As you all know obesity is a huge public health problem that we all deal with in our medical offices. I have been essentially ignoring treating it in my office other than through lifestyle management suggestions. That has had literally no impact on any patient that I know of in my practice.
I have always been leary of offices that treat obesity with various medications and shakes and so on. My understanding of the medications is that they can produce a 5% weight loss at best and my feeling is that they should be used as an adjunct to exercise/healthy food choices.
I am considering an attempt to change the way I practice by treating obesity medically, Does anyone have experience doing this? I know of the American society of Bariatric Physicians and their site seems very legitimate. They have a peer reviewed journal and cme opportunities.
I am hesitant about all of this but being on the sidelines does not seem like an option. For the record, my publuc health wifesays if I am to get into using medications it should be mandatory that patients are in an exercise program or else no meds...and they must prove they are doing so. You should see my marriage stipulations :)
Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com
Is there a way to get them involved in exercise?
We started a "Breast Cancer Survivors" crew team about 4 years ago. The weight loss among those women (most in the 40-50's) was quite remarkable. For our high school-aged kids, we also had significant weight loss (with some comparison photos here).
Exiercise is really the only effective way.
My initial regimine:
"Fat Smash Diet": Phase 1 for 9 days - patient breaks bad nutrition habits. Just eats certain fruits and veggies. No flour products for 9 days.
Phase 2 - for 2 weeks
During this time, start them on the 10,000 steps per day protocol. I like the pedometer sold online at Costco.
Part of those 10,000 steps needs to include atleast 30 minutes of brisk walking.
I created a patient handout with this info from Costco Online:
http://www.costco.com/Browse/Product.aspx?Prodid=11205288&search=pedometer&Mo=0&cm_re=1_en-_-Top_Left_Nav-_-Top_search&lang=en-US&Nr=P_CatalogName:BC&Sp=S&N=5000043&whse=BC&Dx=mode+matchallpartial&Ntk=Text_Search&Dr=P_CatalogName:BC&Ne=4000000&D=pedometer&Ntt=pedometer&No=0&Ntx=mode+matchallpartial&Nty=1&topnav=&s=1
After their stint with the Fat Smash Diet, I move them over to "Body For Life" by Bill Phillips. Lifestyle of nutrition and exercise. 6 small meals a day to rev up the metabolism and 1 hour of exercise 6 days per week. Cardio and resistance training.
Insurances usually won't approve bariatric surgery unless your office notes demonstrate prior counseling of the above type efforts and follow-through by the patient.
On follow-ups I remind them that 1 pound of pure fat = 3,500 calories. Burn 500 calories a day outside of normal activity = 1 pound of weight loss per week. I get them focused on small weight loss amounts over time as they maintain a new lifestyle. 52 pounds of pure fat loss in one year is possible.
Any thoughts on the meds? Some docs in the area are using them but I don't know if the efficacy is really there. I fear it would attract a group who was looking for a quick fix.
Body for life is a book I take it?
Body for Life is a lifestyle.
It started out as a book by same title.
http://www.amazon.com/Body-Life-Mental-Physical-Strength/dp/0060193395/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1218143907&sr=8-1
Has morphed into transformed lives by people who take it on.
Promotes nutrition and exercise. No quick fix.
Examples of Fat Loss
http://bodyforlife.com/success/goals/fatloss.asp
Before doing Body for Life, I recommend "Fat Smash Diet" Phase 1 and 2 weeks of phase 2.
Fruits/Veggies/Legumes
http://www.amazon.com/Fat-Smash-Diet-Last-Youll/dp/0312363133/ref=pd_bbs_1?ie=UTF8&s=books&qid=1218144071&sr=1-1
My own success story - lost 45 pounds and keeping it off. Went from 24% body fat down to 14% body fat.
I was once a sedintary carbohydrate, now I'm lean muscle training for my first triathlon.
I also don't go by BMI for Obesity measurements. I go by Body Fat Percent.
http://www.healthchecksystems.com/bodyfat.htm
I bought this body anaylizer for $300. I charge $30 per use. The personal trainers in the surrounding gyms
also send their new clients into me to be tested. My Med Assistant writes the values down on a sheet I created for them.
http://www.thecompetitiveedge.com/shop/item/123-productId.184549503_123-catId.176160808_123-xsltparam-page.features.html
I"ve got one patient who started working out on a treadmill 1 hour a day walking. He decreased his body fat from 34% to 23% in 6 months, while not exceeding his basal metabolic calorie intake. He's 53 years old. Before he got started, the device listed his metabolic age at 84 years old. He's now decreased his metabolic age to his chronological age. I'm currently 40 years old chronologically and on a good day my metabolic age is 20. I had one athlete in my office who is 38 and his metabolic age is 12. I've had stuborn obese patients leave my office and go directly to a gym to sign up with a trainer after finding out their metabolic age. Its like a smoker who learns about his lung age. It scares them into better health.
Looks like they are selling foods and supplements. Any data on a few years of using the program. i know these companies aren't meant to be scientific but I am curious.
Totally unrelated, I have been buying music CD's at starbucks..Aretha Franklin...great stuff.
Supplements are available at their websites.
Whey protein is a staple to transform a body into lean muscle. Buy off website or at Walmart. When I'm lifting weights, I use one scoop of Betagen prior to the workout. Creatine + HMB.
Body for Life has been around for atleast 10 years. I'm aware of a study that Oprah did. Part of her audience did Atkins, South Beach, and Body for Life. AFter 1 year, the group of people who lost the most weight and stayed on the lifestyle were those who did Body for Life. She sent them to Hawaii.
Some patients will come asking for phentermine. http://en.wikipedia.org/wiki/Phentermine
I have used it only after a patient has hit a serious plateau in their exercising routine. And only for a few weeks. Not the full 3 months.
Other plateau busters include Green Tea ( I like the brand PureGels http://www.vitasprings.com/puregels-green-tea-extract-60.html 2 pills twice daily
has less caffeine than others and includes high amounts of EGCG).
Some like it in a drink: BENEFITS OF GREEN TEA http://www.greenteahp.tv/healthbenefits.html
and also **** apple poly http://www.applepoly.com/ very cool stuff! ****** http://www.applepolyphenols.com/ My patients lose on average 8 pounds
breaking through a plateau using apple poly. I recommend this stuff only when reaching a serious plateau in their exercise routine/nutrition lifestyle.
Others will ask about HCG injections combined with a 500 calorie diet. The FDA has not approved it for weight loss. But there is a craze for it online and people are getting the quick fix results they want. 1 pound per day! I don't recommend it myself. Maybe some of you are braver than me! http://www.google.com/search?hl=en&q=hcg+injections
Phase 1: Lose 1/2 to 2 pounds per day for 6 weeks
http://www.docbron.com/HCGandWeightLoss.html
http://www.americanchronicle.com/articles/49592
http://www.hcgmedical.com/weight.asp
Dr Simeons' Protocol http://www.hcgmedical.com/Simeons.asp
Information AGAINST this approach: http://www.dietscam.org/reports/hcg.shtml The injections are not approved by the FDA for specific weight loss. Use of it is "off label". Though doctors know this, some are prescribing the therapy and patients are losing LOTS of weight.
Just learned there are attempts at oral HCG
http://oralhcg.com/english/in2.1.htm
>>Totally unrelated, I have been buying music CD's at starbucks..Aretha Franklin...great stuff.<<
I gave in to one of those impulse buys at Nordstroms the other day...Immortal Soul. It is great stuff -plus some proceeds went to charity :)
As for weight loss, I have little to comment on. I was raised by a dietitian and an exercise addict. I eat fruit, some greens, chicken, fish and sweets on birthdays and holidays as well as exercising 3-4 days a week. I admire the efforts to get your patients to lose weight. I'm sure it is a thankless task more times than not.
bbchase: As for weight loss, I have little to comment on. I was raised by a dietitian and an exercise addict.
As for weight loss, I have little to comment on. I was raised by a dietitian and an exercise addict.
Luckily you dont have bulimia.
Weight loss ?
Hmmm ...
Eat right, Exercise. ?
Want to lose 20lbs in 4 months guaranteed ?
Sell your car.
bbchase:I was raised by a dietitian and an exercise addict.
Matt raised you???
Graham http://www.synapsedirect.com/ Synapse - the EMR for smart users
Ahh, dieting...meh.
Cutting out all fast food, walking more often and staying off the soda will almost virtually guarantee a drop in weight loss. Now if one actually excercises...woah..then you'd really start seeing a difference.
I do realize that some people have a harder time keeping off weight or losing it to begin with but these diet fads are killing us. With all the money society spends on buying the books, foods, suppliments...they could just eat a little healthier and use some common sense when eating. I just think someone is profiting somewhere but the obesity rate keep climbing..
"Becareful what you wish for...it may end up on the internet"