tells you to do and do what is "fun". However, to lose weight requires lots of work and thought.

I want to thank Susan and Don for allowing the TV people to interview them. As I was watching them being filmed at the office, I was thinking about so many of you who have worked so hard at losing the weight and now look so much healthier and happier. I sometimes laugh when a PR person will ask me whether we have any "testimonials" for our program. We have thousands now and many have come in because of the kind referrals from our patients. It is incredibly fun for me to see my patients shedding weight, shedding medications they are taking and shedding negative self-perceptions. I want to thank you all for allowing the Serotonin-Plus staff and me the opportunity to be a part of your quest to be healthier and happier.

Thursday, April 16, 2009

TV Day!

Today WUSA, Channel 9, is coming to do a story about our weight loss program. In preparation for this, our public relations specialist, Rhonda, sat down with me yesterday and asked me some questions that could be asked by the reporter. One of the questions was :"Why do you think your weight loss program is better than others?"

My answer to this question required no preparation...Here is my answer: Our results are better than any commercial program out there. There are several reasons for this including the appetite reduction and carb craving curbing caused by the prescription medication and our patented serotonin supplement, our dietary plan based on "real food" as opposed to shakes, bars or prepackaged meals that other program use and probably most importantly, the support we provide our patients. When Jenny Craig sells you meals, and if you have a question or an issue, you do not have access to Jenny's cell number. As an internal medicine physician, my emergency line provides my cell phone number, so basically, if my patients ever have an urgent issue to discuss, they can call me directly. Our incredibly wonderful staff answers your phone calls and gets your issues answered quickly. We provide a daily blog, a chat room, access to a registered dietician and personal trainer...all included in the cost of your program.

We have essentially a 100% success rate and an incredible safety profile.

So, long answer to this question, but no preparation is needed to answer why I am so proud of our program and why we so greatly appreciate you coming to see us and also referring your friends/family. We are constantly thinking of ways to help support you even when you stop your formal visits becuase we know how difficult it is to maintain that weight loss you worked so hard to achieve.

Please check the blog to see when you can see the airing of the segment on WUSA.

Wednesday, April 15, 2009

weight control, brain chemicals and sleep

There are many chemicals involved in the brain and body that signal when hunger is present or the sensation of fullness ("satiety) occurs. Aside from serotonin, two of these important chemicals are leptins and ghrelins. Leptins are manufactured from fat cells and when levels are high, this signals the body that enough fat is present and therefore more eating is not required. Ghrelins are made in the stomach cells and conversely, high levels tell the body to keep feeding.

Studies have demonstrated that altered sleep patterns, particularly insomnia, alters the balance of these chemicals and this may explain why people who have difficulty sleeping often have difficultyu controlling their appetite at night.

There is research underway to try to figure safe ways to raise leptin levels which in turn, would make people feel less hungry.

Getting a good night's sleep is essential for many body functions, and this data is yet another reason why poor sleep patterns can adversely affect the body.

Tomorrow local CBS, WUSA, is coming out to film a segment about our program. One segment will be shot at Burke Lake Park with a bunch of us going over there for a midday walk. If you happen to have the day off tomorrow and would like to join us (this will be your chance to be discovered!!!!) PLEASE call us for details. We would love to see you there.

Tuesday, April 14, 2009

weight control and tax week

April 15 is almost here and perhaps this produces a certain anxiety/stress for a number of people who have to come up with some additional bucks to pay into the government. During particularly stressful weeks, I would strongly recommend that everyone that is in a weight losing mode take a step back and think through the concepts of eating and stress. Eating high-caloric food sources may give an immediate "feel-good" sensation, but that is followed by guilt and self-flagellation for "spoiling" your weight loss efforts. Ingesting some high-caloric food source of drinking alcohol will not change your 1040 tax form nor lessen the amount of money you may owe the government. And if you do owe the government money, remember that to replenish your savings, you will need to remain healthy in order to be able to go to work. Losing weight will allow you to be healthier and give you a much better chance of being more work-productive for longer periods of time. Consider weight lifting as an outlet for dissipating negative stress. Even at work, some type of hand squeezing device will allow you to tighten and relax your muscles. Going to that machine at work and getting some high-caloric source will not reduce your stress..it will only add to it.

Monday, April 13, 2009

weight loss and support

A very frequent question I get from a potential patient during a consultation about our program is this: "How many of your patients keep the weight off once they lose it?".

The answer to this is I cannot provide an exact percentage because many people when they leave our rpgram do not stay in touch with us to keep us up-to-date on their weight. I do know that weekly we have patients who return to us for help because they did put weight back on since they left our program.

As I tell everyone when they enter the program, it takes NO effort to gain weight...do what is fun and do what the body tells you to do, and almost everyone of us would gain weight. To lose weight requires planning, strategizing and going somewhat against human nature. We are naturally and instinctually "wired" to be a weight gaining specie. Least you doubt that, ask yourself whether a piece of cheesecake tastes better than a carrot stick or ask yourself whether you find yourself craving chocolates and carbs or craving broccoli.

To lose weight and keep the weight off requires a behavioral change and not just a "diet". There is no finish line to your efforts and this is a frustrating concept because quite frankly the act of losing weight is not "fun". Your reward is being healthier, perhaps getting off of some medications, looking yournger, having more energy, wearing more fashionable clothes etc. But these are not immediate gratification rewards and to an extent, we as humans look for immediate gratification...and eating a high-caloric food source is an immediate reward.

The Serotonin-Plus Weight Loss center offers a number of supportive tools to help you maintain that weight loss. One of these tools is what you are reading now...I am trying to use this blog to get into your head daily....if I can make you think about weight loss issues, you will be more apt to plan and strategize your efforts. When we stop thinking about it is when we get into trouble bcause we will find ourselves drifting back to old behavior patterns. Another tool is the fine and dedicated staff we have to answer your questions or concerns. Send us an e-mail or call and Robin, our Johns Hopkins trained registered dietician or Donna, oru excellent PA or me (the old doctor) will answer you. More tools will include a chat room that we are setting up at: www.spdiet.com. We are trying very hard to create a supportive community where you can exhange ideas, recipes, get guidance from Robin, etc. We also strongly encourage you to come to our clinic and use our scale. This doesnt cost you a penny, yet it may produce a psychological "accountability" that will help you stay focused.

Also, as I have mentioned numerous times before, record your weight once a week and if that weight ever goes up by more than 6 pounds from when you left out program, pick up the phone and call us. This would be a one time visit...not another 12 week program to help you refocus and retool. If you do this, there is no way than any of our patients could ever put back on 10, 20, 30 or even more pounds back on.

Sorry for the long blog this morning...just wanted you all to know that we are trying our best to ensure that all the effort, time and $$$ you put into your weight loss efforts will not somehow go to naught by losing focus. We are here for you in lots of ways!!!!

Sunday, April 12, 2009

weight loss and hereditary issues

In the Washington Post this week there was an article about "good fat" that when present, results in more thermogenesis...i.e. the burning of calories. Those animals with a higher % of this type of fat had better weight control. The article went on to suggest that researchers are working on ways of inducing this type of fat development in people via either an injection therapy protocol or perhaps an oral pill.

I am not certain that this will result in a major impact in weight control in the near future but it does point out the genetic nature of so many issues, including weight control. "Metabolism" seems to be somewhat inherited as I am sure you know of people who can ingest 2X the amount of food you do, yet they have no weight issues at all. Most certainly, genetics do play a role in weight control, so it is not just the environmental issues, but also internal chemical issues. This is frustrating for many people because it just doesnt seem "fair" that some have to work so much harder at controlling weight than others. However, there is LOTS of room to go on the environmental side, so even if you feel that the genetic cards are somewhat stacked against you in your weight loss efforts, you can still most certainly intervene aggressively on the dietary intake part of this.

Saturday, April 11, 2009

weight loss and supplements

I was again perusing the Saturday morning tv shows and lots of "infomercials are present.  Very compelling stories about "easy" ways to lose weight!   Just take this pill, or use this machine 5 minutes a day, and you will have all the weight loss you desire!   To quote PT Barnum "there is a sucker born every minute".   Do NOT be one of those "suckers".  There is no such thing as a pill or machine that passively causes weight loss.  Planning, counting portions, and executing a strategy to reduce caloric intake is what is needed.

I want to thank my VERY wonderful staff for organizing, arranging and being there on Saturdays for our patient appreciation month.   I am VERY proud of my staff for the energy, dedication and planning they bring to the office.  They may be very young (me excluded of course!) but they are years advanced in their skillsets to help us become the very very best weight loss resource any patient could ever ask for.

Friday, April 10, 2009

a very sad patient story

This entry today is more about about a medical patient but it certainly relates to the need for weight loss in those whose health is jeopardized by their weight.

Last nite I made a housecall on a very unfortunate woman, age 57, who 5 years ago had a severe stroke leaving her basically bedridden, unable to communicate at all, no real response to verbal stimuli, inability to eat or drink and reliant on tube feedings and a tracheostomy with a ventilator for air. The family is VERY close, and one of her sons, who is in his 20's, took over daily responsibility for his mother's care., allowing his father and sister to work. The son gave up his work and is at his mother's side the entire day. She has made no progress in 5 years and her neurologists feel that there is a zero% chance of any "meaningful" life.

I have been seeing the woman at her home for about 5 years, treating minor issues that arise, such as a respiratory infection, skin infection etc. The son provides a level of care MUCH better than any hospital or nursing facility would. The only reason she has not died as yet is because of the son's amazing attention to detail.

There was no living will present, and last nite I was called because the family was deciding whether to call Hospice in and perhaps think of withdrawing some of the support such as tube feedings. As a physician, I try to be cognizant of the entire family situation, realizing that it is not just the ill person who is involved, but how this affedcts the entire family. Clearly, in this case, not only is the mother bedridden, but because of the 24/7 attention the son provides, he is basically houseridden. The "quality of life" issue for everyone in the household is an issue in my opinion. At the end of our discussions, the son felt that he would feel too guilty agreeing to withdraw life support.

Purpose of this story for your thoughts: 1-If you do not have a living will now, PLEASE get this done ASAP. Do not leave it to your children or spouse to make decisions for you..the guilt may be too much. I know how I would feel...and that is I would NEVER want my love ones to have to attend to my medical needs if I had no chance of improving to become a functional human being again. If you feel the same, put it in writing. 2- (And this is the relevance to weight loss issues) Sometimes people do things like smoke cigarettes, allow themselves to remain morbidly obese and their attitude is : "Well, if my time comes and I die, so be it..I have lived a good life..." Well, sometimes the "time comes" in a very prolonged and painful way. Whether it be the smoker with COPD who gasps for breath every second of every day or the obese person with diabetes who has a stroke paralyzing them or haveing amputations because of vascular disease, sometimes the sequelae of your decisions can be prolonged and not immediate. Take pause to think about how life would change for you if something like a stoke occurred and you were bedridden for years. Isn't it better to make the choice right now of becoming healthier?

Really sorry for the pretty depressing entry this morning, but my housecall last nite gave me motivation to write this stuff today....but now, to a MUCH better and cheery reminder: PATIENT APPRECIATION DAY TOMORROW, SATURDAY 10AM-2PM.....WE APPRECIATE YOU AND WANT TO SHOW YOU!!!!! FREE STUFF!!!!!! BRING FRIENDS!!!!

Thursday, April 9, 2009

weight loss and social sensitivities

When discussing the very "positives" of weight loss, as an internal medicine physician, I immediately focus on thehealth benefits: lessening the chances of diabetes, heart attacks, strokes, cancers, arthritis imporvement, sleep apnea resolution, etc. Of course, the aesthetic implications...looking younger, healthier and more fit are positives as well.

Yesterday I saw a patient who brought up an issue, that I think females can relate to much more than males. The patient told me that receiving invitations to social events..weddings, retirement parties, etc. was incredibly intimidating because immediately, she would think "What am I going to wear and how will I look in front of others?" I doubt very many males think of these issues when they are carrying more weight than they want to. However, whether it be a societal issue, hormonal, familial or other, women are under/feel much more pressure in this world to "look good". This results in anxiety for many when they feel they are under a sort of scrutiny. And admit it ladies, guys do not go to events checking out what other guys are wearing or the shoes they are walking around in. Perhaps this is the reason that we have about 4 times as many females entering our program as males. Both sexes understand and feel the medical need to lose the weight equally, but females feel much more pressure to "look better". Not fair at all in the least. I am very interested in your feedback on this topic...please feel free to post your thoughts.

Wednesday, April 8, 2009

weight loss and support

There is no question that the success in achieving weight loss is helped dramatically by support along the way. Clearly, when you are coming in for your visits, we try very hard to be a major support system for you. We are striving to find ways of providing support when your formal visits end. Toward that goal, we are developing a "chat room" for our website...this should be "live" in a few weeks. We encourage you to check our website: www.spdiet.com and when the chat room becomes active, please feel free to participate in such things as posting recipes for meals that lack boredom, yet comply with your dietary goals, discussing challenges, such as business travel and how to successfully navigate around the treacherous times, etc. Also, please remember that we have brought on board Robin Haaland, a Johns Hopkins trained Registered Dietician who is available for your queries. Robin will be monitoring the chat room and answer questions.

Also, please remember our PATIENT APPRECIATION DAYS ...SATURDAYS....at the office...10AM-2PM.

Tuesday, April 7, 2009

weight loss and the weekends

I had a patient yesterday who has been incredibly successful in the program tell me there is a reason why she always comes in on a Monday. Historically, she said that even before the program, she would do a pretty good job during the week of watching her caloric intake, but on the weekends, she would go to restaurants, attend social functions, etc and this is were most of the "damage" was being done. When she started the program, rather than weigh-in on a Friday, see good results, and then feel psychologically she could "enjoy" the weekend (enjoy meaning partake of the food choices she normally would have before the program) she decided to have her appointment on a Monday. This would ensure that over the weekend, she would think about Monday and make better choices.

Yes, for most of us, including me, the weekends mean "let loose a bit"..that can mean anything from sleeping later to enjoying our leisure hobbies to eating more food. Obviously, sleeping later, playing golf, walking the dog longer etc does not hinder weight loss efforts. However, going to the restaurant, having the cocktails, eating a dessert etc will derail our efforts.

Figure out a way that you can make yourself accountable for your weekend eating behaviors. When you weigh yourself at home, do this on a Monday as opposed to Friday. Reward yourself (non-calorically) if you see on a Monday that your weight is no greater (or even less) than it was before the weekend. Do not let old behavior patterns on the weekends hinder your progress to become healthier and happier.

Monday, April 6, 2009

weight loss and the holidays

Good Monday Morning.....

Easter and Passover are coming up real soon and we are all planning our family gatherings. Traditionally, the dinner table will contain food bountiful enough to feed 2-3 times the amount of people around the table. Side dishes, desserts, etc. will abound.

If you are actually planning/cooking the meal, and/or if you are in a weight losing mode, keep in mind that the love of family gatherings can be separated from the absolute requirement to eat lots of food that will derail your weight loss goals. This is a very important step for long term weight loss, and that is learning to separate the event itself from the foods that accompany that event. Being with your family and loved ones, sharing stories, discussing life's events, etc. causes no weight gain. Having a dessert when you have no hunger at at will cause weight gain.

I am not suggesting that we all give up everything that we would consider really fun food choices during the holidays: I am recommending that you take a step back and think about it, perhaps allow yourself "tastes" of some of the very high-caloric sources, and do NOT allow yourself to eat if you are not hungry.

REMEMBER: APRIL MEANS PATIENT APPRECIATION MONTH AT OUR OFFICE. EVERY SATURDAY IN APRIL WILL HAVE FUN EVENTS AND GUEST APPEARANCES. COME THIS SATURDAY!!!!!!! 11-2:30

Sunday, April 5, 2009

weight loss and cookouts

The weather is supposed to be gorgeous today...traditionally, lots of people fire up the outdoor gas grill and cook their dinners outside on beautiful Sundays. When we think "cookout" we almost automatically envision hamburgers, hot dogs, potato salad, beer, etc.

When in a weight loss mode, cookouts are perfectly conducive with your plans...but the emphasis should be on the high-protein alternatives...chicken, a low fat steak such as filet, shrimp, lean chopped meat....and grill those vegetables.

The hamburger/hot dog buns, the beer, the chips...obviously, these are the food sources used in barbeques that will derail our weight loss efforts.

When you plan your cookout, remind yourself of the need for high-protein/low carb choices and you most certainly can plan a very fun barbeque with some great food...and at the same time continue in your efforts to be healtheir and happier.

Saturday, April 4, 2009

weight and dinner selections

REMINDER!!!!! PATIENT APPRECIATION TODAY AT 1230!!!!!
I was out to dinner last evening at Spartans, a very good family restaurant in Burke. The food is good, the prices are excellent and the portions are bountiful. For these reasons, the restaurant always seems crowded. Sometimes I feel sort of bad going there because I always bump into patients and I think when a patient sees his/her physician, they start feeling guiltuy of what may be in front of them on the plate. Of course, I NEVER stop by for more than a few seconds to say "hi" and I purposefully never look at their plate and most certainly would NEVER make a comment such as :"Hey...you have high cholesterol..why are you having that chocolate dessert???"

Last night though I did have an observation. As I was walking to my table and when I was exited, it seemed that the very overweight patrons of the restaurant had one thing is common: they all had a pasta dish in front of them...lasagna, spaghetti, manicotti, etc.

Obviously, carbohydrates hinder weight loss goals, but certain carbs will be more detrimental than others. A slice of wheat bread is a carb. So is the spaghetti. The point here is that for the longterm, staying on Phase 1 (no carbs) is not practical, and carbs do need to be reintroduced. But if you are in a weight losing mode, try to watch the types of carbs you have coming in, and avoid any pasta as part of your plan.

Friday, April 3, 2009

Serotonin and Mood

Serotonin imbalance is certainly involved with carbohydrate cravings and the feelings of satiety, but also mood disorders are linked to serotonin imbalance. Depression, anxiety, bipolar disorder, panic attacks, obsessive-compulsive disorder and seasonal affective disorder are all linked to serotonin imbalance.

How does one know if he/she has a serotonin imbalance? Unlike peripheral chemicals like thyroid hormones, you cannot draw a blood test and get a meaningful measure of serotonin. This chemical is present in minute concentrations in the brain and the most subtle imbalances may lead to devastating clinical mood disorders.

If you or a loved one seems to have any symptoms that suggest a neurochemical imbalance, aggressive evaluation is strongly recommended.

Thursday, April 2, 2009

Patient Appreciation Month

Exciting Saturdays in April, starting this Saturday!!!! We are having Patient Appreciation Days....lots of really FUN and FREE stuff such as massages, accupuncture and lots of greats gifts and surprises!!! PLEASE come on out to the office Saturday from 1230 till 2 PM....Bring a friend!!!

weight loss and sensitivity

Yesterday I had a family member ask whether he could join up with the weight loss program. I, of course, am thrilled to help him become healthier and happier.

It is often difficult to approach friends or family about their weight issues. Obviously, anyone who is overweight knows they are overweight...do they really need you to come up to them and say: "Hey...you should lose weight"!? I would dare say that 99.9% of overweight people want to lose weight but there is a great deal of embarrassment and senstivity about approaching this with friends and family.

You risk hurting the person's feelings by trying to discuss the weight issue. It becomes much easier if the person doing the approaching brings it up like this: "Hey...I really want to do something about my weight, and it most definitely helps if people partner with each other for support..interested?" However, if the person doing the approaching does not have a weight issue, then a supportive line such as: "I know this is a sensitive issue, but I love you and feel that I am letting you down if i do not bring this up, but I am concerned that your health may be in jeopardy because of your weight....can i help you at all?"

Think of it: if there are people in your world...family or close friends who are obese and NOT doing something about their weight, are you being negligent in NOT bringing this topic up? If you really loved the person, why would you not try to get involved. If you saw the person about ready to get hit by a car, would you not shout for them to get out of the way?

Yes, it is sensitive and yes it is difficult, but if there are people in your circle who you care lots about and want to help them delay early heart disease, diabetes, stroke, etc, you shoud offer your support and help.

Wednesday, April 1, 2009

weight loss and vacation

Spring is here and I am sure most of you are formulating your vacation plans for the summer. When you are in a weight losing mode, vacations may throw a bit of a roadblock into your progress. When most of us think "vacation", we picture tall Pina Coladas on the beach, great desserts, fun restaurants etc. Often, people can put on 4 or mor epounds in one week.

Some vacations are more conducive to actually help your weight loss efforts Let me provide some examples of vacations that will "help" and those that won't:

All inclusive resort in Jamaica: WILL NOT help...why??? all inclusive means all the food and booze you can ingest, and price remains the same...human nature? we will not feel that we got our money's worth if we do not eat and drink alot.

European Trip with sight-seeing: WILL help....why??? lots of walkign to activities and the trip is focused on the sightseeing as opposed to sitting lots and eating/drinking

Cruise ship to the Carribean: WILL NOT help...why??? see above for the all-inclusive resort trip...once again..pay one price whether you eat lots or eat little..human nature will take over

Spa resort in Arizona: WILL help....spas are focused on massages, treatments, working out, etc....lots of healthier food choice restaurants there

These are some examples...make your own list and as you plan your vacation, choose the type that will not damage your weight loss efforts..you are working way too hard on your weight loss to backslide lots in one week.