Every day presents challenges, some unique and some common , to your weight loss efforts. Whether it be a business trip which places you at airports, lunch meetings where food is provided by the company, a child's baseball game that doesn't end until 8pm; the list goes on and on with roadblocks and obstacles that get in the way of being able to focus on your weight loss efforts.
When you are in a weight losing mode, planning, eating meals on time, being able to select high-protein/low carb food choices are all integral components for success. These life events as mentioned above, and hundreds of more, make the planning more difficult.
You have a choice: learn to navigate around these obstacles or cave in and use them as excuses. For the long term success of losing weight and keeping it off, you must learn how to control the environment and not have the environment control you.
Tuesday, June 30, 2009
Monday, June 29, 2009
weight loss and culture
Although different cultures have many differences, when it comes time for family celebrations, one thing is quite common: family members getting together being fed high-caloric food sources. I grew up in a Jewish family, and to this day, I remember Bubbie Sadie filling my plate with knishes (free bottle of multivitamins for anyone , without googling, can tell me what a "knish" is....sorry Jewish patients, you are exempted from this trivia contest), matzoh balls, and sundry other high-caloric items. My Italian patients describe bountiful feasts of mostly pasta containing dishes. My latina patients tell me about rice accompanying almost every family gathering. My African American patients relate stories of family gatherings including many fried foods and potatos. Once again, irrespective of the culture/religion, the commonality os being fed lots of food, mostly NOT consistent with "healthy" eating patterns.
Keeoing cultural and family traditions intact is often what gives us perspective and a sense of belonging. However, changing some of the eating traditions will go a long way in ensuring that our children and our grandchildren will live longer and healthier lives.
Keeoing cultural and family traditions intact is often what gives us perspective and a sense of belonging. However, changing some of the eating traditions will go a long way in ensuring that our children and our grandchildren will live longer and healthier lives.
Sunday, June 28, 2009
Reward systems
Thanks for the comment Suzanne yesterday about the concept of rewarding grandchildren with food itmes other than the "usual" high-caloric sources such as cookies.
No matter what the age, I believe we all reward ourselves at times with high-caloric food sources. Why? Well, first of all, they taste good, they are readily available and they are relatively inexpensive. Non-caloric rewards, such as treating yourself to a massage, going on a vacation, buying a new clothes item...all of these are rewards but they are delayed in their gratification and they are costly. We, as humans, do tend to be an immediate gratification specie. Least you doubt that, read an article about the savings rate in America. It is abysmally low, and the reason is that once again, buying a wide screen television or a new car is an immeidate gratification as opposed to socking money away in a retirement account.
It does start by rewarding our children and grandchildren with things other than cookies and candies. Teaching them at an early age that rewards do not have to be in the form of high-caloric food items may shape their minds futuristically to not reward themselves in that manner.
No matter what the age, I believe we all reward ourselves at times with high-caloric food sources. Why? Well, first of all, they taste good, they are readily available and they are relatively inexpensive. Non-caloric rewards, such as treating yourself to a massage, going on a vacation, buying a new clothes item...all of these are rewards but they are delayed in their gratification and they are costly. We, as humans, do tend to be an immediate gratification specie. Least you doubt that, read an article about the savings rate in America. It is abysmally low, and the reason is that once again, buying a wide screen television or a new car is an immeidate gratification as opposed to socking money away in a retirement account.
It does start by rewarding our children and grandchildren with things other than cookies and candies. Teaching them at an early age that rewards do not have to be in the form of high-caloric food items may shape their minds futuristically to not reward themselves in that manner.
Saturday, June 27, 2009
weight loss and realistic goals
I have covered this topic before but this week I had several new patients enter our program who set their weight loss goals at too stringent a number.
We must differentiate a weight loss goals that could be achieved vs. a goal that is maintainable. For instance, if you were a Hollywood star, preparing for a role in a movie, and that role required you be at your old high school weight, there is a good chance that you can get yourself down to that weight for purposes of the acting role. However, to maintain that weight forever would be near-impossible.
This week, I had several patients set their goal at their old high school weight and I informed them that this would not be a maintable weight for them. Obviously, metabolism changes and what was easy to maintain (easy? you didn't even have to think about it at that age!) becomes very difficult to maintain at a later age. Aesthetically, it also will not look great to be at that weight, as most people would now look unhealthy at their high school weight. Persoanlly, I was 155 pounds when I graduated. If I was that weight now, my patients would think I had developed some really bad disease.
Set your goals realistically based on age and other factors. That goal needs to be one that is "maintainable".
We must differentiate a weight loss goals that could be achieved vs. a goal that is maintainable. For instance, if you were a Hollywood star, preparing for a role in a movie, and that role required you be at your old high school weight, there is a good chance that you can get yourself down to that weight for purposes of the acting role. However, to maintain that weight forever would be near-impossible.
This week, I had several patients set their goal at their old high school weight and I informed them that this would not be a maintable weight for them. Obviously, metabolism changes and what was easy to maintain (easy? you didn't even have to think about it at that age!) becomes very difficult to maintain at a later age. Aesthetically, it also will not look great to be at that weight, as most people would now look unhealthy at their high school weight. Persoanlly, I was 155 pounds when I graduated. If I was that weight now, my patients would think I had developed some really bad disease.
Set your goals realistically based on age and other factors. That goal needs to be one that is "maintainable".
Friday, June 26, 2009
weight loss and snacks
Most people do not have diffuculty sticking to"healthier" snacks during the morning and afternoon. Vegetables, 90 calorie yogurts, sugar free ice pops, a low-calorie protein bar, shaved turkey, low fat cheese, etc. However, the after-dinner snacks are more challenging because we have been so conditioned to start reaching for the ice cream, cookies, etc. There is someting about sitting at the tv set watching your favorite show or ballgame and akmost reflex-like, seeking a "comfort" food.
Try to time your dinner such that there is not too many hours between your dinner and sleep..preferably no more than 4. Also, consciously avoid those snacks that were part of your past that led to the weight problem to beging with. Do not have them around the house because there is less chance of getting dressed, going into the car and driving to a 7/11 than if that ice cream was in your freezer. These old, damaging "snacks" will call out to you by your first name if they are there!
Try to time your dinner such that there is not too many hours between your dinner and sleep..preferably no more than 4. Also, consciously avoid those snacks that were part of your past that led to the weight problem to beging with. Do not have them around the house because there is less chance of getting dressed, going into the car and driving to a 7/11 than if that ice cream was in your freezer. These old, damaging "snacks" will call out to you by your first name if they are there!
Thursday, June 25, 2009
weight loss and accountability
Often I am asked what part of our program is "most" important. Phentermine certainly reduces appetite...we know that alone, studies on phentermine show about a 1.2 pound weight loss per work, yet our program produces an average of 2.5 pounds, so is the Serotonin-Plus the key? Or, is it the need to come in for weekly visits for accountability?
The answer, I believe is that ALL aspects of the program are important, and most definitely, having to come in for weekly visits, getting on the scale in front of our medical person, and discussing the issues of the week is a vital aspect of our program or any program.
How can we help you develop a "self-accountability" behavior pattern that allows you, when you leave the formal program visits, to maintain this sense of accountability? Certainly, first and foremost is requiring yourself to write down your weight once a week on a sheet that allows you to see the weight measurement for every week before. Perhaps developing a "reward" system (or punative if you respond to that better) based on your weight loss efforts..example: when you reach certain goals, you allow yourself to get a massage, a piece of jewelry or some other reward that you will not indulge yourself with until you reach that goal.
Does paying money for weight loss results make us more motivated? Meaning, when you come here and spend lots of hard earned money, do you mentally feel more drive to not waste the money and therfore get results?
Self-accountability is the key for maintaining your weight loss. Feel free to come in and use our scale once a week after your visits are finished. Perhaps that will provide a sense of accoountability without spending any more money!
The answer, I believe is that ALL aspects of the program are important, and most definitely, having to come in for weekly visits, getting on the scale in front of our medical person, and discussing the issues of the week is a vital aspect of our program or any program.
How can we help you develop a "self-accountability" behavior pattern that allows you, when you leave the formal program visits, to maintain this sense of accountability? Certainly, first and foremost is requiring yourself to write down your weight once a week on a sheet that allows you to see the weight measurement for every week before. Perhaps developing a "reward" system (or punative if you respond to that better) based on your weight loss efforts..example: when you reach certain goals, you allow yourself to get a massage, a piece of jewelry or some other reward that you will not indulge yourself with until you reach that goal.
Does paying money for weight loss results make us more motivated? Meaning, when you come here and spend lots of hard earned money, do you mentally feel more drive to not waste the money and therfore get results?
Self-accountability is the key for maintaining your weight loss. Feel free to come in and use our scale once a week after your visits are finished. Perhaps that will provide a sense of accoountability without spending any more money!
Wednesday, June 24, 2009
weight loss and food makers..a cospiracy?
http://www.nytimes.com/2009/06/23/health/23well.html
My son, Brian forwarded me the above article in the NY Times which discusses a book written by the ex-FDA head.
The book focuses on the admixture of sugar, salt and other ingredients that food makers purposefully put into high-caloric foods to get the consumer to obssess about the food source and crave it. Supposedly, cookie makers, certain restaurants and other groups in the food industry specifically blend their ingredients in ways that make us insatiable for their products. They are trying to tap into our brain chemistries to "force us" to eat their foods.
I do believe that there is a complex interplay of brain chemistries and eating issues. However, I am not certain there is a complete understanding on the Oreo's manufacturer that the exact amount of middle cream filling depletes serotonin at the 2-C receptor sites, thereby causing increased cravings.
Clearly, there is a difference amongst individuals between their cravings, level of satiety etc. Some of this has to do with brain chemistries, peripheral stomach receptor issues and learned behavior patterns. However, it is a stretch to think that food manufacturers tap into our brain chemistries in a purposeful manner. I do think they hire taste-testers that say."Yep, that tastes better than the other one!"
My son, Brian forwarded me the above article in the NY Times which discusses a book written by the ex-FDA head.
The book focuses on the admixture of sugar, salt and other ingredients that food makers purposefully put into high-caloric foods to get the consumer to obssess about the food source and crave it. Supposedly, cookie makers, certain restaurants and other groups in the food industry specifically blend their ingredients in ways that make us insatiable for their products. They are trying to tap into our brain chemistries to "force us" to eat their foods.
I do believe that there is a complex interplay of brain chemistries and eating issues. However, I am not certain there is a complete understanding on the Oreo's manufacturer that the exact amount of middle cream filling depletes serotonin at the 2-C receptor sites, thereby causing increased cravings.
Clearly, there is a difference amongst individuals between their cravings, level of satiety etc. Some of this has to do with brain chemistries, peripheral stomach receptor issues and learned behavior patterns. However, it is a stretch to think that food manufacturers tap into our brain chemistries in a purposeful manner. I do think they hire taste-testers that say."Yep, that tastes better than the other one!"
Tuesday, June 23, 2009
do you know your heart rate?
First, I am sorry about missing a posting yesterday. I returned late on a flight from the weekend and work was really busy yesterday (what a whining doctor with excuses !!!)
Do you know what your heart rate is? In a resting mode, the slower the heart rate, the better the cardiovascular conditioning in most cases. Similarly, when you exercise, the longer it takes to get the heart rate up, the better the CV conditiioning (that of course does not inclde people on beta blockers).
Walking is certainly an activity that can get the heart rate up, but to get a good caloric burnoff going, you need to get the rate up to 80% or more of maximum heart rtate for age (220-age). If you find that your heart rate is only 80-90 when you are walking, I would advise more brisk walking or interbval training (walk, jog, walk, jog) and that will get the heart rate up.
Please consider a heart rate monitor to find out what your rate is doing at rest and with exercise.
You will find that the more weight you lose, the less your resting heart rate and thye longer it takes for the heart rate to go up during exercise. These are excellent signs of improved cariovascular conditioning.
PLEASE utilize our FREE training resources in the office by calling and setting up an appointment to meet with Joanne.
Do you know what your heart rate is? In a resting mode, the slower the heart rate, the better the cardiovascular conditioning in most cases. Similarly, when you exercise, the longer it takes to get the heart rate up, the better the CV conditiioning (that of course does not inclde people on beta blockers).
Walking is certainly an activity that can get the heart rate up, but to get a good caloric burnoff going, you need to get the rate up to 80% or more of maximum heart rtate for age (220-age). If you find that your heart rate is only 80-90 when you are walking, I would advise more brisk walking or interbval training (walk, jog, walk, jog) and that will get the heart rate up.
Please consider a heart rate monitor to find out what your rate is doing at rest and with exercise.
You will find that the more weight you lose, the less your resting heart rate and thye longer it takes for the heart rate to go up during exercise. These are excellent signs of improved cariovascular conditioning.
PLEASE utilize our FREE training resources in the office by calling and setting up an appointment to meet with Joanne.
Sunday, June 21, 2009
weight loss and fast foods
Yesterday, with interest, I saw a new Subway commercial which showed numberous obese people, purportedly eating burgers, having maladies strike because of their weight. Supposed to be comical in nature, the commercial showed these overweight people falling through boardwalks, breaking chairs, etc. The commercial went on to explain that these people should be eating Subway sandwiches instead of the burgers and this would solve their weight problem.
First, it is pretty insulting to depict overweight people suffering embarrassing events because of their weight. Second, this is the same chain that tries to upsell you to a bag of chips and cookies by offering a "value" meal.
The Jarod from Subway campaign exponentially grew this company's business by inferring that there would be a good chance of losing lots of weight by eating at Subway. I am not sure this is the "usual" outcome, as everytime I have ventured into a Subway, most of the people eating there are overweight.
There is no easy way around weight loss, most certainly not being made to think that by eating at a sandwich shop offering value meals of chips and chocolate chip cookies, that weight loss will be a natural outcome. And shame on Subway for making fun of overweight people.
First, it is pretty insulting to depict overweight people suffering embarrassing events because of their weight. Second, this is the same chain that tries to upsell you to a bag of chips and cookies by offering a "value" meal.
The Jarod from Subway campaign exponentially grew this company's business by inferring that there would be a good chance of losing lots of weight by eating at Subway. I am not sure this is the "usual" outcome, as everytime I have ventured into a Subway, most of the people eating there are overweight.
There is no easy way around weight loss, most certainly not being made to think that by eating at a sandwich shop offering value meals of chips and chocolate chip cookies, that weight loss will be a natural outcome. And shame on Subway for making fun of overweight people.
Saturday, June 20, 2009
weight issues in America
I was reading Suzanne's comments from yesterday concerning the approach to weight loss 20 years ago and commercial weight loss programs such as the Diet Center.
One of the programs that has withstood the test of time is Weight Watchers. The reason why I believe they have been around so long is that the plan is not some "fad" diet plan and there is not this "sell, sell, sell!" mentality instilled in the staff.
Any plan that will have a chance of long-term success must utilize "real" food...not the prepackaged meals or liquid diets.
We have much more knowledge now than 20 years ago about the association of weight problems with medical problems...we have always known abou the diabetes, heart disease, arthritis but, sleep apnea, restless leg syndrome, certain cancers such as pancreatic and breast, are linked to obesity. So if we know more now about this, then why are weight problems more preevalent now than 20 years ago?
Any comprehensive healthcare reform in the US MUST include some strategy about reducing weight problems in America. Reducing obesity, especially childhood oobesity will tremendously lessen expenditures on medical problems. It is MUCH less costly to prevent a heart attack than to treat one.
One of the programs that has withstood the test of time is Weight Watchers. The reason why I believe they have been around so long is that the plan is not some "fad" diet plan and there is not this "sell, sell, sell!" mentality instilled in the staff.
Any plan that will have a chance of long-term success must utilize "real" food...not the prepackaged meals or liquid diets.
We have much more knowledge now than 20 years ago about the association of weight problems with medical problems...we have always known abou the diabetes, heart disease, arthritis but, sleep apnea, restless leg syndrome, certain cancers such as pancreatic and breast, are linked to obesity. So if we know more now about this, then why are weight problems more preevalent now than 20 years ago?
Any comprehensive healthcare reform in the US MUST include some strategy about reducing weight problems in America. Reducing obesity, especially childhood oobesity will tremendously lessen expenditures on medical problems. It is MUCH less costly to prevent a heart attack than to treat one.
Friday, June 19, 2009
weight loss and business
Yesterday we had a chance to have a discussion with someone very initmate in his knowledge of the rise and fall of some major weight loss organizations that provided commercial weight loss programs to consumers. These companies were/are multimillion dollar companies whose advertisements you have all seen. These companies have had in common, a meteorical type of rise and then a major fall. The reason? Initially it was all about the consumer and at the end, it became all about the business. How many products can you upsell? What is each person spending in the business? How can you bonus your workers based on them selling the people more products?
I am a huge believer in studying history because you can learn lots about mistakes to be avoided. Serotonin-Plus started as a very small part of my internal medicine practice and now, although we are not close to being a huge company, our volume of business is growing and we are expanding out to other physicians.
On a daily basis, we still strive to keep adding more and more value to our program so we NEVER forget our priorities and "A"- Number 1 priority is to help you lose weight safely and effectively. The very experienced expert remarked yesterday that as soon as these large commercial companies lost site of that mission, it spelled the beginning of the end for them.
We now offer FREE personal training sessions, FREE consultation with our inhouse nutritionist, and soon, we will be offering FREE body composition analysis with a state of the art body fat/lean muscle mass body analyzer. Soon, there will be FREE group meetings to further help in your support.
PLEASE let us know what else we may be able to do to improve our program further. We never forget that YOU are the reason we are the largest and fastest growing weight loss program in the nation's capital and our support for your weight loss efforts will continue to enhance. Thanks for being our patient! And you know, that is truly the difference between a medially supervised weight loss program such as ours and a commercial program which sells you products...we bond with you as a "patient" ...not as a "client". This relationship is much more vested in its nature!
I am a huge believer in studying history because you can learn lots about mistakes to be avoided. Serotonin-Plus started as a very small part of my internal medicine practice and now, although we are not close to being a huge company, our volume of business is growing and we are expanding out to other physicians.
On a daily basis, we still strive to keep adding more and more value to our program so we NEVER forget our priorities and "A"- Number 1 priority is to help you lose weight safely and effectively. The very experienced expert remarked yesterday that as soon as these large commercial companies lost site of that mission, it spelled the beginning of the end for them.
We now offer FREE personal training sessions, FREE consultation with our inhouse nutritionist, and soon, we will be offering FREE body composition analysis with a state of the art body fat/lean muscle mass body analyzer. Soon, there will be FREE group meetings to further help in your support.
PLEASE let us know what else we may be able to do to improve our program further. We never forget that YOU are the reason we are the largest and fastest growing weight loss program in the nation's capital and our support for your weight loss efforts will continue to enhance. Thanks for being our patient! And you know, that is truly the difference between a medially supervised weight loss program such as ours and a commercial program which sells you products...we bond with you as a "patient" ...not as a "client". This relationship is much more vested in its nature!
Thursday, June 18, 2009
weight loss and groups
First, thanks Mary for reporting in and I am glad you are following this daily! Hope it helps your efforts!
Many people, when they embark on a weight loss effort would rather not tell anyone else, least if little-no success is achieved, then there is less embarrassment about being seen as a "failure".
I try very hard to have my patients be very upfront with everyone about their weight lossefforts, as often, your family and friends, once they know this, will be more apt to bea help as opposed to a saboteur. If your family knows you are trying to lose weight, they will be encouraging, and perhaps select restaurants and offer food choices at their houses that would be supportive of your efforts. Also, witht he overweight rate in the US being 67%, I would bet there are some other family members and friends who need to lose weight , and your mission will inspire them to also move forward to become healthier.
Weight Watchers and other organizations offer group meetings for support. Some people thrive on this and others find it abhorrent to be with other people in a group. My daughter, Kymberly, is currently a graduate student at George Mason in a counseling program. Her undergraduate degree is in criminal justice. Not that eating an Oreo is a criminal act, but Kymberly has excelled at facilitating group meetings, and we are going to offer some group meetings in the near future. More details will follow both here and at the office.
Your friends, family and certainly your family here at Serotonin-Plus can be a great support system for you during your efforts. If your goal was to gain weight (some actors/actresses need to do this for movie roles) no support is needed at all..do what is fun and do what the body tells you to do. However, to lose weight, lots of support is needed.
Many people, when they embark on a weight loss effort would rather not tell anyone else, least if little-no success is achieved, then there is less embarrassment about being seen as a "failure".
I try very hard to have my patients be very upfront with everyone about their weight lossefforts, as often, your family and friends, once they know this, will be more apt to bea help as opposed to a saboteur. If your family knows you are trying to lose weight, they will be encouraging, and perhaps select restaurants and offer food choices at their houses that would be supportive of your efforts. Also, witht he overweight rate in the US being 67%, I would bet there are some other family members and friends who need to lose weight , and your mission will inspire them to also move forward to become healthier.
Weight Watchers and other organizations offer group meetings for support. Some people thrive on this and others find it abhorrent to be with other people in a group. My daughter, Kymberly, is currently a graduate student at George Mason in a counseling program. Her undergraduate degree is in criminal justice. Not that eating an Oreo is a criminal act, but Kymberly has excelled at facilitating group meetings, and we are going to offer some group meetings in the near future. More details will follow both here and at the office.
Your friends, family and certainly your family here at Serotonin-Plus can be a great support system for you during your efforts. If your goal was to gain weight (some actors/actresses need to do this for movie roles) no support is needed at all..do what is fun and do what the body tells you to do. However, to lose weight, lots of support is needed.
Wednesday, June 17, 2009
weight loss and exercise
During the weekly visits, I almost always ask my patients about their exercise for the week. Often, the answer I get is "I walked". I then pry a bit deeper to find out if the "walking" was done during a dedicated time outside, work out cl;othes on, etc., but most frequently I am told that the walking is in the environment of work.
Clearly, rather than admit initially that really no "exercise" is being performed, the "walking" answer makes it seem that the person is doing some exercise, so I will not start pounding my chest and telling the patient how important exercise is, and they are failing in their efforts.
NOOOOOOOO!!!!!! Please remember, my staff and I are NOT judgmental about your weight loss success/less success in any given week. We are here to help you in your weight loss efforts and support you. So if you ate a funnel cake (gotcha Paul) or did not "exercise", we do NOT get angry or upset with you.
Getting back to the exercise issue: Many people do NOT formally exercise. Walking at work is not exercise. Yes, walking from office to toffice , parking further away from the workplace, using the stairs etc...all of these are great ancillary activities. However, for long-term weight loss efforts, a rreasonable exercise program should be utilized. The reasons why most people do not exercise are simple: It takes time and when you have a fulltime job, kids/family to take care of, etc., the day does not have enough hours AND exercise for most people DOES NOT FEEL GOOD. Laying in bed and getting an extra 45 minutes of sleep feels much better than getting youself up and getting on that treadmill or elliptical.
Often, orthopedic limitations make it difficult to exercise aggressively, However, there are less strenuous exercises that can still be done.
We encourage you to call Joanne, our personal trainer, and find out how to start a program that makes sense for "you". We certainly do not expect everyone to run 5 miles a day, train for marathons, etc. However, for long-term weight loss, some sort of real exercise will greatly help.
Clearly, rather than admit initially that really no "exercise" is being performed, the "walking" answer makes it seem that the person is doing some exercise, so I will not start pounding my chest and telling the patient how important exercise is, and they are failing in their efforts.
NOOOOOOOO!!!!!! Please remember, my staff and I are NOT judgmental about your weight loss success/less success in any given week. We are here to help you in your weight loss efforts and support you. So if you ate a funnel cake (gotcha Paul) or did not "exercise", we do NOT get angry or upset with you.
Getting back to the exercise issue: Many people do NOT formally exercise. Walking at work is not exercise. Yes, walking from office to toffice , parking further away from the workplace, using the stairs etc...all of these are great ancillary activities. However, for long-term weight loss efforts, a rreasonable exercise program should be utilized. The reasons why most people do not exercise are simple: It takes time and when you have a fulltime job, kids/family to take care of, etc., the day does not have enough hours AND exercise for most people DOES NOT FEEL GOOD. Laying in bed and getting an extra 45 minutes of sleep feels much better than getting youself up and getting on that treadmill or elliptical.
Often, orthopedic limitations make it difficult to exercise aggressively, However, there are less strenuous exercises that can still be done.
We encourage you to call Joanne, our personal trainer, and find out how to start a program that makes sense for "you". We certainly do not expect everyone to run 5 miles a day, train for marathons, etc. However, for long-term weight loss, some sort of real exercise will greatly help.
Tuesday, June 16, 2009
weight loss and self-perception
First, congratulations to Suzanne and Paul for their 41st anniversary!!! I wish you a great time at the beach!!! (And no funnel cakes Paul, hear me???)
I have had a number of patients who come into our program, prompted by seeing themselves ina group picture taken with family of colleagues. The usual comment is: "I looked at the picture and thought, oh my God, I cannot believe how overweight I looked." The person will then go on to explain that they never saw herself as an overweight person, even though she had to change clothes sizes, felt it more difficult to get around, etc. It was actually seeing a picture that "woke me up".
This is a common psychological issue with many of us, meaning that reality is often different than self-perception. Laughing...I see the TV commercial that we are running currently that we made almost 7 years ago, and I think to myself: "Hey, who is the old doctor in the commercial, that can't be me!!!" Lots more gray hair for sure!!! (okay...some more wrinkles too).
Facing reality by getting on that scale weekly is an important step in keeping your weight under control long-term.
I have had a number of patients who come into our program, prompted by seeing themselves ina group picture taken with family of colleagues. The usual comment is: "I looked at the picture and thought, oh my God, I cannot believe how overweight I looked." The person will then go on to explain that they never saw herself as an overweight person, even though she had to change clothes sizes, felt it more difficult to get around, etc. It was actually seeing a picture that "woke me up".
This is a common psychological issue with many of us, meaning that reality is often different than self-perception. Laughing...I see the TV commercial that we are running currently that we made almost 7 years ago, and I think to myself: "Hey, who is the old doctor in the commercial, that can't be me!!!" Lots more gray hair for sure!!! (okay...some more wrinkles too).
Facing reality by getting on that scale weekly is an important step in keeping your weight under control long-term.
Monday, June 15, 2009
weight loss and health
This time of year, many of you are fortunate to have your children, relatives or family friends graduate from school. Attending these functions, you bear witness to that huge smile that appears on their faces as they traverse the stage to get their diploma. Their entire life is ahead of them with great aspirations and goals to make an impact on this world.
The pride you feel brings tears to your eyes and you feel so incredibly lucky to be a part of this.
Futuristic weddings, births of grandchildren, anniversaries and other major events of you and your loved ones' lives are times that we cherish the fact that we healthy enough to be there.
As a practicing internist for over 25 years, I have unfortunately seen too many cases of people whose lives are shortened by catastrophic illnesses such as heart attacks, cancers, etc. Those affected have missed out on many of these occasions.
Your choice to lose weight, which will require you to give up some of your favorite food sources will raise your chances of being able to be a part of all of these great occasions. Lowering your risk of heart disease, cancer, etc. all occurs when you lose weight.
The next time you are a part of a wonderful event, such as a graduation, try to "bottle up" the wonderful thoughts you feel, and the next time that chocolate cake, bottle of wine, bag of nuts tempt you, remember what is more important. The choice is obvious.
The pride you feel brings tears to your eyes and you feel so incredibly lucky to be a part of this.
Futuristic weddings, births of grandchildren, anniversaries and other major events of you and your loved ones' lives are times that we cherish the fact that we healthy enough to be there.
As a practicing internist for over 25 years, I have unfortunately seen too many cases of people whose lives are shortened by catastrophic illnesses such as heart attacks, cancers, etc. Those affected have missed out on many of these occasions.
Your choice to lose weight, which will require you to give up some of your favorite food sources will raise your chances of being able to be a part of all of these great occasions. Lowering your risk of heart disease, cancer, etc. all occurs when you lose weight.
The next time you are a part of a wonderful event, such as a graduation, try to "bottle up" the wonderful thoughts you feel, and the next time that chocolate cake, bottle of wine, bag of nuts tempt you, remember what is more important. The choice is obvious.
Saturday, June 13, 2009
weight loss and prescription meds
Yesterday I did a consult about the program to two very lovely sisters and both were very concerned about taking phentermine. One of them had hypertension, and was particularly concerned about the interactions of the medication she is taking and phentermine.
I very much respect people's hesitancy about taking any medications, most certainly including prescription amphetamines. I tried to reassure them as best as possible that the dosaging, weekly follow-ups etc. are meant to minimize the risks of the medication.
Most physicians share these same concerns, and when a prospective patient for our program asks his/her physician about starting, often the physician will tell them "No..it is not safe."
Please be assured that we, at our centers, are very careful about the usage of amphetamines, and when the protocol was written for the program, I spent weeks sifting through the medical literature about the use of anorectic medications. Our dosing of the meds was based on this research. To date, we have put over 8400 patients through our program in 7 years, and (knock on wood) we have had NO significant adverse events, direct hospitalizations attributable to our program or any legal actions.
What is more dangerous: being markerdly overweight and taking meds for hypertension, cholesterol, diabetes, arthritis, etc OR being under medical supervision, taking a prescription med FDAapproved for over 40 years with 50-million-plus patient experiences? You obviously know my answer to this question.
We do not take use of these medications lightly....this is why you go through a medical clearnace before we prescribe the meds. However, they do provide a great jumpstart to your weight loss efforts and psychologically, when you embark on a weight losing effort, you need to see aggressive results quickly.
I very much respect people's hesitancy about taking any medications, most certainly including prescription amphetamines. I tried to reassure them as best as possible that the dosaging, weekly follow-ups etc. are meant to minimize the risks of the medication.
Most physicians share these same concerns, and when a prospective patient for our program asks his/her physician about starting, often the physician will tell them "No..it is not safe."
Please be assured that we, at our centers, are very careful about the usage of amphetamines, and when the protocol was written for the program, I spent weeks sifting through the medical literature about the use of anorectic medications. Our dosing of the meds was based on this research. To date, we have put over 8400 patients through our program in 7 years, and (knock on wood) we have had NO significant adverse events, direct hospitalizations attributable to our program or any legal actions.
What is more dangerous: being markerdly overweight and taking meds for hypertension, cholesterol, diabetes, arthritis, etc OR being under medical supervision, taking a prescription med FDAapproved for over 40 years with 50-million-plus patient experiences? You obviously know my answer to this question.
We do not take use of these medications lightly....this is why you go through a medical clearnace before we prescribe the meds. However, they do provide a great jumpstart to your weight loss efforts and psychologically, when you embark on a weight losing effort, you need to see aggressive results quickly.
Friday, June 12, 2009
food as a treatment
I was reading a story about the ex-tennis star, Monica Seles, and her battle with weight after her horrific stabbing that occurred during a tournament. As you may remember, Ms. Seles was a tennis phenom, and at a very young age was one of the best, replacing Steffi Graf as the premiere women's tennis player. In the early 80s, after a match, a crazed fan of Ms. Graf rushed the court and stabbed Ms. Seles in the back, interrupting her brilliant career.
During her physical rehabilitation, she turned to binge eating as a source of "treating" her depression from the events. The weight gain, in turn , caused even more depresssion.
This is a viscious cycle that even non-celebrities endure...turning to food during times of depression, anxiety, sadness or even happiness. We often will use food as a "treatment" for these issues. You do not need a prescription for it, food is relatively cheap, it is legal and you can do it without anyone seeing you. However, the self-loathing that occurs after these cycles further compounds the mood disorder which started the cycle in the firts place.
Take a step back and think about whether you reach for food as a "medicine" at times, and if you do, consider visiting with your physician to see if your mood issues may be addressed in less deleterious ways.
During her physical rehabilitation, she turned to binge eating as a source of "treating" her depression from the events. The weight gain, in turn , caused even more depresssion.
This is a viscious cycle that even non-celebrities endure...turning to food during times of depression, anxiety, sadness or even happiness. We often will use food as a "treatment" for these issues. You do not need a prescription for it, food is relatively cheap, it is legal and you can do it without anyone seeing you. However, the self-loathing that occurs after these cycles further compounds the mood disorder which started the cycle in the firts place.
Take a step back and think about whether you reach for food as a "medicine" at times, and if you do, consider visiting with your physician to see if your mood issues may be addressed in less deleterious ways.
Thursday, June 11, 2009
weight issues and parental involvement
Yesterday I saw a patient who got very emotional during our meeting and this related to the fact that she will be traveling to visit with her parents this weekend. Unfortunately, the patient has constantly been admonished about her weight status by her mother, and her efforts never seem to be "good enough" for her mother. I have had several other patients in our program who, for years, have been constantly chastised about their weight by their parents, interestingly, much more often the mother than the father.
This situation becomes a psychological "control" issue, as the affected person will feel that he/she is disappointing their parents, almost like coming home with bad grades from school. Depending on how the parent approaches the person, it could be perceived as very degrading and controlling. After years and years of basically being told "you do not look good", the person develops a very low self-esteem and starts believing that they are a "failure".
As a parent, you of course should encourage health and well-being for your loved ones/children, and try to set a good example. Approaching your child about his/her weight issue is somethign that should be done, but the manner needs to be loving and supportive as opposed to harsh and cruel. There is no book or formula that will spell out how to supportively and positively approach loved ones about their weight issues, but certainly in the case of children, much psychological harm can be done if this approach is harsh and judgmental
This situation becomes a psychological "control" issue, as the affected person will feel that he/she is disappointing their parents, almost like coming home with bad grades from school. Depending on how the parent approaches the person, it could be perceived as very degrading and controlling. After years and years of basically being told "you do not look good", the person develops a very low self-esteem and starts believing that they are a "failure".
As a parent, you of course should encourage health and well-being for your loved ones/children, and try to set a good example. Approaching your child about his/her weight issue is somethign that should be done, but the manner needs to be loving and supportive as opposed to harsh and cruel. There is no book or formula that will spell out how to supportively and positively approach loved ones about their weight issues, but certainly in the case of children, much psychological harm can be done if this approach is harsh and judgmental
Wednesday, June 10, 2009
Health care Initiatives
Yesterday on the front page of the Washington Post was an article about the new administration's plans to overhaul the healthcare system. The article pointed out that despite the enormous per capita expenditures we make on healthcare, we have a very bad system, ranking poorly on infant mortality rates, obesity rates etc. The article went in to further explain that one of the important changes tobe enacted in any new system is to focus on disease prevention and wellness programs.
This made me think of how currently insurance companies cover weight loss programs. Or should I say, how they do NOT cover weight loss programs. Often, a new prospective patient will call us about the program and ask about insurance coverage for our program. We are always honest and tell them that perhaps their firts visit will be covered but most likely not the entire program or even a % of the entire program.
These same companies will pay for the treatment of heart attacks, strokes, infections from diabetes complications, breast/colon/pancreatic cancer treatments...yet, efforts to PREVENT these entities are not covered. Does this make sense? I would think that the insurers would save tremendous amounts of money by preventing the disease states associated with weight problems. Moreover, expenditures on medicines would be much less as well.
On a personal level, your decision to lose weight will ultimately save you lots of money from lost wages due to medical complications, paying for less meds, etc. Your decision to invest in your own health is the best investment you can make.
This made me think of how currently insurance companies cover weight loss programs. Or should I say, how they do NOT cover weight loss programs. Often, a new prospective patient will call us about the program and ask about insurance coverage for our program. We are always honest and tell them that perhaps their firts visit will be covered but most likely not the entire program or even a % of the entire program.
These same companies will pay for the treatment of heart attacks, strokes, infections from diabetes complications, breast/colon/pancreatic cancer treatments...yet, efforts to PREVENT these entities are not covered. Does this make sense? I would think that the insurers would save tremendous amounts of money by preventing the disease states associated with weight problems. Moreover, expenditures on medicines would be much less as well.
On a personal level, your decision to lose weight will ultimately save you lots of money from lost wages due to medical complications, paying for less meds, etc. Your decision to invest in your own health is the best investment you can make.
Tuesday, June 9, 2009
weight loss and resources
Many times we have new patients enter our weight loss program and previously, they have tried other medically supervised programs in the area. Obviously, we strive to provide the "best" program in town, and towards that end, we feel that the measure as to how successful the program is relates not only to the weight loss that occurs when you are coming here for your visits, but also the support you get when you leave.
Toward that end, I want to remind everyone that we have a full-time personal trainer , Joanne, and a full time dietician, Julia, who are available for your e-mail questions, one-on-one meetings, etc. When you join our program, we want you to know that we are providing these resources to you even when you leave your formal visits. We also encourage you to come into our office and use our scale periodically. As mentioned previously, record your weight and if it ever goes 5 pounds above the weight you achieved when you left your visits, come in for a one-time appointment to get refocused.
We realize that you are committing much time and money towards your weight loss efforts and we are here for you, even when your formal visits are "over". There is no "finish line" to your efforts and pleade utilize our resources to help you maintain the weight loss you worked so hard to achieve.
Toward that end, I want to remind everyone that we have a full-time personal trainer , Joanne, and a full time dietician, Julia, who are available for your e-mail questions, one-on-one meetings, etc. When you join our program, we want you to know that we are providing these resources to you even when you leave your formal visits. We also encourage you to come into our office and use our scale periodically. As mentioned previously, record your weight and if it ever goes 5 pounds above the weight you achieved when you left your visits, come in for a one-time appointment to get refocused.
We realize that you are committing much time and money towards your weight loss efforts and we are here for you, even when your formal visits are "over". There is no "finish line" to your efforts and pleade utilize our resources to help you maintain the weight loss you worked so hard to achieve.
Monday, June 8, 2009
weight loss and age
Last week we entered several women into our program who were in their 70's. Unlike most people who enter our program greater than age 50, they were on no medicines and had no previously diagnosed weight-related medical problems. When queried, it seemed that their major motvation for coming into our program was to look younger and more fit.
Usually, when we think of people i their 70s, the image of a nurturing grandmother appears. My grandmother Sadie when she was alive was constantly cooking, insisting that we all eat lots, and she, herself had really large flabby arms. I would bet that she didn't think for one second about how she would look in an evening dress, what other people thought about her weight isue, etc.
Different times/different generation. There is no reason why anyone, at any age, should not be "allowed" vanity thoughts...wanting to look younger, fit better into clothes, wear my stylish clothes, etc. Feeling a higher level of confidence and self-esteem are things we all are entitled to independent of age and losing weight helps us gain that confidence level back.
Usually, when we think of people i their 70s, the image of a nurturing grandmother appears. My grandmother Sadie when she was alive was constantly cooking, insisting that we all eat lots, and she, herself had really large flabby arms. I would bet that she didn't think for one second about how she would look in an evening dress, what other people thought about her weight isue, etc.
Different times/different generation. There is no reason why anyone, at any age, should not be "allowed" vanity thoughts...wanting to look younger, fit better into clothes, wear my stylish clothes, etc. Feeling a higher level of confidence and self-esteem are things we all are entitled to independent of age and losing weight helps us gain that confidence level back.
Sunday, June 7, 2009
weight loss and other people
First, Jaquel....thanks for the best wishes for the game....the Mets were HORRIBLE and I was sitting their with my Mets jersey and name on it....UGH!!! About three years ago I went to the NY Mets fantasy baseball camp. You go down to their training facility in Port St. Lucie Florida and they cart out a bunch of old players from the Mets teams inthe 60s, 70s, and 80s. You play ball for 3 days with them. Most of the teams have these camps. It was really fun.
This morning I was reading an internet story about how Kelly Clarkson, the original American Idol winner, came out with statements that she is tired of reading stories about her excessive weight. She stated that she loves her body and she wishes the media would stop writing about her weight.
This gave me pause to think about how we all feel about the scrutinization of our weight and how this affects us. When we go to work, do people talk about us behind our backs? Is there some judgement made about our weight? Do we feel compelled to lose weight not just for ourselves but also to have people around us think that we look better? I am interested in your thoughts.
This morning I was reading an internet story about how Kelly Clarkson, the original American Idol winner, came out with statements that she is tired of reading stories about her excessive weight. She stated that she loves her body and she wishes the media would stop writing about her weight.
This gave me pause to think about how we all feel about the scrutinization of our weight and how this affects us. When we go to work, do people talk about us behind our backs? Is there some judgement made about our weight? Do we feel compelled to lose weight not just for ourselves but also to have people around us think that we look better? I am interested in your thoughts.
Saturday, June 6, 2009
weight loss and restaurant choices
Chances are that your spouse/friends may not also be in a weight losing mode. In your quest to lose weight, you are trying to stay away from restaurants that only offer high-caloric choices...pizza and pasta places, fast food restaurants, etc. Sometimes, you feel as if you are a "party-pooper", meaning that others around you want to go to these places but you inform them that your choices are limited there and you would rather go somewhere else.
There are MANY places that will offer you some great choices AND offer the cheesefries, wings and other sh-- that some of the people around you may like. Diners are EXCELLENT choices, because the array of food is great...many wonderful protein and vegetable choices for you.
Please set yourself up for success by choosing restaurants that will not box you into a bad choice.
On a separate note...going to the Mets-Nationals game tonight. Two pretty bad teams. I grew up near Shea Stadium in Queens. Price for the upper deck back then: $1.30...hot dog..60 cents...soda 25 cents. God, I feel old!!!!!!!
There are MANY places that will offer you some great choices AND offer the cheesefries, wings and other sh-- that some of the people around you may like. Diners are EXCELLENT choices, because the array of food is great...many wonderful protein and vegetable choices for you.
Please set yourself up for success by choosing restaurants that will not box you into a bad choice.
On a separate note...going to the Mets-Nationals game tonight. Two pretty bad teams. I grew up near Shea Stadium in Queens. Price for the upper deck back then: $1.30...hot dog..60 cents...soda 25 cents. God, I feel old!!!!!!!
Friday, June 5, 2009
weight loss and planning
Due to our very busy schedules, taking the time to plan in advance your meal schedule for the upcoming week is difficult. However, for the long-term success of losing weight and maintaining that weight loss, planning is an important element.
I would encourage each of you to perhaps reserve some time on Sunday and take out a piece of paper and start thinking about the week in advance. Do you have travel coming up that will place you at lunchtime at an airport on Thursday? Will you be in a late meeting Wednesday and have to bring dinner? If the kids have a late game on Tuesday, what about dinner that night?
Every week will present different or similar challenges, and "mentating" through these issues will go a long way in helping you maintain focus and control. When we make choices on the go, often these spontaneous actions will lead us to poor food choices. Take the time to plan...it is worth it!
I would encourage each of you to perhaps reserve some time on Sunday and take out a piece of paper and start thinking about the week in advance. Do you have travel coming up that will place you at lunchtime at an airport on Thursday? Will you be in a late meeting Wednesday and have to bring dinner? If the kids have a late game on Tuesday, what about dinner that night?
Every week will present different or similar challenges, and "mentating" through these issues will go a long way in helping you maintain focus and control. When we make choices on the go, often these spontaneous actions will lead us to poor food choices. Take the time to plan...it is worth it!
Thursday, June 4, 2009
Losing weight and paying for it
Yesterday I saw a patient who (like most of you) is losing weight very aggressively, and when I complimented her on her efforts, she said "Well, I am paying lots of money here and I will be really angry at myself if I don't lose lots of weight." This made me think that over the years, we have occasionally put a person into the program for free, such as an office manager of a specialist's practice , to show the specialist how effective our program is. We stopped doing this awhile ago because we found that when we put a person in the program who didn't pay for it, they didn't seem to take the program as seriously as a paying patient. Perceived values of an item or service often are related to the cost of said item or service. When someone is paying 1200 bucks for a program, that is lots of money, and psychologically, that person will most definitely work very to "get their money's worth". When someone pays zero, perhaps their perceived value of what they are getting is zero, so not coming to appointments, not following the plan, etc. is the outcome.
So how can we help people, when they leave their formal visits and no longer "investing" in their weight loss efforts still keep that mindset? Perhaps a self-incentive system where if the patient keeps the weight off, they get to spend X dollars monthly on some hobby? Maybe some type of "maintenance" program where they pay a monthly fee and can come in for periodic visits?
Human nature is a very strong force and when it realtes to weight loss, this force often can affect the outcome. Your thoughts???
So how can we help people, when they leave their formal visits and no longer "investing" in their weight loss efforts still keep that mindset? Perhaps a self-incentive system where if the patient keeps the weight off, they get to spend X dollars monthly on some hobby? Maybe some type of "maintenance" program where they pay a monthly fee and can come in for periodic visits?
Human nature is a very strong force and when it realtes to weight loss, this force often can affect the outcome. Your thoughts???
Wednesday, June 3, 2009
weight loss and rewards
Yesterday a patient of mine who is a teacher was describing an end of the year party she is organizing for her students. The food provided will be pizza, cake and other assorted high-caloric foods. Clearly, with childhood obesity being the nation's largest health concern, the question arises as to how socially responsible this is? However, what a dilemma! Would a "treat" for this event to children be chicken breast on a bed of salad? A dessert of no-calorie jello? Many of the kids attending this event will not have a weight problem at all. Is it fair to them to only provide caloric-restricted choices?
I am not sure of the answer to this problematic issue. Providing pizza and cake to overweight kids is certainly not helping their weight problem. Only providing low-caloric choices will make the event less fun. What is the correct thing to do?
Perhaps labeling the food items out with caloric counts on a card beside the food choice will allow both parents and children to see the differences. It would be difficult to separate the food chices to different areas because then the overweight children will feel compelled to go to a different area to get their food.
The same issue holds true for adults attending conventions and seminars. Often the hosting entity fails to provide food choices that a re compatible with a weight loss effort. When there is only sandwiches or pizza and chips at a lunchbreak, this becomes very challenging to a person trying to lose weight.
I am interested in your opinions on this, especially teachers. Please feel free to comment.
I am not sure of the answer to this problematic issue. Providing pizza and cake to overweight kids is certainly not helping their weight problem. Only providing low-caloric choices will make the event less fun. What is the correct thing to do?
Perhaps labeling the food items out with caloric counts on a card beside the food choice will allow both parents and children to see the differences. It would be difficult to separate the food chices to different areas because then the overweight children will feel compelled to go to a different area to get their food.
The same issue holds true for adults attending conventions and seminars. Often the hosting entity fails to provide food choices that a re compatible with a weight loss effort. When there is only sandwiches or pizza and chips at a lunchbreak, this becomes very challenging to a person trying to lose weight.
I am interested in your opinions on this, especially teachers. Please feel free to comment.
Tuesday, June 2, 2009
weight loss and exercise
Often, when I ask a patient whether he or she exercises, I will get a tentative "yes" and then when I further query as to the type of exercise, I will then be told about having to walk alot at work, taking the stairs at work, parking further from the building entrance, gardening and other activities that, while certainly are better caloric burnoff activities than sitting, are not aggressive enough.
No one, most certainly me, expects people who have not been doing regular exercise to start going out and running marathons. Many people loath running or have orthopedic situations that preclude traditional caloric burn-off exercises activities. However, there are exercise activities that people can do that will increase caloric burniff allowing you to lose weight quicker.
We have a certified personal trainer on staff, and Joanne is a resource for you. NO EXTRA CHARGE!!! Please, if you are not doing any formal exercise right now (planting flowers does not count) call Joanne and set up a time to meet with her so she can help you start a program for yourself. This will help your long-term goals of losing that weight and keeping it off.
No one, most certainly me, expects people who have not been doing regular exercise to start going out and running marathons. Many people loath running or have orthopedic situations that preclude traditional caloric burn-off exercises activities. However, there are exercise activities that people can do that will increase caloric burniff allowing you to lose weight quicker.
We have a certified personal trainer on staff, and Joanne is a resource for you. NO EXTRA CHARGE!!! Please, if you are not doing any formal exercise right now (planting flowers does not count) call Joanne and set up a time to meet with her so she can help you start a program for yourself. This will help your long-term goals of losing that weight and keeping it off.
Monday, June 1, 2009
Body fat and weight loss
Sorry for the late entry...I took a red-eye flight from Vegas arriving this morning at 700AM. I am way too old to do this anymore!!!
We were meeting with a large medical device company that is launching a body fat measuring scale that is incredibly detailed. This device can measure lean muscle mass, body fat and other parameters segmentally in different parts of the body. A detailed report accompanies this. The machine is being retailed to doctors at close to 5000 dollars! (For that amount of money I would hope they include free AA batteries!)
Often, the weight on the scale does not tell the entire story. We have a number of patients who notice a marked change in their clothes fitting yet the scale weight does not change siginficantly. Sometimes, as we lose body fat, we build muscles mass, and as you know, muscle weighs more than fat.
We will hopefully be getting this new monitoring device so we will be able to measure your lean muscle mass, body fat etc. at your visits. Here is the great news..no extra charge!!! I will let you know when we get the machine in and we are trained on it. (Hmmm..maybe I am sleep deprived and offering free stuff!!!)
We were meeting with a large medical device company that is launching a body fat measuring scale that is incredibly detailed. This device can measure lean muscle mass, body fat and other parameters segmentally in different parts of the body. A detailed report accompanies this. The machine is being retailed to doctors at close to 5000 dollars! (For that amount of money I would hope they include free AA batteries!)
Often, the weight on the scale does not tell the entire story. We have a number of patients who notice a marked change in their clothes fitting yet the scale weight does not change siginficantly. Sometimes, as we lose body fat, we build muscles mass, and as you know, muscle weighs more than fat.
We will hopefully be getting this new monitoring device so we will be able to measure your lean muscle mass, body fat etc. at your visits. Here is the great news..no extra charge!!! I will let you know when we get the machine in and we are trained on it. (Hmmm..maybe I am sleep deprived and offering free stuff!!!)
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