1. Be an example to your kids. Be physically active. Promote healthy eating. Strive for and maintain a normal weight.

2. Write a letter to the editor. Let your voice be heard in your local paper or newsletter. Let people know this is one of the most serious and worsening health problems in the country affecting our young people.

3. Joint the Parent Teacher Organization of your local schools. Ask about healthy hot lunches, snacks and meals for all the school children.

4. Write your member of congress. While you are bringing out the pen and paper, send a personal letter to your congressional representative. Let them know what a devastating problem this is in your community and in the nation. Collectively we can do something about it, but it will take change from the highest levels of government. A sample of such a letter is available at www.obesitypreventionfoundation.org.

5. Get outside! Take the neighborhood children outside at least three times a week for some vigorous activity. Take a long walk but bring a Frisbee or a football with you so you can run and catch during the walk. Make it fun and interesting for the kids.

6. Bring it to the Club. The importance of childhood obesity must be brought to the consciousness of everyone. If you belong to Rotary or Elks or a country club, or just your own reading group, bring it up at the club and encourage everyone to get engaged.

7. Support local school extracurricular activities and sports. One of the reasons schools must turn to fast food and soft drink sponsors, is that no one else is stepping up to the plate. Attend the games, encourage your community to take an active interest in sports and extracurricular activities that are “active” for the kids in your area. Then find ways to support them financially.

8. Volunteer. Public school libraries, hospitals and clinics, boys and girls clubs, youth programs: all of these programs, organizations and centers need volunteers. Be a volunteer who also brings awareness about healthy eating and exercise. If you read to toddlers or school children, make it active; between books or chapters stand up, do jumping jacks, go outside, walk, emphasize the importance of physical activity and healthy eating whenever you get a chance.

9. Be a volunteer coach. Today more than ever, the sports and extracurricular activities for youth depend upon coaches and parents who are in short supply and lead busy lives. If you once played soccer or volleyball or anything else, you might make a perfect volunteer assistant coach at a local school. Who knows, you may get tapped to start a new team or a junior varsity or, in some other way, bring in more children into an athletic environment. You could change a life.

10. Join the Obesity Prevention Foundation community today. And tell two friends. This project, to prevent childhood obesity, will take all of us. And together we can make a very important difference in the lives of young people.

In the last few years, I have been approached by a number of people who were not comfortable sharing this health decision with the public. A number of them are famous for one reason or another and wished to undergo weight loss surgery, but they did not wish to disclose this decision publicly. I have also performed weight loss surgery for a number of private citizens who felt that they would prefer to keep their health decisions and weight loss surgery decision private.

It is part of the physician’s code of ethics to honor patient privacy. As a physician and surgeon, I always strive to do the utmost to do so. Bariatric surgery is no different from any other health decision when it comes to privacy.

Or is it? Studies have shown that people wishing to lose weight are more successful when they have the support of friends and family, or others like them who are also striving to lose weight. In addition, many of the best weight loss surgical programs provide not only support groups but also group education events such as seminars and classes on weight loss surgery, weight loss techniques, dieting, exercise, etc.

So how do we respect the privacy wishes of an individual and also offer the very best weight loss solution?

I have spent a lot of time thinking about this question, and ultimately I have crafted what I think is the best solution for the patient who wishes to protect their privacy and not disclose their decision to have weight loss surgery.

What I have done in these cases is make special arrangements to minimize the exposure of the patient to any other patients or bystanders in the office or at the surgery center. We have gone so far as to create an alias under which people schedule their appointments and check in at the surgery center. We have also created a personalized version of the classes and study materials and utilized on-line teaching and training methods.

All of this has worked well, and for the person who wishes to keep their decision to have weight loss surgery private, we can both respect that decision, and provide the best surgical weight loss solution.

There are pros and cons to pursuing weight loss surgery in this private fashion. You may avoid unwanted judgments but miss out on some support from other people. And of course, there is no absolute guarantee to privacy!

In a future blog post, I plan to discuss more aspects of this question:

Should you keep your decision private or should you disclose it?

WHY DIETS LEAD TO REBOUND WEIGHT GAIN AND HOW MEDICALLY SUPERVISED CALORIE RESTRICTION CAN BE BETTER

Rebound Weight Gain causes almost all diets to fail. I have worked to help people avoid this frustrating problem after all the hard work of losing the weight with a diet. And there is a better way!

Successful weight loss does not happen by magic. There are no solutions that take all the burden off your shoulders and eliminate the need for hard work, dedication and perseverance. And yet, clearly some weight loss solutions succeed much more often than others. Diets, by and large, do not work. But what do we mean by “diets”?

Generally, what we mean by diets are temporary changes in one’s nutritional intake that result in a significant calorie intake reduction. There are numerous published diets, fad diets, and many personalized diets that individuals have used before to lose five or ten pounds prior to summer season, for example. By and large, these involve eliminating certain food groups or certain subsets within the diet and, in addition, restricting calories a great deal through certain mechanisms such as simple avoidance or substitution with very narrow list of foods, like raw carrots.

Why don’t diets work? Diets don’t work because they don’t involve a plan to transition to future phases of the diet or to a maintenance program. Diets don’t work because they are not sustainable as eating behaviors beyond a very short term. Diets don’t work because they feel like deprivation and they require a high level of motivation to deprive oneself. This does not last.

And lastly, diets don’t work because they don’t involve creating the right kind of calorie intake that can result in appetite suppression, as well as maintenance of lean body mass. Nearly all diets that people try result in burning of lean body mass or protein mass to an equal or greater degree than burning of the fat mass. When the diet comes to an end, a phenomenon known as rebound weight gain occurs as a result of the hunger and nutrient deprivation experienced by the muscles. So it’s a very powerful biochemical response that leads to an even higher level of hunger and a rapid rebound weight gain.

So if diets don’t work, how can “calorie restriction” work?

Well, calorie restriction can work if it is used properly, if it involves the proper selection of foods, and if it employs the optimal techniques to avoid rebound weight gain. Let’s examine what those are:

First, calorie restriction needs to reduce carbohydrate calories. The most potent stimulus of circulating blood glucose is carbohydrate intake. The carbohydrates stimulate secretion of insulin and leptin into the bloodstream and these surges of hormones cause surges of satiety followed by equally powerful surges of hunger. Protein and fat stimulate these responses to a much less degree. It’s true that protein, and its building blocks, amino acids, do stimulate a rising blood sugar, but it is much less potent in effect than carbohydrate intake. Fats, interestingly, do not stimulate a rise in the blood sugar or insulin. So one of the keys to successful calorie restriction is to limit the carbohydrate intake and try to dampen these surges in circulating blood glucose and the hormones, insulin and leptin. You will then experience less hunger during your calorie restriction. It’s well known, for example, that people on an Atkins type diet that emphasizes protein will feel less hunger and greater satiety over the course of the yearlong dieting attempt than people who attempt to consume a low fat diet that does not restrict carbohydrates. As a result, the diet that restricts carbohydrates and allows more protein, results in somewhat greater weight loss over the course of the year. These findings have been reported in 2007 after a major national trial, and made headline news in the New York Times.

Next principle – protect lean body mass. How do you do this?Two ways:Exercise and protein and vitamin intake. So the key is to try to burn as much fat mass as possible while preserving all the muscle mass that we can. This is best accomplished by adequate intake of protein with a wide variety of amino acids, and an adequate vitamin intake.

Next, you must think of the calorie restriction as a step toward long-term weight loss and this requires developing a transition plan. Ideally, this means setting a number of weeks for the initial calorie restriction component and then having a planned transition to the next phase that is also clearly defined. We are much more likely to comply with the program if the program is clearly defined. That way we know exactly how many days we have to follow one regimen and we know exactly when the transition is to the next regimen.

Next, the calorie restriction program needs to be very well spelled out. This is one reason why meal replacement programs work so well. The “diet” is not open to discussion or debate. It is very clearly laid out for you:Meal replacement shakes and bars through the day at prescribed hours with no substitutions and no variations. Period. Simple.

As a weight reduction program prior to bariatric surgery.

Here is a role that has proven very successful for calorie restriction programs. For successful weight loss surgery to take place, it is best to optimize your condition prior to undergoing surgery. There are numerous studies indicating that if a patient loses weight prior to surgery, their outcome is improved. In addition, there is specific information about calorie restriction resulting in a very advantageous shrinkage of the liver prior to bariatric surgery. The liver shrinkage makes for less cracking and bleeding and less chance of conversion to an open operation. So a four to eight-week program of calorie restriction, ideally using meal replacements, is very helpful for the successful outcomes of weight loss surgery. And the added advantage is that the time frame is very finite. There is a clear transition to the “postsurgical diet” and a clear transition point on the date of surgery after which eating will never be the same again. The vast majority of people who lose weight with a preoperative calorie restriction weight loss program will never see those pounds again in their lifetime.

As a weight reduction “induction” program in a medical weight loss center.

Here, an individual begins his or her weight loss journey with a powerful initial induction program that consists of significant calorie restriction using meal replacements. The choices are eliminated, and a strict regimen of shakes and bars, fluids and vitamins is established. In some centers, prescription appetite suppressants are added. During this phase, the individual loses weight rapidly, usually 2-4 pounds per week. At the end of a 12 week program, a substantial weight loss has occurred. But the only way it will succeed is if the 12 weeks are used learning behaviors that will succeed for the long term. Transition to a plan of slowly introducing real foods occurs next. These real foods contain lower calories and carbohydrates than the individual was consuming under their old bad habits. The best centers teach motivational and will power techniques that enable the person to fight the hunger and stick with the healthier, lower calorie, lower carb meals and snacks. In time, the whole package of induction, behavior techniques, motivational tools, group support, prescription medications, and meal replacements come together for a person to succeed long term. It’s not magic, but it works.

So in summary, calorie restriction does work if used properly. The critical elements are to reduce carbohydrates, maintain protein, amino acid and vitamin intake, exercise is critically important to maintain lean body mass and avoid rebound weight gain. View the calorie restriction as a key step towards a long-term goal of weight loss. Define the calorie restriction time frame very clearly, whether it is four weeks, eight weeks or 24 weeks. Have a clear date on the calendar when the calorie restriction period ends and know what you are transitioning to. This is often a good time for some professional help as it is difficult to craft a healthful and effective long-term maintenance program. Calorie restriction works very well in preoperative weight loss and as a weight loss program to move off of a plateau or to reverse a relapse or period of weight gain. Meal replacements work best as they take away all the choices in the day and the opportunity for cheating or rationalizing extra calorie consumption.

What experiences have you had with calorie restriction?What has worked for you and what has failed for you?

Get Started!

Losing weight is among the most important things you can do for your health and quality of life. Even modest weight loss will improve your chances of avoiding sickness, diabetes, infection and high blood pressure. None of these are cosmetic issues.

The solutions to help you lose the pounds and keep them off are better than they have ever been before. Weight loss with medical supervision is a growing, and increasingly successful method of losing weight. You can succeed, and no goal is more worth it.

Aristotle once said, “We are what we repeatedly do. Excellence, then, is not an act, but a habit.” Successful weight loss means establishing excellent habits.

Here are the Top 10 tools for weight loss success you can start today.

1. Set a short term goal today.

How many pounds do you want to lose in the next 1 month? Write it down.

Write an even shorter term goal of your plan to weigh yourself daily, exercise five hours this week, and avoid desserts this week. No one can accomplish a long-term objective all at once. It takes time and baby steps. Plan that first baby step in detail.

2. Park two extra rows away from the entrance to your work.

Two extra rows away might not seem like much, but think of adding 50 extra calories a day to your regimen from parking and walking; that’s 18,250 calories in the course of a year. That translates into over five pounds lost every year, just from this one change!

3. Serve yourself on a smaller plate.

We get used to big portions on big plates, but research suggests we feel just as satisfied with a small plate of food. Have you ever really enjoyed the ninth bite of apple pie quite as much as the first bite? If we use smaller plates, we feel just as satisfied, and, you guessed it, we end up consuming far less calories.

4. Walk up one flight.

If you are only going up one level, make yourself walk. Think of the advantages. For one thing, you don’t have to wait, and then stand in a crowded elevator with a bunch of strangers who don’t share your tastes in cologne. One flight can burn over 16 calories, and it probably will even speed up your arrival. Make it your habit.

5. Eat breakfast every morning.

It turns on our metabolism, and we burn more energy through the day. Skipping breakfast means eating later meals throughout the day and night, a pattern that leads to increased fat storage. The key is to avoid the harmful high calorie, high carbohydrate offerings such as donuts and fast food. It’s really the ideal meal of the day for a healthy protein bar. The best ones contain around 150 to 230 calories and 12 to 15 grams of protein with less than 10 grams of carbohydrates.

6. Brush your teeth an hour earlier.

Then keep them clean and have only ice water the rest of the night. Who doesn’t like to have fresh, minty clean teeth? Sometimes around 7:00 p.m. there comes a vague decision to have more food, dip into the ice cream, or pop some popcorn. We could really do without the calories, and we’re not that hungry then anyway. Most of us will just skip the late night snack if we already brushed.

7. Read every label.

We tend to change our own shopping behaviors without real outside pressure, once we become knowledgeable or mindful of the consequences of our behaviors. So can you become more mindful just by reading the label? You bet you can. Your goal is to reduce calories, but more importantly, reduce carbohydrate calories. And pay attention to the serving size on the label, too.

8. Make a rule opposite to what your mother told you: Always leave food on your plate.

Never finish all of anything, no matter how good it is. Unfortunately, in this one case, mother was wrong. Telling us to finish everything on our plate was a bad idea, in this modern, overweight world.

9. Find rewards for yourself other than food.

Try a massage, good books, movies, a visit with friends, clothes. Reward yourself with these treats. Just make them anything but food. Celebrate your successes.

10. If you watch TV, new rule: no sitting.

Studies have shown standing and pacing burns over twice the calories of sitting. Just imagine if you used that time to exercise, even if only mildly. The result would be a substantial caloric burn. A simple change from sitting to standing or pacing while watching TV can lead to significant weight loss.

This is your life. Your choices define you, your health and your quality of life. Don’t give up.

Today, weight loss solutions exist that can help you lose the pounds, improve your health, and live longer. Nothing is more important for your health.

Kent C. Sasse, M.D., MPH, FACS

It is important to always remember that each person is unique and every patient has unique medical situations. General medical advice such as proven treatments that are usually helpful for conditions like diabetes or hypertension can make good sense and improve understanding of these medical principles is helpful to everyone. However, before you apply any specific advice to yourself, make sure you have talked it over with your physician.

Let me give you an example of how some general advice that works well for most people did not apply to a specific individual. I saw a patient in the office who had a long history of difficulties with high blood pressure and gradual impairment of his kidney function as a result. He already took four different drugs to control his blood pressure and was teetering on the edge of requiring hemodialysis, a filtering procedure that takes over the work of the kidneys when they have failed.

Now this patient, whom I will call Jim, had done a lot of reading about his health conditions and he knew that he was at least 40 pounds overweight. He had read about the benefits of low carbohydrate diets and began a program on his own that consisted of 800 to 900 calories per day from protein-based meal replacement shakes and bars. He added some snacks and he was soon taking in 90 to 120 grams of protein daily.

In addition, Jim had read about the beneficial effects of weight loss medications, particularly phentermine. He had managed to procure phentermine from an online pharmacy. When I saw him, Jim’s blood pressure was sky high, and I worried that the protein intake might be a bit too much of a load for his kidneys to filter. I ran some blood tests which confirmed my fears: his creatinine had risen to a more dangerous level.

I advised Jim that since he had specific health conditions that were adversely affected by the weight loss methods he had chosen, he would be better served by changing his methods. We talked about alternative prescription medications and we talked about lowering the protein content in his diet regimen.

While for most people Jim’s strategy would have been an excellent one, with Jim, the strategy created some risks. It’s an example of how general advice needs to be interpreted a bit more carefully before it is applied to any one individual. I advised Jim that before he self-administered any further medications or supplements that he talk to me or his primary doctor first.

The same holds true for you and in the medical treatments or medical weight loss program you undertake, it is always best to do so with the guidance, support and assistance of your physician. It may save you a lot of health troubles down the road.