MEDICAL WEIGHT CONTROL AND NUTRITION
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Do Diets Work?
Everyone is saying
that diets don't work.
Is it true?
The answer is that diets can work. When people say "diets don't work" they are taking all diets and lumping them into a single category and then asking if they work. A diet is an eating program. Everyone has a diet. If you are at a healthy weight and you are able to maintain it easily then your diet "works". If you are not maintaining a healthy weight then your diet doesn't work. In order to reach a healthy weight and then maintain it you are going to have to change your eating habits which means you are going to have to change your diet.
When people say "diets don't work" they are referring to unhealthy diets or fad diets that produce only temporary weight loss. This type of dieting really doesn't work if what you are trying to do is lose fat and develop the habits that you will need to keep the it off.
A healthy and sound diet on the other hand is one of your best friends when you are losing weight. You are going to have to eat fewer calories than you body burns in order to lose weight. The best way to reduce calories is to replace bad eating habits with good ones. Once you develop healthy eating habits then you will have a diet that works.
What Is a Bariatrician?
A bariatrician is a medical doctor who specializes in the treatment of obesity. The bariatrician is licensed by the state to practice medicine. In addition they are also registered and approved by the DEA to prescribe medication as part of the treatment that they offer.
How Is a Bariatrician Educated?
A bariatrician is a member of the American Society of Bariatric Physicians (ASBP). The ASBP holds several educational meetings each year which the members attend in order to stay up to date about the latest available treatments. The ASBP also publishes a journal to keep its members updated between meetings. Bariatricians invest the time required to stay current in the field of medical weight management.
How are ASBP Members Different from Other Doctors?
The ASBP has a "standard of practice" which its members agree to adhere to. This means that the ASBP member is using treatments that are generally accepted as both safe and effective. The ASBP member physician is part of a larger organization that is dedicated to providing the best possible treatments available for obesity.
What Is the Advantage of seeing a Bariatrician?
The main advantage of seeing a bariatrician over non-medical programs is that they are seeing a doctor. The advantage of seeing an ASBP member doctor is that you know that the doctor is staying current on new developments and adhering to a standard of practice. The doctor can detect other medical problems that might effect the treatment for weight loss. Only the bariatrician can provide the patient with prescription medication that often works where dieting has failed in the past.
Also since bariatricians are doctors they are accountable to their state medical boards, the DEA, and a state licensing agency. In most states there is no individual or organization that oversees non-medical weight loss clinics.
Weight Loss Frauds
An old saying tells us that if something sounds too good to be true then it probably isn't. Nowhere is this more evident than in the vast array of products and services being sold to people who want to lose weight.
We've all seen books and ads that promise "30 pounds in 30 days", "14 pounds in 14 days", "The 5 day diet". Can you really lose a pound of fat in one day? Lets look at some facts.
A 35 year old woman who is 7 feet tall and weighs 300 pounds would require about 3500 calories per day to maintain their weight. Since there are about 3500 calories in a pound of body fat it means that this person could eat no food and expect to lose one pound. Someone of more modest proportions who desires to lose weight would have a difficult time losing one pound per day.
The body contains a lot of water which can be gained and lost quickly. The promoters of the "Pound-a-Day" programs know this and they know that even for as long as one month they can probably get the results they claim. The problem is that as quickly as the "Pound-A-Day" programs take the weight off it will come back.
The number 4 health fraud according to the FDA is "Instant Weight Loss Schemes" (Arthritis, Cancer, and AIDS cures are the top 3). Fraudulent weight loss schemes are usually sold with full-page newspaper ads promising rapid, dramatic, and easy weight loss. Some key words to look for are easy, effortless, guaranteed, miraculous, magical, medical breakthrough, new discovery, mysterious, exotic, secret, exclusive, and ancient. These products vary between those that merely don't work and those that are truly dangerous. The only thing that will get permanently lighter is your wallet.
A well known New York City weight loss physician was being interviewed on Good Day New York. At one point he was asked "Why are so many people overweight?". His answer included a number of reasons the last of which was "people are lazy".
I was surprised to hear him say that because the idea that overweight people are lazy is an old fashioned idea that we now know is not true. Overweight people are not weak willed, lazy, or stupid but yet this impression of overweight people seems to be ingrained in our culture. It has been demonstrated even in very young children so we know that it is learned at an early age. Recently advocacy groups have been working to change these opinions. Overweight has been called the last legal prejudice. To hear a doctor say "overweight people are lazy" today demonstrates that we still have a long way to go.
The question remains, however, "Why are so many people overweight?". The answer is actually quite simple. It appears to be a combination of a treatable chemical imbalance and correctable "bad habits". Dr. Michael Weintraub in numerous studies for the NIH demonstrated that currently available medications can be used to control appetite and achieve long term (four to seven years) weight loss.
The other piece of the puzzle is habits. There are habits that you want to break such as eating when you are under stress, eating in front of the television, or eating high fat and high sugar foods. There are also habits that you want to develop like regular exercise and meal planning. Habits are the foundation of your day to day behavior. If you ignore them they can be one of your fiercest enemies in your weight loss program. If you understand them and use them well they are one of your strongest allies.
There is so much material that crosses my desk about dieting and weight control that I don't often see something that surprises me. I did recently run across something that I hadn't seen before and it was a surprise.
Not A Surprise:
The high cost of being overweight is not a surprise. According to Healthy Weight Journal, the annual costs of obesity are estimated at over 45 billion dollars. This is almost 7% of the total amount spent on health care. This is not a surprise.
Also Not A Surprise:
According to a newly released study by Chrysler Corp. and others, People outside a healthy weight range incurred 143% higher hospital inpatient utilization than those in the healthy weight range. This is not a surprise.
Still Not A Surprise:
Also from this study was the fact that people defined as elevated risk for weight used hospitals 143% more than people considered low risk. This is also not a surprise.
The surprise was also from this study. Of all the health behaviors studied, eating habits resulted in the largest difference (41%) in costs by risk level between those with poor vs good habits. This means that by working to develop good eating habits you can improve your appearance, your quality of life, and ultimately reduce your health care costs. Remember its never to late to begin.
How to Help Your Child Lose Weight
Catch them doing something right. When you notice them making healthy choices be sure to praise them for it. A few words of praise from you can make the effort seem worth it.
If you catch them eating something that they shouldn't avoid being harsh or critical. Use this opportunity to remind them of their weight loss goals. This is the time that they need the most support. Be sure to tell them that they haven't failed or "blown the diet"" just because of a slip.
Stock up on the foods that they can eat on their diet. Have fresh fruit and raw vegetables on hand so that they will have snacks available.
Avoid buying foods that will be a temptation. High-fat, high-calorie foods aren't good even for family members that aren't on a diet. Remember that "Fat-Free" does not make it a diet food. Most "Fat-Free" foods have close to the same number of calories as the high-fat variety.
Even if your child is young begin teaching them about nutrition. Involve them in meal planning and teach them that eating well involves making choices about what to eat and how much.
Don't do everything for your child. They must learn to make the correct choices for themselves. The biggest gift you can give them is the sense that they are in control and that they can do it.
Respect your child's privacy. Some people don't like to talk about their dieting with others. You should be aware of you child's wishes about this and respect them.
Don't talk to other people about your child's successes or failures with weight loss. This is a very personal matter and your child should feel that you respect that.
Food is often used as a reward. Begin to notice with your child where the two of you do this. Find other ways to reward.
Never offer food as a reward or withhold food as a punishment.
The 5-a-day Challenge
The National Cancer Institute is urging Americans to "Take the 5 A Day Challenge". The program is designed to increase people's awareness of the importance of eating enough fruits and vegetables everyday.
"One of the 5 A Day message's greatest strength is that it is positive. We're encouraging Americans to eat more of something that tastes good for better health, rather than sending the `less is better for you' message that we're all used to hearing", says Peter Greenwald, MD.
Many Americans only need to add two servings of fruits and vegetables every day to reach the 5 a Day minimum. Start by figuring out how many servings you are currently eating. Keep a log for one week counting the number of servings of fruits and vegetables. If you find that you are eating less than 5 a Day then begin to make an effort to add more to your diet. Start slowly by adding one serving per day for a week until you reach the 5 a Day level.
If you are trying to lose weight or maintain the weight you have already lost then the 5 a Day challenge will help you to add healthy foods to your diet. Fruits and vegetables make you feel fuller which in turn makes you less hungry. To increase the effect make sure you drink a glass of water with each serving.
Consumers can call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER and request the free brochure "Time to Take Five."
The Water Test
How do you know if you are really hungry? People have all sorts of different answers to this question. If you are trying to manage your weight you should know about the water test. I tell all of my patients to always use it if they think that they are hungry.
The water test is simply drinking a glass of water and then waiting five minutes when you think you are hungry. If you are still hungry after taking the water test then you should eat. We like to say that the water test is used to distinguish real hunger from false hunger but it really does much more than that.
Drinking a full glass of water before you eat will help to fill you up so that you won't want to eat as much even if you are still hungry. If the desire to eat was an emotional one as opposed to a physical one then the water test will interrupt the emotional eating habit and give you a chance to make a different choice. The water test will also help you to drink more water during the day which is very important to your weight control program.
The water test is a very simple habit that should be a cornerstone of your weight control program.
The Hard Way or The Easy Way
I am often asked "Dr.Gazit, is there an easy way to lose weight and keep it off?". My answer may come as a surprise. There is one easy thing that you can do that will make it much easier to lose weight and keep it off. That one thing is regular exercise.
Most people respond to this news with the enthusiasm usually reserved for catching a cold. "That's not the easy way!", they complain. "That's the hard way." I still insist that it is the easy way and I will explain how that is possible.
We know that most people who begin an exercise program (70%) quit within the first year. They are quitting just when the benefits of all that work are starting to happen. We all know the excuses about how much time it takes or how difficult or unpleasant it is.
But is it really the hard way?
Suppose that you decide that you are going to exercise for 30 minutes per day, five times per week. I will concede that those 150 minutes of exercise are strenuous or even hard BUT every other minute becomes easier. Your body's response to exercise is nothing short of a miracle. As you become fit all of your everyday tasks get easier. Those stairs in your house that you used to dread become nothing. You find that just getting through the day is no longer so hard. You find that you are less hungry and more able to stick to your weight control program. You even start to find that the exercise itself gets easier.
People who get regular exercise live longer. Whenever I say this someone always jokes "Yeah but they spend all the extra time exercising." They don't just live longer, however, they live better. When they are not exercising they are more able to participate in life. Their bodies become a benefit instead of a burden. Whatever you are doing to manage you weight will be augmented by exercise.
MEDICAL WEIGHT CONTROL AND NUTRITION
Last Updated: 21-Dec-2009
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