Weight Reduction 

The issue of obesity is receiving a lot of attention these days. Due to a combination of factors including readily accessible food, high calorie fast food, physical inactivity, and sedentary jobs, Americans have become increasingly overweight. Two of my favorite states – Mississippi and Alabama – have the dubious distinction of being among the leaders in this trend.

With regard to health, obesity is manifested in many ways. Some of these are an increase in the incidence of cardiovascular disease, arthritic problems, and psychological issues. For the purpose of this discussion, obesity will be defined as having a BMI (Body Mass Index) greater than or equal to 30.

Over time, I suspect I have lost at least 300 pounds in increments of 10-20 pounds, only to regain them as soon as I stopped focusing on proper diet and exercise, so I understand the difficulty faced by those trying to achieve and maintain a more ideal body weight. Frequently, people will blame their weight on genetic predisposition, stress, comfort foods, fatigue, low metabolism, or just being “big-boned.” While all of these factors can contribute, it is irrelevant once any underlying medical problems such as hypothyroidism have been addressed. Regardless of the original cause of being overweight, it is well worth the effort to shed those extra pounds, and any excuse to avoid trying is just that – an excuse.

As far as I am concerned, there is only one legitimate way to lose weight. Burn more calories (exercise) and take in fewer calories (diet). I recommend using diabetic diets for weight reduction. The meal plans are well-balanced, and they have the added bonus of being pretty decent cholesterol diets. Weight loss or gain is a simple mathematical matter – if you eat more than you burn, then you gain weight. Conversely, if you eat less than you burn, then you lose weight. Many patients insist they “don’t eat that much.” That may be true, but whatever they are eating is more than they need if they can’t lose weight. In a crass (but true) joke, someone once pointed out that obesity wasn’t a problem for ANYONE in the Nazi prison camps.

As a rough rule of thumb, a normally active person will settle out at about 1/10th of their daily consumption if pounds are compared to calories. For example, a person eating 1500 calories per day will generally settle out at about 150 pounds. Obviously, this is a crude measure and subject to error based on the level of physical activity. Current recommendations suggest walking 10,000 steps per day to meet an adequate exercise level. Pedometers are inexpensive and can help you monitor your progress.

I am unequivocally opposed to “diet pills” (traditionally, these have been inappropriate thyroid supplementation or stimulants such as amphetamines) or “fluid pills” for the purpose of weight reduction. They are not useful for long-term weight control, and they are dangerous. I personally have witnessed the death of two young women using such agents, one obtaining the medication from an unscrupulous diet doctor and the other using her sister’s prescription for a diuretic. Patients will be wise to ignore the television ads selling any “easy” solution unless it revolves around proper diet and exercise.

Not surprisingly, there has been a lot of research trying to find safe and effective pharmacological agents to assist with weight loss. It is my understanding that medications related to the antidepressants are becoming available and hold great promise as appetite suppressants. Xenical is a relatively safe agent which can aid in weight reduction by reducing fat absorption from the G-I tract, but it is frequently not tolerated well due to gas and bloating – side effects related to not absorbing the fat. I have observed that most patients having success with Xenical typically have learned to simply reduce their fat intake. If you have the self-discipline to do this, then you don’t need the pill.

Another popular approach is “gastric by-pass” surgery. While this surgery can be effective and has merit in rare cases, it is my opinion that it has been used far too often and may be driven more by a powerful combination of the patient’s desire for an easy way out along with the lure of a hefty surgical fee than by legitimate medical indications. Most patients having success with this procedure have significant lifestyle changes after surgery. Had they achieved these lifestyle changes prior to surgery, they would have lost the weight without having the procedure. I advise great caution and a high degree of discretion before seeking this surgery as a solution.

In summary, the answer for most of us really is simple, but it is a bitter pill to swallow. Forget your excuses, back away from the table, and go for a long walk instead! (Do as I say, not as I do.)

My opinion,

Thomas L. Horton, MD