Weight Loss
More than 1/3 of Americans are classified as obese. Obesity is also a leading contributor to heart disease, stroke, Type 2 diabetes and several types of cancer. Obesity is estimated to add $147 billion in medical costs yearly

Efforts to lose this extra weight have not escaped the notice of entrepreneurs who have turned the the desire for thinner bodies into a $20 billion per year industry including books, supplements, drugs, and surgery.  Approximately 100 million Americans are dieting in any given year and 85% of those are women.

Because there is so much demand for weight loss products and so much money to be made this industry has attracted a wide ranging group of individuals looking to profit from the demand. Some of the products and information are helpful and accurate while much of the rest is either ineffective or maybe even dangerous. It can be difficult to separate fact from fiction in all the hype for the latest"fat burning supplement" or  the great "eat all you want and still lose weight" diet. This article will attempt to address some of the confusion surrounding the wide spectrum of weight loss methods and products on the market but the shear volume of items sold to help with weight loss means that I won't be able to cover everything. It may help to keep in mind that as with all tings in life and perhaps even more so with weight loss products  " If it sounds too good to be true it probably is".

The Science of Weight Loss

Its important to separate the science of weight loss from the magic that is often promised by the purveyors of weight loss products. There is no magic to weight loss. Its simple math. Burn more than you consume and you will lose weight. Burn less and you will gain.
Weight change = Calories In - Calories Out ( Basal Metabolic Rate + Exercise)

This formula expresses the basic concept of weight loss. Add up all the calories consumed in a day. Then subtract the calories your body burns at rest  ( The Basal Metabolic Rate or BMR) and the calories burned during exercise. If the number you get is negative then you will lose weight. If its zero there will be no change, and if its positive you will gain weight. All weight loss strategies have to address this basic equation.
Diets obviously address the Calories In portion of the equation. A balanced diet should include enough calories to meet the daily needs along with the correct balance of protein, essential fats, and other nutrients. 

The Calories Out portion of the equation is the more difficult part for many people to figure out. Many of today's exercise machines will calculate your calories burned during exercise and for those who prefer to bike or run outside there are smartphone apps to help ( see links on this page).

The more difficult part of the equation is the Basal Metabolic Rate ( BMR). In order to get an accurate determination of the BMR a person would have to go through extensive testing in a research lab. Obviously this is not something that is available to most people. Alternatively there is an in office machine that can give a reasonable estimate and it is available through some nutritionists offices. For a less precise but more practical estimate we can use a formula based on an individuals age, weight, height and sex to estimate the BMR ( see calculator tool on this page).

The BMR is determined in part by genetics but it is also affected by muscle mass and total body mass. A larger person will have a higher BMR simply because it takes more energy to keep all those cells alive. This is why it gets harder to lose weight after an individual has lost 10 or 20 lbs.  BMR is also affected by muscle mass percentage because muscle burns  more calories than fat. If we have two people who weigh the same but one has more muscle and less fat, that person will have a higher BMR. Weight training and aerobic exercise can improve BMR by increasing muscle mass and lowering body fat percentage.

Diet and Exercise

Diet and exercise are the healthiest and the only proven long term methods of weight control. In addition to controlling weight a balanced diet and moderate exercise have many other beneficial effects including reduced risk of cardiovascular disease, cancer, arthritis, and diabetes. 

A good diet does not require gimmicks. Recent history is filled with all sorts of silly diets. The Cabbage Soup Diet, The Blood Type Diet, The Atkins Diet, and the Cave Man Diet are just a few of the many diets that have come in and out of vogue in the past few years and have promised miraculous results but delivered far less. Every day brings a new fad diet or another diet book claiming to let us eat all we want and still lose weight.

Remember if it sounds too good to be true it probably is. There is no trick to dieting. We know what we should eat. Its just a matter of controlling our impulses to eat too much of the wrong things. The problem with most fad diets is that many of them are just some form of fasting  disguised behind a new gimmick and nearly all are geared to create short term rapid weight loss because that's what makes headlines and sells books. Many of them require their followers to consume a lot of one type of food or very little of something else. Few of them provide a balanced diet or any hope for long term weight control. 

Short term weight loss doesn't lead to long term health gains and may actually cause harm. Any effort to control weight through diet has to be looked at as a life long lifestyle change. If you are going to start a diet ask yourself one question, "Can I do this for the rest of my life?" If you can't see yourself doing it forever than don't start it at all. If you are looking for quick gains and instant gratification then you are setting yourself up for failure. Weight control is a long term commitment. I always tell  my patients that I don't care what they weigh in 2 months, I care what they weigh in 2 years.

Not all diets are bad though. There are good diets out there for those who are serious about losing weight. These are diets that are well balanced in terms of calories and nutrients. Good diets also allow you to eat everyday foods so that sticking to the diet doesn't turn into an expensive chore. The key to a healthy diet that will help you lose weight and keep it off is to focus on portion control and good food choices. Diets that satisfy this requirement can be designed by a nutritionist to meet your individual needs. If cost is an issue and you don't need a custom diet then Weight Watchers is an excellent alternative.

 A reasonable initial goal would be to lose about 10% of body weight. To do this you should lose no more than 1/2 to 2 lbs per week. A pound of body weight equals approximately 3,500 calories so to lose a pound a week you need to do some combination of diet and exercise that will allow you to burn 3,500 calories per week ( or 500 calories per day) more than you consume.

Medications

A number of medications have been approved for weight control use in the U.S.  These medications can help individuals lose a moderate amount of additional weight when combined with diet and exercise but there is little evidence that the additional weight loss can be maintained once the drugs are stopped. All of these drugs have potential side effects and none of them are approved for long term use.
  • Alli ( Formerly called Xenical) - Works by interfering with the body's ability to digest and absorb fats. Produced an average of 5% weight loss, only slightly more than the control group. Side effects occurring in a significant number of patients include bloating, gas, diarrhea, and oily stools and fecal incontinence.
  • Phentermine and Qsymia ( Phentermine- Topiramate ) - These drugs are appetite suppressants. In two studies patients lost an average of about 10% of their body weight compared to 1.5% in controls. Side effects can include mood changes, insomnia, and trouble concentrating. There have been reports of heart valve injuries in the past in patients who took phentermine in combination with a second medication.
  • Belviq - This is an appetite suppressant. Studies showed that patients who took this lost about 6% of their body weight compared to 2.5% in a control group. Impairment in attention, memory, somnolence, confusion, and fatigue, have been reported in patients taking Belviq.
  • Metformin - Mechanism of action is unclear. This is a medication often used for diabetes but has been associated with weight loss in patients. The most common side effect is soft stools or diarrhea.
  • Meridia ( withdrawn from the U.S. market in 2010 due to increased risk of heart attack and stroke)
Data source: http://www.nejm.org/doi/full/10.1056/NEJMp1211277

Surgery

Weight loss surgery also called Bariatric surgery is reserved for patients who are significantly over weight and have failed multiple attempts at diet and exercise. Generally patients should have a body mass index of 40 or more may be considered for bariatric surgery. There are two distinct types of bariatric surgery currently available.
  • Laparoscopic Band Surgery (Lap Band) - This procedure is done through a laparoscope which is an instrument that allows a doctor to operate through a couple of very small incisions in the abdomen. The doctor then places a band around a portion of the stomach which restricts the stomach contents. Because the incisions are small recovery time is very quick. Patients often return home less than a day after the procedure. The size of the band and the degree of restriction can be adjusted during a routine office visit by injecting or removing saline from a reservoir which lies  just beneath the skin .
    • Side Effects - Nausea, Vomiting, Reflux. constipation, and ulceration of the band site.

  • Gastric Bypass ( also called Roux En-Y procedure) - In this procedure a small pouch is created from the top portion of the stomach and attached to the small intestine. The remaining larger part of the stomach is separated and no longer accepts food. After this procedure, when a patient eats, the capacity of the stomach is much less and they can only eat small amounts. Gastric Bypass can not be done laparoscopically and requires a longer recovery period than the Lap Band procedure and is associated with a higher risk of complications. On the positive side patients who have this procedure done tend to lose more weight than those who have  the Lap Band. In addition, Type 2 diabetic patients who go through this procedure often see a rapid and dramatic reversal of their disease.
    • Side Effects - Since this is a more extreme form of surgery there are obviously more potential side effects and complications. The possible side effects include Dumping syndrome, Dehydration, Difficulty swallowing, Gallstones, Reflux, Nausea, Vomiting and changes in Bowel habits. In addition, the removal of a large portion of the stomach and some of the small intestine from the digestive process can result in the incomplete absorption of some nutrients. It is often advised that patients take vitamin supplements and have routine blood work after gastric bypass surgery to ensure that they do not become malnourished or vitamin deficient.

Weight Control Smart Phone Apps

Exercise and diet tracker

MyFitnessPal - Android, iPhone, Windows phone. This app allows you to record calories consumed and calories burned each day and even has a bar code scanner to make it easier to get calorie information into the app for the foods you eat. Free app
FitBit - iPhone and Android. This app tracks your activity during the day and counts calories.

Exercise Apps

Road Bike - Android,iPhone, Windows phone This is a great bicycle computer app which tracks and maps your ride as well as the calories you burned.  Basic app is free.
MapMyRun - Android,iPhone,Windows phone  This app will track and map your run and also calculate calories burned. Basic app is also free.

Calculators

Basal Metabolic Rate

Powered by BMR Calculator

Body Mass Index