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.

For many years, the kind of protein powder shake mix that one could find was meant for muscle building in the gyms.  These shake mixes often had names that implied bulk and strength and growth and they were not only high in protein but were also very high in calories generally. So for a body builder or a young football player or wrestler aiming to bulk up, these shake mixes were just the ticket.

Today, more and more people are going to gyms for different reasons.  Yes, they  need to increase muscle, almost all of us do.  But increasingly, most people are also needing to burn fat and lose weight.

So the protein shake mixes must be different.  Instead of something aimed at helping a young person build muscle and build weight, this more modern shake mix must help a person build muscle while reducing weight.  So how does one do this?

The key is in the ingredients of the shake mix, as well as in the exercise performed by the person using it.  Sometimes young athletes are able to devote several hours a day toward pumping iron and building muscle. Very few adults can do that, simply because of time.  In addition, a  young athlete has typically a much higher basal metabolic rate than does the average person who needs to lose some pounds.  So the ingredients much match the person.

The ideal shake mix has now changed and takes into consideration all these factors.  One that now consists predominantly of proteins with the right amino acid mix, adds vitamins that are helpful both for muscle building and weight loss, and lastly contains low total amount of calories, serves to accomplish all the goals.  In this way, a person can benefit greatly from both the protein shakes and from their exercise regimen.  I highly recommend the protein shake mix from iMetabolic that accomplishes all of these goals with some great flavors.  Please let the creators of iMetabolic know what flavors you  might prefer or what tastes you do and don’t like about their shake mix.

Sometimes weight loss surgical patients have asked just what is critically important for postoperative success and long-term weight loss.  Does everyone really need an iMetabolic, a comprehensive, multidisciplinary, medically supervised program after surgery?

For most people, the answer is probably no, with some qualification of that answer.  Based on the long-term studies we have available, most people do succeed after weight loss surgery in losing the weight and keeping it off.  However, a percentage of people regain their weight or fail to reach a satisfactory amount of weight loss.  And many others struggle over the years to maintain the level of weight they have lost, though they still would be considered “success stories”. In my opinion, these patients could benefit from a multidisciplinary, medically supervised weight loss program like iMetabolic.

There are many benefits of a medical weight loss program.  First, physicians who are experienced in prescribing weight loss medications could make use of phentermine and other drugs to help battle resurgence of appetite and promote improved weight loss.  Next, the team of trainers, dietitians and coaches can keep patients focused on their goals, habit development and how to succeed over time.  Some elements that have been proven in scientific studies to add to the success of weight loss may not be easily available outside of medically supervised programs. These include support groups, a “holding you responsible” routine weigh in, review of food journals, and prescription medications.  An added benefit of a medically supervised program that has psychologists and experts in eating behavior is that some abnormal eating behaviors and eating disorders (such as binge eating) may be uncovered and treated more effectively in such a form.

I think we will see a continued role for medically supervised programs to integrate with or at least augment the success of surgical weight loss programs in the future.

There is no question that losing weight successfully is a complex undertaking.  There is no question there are many elements to it.  But awareness has to be one of the first steps and helping make children aware will help them later in life as they work to maintain a healthier weight.  For a surprising number of adults and kids, there is not a really clear understanding of the link between high calorie, high carbohydrate foods and soft drinks, and painful joints, difficulty breathing, insulin injections, and obesity.  So if there were a motivational breakdown, it might look something like this.

1.    Identification of the problem:  “I’m overweight”.

2.    Fuller understanding of the ramifications of the problem: “My weight is causing me pain, impairing my health, shortening my life expectancy, and reducing my quality of life.”

3.    Recognizing what causes the problem:  “I’m consuming far too many calories, high carbohydrate foods and drinks, and burning too few calories with too little exercise.”

4.    Define your goals:  What you personally hope to gain or experience:  “I want to play with my children outside and experience less pain in my knees and back.”

5.    Define specific weight loss goals:  “I want to lose 50 pounds in 12 months.”

6.    Make a specific plan:  “I am enrolling today in the medically supervised weight loss program with IMetabolic.”

7.    Start today.  No delays, no waiting.  No excuses.  Just start.

One of the keys to staying on track with your personal weight loss goals is to continue to write down why you want to achieve the goals you have set.  What personally, most deeply affects you and your loved ones, your health, and your quality of life.  Write down the goals, such as, “I want to lose weight so I can never take another insulin shot again.”  Or, “I want to lose 30 pounds so I can resume skiing again.”

What are your goals?  What do you want to achieve?

I recently had the pleasure of speaking at a medical conference devoted to diabetes. Mine was the talk focused on the association between weight gain and diabetes. While there are a great many interesting discoveries occurring all the time in the field of diabetes, it remains the case that the disease itself marches on, increasingly affecting more and more people around the country and around the world.

What strikes me as the most stunning statistic is the one which describes the close relationship between obesity and type 2 diabetes mellitus. The relationship is truly stunning. Even modest weight gain leads to dramatic increases in the development of type 2 diabetes.

We think of a normal body mass index as being 18-25, but really when one goes from a healthy body mass index to a body mass index of 25, the risk of type 2 diabetes more than doubles. Then when the body mass index climbs even higher, hold onto your hats because the risk of diabetes climbs through the roof. What does this mean? How are we to treat this runaway epidemic?

While there are new drugs that come out every year and better insulin management regimens hold promise for steadier regulation of the blood sugar, these treatments do nothing to reverse the growth of the disease around the country among men and women, young and old and people of all races. What is needed is really a prevention solution or a solution aimed at the root cause.

The only real solution at this point in time that reverses and eliminates the disease is weight loss. Weight loss takes a person back down curve and below the threshold at which their body can no longer handle the blood sugar. So while the treatment must involve controlling the blood sugar, and must involve medications, attacking the root cause by losing weight, must become the top priority for most people with type 2 diabetes.

Medically supervised weight loss holds the best promise for producing sustained weight loss in moderately overweight people. Weight loss surgery provides the best results for people with type 2 diabetes with body mass index over 30. There may even be a role for gastric bypass surgery as a type of “metabolic surgery” as the treatment for type 2 diabetes in normal weight individuals.

I saw a patient in the office this week who brought in a list of diet plans and programs that she had read about or heard about. She wanted my opinion on each one. So we went through the list. And I must say that I was very discouraged to see that of the 12 or 13 diet plans that had piqued her interest, only one of them would qualify as having any sort of scientific validity or underpinning whatsoever.

Yet, weight loss fads and popular diets seem to have become more commercially successful and popular in the public consciousness than ever before. It is big business.

Yet why is there such growth in fad diets which offer very little chance of success?

I think the answers come from many corners. From one thing, scientifically based programs usually lack the sort of commercial push behind them that would allow them to be successful in the public market place. It is very difficult to compete with the commercial plans that can hire celebrity spokespeople and buy huge amounts of media time, create magazine and newspaper placements, and, in short, do all of the things that bring their products to our attention. There are many other factors, of course; for example, the media in general is usually very apt to cover “news items” that seem “timely or hot.” They are often interested in fresh angles and novel stories, and medically-supervised weight loss programs don’t always offer that kind of appeal.

But I would argue there is also a lot of blame to laid at the feet of the medical establishment. For many years, physicians and the medical community in general failed to address obesity as a serious disease. Only now that it is the number one cause of shortened life expectancy and the number one preventable cause of disease in the country, are physicians and medical systems really engaging in a serious way in the process. So in a sense, it can be argued that the medical establishment vacated the playing field and left it to commercial enterprises and fad diet profiteers instead of focusing on the challenges of clinical research and finding cures for this serious health problem.

It would be great if a product existed that allowed us all to “burn fat while we sleep.” And it would be great if a diet plan enabled us to effortlessly lose all the pounds we wanted to lose without any sacrifice on our part. And it would be great if some of our favorite fruits contained the secret mystery ingredient of health and fitness. The truth is that you can succeed in losing weight and keeping it off, but it is not easy. You need serious motivation and you need the right tools and the right information. It takes hard work, persistence, dedication and attention to many small and large things that add up over the course of the year to reduce pounds. It won’t happen overnight, but with a sound medically supervised, or scientifically-based weight loss program, you can do it.

With so many people around the world gaining weight, the Metabolic Syndrome has taken on greater importance as a cause of individual heart attacks and strokes, and as a public health problem.

The clinical definition of the metabolic syndrome is as follows:

Metabolic syndrome is diagnosed when a person has three or more of these conditions:
1. Elevated blood pressure. Blood pressure of 130/85 or higher is a component of metabolic syndrome. If only one of your two blood pressure numbers is over the limit, it’s still a risk factor for metabolic syndrome.
2. Elevated triglyceride level in the blood of 150 mg/dL or higher (or you are taking medicine to treat high triglycerides).
3. A lower than normal level of HDL cholesterol, less than 50 mg/dL for women and less than 40 mg/dL for men (or you’re on medicine to treat low HDL).
4. A large waistline. A waist measurement of 35 inches or more for women and 40 inches or more for men.
5. Higher than normal fasting blood sugar (glucose) (or you’re on medicine to treat high blood sugar). Fasting blood sugar of 126 mg/dL or higher is considered diabetes. A fasting blood sugar of 100 mg/dL or higher (prediabetes or diabetes) is a component of metabolic syndrome.
The more of these risk factors, the greater the chances of developing heart disease, diabetes, or stroke. Someone with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.

The treatment for the metabolic syndrome is really based on two concepts: Historically, doctors tried to treat all of these diseases or problems independently. For example, we would treat diabetes with blood sugar lowering pills or insulin shots. We would then treat the high blood pressure with blood pressure lowering medication and lastly, we would prescribe lipid-lowering drugs for the hyperlipidemia. While this still remains a necessary part of the treatment, some of these drugs can have adverse effects also including weight gain. And since weight gain is such a powerful factor in the development of metabolic syndrome, it really makes sense to focus efforts on losing weight.

So the more modern and forward-thinking approach to the metabolic syndrome is to emphasize weight loss as a primary treatment. It is very common to see that people with full-blown metabolic syndrome resolve one, two or three diseases entirely as a result of a successfully medically supervised weight loss program. And while losing weight successfully and keeping it off for the long-term is definitely harder than just taking a pill to treat the high cholesterol level, the results are worth it.