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.

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.

I saw a patient today who has battled with depression intermittently throughout her life and also struggled with obesity. She wonders if the two are related, but also about how she will manage the depression after her weight loss surgery. Is it still possible to take medications should she need them? Might her depression improve if she undergoes weight loss surgery?
Interestingly, the research on depression and obesity shows it is a two way street: depression leads to more obesity, but obesity itself exacerbates depression. It makes sense, if we think about it. Depressive feelings can lead to overeating and loss of motivation to exercise. Likewise, obesity can lead to feelings of lower self-esteem and lower one’s mood.
Research also indicates some people do experience improvement in their depression after weight loss surgery.
Similar data exists about non-surgical weight loss. Of course it is hard to separate out which comes first, better feelings of self-esteem and higher motivation that lead to successful weight loss or some improvements in weight, leading to better body image and some improvement in mood. Ultimately, this chicken and egg question may be difficult to answer, and the most important advice is to seize the day and to work very hard on both problems. By this, I mean that if you struggle with depressed mood then seek help immediately including psychological counseling and visiting with health professionals who may offer effective antidepressant medications and recommend mood elevating activities like exercise. Likewise, if you are overweight or obese, don’t let another day go by without working on this problem too. Seek professional help. Follow the strategies and tips outlined here and in my books and you will benefit with lower weight and an improved mood.
For my patient today, I also let her know that antidepressant medications can be taken and absorbed after Roux-en-Y gastric bypass surgery. We do believe it is best to change from any extending release formulations (for example Effexor XR) to the standard release formulations that usually must be taken two to three times a day rather than only once a day.
Like so many complex facets of human health, depression and obesity are closely linked. One affects the other, but more importantly one is improved by improving the other

If you’ve been searching for a weight loss solution and your Body Mass Index is between 28 and 35, you may have found that solutions are hard to find. (Calculate your BMI here).

An increasing number of large, high quality prospective research studies have demonstrated a high success rate in effectiveness with laparoscopic adjustable gastric banding surgery. Studies have also indicated that other types of weight loss surgery are effective in this “lower BMI” group. To date, the generally accepted guidelines that health insurers and most bariatric surgical centers follow begin at a BMI of 35 and go upward.

Options for Weight Loss If BMI is 28 to 35
In this category of severe overweight or moderate obesity, weight loss considerations boil down to a few important options:

Medically based weight loss
A medically based or medically supervised weight loss program. Increasingly, physicians who are devoted to weight loss surgery offer specialized programs for people in this Body Mass Index category. The best of these kinds of programs combine all of the elements of proven weight loss strategies. I outline a comprehensive strategy that is based on our medically supervised weight loss program at iMetabolic in a soon to be released book entitled, “Life Changing Weight Loss.” This book offers a very candid and revealing look at what a comprehensive medically based weight loss strategy entails. As you might predict, it centers around making permanent changes in ones diet and physical activity. It also centers specifically on a focus toward true and enduring “life change”, which is sometimes easier to talk about than actually do. But it requires a change in attitude and a change in habits, as well as a very structured program. The best medically supervised weight loss programs involve many or all of the following elements:

• Structured dietary advice.

• An induction or initial weight loss program to get the pounds off rapidly and early, over eight to 24 weeks.

• The use of medically formulated protein-based meal replacement shakes.

• Maintenance of a diet or food journal.

• Individualized counseling from specialists, experts in eating behavior and psychology.

• Ongoing support groups with other people on the same journey.

• Regular exercise programs with commitments such as walking groups.

• Goal oriented encouragements with participation and performance goals.

• A transition phase with specific introduction of carefully designed and monitored foods.

• Rigorous teaching for increased awareness of calories, carbohydrates, vitamins and nutritional needs.

• Inclusion of appropriate vitamins and supplements for weight loss and maintenance of healthy muscle mass.

• A long-term ongoing maintenance program after the weight has been lost to stay engaged and focused and avoid rebound weight gain.

In the next post I will discuss the surgical weight loss options for people who fall into the lower BMI range of 28 – 35.

Did you know that lack of sleep leads to more weight gain? As if there weren’t enough things out there to cause us to gain weight, research as shown that a lack of a good night of sleep leads to more wight gain. The mechanism is thought to be related to an increase in hunger and a decrease in some of our impulse control and mindfulness with respect to eating and giving into temptation around food.

I have definitely seen this phenomenon in my own life. After a night on call when I have had very little sleep, I tend to do a very lousy job of eating well the next day. Somewhere in my subconscious I seek to reward myself, or find comfort and pleasure in things like doughnuts and pastry’s in the doctor’s lounge that I would otherwise, usually avoid. I also find that if I have not slept well, or slept enough hours, that it is much harder for me to find the energy or motivation to go for a run or do other exercise. So, none of these are health results from lack of sleep!

So what can you do about it? Well, there are a few, very important practices you can undertake that will maximize better sleeping and therefore help you in your journey to a healthier weight.

• For starters, don’t consume caffeine or other stimulants in the afternoon or evening. Avoid alcohol beyond two or three ounces of wine and avoid eating a late night meal.
• Find 30 minutes for a brisk walk or other exercise in your day or evening and you will sleep much better.
• Establish a routine in which you sleep in a safe and comfortable environment that is controlled to your likings, in respect to the temperature and darkness.
• Establish your bedtime and stick to it every night. Try to minimize emotionally charged events and activities that occur close to bedtime.

Importantly, many of us have un-recognized sleep disturbances that can only be diagnosed by a formal sleep study. The most common among these is obstructive sleep apnea, a very common condition that occurs as a result of weight gain. It results from airway obstruction of some soft tissues.

You may be saying that you have relied upon good medically based and scientifically based information from me and my books and columns so that you can achieve better fitness, improve your health and live at a healthier weight.  But you really were not interested in competing with anybody, and I understand this.  But what I am raising with this idea of competition goals is a little bit like a psychological lever that you can use to motivate yourself to achieve your broader goals of improved fitness, health and longevity.

We all have a competitive instinct. Some of us display it and are driven more by it than others, but we all have it.  What you want to do is tap into it to help you achieve your goals.

Sometimes the competition is only with yourself and sometimes it is with others.  But the point here is to not shy away from some competition and to enjoy it and use it as a motivational tool for you to reach a better level of fitness, and lose weight in the process.

Let me give you an example:  A patient of mine had been active as a teenager, but gained a large amount of weight after each of her pregnancies and found herself seriously obese in her early forties.  As part of her weight loss program, I encouraged her to join our weekly walking group and eventually encouraged her to sign up for a 5K run/walk race.  Now the word “race” causes many people to shy away from the event. After all, she had never “raced” before, certainly was not in good enough shape to win any races.  On the other hand, I knew that once I got her hooked on the idea that she would begin to compete against herself and want to improve her times.

In fact, she went on to complete a 10K race and is signed up for more future races.  Each race is scheduled several months out in advance and it gives her a target for her “training”.  Now, all of a sudden, instead of being a seriously overweight 40-something, she is an active person who is training for races.  It changes the way she thinks. It changes what she talks about with her friends and colleagues.  It has changed, in fact, who she is as a person.  And, oh by the way, she has lost 60 pounds.

Well, that’s really a mouthful!  But what does it mean?  Multidisciplinary means that professionals with different areas of expertise can offer helpful guidance after your weight loss surgery.  This finding is supported by several research studies that have recently reported their data in addition to our own clinical experience at Western Bariatric Institute and iMetabolic.

After weight-loss surgery we have found that the people who succeed in losing weight best and maintaining their weight loss, do follow up with our multidisciplinary team.  So what are some of those “disciplines” and how do they help?

Well, one of them is with our medical staff. This includes the doctors, the bariatric surgeons, in addition to the physician assistants, nurse practitioners and registered nurses.  This group of people has a medical or clinical focus thinking about health problems related to obesity as well as potential health problems that might result as people return year after year.  They also understand things like vitamin deficiency and future risks for people who have had weight-loss surgery.

Another discipline is dietary.  So a registered dietitian can offer insights into improved eating behaviors, food choices, meal planning and so forth.

Another discipline is eating behaviorists or psychologists.  This is a group of professionals who focus on what really goes on above the shoulders and between the ears.  This is where some of the best work is often accomplished, with people learning to avoid temptations, identifying their “triggers”, finding better coping mechanisms other than food, and generally working on psychological strategies that allow reduction of carbohydrate and calorie intake.

In addition to all of these, follow up with support groups, with lay people, as well as motivational life coaches, and exercise therapists and personal fitness trainers are all exceedingly valuable in keeping the momentum going and promoting and maintaining the weight loss.

All of these concepts are covered in more detail and with more specificity in the recently released e-book entitled, “After Weight Loss Surgery”.  I highly recommend it as a way to add some very valuable guidance to your journey after weight loss surgery.  I wish you the greatest success in your weight loss journey.

Many times I am asked why a medical center focused on weight loss would emphasize vitamins.  After all, some might say, the people who need to lose weight have had an excess of nutrients, not a deficiency, right?

Well, the truth is that excess fat is deposited as a result of too many calories being consumed, in excess of the calories that are burned or used up by the body.  But just because one has taken in too many calories in the form of (mostly) of carbohydrates and fats, this does not mean that the person has also had an excess of all of the essential vitamins, minerals and amino acids.  In fact, a very interesting and surprising finding of our research and the research of other centers on seriously overweight or obese individuals was that a great many of them were very deficient in a number of key vitamins.  Quite commonly, even seriously obese individuals will have profoundly low levels of vitamin D, B complex vitamins, and minerals like zinc and iron.  But why is that important?

The reason that it is highly important is that these vitamin and mineral deficiencies contribute to symptoms like fatigue, loss of energy, depression and lower quality of life.  You might recognize that these same symptoms are very likely to contribute to eating and weight gain.  In fact, these vitamin and mineral deficiencies are found so commonly among obese individuals that I have begun to think that they may be an independent risk factor for obesity.

While we have not yet conducted research to try to establish this link, the theory makes sense: a poor diet that does not include all the vitamins and minerals necessary will lead to deficiencies of some nutrients that cause fatigue, loss of energy and depression, risk factors for reduced activity, excessive eating and weight gain.

Future research will tell us which comes first, the weight gain and its many side effects or possibly the vitamin deficiencies which lead to weight gain.  You can certainly protect yourself and reduce your own risk of the side effects and symptoms of vitamin deficiency by taking vitamin supplements that we recommend.

Once the weight loss surgery is completed, how do you truly maximize its success?  What are the critical secrets to losing weight effectively and in the most healthy way possible?  How can you not only lose pounds, but also feel better and have more energy?

These are some of the most important questions that are answered in my newly released e-book called, “After weight-loss surgery”.

I have had the great privilege and the unique position of serving as the Medical Director for both a nationally recognized surgical weight loss center, as well as an acclaimed medical (nonsurgical) weight loss surgery, iMetabolic or the International Metabolic Institute.  From these positions, I have had the great privilege of helping thousands of people successfully lose weight using all of the proven techniques available from every discipline.  It has given me some great insight into what truly works to successfully lose the weight and keep it off.  Some of the critical factors that are described in detail in “After weight-loss surgery” include:

• How to adopt the life changing attitude necessary for successful weight loss.

• What to do if your weight loss stalls or you  hit a plateau.

• How to avoid weight regain and what to do about it if you experience rebound weight gain.

• Every thing you must know about vitamins, minerals and nutrients after your weight loss surgery.

Each of these topics is covered based on experience from real people and also from the very latest in clinical scientific publications in the field of weight loss and weight loss surgery.  I highly recommend this publication for anyone who has had weight loss surgery or is about to have it to help serve as a blueprint for your future success.

Increasingly, I encounter people who describe that they feel a terrible sense of fatigue and a loss of energy.  Many people lose their zest for fun things in life because of lack of energy. At our weight loss centers, a lack of energy impairs people’s efforts to exercise and lose weight.  It interferes with many aspects of life and with enjoyment of life.  Certainly, it interferes with a person’s motivation level to try to successfully work on any weight loss program.

With fatigue being so common, are there causes of it that can be fixed?

Indeed there are.  Finding the cause is important to a weight loss physician as part of a medical supervised weight loss plan.  Without investigating some of these potential root causes of fatigue, it may be difficult to get out of the starting blocks and begin losing weight.

Here just a few of the treatable causes for fatigue that a doctor might help you to diagnose and treat:

Hypothyroidism (low level of circulating thyroid hormone treated with a common medication: thyroid replacement hormone).
Anemia (low circulating red blood cells, often as a result of iron deficiency).
Depression (often markedly improved with medication and psychological counseling).
Viral illness (one example is mononucleosis).
Diabetes.
Heart condition.
Liver dysfunction.

and
Vitamin deficiencies.

Here are some common vitamin and mineral deficiencies that can cause fatigue, sometimes, profound fatigue:

• Vitamin B6.
• Vitamin B12.
• Iron deficiency.
• Vitamin D

In future discussions, I will explore how some of these causes can be identified and corrected in many cases. Some times, people experience dramatic improvement in their energy level after identifying these problems.