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Obesity: Current Medical Knowledge – Part Three

By Suheil Khuri M.D. –

Obesity: Current Medical Knowledge - Part Three2. Behavior / Habit
With all other senses you think before you respond, but with scent, your brain responds before you think. This makes us seek food without thinking.

For a successful weight reduction program the following behavior / habit changes and modifications are needed:
– Self-monitor your progress daily.
– Develop methods to recover from overeating or weight regain
– Avoid foods and situational triggers that prompt eating
– Portion control. This is key to develop and maintain as a habit
– Decrease the negative impact of stress on positive behavioral patterns. In stressful situations one should develop relaxation techniques as in:
a.) Music, b.) Body relaxation (yoga, meditation),
c.) Stress reduction (take     deep breaths, walk, exercise)
– Get family and friends to support the changes in your lifestyle behaviors
– Substitute one healthy food for a non-healthy one or consider no food
– Prepare for special events
– Avoid mindless eating
– Change your shopping habits for healthier foods
– Think in a positive manner and replace thoughts that undermine weight management efforts
– Expect setbacks and be prepared for them but look at them as temporary
– Congratulate yourself on successes and not mistakes. Modify dysfunctional and unhappy thoughts

Changing a habit takes 4 weeks to install and 1 – 2
years to make permanent.

3. Physical Activity
There is strong scientific evidence that physical activity:
a.  Lowers the risk of:
– Early death.
– Stroke
– High blood pressure
– Diabetes type-2
– Heart disease
– Abnormal lipid profile (cholesterol, triglycerides)
– Colon and breast cancers.
b.   Has other health benefits including:
–     Prevention of weight gain
–     Weight loss when combined with diet
–     Prevention of falls
–     Reduced depression
–     Improved cardiorespiratory and muscle fitness
–     Better cognitive function (in older adults)

With weight loss one loses both fat and muscle. It is estimated that 75% of the weight lost is fat and 25% is muscle mass. To rebuild and decrease the muscle mass loss associated with weight loss, one needs to do regular resistive exercises (weight training) as well as increase your protein intake.

General health benefits are achieved with the following physical activity:
– Moderate aerobic exercise: 150 minutes/week (30 minutes 5X/week). Should be performed in episodes of at least 10 minutes and preferably all through the week.
– Additional health benefits are provided by increasing to 300 minutes a week of moderate intensity aerobic physical activity.
– Muscle strengthening activities that involve all major muscle groups performed on 2 or more days per week.

In a 6-year follow up of 50,227 women study the
following was noted:
a.    Each daily 2 hr. increment of television watching was associated with a 23% increase in the risk of becoming obese.
b.    Each daily 1 hr. increment of brisk walking was associated with a 24% decrease in the risk of developing obesity.

4. Pharmacotherapy
Medications used for weight loss are primarily ones that suppress the appetite. Their exact mechanism of action to induce weight loss is unknown.

There is a general misconception in the public as well as by the medical community that obesity medications have many side effects and carry a high addiction potential. However, many long-term studies have proven this to be inaccurate.

Several appetite suppressants have been used and studied for prolonged periods of time (up to 21 yrs. with Phentermine) with little to no risk of abuse or misuse, minimal side effects, cravings or withdrawal after cessation.

However, those are controlled substances and have to be prescribed and monitored by a physician. They have shown significant help in suppressing appetite that leads to significant weight loss.

In a randomized controlled trial of 700 subjects at 2 years: appetite suppressant medications showed a 9.3% – 10.5% initial body weight loss compared to placebo which showed a 1.8% initial body weight loss. The treated group showed also an improved cardiovascular health and decreased incident of diabetes.

Other drugs that are used in obesity treatment help in dealing and addressing the co-morbidities associated with excessive weight gain particularly diabetes and especially in the development of Insulin resistance.

VI – Successful Weight Loss and
Maintenance:
One of the difficulties in the treatments of obesity lies in the ability to maintain successfully the achieved weight loss.

The national weight control registry shows that around 5000 successful long-term weight loss maintainers with a 30 lbs. average loss and maintained for at least one year (a mean of 6 years) achieve this maintenance and prevent relapse by:

Frequent self-monitoring of: weight, food intake and physical activity.

They achieved this by:
– 98% modified their food intake in some way: Portion Control, eat breakfast every day, low calorie diet with an average of 1,400 kcal /day.

– High level of physical activity.
90% exercise on average 1+ hour per day burning 400 calories
– Eat meals away from home < 3 times/week.
– 62% watch television < 10 hours / week on average

To achieve an active weight loss, one needs to exercise 150 – 300 minutes per week. But for prevention of weight regain/maintenance,
one needs to do more activity of 200-420 minutes per week.

Call us at: 561-427-2232 or e-mail us at Jupiter.florida@drgsweightloss.com for a free consultation at
Dr. G’s WeightLoss and Wellness Center of Jupiter

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