I am so excited to announce that our very own Obesity Prevention Foundation will sponsor and support the Kid’s Run, a proud feature of the Reno Rock-n-River Marathon. I have been talking up this event for months, actually ever since last year’s event at which I and over thirty of our colleagues from iMetabolic and Western Bariatric Institute and the Obesity Prevention Foundation ran, walked or otherwise completed the 10K portion of the race. We even had some amazing racers who had just completed their own weight loss surgery in the weeks prior and proudly completed the race. This coming May we hope to seal the team of as many as 100 racers and raise awareness for childhood obesity prevention efforts in our community. Join us for this year’s event! You can download and print out a race registration form here.

I end up talking a good bit with my patients about goal setting so I have been thinking about my own goals for 2010. So, in no particular order, here are some of the goals I have thought about:

• 1. Field a team of 100 racers for the Reno Rock-n-River 10K and the Kid’s Run and succeed in raising awareness of the problem of childhood obesity.

• 2. Take that awareness to the next level by making an impact in schools and communities and in the consciousness of policy makers (I know this one isn’t very specific, but I am working on it).

• 3. Run a personal best marathon time this year and run a marathon in under 3 hours, 30 minutes.

• 4. Complete the Second Edition of Out-Patient Weight Loss Surgery with thorough updates of the emerging technology, the importance of pre-operative meal replacement shake programs and many other new features and testimonials.

• 5. Give more to those around me, those less fortunate and those whom I love.

• 6. Spend more time with my children including some special time on vacations with them.

• 7. Work harder to see that the post-surgical care for our weight loss patients is comprehensive, committed, compassionate, thorough and frequent.

• 8. Improve our support groups, walking groups and ongoing support for all of our patients both surgical and non-surgical who are trying to lose weight.

Set goals for yourself today.

Weight loss surgery is highly effective as a tool or method for losing weight and changing ones life.  But it is only a tool.

One of the toughest things for people to begin to understand is that they themselves are the true instrument of change.  The surgery is a highly effective component in that change journey, but ultimately the person who makes the decision to lose the weight and undergo weight loss surgery is, in fact, the most important element that will insure long-term success weight loss.

When I meet with individuals who are pursuing weight loss surgery, I begin emphasizing this point very early on, beginning in fact with our informational seminar.  I think that our group emphasizes this point so much because over time we have come to appreciate more about what it takes to succeed beyond one year or two years and we have begun to explore how to insure success beyond ten years, twenty years and for a lifetime.  Today estimates are that between 10 and 20% of people regain their weight years down the road after Roux-en-Y gastric bypass surgery, though the statistics on this are a little murky.  How then, does one avoid becoming one of those statistics?  We believe the answer lies in adopting a new outlook and a new way of viewing the problem of weight loss and health.  The people who do succeed and keep it off for a lifetime accept total and complete responsibility for their weight loss journey. They begin looking, not outward, but inward for solutions to the long-term problems of poor health and weight gain.  They adopt the “battle” mentality against excess calories, desserts, treats, and snacks.

They adopt the attitude of life change that is crucial to success in this battle.

Here is a funny thing: When the time comes around for us to eat, let’s say lunchtime, many of us can think of only one thing: food. Plus, when the opportunity arrives to eat that food, most of us can hardly contain ourselves as we anticipate the satisfaction of eating it. It is furthermore difficult to stop midway through a meal with so much more food, delicious food, still available to eat on our plates or on the table or in the serving area. In fact, many of us experience this phenomenon something akin to a biological imperative. We feel a strong compulsion to eat the food that is presented to us. One could imagine some biological programming that speaks to ensure we do in fact the calories that become available because one could never know if a reliable source of calories would be available later. Such a strong behavioral instinct to consume the calories currently available, would serve to guarantee a strong nutritional intake for a species that struggled to obtain reliable sources of food through difficult harvests, bad weather, poor hunts, etc.
So if we are seeking to lose pounds and achieve a healthier overall weight, how in the world are we supposed to overcome such a strong and deeply engrained behavior to eat at mealtime and to eat all the food available to us? Well, here is one trick that works well and has served many of my patients well. Put simply, think of the next meal.
What I mean by this is force yourself to stop focusing on the food that is currently right in front of you and instead think about the meal you are going to eat in just a few hours. For example, it is lunchtime and you are being served a mediocre burger with some nothing-special side dishes and wilted lettuce salad, nothing great here, right? Yet, of most of us are driven to eat that meal and we take satisfaction from eating most of it or all of it. It is very difficult to overcome that drive, and instead simply eat a small portion of the meal that would be more appropriate for achieving weight loss. But if you stop focusing your mental energies on the meal that is currently in front of you and instead think about the next, that is the really delicious dinner, that is something you actually look forward to, say, your favorite marinated meatballs with yummy spices, then it becomes far easier to overcome the temptations to overeat in the present meal.
I know this all might sound a little strange, but is it a behavioral trick that often works. Let me give you an extreme example and you will see how you might use this in your day-to-day weight loss efforts and your goal of cutting down portion sizes. Let’s say you have a dinner planned for a special evening at your very favorite restaurant. Now if you are at all like me, you love those special meals with your favorite chef cooking your most favorite recipe (think of a mouthwatering sizzling steak from your favorite steak joint or think of what you know as your special favorite dish). Many of us with such a special, special meal coming up would “save room” and eat less during the day approaching the special meal in order to more fully enjoy the dinner. Many of my patients and I, myself even have entirely skipped lunch and all food through the afternoon on a day when a special gourmet feast was planned. So the trick here is to tap into that sort of thinking on a more regular basis and when you are presented with food at mealtime, pause for a second and think about the next meal. Then remind yourself you have a plentiful steady supply of food and it is really not important for your health or nutrition to eat everything on your plate at lunch, in fact it is really not that important that you eat any of it. But a small healthy portion is good for you to maintain your metabolism and stave off hunger later in the afternoon. Reminding yourself that a whole other meal is just a few hours away will often help you find the willpower it takes to cut down your portion size and stop eating. This type of psychological trick is just the sort of thing that may help you regularly avoid excess lunchtime calorie consumption and lead to a healthier new you over the course of the year.

There is no doubt that a certain satisfaction comes from eating a large quantity of food. I will be the first to admit I have overindulged in some meals when the food was particularly delicious and I found it satisfying, albeit in a strange way. For example my favorite Indian, Thai or Chinese food seems to be gobbled up so fast that it practically vanishes from the plate and I find myself dishing out more from those white cardboard boxes before I even know what I’m doing. Or a really great pizza made from terrific dough and delicious sauce is so hard to resist before 3, 4, 5 or 6 pieces disappear.
More disturbingly, however, we often find ourselves overeating quantities of food that isn’t really that great. Think about it: How many times have you been served a lukewarm burger and lousy fries, but for some reason continued eating until every last crumb was devoured?
What I am saying is it is time for a new way of thinking about food. Pure and simple, it is time to start thinking about quality and not quantity. At first, you will have to trust me that it can be at least as satisfying to emphasize quality over quantity. You will probably have to take it on faith to begin with that a few bites of something truly amazing, enjoyed slowly, can be equally as satisfying as demolishing a large quantity of something mediocre, but it can be and it is. Once you begin to enjoy the real satisfaction that comes from watching the number on the scale move downward, watching your body look healthier and seeing a person in the mirror who feels better and more energetic, then you will truly begin to see the light.
Be selective, be choosey, don’t eat anything that isn’t truly delicious, emphasize quality and not quantity.

After some delays, we have received the shipment of my newly released book: Life Changing Weight Loss. In these times, everyone could use a guide to real, successful weight loss.

In radio interviews on stations around the country, I have been so pleased at the reception the book has received so far. One of the common threads I hear is that media people are inundated at this time of year with weight loss books and information, most of which has very little basis in the practical science of what truly works. Much of it is based on wishful thinking, marketing plans or fanciful obsessions with obscure root extracts and proprietary blends of unregulated secret, magical herbs. The truth about successful weight loss is much simpler and yet, also much more complicated.

At the end of the day, to solve a weight problem and keep the pounds off, we must find a successful strategy to consume less calories every single day, burn more calories every single day, and find satisfaction and contentment despite this. Many of us can muster the motivation on a short term basis to consume less calories and burn more calories, but we feel like we are starving ourselves or doing the impossible. That won’t work for the long term. Long term success lies in mustering that motivation, but making an internal life change, a new look at how we view ourselves, our weight, our diet and our activity. Only then does the “light switch” flip on, only then do we successfully lose the weight and keep it off for the long term.

I have often wondered why I see so many seriously overweight and morbidly obese vegetarians in my clinical practice. I realize the answer is mainly because I specialize in weight loss, both with medically based methods and with surgical weight loss. So it stands to reason the cross-section of people with obesity will be seeking my help, this will include vegetarians as well as all kinds of other eaters.
Yet, when speaking to these individuals who are struggling with unhealthy weight gain that is wreaking personal havoc on their heath, I have delved into some of the details of what it is they are eating and drinking specifically to help understand why they suffer from obesity. A few of the points that have emerged from these conversations are offered here in hopes that other people may be able to avoid this unfortunate progression to morbid obesity.
The primary danger of choosing a philosophy of vegetarianism is in believing that doing so will lead to improved weight control or even weight loss. That is very unlikely to be the case. Simply shifting from animal sources of nutrients to vegetable sources will have very little to no impact on a person’s weight.
The second danger of vegetarianism and the risk of obesity is that so many so-called vegetarian foods contain high amounts of the very nutrients that are most closely associated with obesity: simple carbohydrates. Many snacks and treats, juices, fruit based products, syrups, flavorings, pastas, rice, noodles and a host of other foods consumed as vegetarian consist mainly of high calorie, high carbohydrate food sources, precisely the kind of nutrient most closely associated with the obesity epidemic. On the other hand, a healthy vegetarian may consume whole grains, legumes, a wide range of beans, vegetables and a wide array of fruits while avoiding all of the previously listed simple carbohydrates and find themselves losing weight and becoming much healthier.
The third danger is the psychology of “good food vs. bad food”. In the “good food/bad food” syndrome, we tend to help ourselves stick to a particular dietary plan by labeling certain foods as “bad foods” and acknowledging other foods as “good foods”. The problem with vegetarianism is that often all animal based foods become as labeled as “bad foods”, leaving all of the non-animal products available as “good foods”. The trouble here is that many of these non-animal foods are absolutely terrible. I am thinking of Twinkies, fruit juice drinks and French fries just to name a few of the millions of obesogenic foods many vegetarians do consume. Don’t get me wrong, if your goals of being vegetarian are purely to avoid animal products then you may succeed with this strategy, but if your goal is to lose weight and be healthier, such a strategy is doomed to failure unless your focus is on reducing foods that cause obesity.
Number four; I call this the danger of the white foods. Many of the obese vegetarians I have met gravitated toward the dreaded white foods: foods that tend to be white in color and dominated by simple carbohydrates. These include potatoes, potato chips, French fries, white sugar, white rice, white pasta, treats with vegetable based frostings and, of course, all sorts of baked goods…breads, crackers, cookies and treats made with white flour. I can throw in high fructose corn syrup, but what’s the point? These are the most harmful foods and nutrient sources in our diet, the ones most closely associated with hunger, fat storage, weight gain, diabetes and obesity. In terms of health and weight, it is a very poor trade-off to get rid of animal products, but gravitate toward these white foods. In fact, it is a recipe for obesity and diabetes.

Recent reports offered some disturbing news: a series of drugs commonly prescribed to treat mental health conditions in adolescence cause weight gain as a side effect. This is not terribly surprising news as it has long been noted that many of the antidepressants and anti-psychotic drugs have been associated with weight gain in numerous previous studies. What is disturbing is there has frequently been lack of full recognition of the deleterious effects of weight gain on the mental health conditions themselves. This is perhaps most aptly demonstrated in the relationship between obesity and depression. It is well known depression itself often leads to over-eating, inactivity and weight gain. Likewise, it has been demonstrated that weight gain and obesity lead to depressive feelings and a cycle of downward mood spiral.
These latest reports offer further disturbing news that sometimes our pharmacologic answers to serious health conditions can often have a dangerous side effect: obesity. It also speaks to the fact that when any prescribers are offering drugs to treat one condition, it would be terribly helpful to consider the negative effects of weight gain just as other side effects are factored into the decision of the prescribing the medication. In the past, weight gain has often been thought of as a relatively minor side effect, but in today’s obesogenic environment, I don’t think that should be the case any longer. Obesity is more widely recognized now as a quite serious health problem in its own right and drugs that lead to weight gain and obesity as a side effect must be scrutinized closely before they are prescribed. I would argue that patients, who are embarking upon any drugs that include weight gain as a typical side effect, should concomitantly enroll in a weight controlled program or weight reduction program to actively combat the effects of the drug.
Some of these drugs directly stimulate appetite. Others lead to inactivity, but many of them have in common the empirically noted finding that patients on the drug gain weight when compared to patients on placebo.

One of the challenging questions that many of us in the bariatric surgical field struggle with is trying to identify factors among the eating behaviors of prospective patients prior to surgery that might help us predict the success a patient can expect after surgery or, even better, allow some type of intervention-such as counseling or therapy of some sort- that can prove that outcome. Research studies have taken place that involve asking detailed questions about eating behavior of a large group of patients expected to undergo weight loss surgery and then compared the weight loss success afterward. For the most part, prospective studies aimed at assessing pre-operative problems such as binge eating disorder, reveal no real consistent predictors of post-surgical weight loss success. Binge eating disorder specifically is reduced markedly after laparoscopic adjustable gastric banding surgery and Roux-en-Y gastric bypass surgery. Probably because it just becomes much more difficult or impossible to consume large amounts of food in a single sitting.
In multiple prospective studies of numerous types of eating behavior disorders, including binge eating disorder, all patients experience a significant and marked weight reduction after weight loss surgery with both Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding. In some programs, historically, binge eating disorder has been considered a reason to exclude people from surgery, a practice that is clearly ill-advised given the very poor success of non-surgical weight loss efforts among binge eaters.
We will explore more details of eating behavior and psychology as it relates to weight loss surgery and medical weight loss programs in other posts. The bottom line is that these eating behavior problems are common, but are not a reason to exclude someone from weight loss surgery or from medically supervised weight loss. On the contrary, they are simply characteristics to be identified and then acknowledged as deserving of more help, counseling and support.

In my practice serving seriously overweight people seeking medically based solutions, I see a very high number of obese patients who described themselves as vegetarians. Many of these individuals chose vegetarianism out of a belief that doing so would help them lose weight or maintain a lower weight. Unfortunately, that is not usually the case.
While there are many reasons a person chooses vegetarianism, selecting this diet to lose weight will be unsuccessful as a strategy in and of itself. At the end of the day, or at the end of the year, one’s weight is determined by the balance of net calories in, against the net calories the body has burned. A great many vegetarians are consuming far more calories than their bodies’ burn through the course of the year and are thus gaining weight. The successful strategies for losing weight or maintaining a healthier weight involve a conscious, mindfulness of overall calorie intake and a reduction in the net calorie intake to levels below that which the body is burning through resting activity and exercise. One can dramatically improve that equation by increasing exercise, using muscles and cutting down on the types of foods that tend to stimulate appetite and stimulate fat storage, namely simple carbohydrates.
Evidence has mounted over many years that simple carbohydrates serve to provide rapid, transient satisfaction when we consume them, but this is followed by increases in our appetite and even cravings for those nutrients, in addition to the hormonal cascades stimulated so potently by the simple carbohydrates leads, in fact, to storage of fat and stimulus of more appetite. Epidemiologic data reinforces the understanding of simple carbohydrates as being the most closely linked nutrient group to the obesity epidemic. There is a virtual parallel increase in the prevalence of obesity in the last thirty years and the per capita consumption of high fructose corn syrup and other sweeteners over the same time period (something that is not the case for consumption of fats and proteins).
If a person wishes to change his/her diet to lose weight, the most compelling strategy would appear to lie with a shift away from the consumption of simple carbohydrates to other nutrient classes. Certainly, this strategy is further born out in our clinical practice where we have success employing such a strategy in the real world of medically based weight loss programs. There is little data to support a shift away from animal nutrients toward vegetable nutrients as a successful weight loss strategy.
This is not to say that a vegetarian philosophy cannot be a successful weight loss strategy if one works not only on the vegetarian aspect, but also on the weight loss aspects, which should be viewed as independent objectives.