- WHAT IS A BODY MASS INDEX (BMI)?
- WHAT IS A RESTING METABOLIC RATE (RMR)?
- HOW CAN I INCREASE MY RMR?
- WHAT CAUSES OBESITY?
- HOW IS BEING OVERWEIGHT OR OBESE UNHEALTHY?
- THE PSYCHOLOGICAL & SOCIAL EFFECTS OF OBESITY
- CAN OBESITY BE CONTROLLED?
- WHAT IS A “SUGAR ALCOHOL”?
- WHAT ARE “NET CARBS”?
- HOW MUCH WEIGHT CAN I LOSE
- HOW FAST CAN I LOSE THE WEIGHT?
- HOW LONG IS YOUR PROGRAM?
- WHAT TYPES OF MEDICATIONS DO YOU USE?
- ARE PRESCRIPTION APPETITE SUPPRESSANTS SAFE?
- CAN I ORDER MEDICATIONS OVER THE INTERNET?
- ARE THESE MEDICATIONS ADDICTIVE?
- CAN I TAKE THESE MEDICATIONS IF I HAVE HIGH BLOOD PRESSURE, DIABETES OR TAKE ANTIDEPRESSANTS?
- CAN MY PRESCRIPTIONS BE PHONED IN?
- WHAT ABOUT SIDE EFFECTS?
- WHAT ABOUT EXERCISE PROGRAMS?
- WHY EXERCISE AT ALL?
- IS INCREASED EXERCISE GOING TO HELP CONTROL WEIGHT?
- HOW MUCH CAN EXERCISE HELP ME LOSE?
- HOW LONG DO I MAINTAIN MY EXERCISE PROGRAM?
- HOW MANY CALORIES ARE BURNED BY VARIOUS EXERCISES?
- DOES “SPOT REDUCTION” WORK?
- WHAT HAPPENS AT MY FIRST APPOINTMENT?
- HOW OFTEN DO I HAVE TO COME IN?
- DO YOU ACCEPT INSURANCE?
1. AT WHAT POINT IS SOMEONE CONSIDERED OVERWEIGHT?
Overweight can be defined in terms of its impact on health. Overweight is an excess of body fat sufficient to shorten one’s life span and make one susceptible to a greater amount of illness than would occur if the body weight were normal. According to the Centers for Disease Control and Prevention (CDC), overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the “body mass index” (BMI). BMI is used because, for most people, it correlates with their amount of body fat.
- A BMI of 18.4 or less is considered underweight.
- A BMI between 18.5 and 24.9 is considered healthy.
- A BMI between 25 and 29.9 is considered overweight.
- A BMI of 30 or higher is considered obese.
It is important to remember that although BMI correlates with the amount of body fat, BMI does not directly measure body fat. As a result, some people, such as athletes, may have a BMI that identifies them as overweight even though they do not have excess body fat. Other methods of estimating body fat and body fat distribution include measurements of skinfold thickness and waist circumference, calculation of waist-to-hip circumference ratios, and techniques such as ultrasound, computed tomography, and magnetic resonance imaging (MRI)
2. WHAT IS A BODY MASS INDEX (BMI)?
BMI is a person’s weight in kilograms (kg) divided by their height in meters (m)squared. Since the BMI describes the body weight relative to height, it correlates strongly (in adults) with the total body fat content. Some very muscular people may have a high BMI without undue health risks. BMI is used to screen and monitor a population to detect risk of health or nutritional disorders. On an individual basis, other data must be used to determine if a high BMI is associated with increased risk of disease and death for that person. A healthy BMI for adults is between 18.5 and 24.9. According to the Centers for Disease Control and Prevention (CDC), individuals with a BMI of 25 or greater are considered at risk for premature death and disability as a consequence of overweight and obesity, as are people with a large waist circumference (males greater than 40 inches/females greater than 35 inches).
3. WHAT IS A RESTING METABOLIC RATE (RMR)?
Every person has his or her own resting metabolic rate (RMR). This is the rate at which calories are used or burned off while the body is performing its normal physiologic processes (i.e. non-exercise). Every individual has their own RMR which is initially determined by genetics and then influenced by environment, diet, exercise levels, etc. As a person ages, RMR tends to decrease. In a 24-hr period, most of a person’s calories are burned at their RMR (non-exercise) and comparatively very few are burned at higher metabolic rates (i.e. exercise). Therefore, someone with a genetically higher RMR will burn more calories and tend to be thinner.
4. HOW CAN I INCREASE MY RMR?
Low to moderate daily exercise has been shown to increase a person’s RMR, and this can result in significant weight loss over time. Intense exercise will also increase RMR, however, with intense exercise, the energy demands of the body are so great that the body may preferentially burn muscle instead of fat during these periods of exercise. High protein intake is therefore necessary to sustain lean muscle mass if a person engages in regular intense exercise. Additionally, increasing your lean muscle mass can increase your RMR.
5. WHAT CAUSES WEIGHT GAIN?
Obesity results from a complex interaction of genetic, behavioral and environmental factors causing an imbalance between energy intake and energy expenditure. It results when a person ingests more calories than he or she can burn off. If this happens regularly over a period of time, the body will store the extra calories as fat. The body is able to burn off calories as energy needed throughout the day, but if the energy is not burned away, it will be stored as fat. The body stores extra calories as fat as a precaution against times of starvation. In the western world, starvation rarely affects people who eat regularly. If a person continually eats calories that he or she cannot burn off, obesity may occur. In rare cases, there are specific medical causes for obesity. These include conditions such as hypothyroidism and Cushing’s disease. There are also certain medications that can cause weight gain, such as steroids.
6. HOWUNHEALTHYIS BEING OVERWEIGHT?
Being overweight or obese increases the risk of developing a number of diseases including:
- Type 2 (adult-onset) diabetes
- High blood pressure (hypertension)
- Stroke (cerebrovascular accident or CVA)
- Heart attack (myocardial infarction or MI)
- Heart failure (congestive heart failure)
- Cancer (certain forms such as cancer of the prostate and cancer of the colon and rectum)
- Gallstones and gall bladder disease (cholecystitis)
- Gout and gouty arthritis
- Osteoarthritis (degenerative arthritis) of the knees, hips, and the lower back
- Sleep apnea (failure to breath normally during sleep, lowering blood oxygen)
7. IS OBESITY A MEDICAL CONDITION?
Yes, and it is now considered an epidemic. The statistics are startling. Obesity is fast becoming our nations’ leading cause of preventable death, claiming nearly 300,000 lives each year! Over 60% of the adult population is overweight. Excessive body weight leads to an increased risk of cancers, diabetes, heart disease, arthritis, depression, sleep apnea, gall bladder disease, stroke, osteoarthritis (wearing away of the joints), gout, and multiple other medical complications. The more overweight you are, the more likely you are to have health problems. It has been estimated that if we could cure obesity, we could add six to eight years to the life of the average American. Statistics show that because of their slower movements, obese persons are more apt to be hit while crossing a street; they are more prone to injury. They are more difficult to examine and x-ray. A surgeon hates to operate on an obese patient because of the greater operative risks and the lesser chance of a successful outcome. Obesity may be the number one public health problem in this country and in all of the developed countries of the world. The good news is that even a moderate weight loss can help to improve your health and well being. Physicians are finally being called upon by national medical leaders to aggressively treat obesity and excessive weight.
8. THE PSYCHOLOGICAL & SOCIAL EFFECTS OF OBESITY
In addition to the health risks, there are also psychological and social effects associated with obesity. For many people, emotional suffering is one of the most painful parts of obesity. Our society places great emphasis on physical appearance, often equaling attractiveness with slimness, especially for women. Messages of thinness are conveyed repeatedly in all forms of media, making overweight people feel unattractive. Many people label obese individuals as gluttonous and lazy, even though this is not true. As a direct result of this stereotyping, obese people often face prejudice or discrimination in the job market, at school and in social situations. With this prejudice and discrimination come feelings of rejection, shame and depression.
9. CAN OBESITY BE CONTROLLED?
Yes! The way to do this is to make sure that the energy you take in as food calories doesn’t exceed the energy you expend in daily activities and exercise. To lose weight, you have to consume less energy than you use. You can accomplish this in two ways. You can eat less and not increase your energy expenditure, or you can eat the same amount while increasing your energy output through exercise. The best way to control obesity is to establish a lifestyle in which you eat less and exercise more. Our program is designed to help you achieve that goal.
10. WHAT IS A “SUGAR ALCOHOL”?
Many new products popping up these days in the supermarket are being marketed as “sugar free”, but the nutritional information lists “sugar alcohol”. Basically, sugar alcohols, such as mallitol, are modified sugar-like chemicals. Although they are not technically “sugar”, their impact on weight loss and ketosis are the same as sugar. The only difference is that they are absorbed slightly more slowly, so they will have somewhat less impact on blood glucose levels. This is only relevant for diabetics who are adjusting their insulin dose. For weight loss purposes, sugar alcohols should be treated the same as sugar. One gram of sugar is the same as one gram of sugar alcohol.
11. WHAT ARE “NET CARBS”?
Total carbohydrates include sugar, sugar alcohols, dietary fiber and starch. Of these, the pure sugar has the fastest and greatest impact on blood glucose levels and insulin release. Therefore, diabetics who adjust their daily insulin doses use only the amount of pure sugar when calculating how much insulin they require after a particular meal. Of course, the rest of the carbs will still contribute to weight gain, they just don’t have as great an effect on insulin requirements. “Dietary Fiber” is the one type of carb that can actually be subtracted from the total carbs, as none of it gets absorbed in the digestive tract. Thus, for weight loss purposes, if counting carbs, begin with total carbs and subtract the dietary fiber leaving a figure that represents sugar, sugar alcohols and starch – all of which contribute to weight gain and prevent fat burning.
13. WHAT ARE THE CONTROL BARS/SHAKES SOLD BY WEIGHTWISERX?
Control Bars/Shakes are very unique products. They were created by an MD and were initially designed to help diabetics stabilize body insulin levels. Although a Control Bar/Shake contains a total of 21 grams of carbohydrates, most of the carbs contained in the Bar will be absorbed extremely slowly and therefore your body will continue fat burning. The secret is that they contain uncooked corn starch as one of the main sources of carbohydrates. It takes the body at least eight hours to fully digest this type of starch.
14. HOW MANY CONTROL BARS CAN I EAT AND STILL BURN FAT?
Do not eat more that one Control Bar per day and no more than ½ of the Control Bar per meal or snack. If you eat an entire Control Bar, count it as your daily serving of fruit and as 1 serving of protein.
16. HOW MUCH WEIGHT CAN I LOSE?
It is up to you. An initial weight loss goal of 10% of your body weight is a good start. A final goal of maintaining a weight that puts you at a BMI of 24 is ideal. But, if you lose just 10% of your body weight, you will reduce your risk of diabetes, high blood pressure, and heart attack. You will have more energy during the day.
17. HOW FAST CAN I LOSE THE WEIGHT?
Safe and rapid weight loss can be a contradiction in terms! The more weight you have to lose, the faster your initial weight loss will be. Patients with medical problems who have a significant amount of weight to lose should be under a physician’s supervision while losing weight. Because medications are regularly dispensed and weight loss can be rapid, side effects must be monitored carefully. Results vary depending upon the sex of the patient as well as the starting weight. Men usually lose faster due to their larger muscle mass. Usually the greatest loss is in the very beginning, sometimes as much as 10 – 15 pounds in the first week (of course, most of that is water!) A more realistic amount is 2-4 pounds per week. The smaller the body becomes, the slower the weight loss. That is the reason the last 10 pounds is always so frustrating! Many times, after 25-30 pounds, a plateau will be reached, causing much frustration. Coaching and keeping the patients’ eye on the target are critical at this point. A body mass index will be performed weekly to make sure that the patient is losing fat, rather than muscle mass. Slow and steady is the safest, most long lasting way to lose weight.
19. WHAT TYPES OF MEDICATIONS DO YOU USE?
We use a wide variety of FDA approved weight loss medications most of which have been in use for 40 years or more without problems when taken as prescribed. The particular prescription that you will receive will be based on your individual needs. These medications do not contain ephedra or caffeine. We do not offer Meridia. After medical evaluation, appetite suppressants can be used to reduce hunger and appetite, reduce thoughts of food (aversion), and make you feel more full on smaller portions (satiety). This can greatly increase your ability to stick with the diet. Dr. Weinstock will go over the risks of medication and you will be fully informed about the type and strength of any prescribed medication. You may receive a prescription for appetite suppressants from our clinic to be dispensed by the pharmacy of your choice.
20. ARE PRESCRIPTION APPETITE SUPPRESSANTS SAFE?
Yes, when taken under the supervision of a physician who is familiar with the indications and contraindications for their use.
21. CAN I ORDER MEDICATIONS OVER THE INTERNET?
No! We are a responsible medical practice and never prescribe or sell medications over the internet.
22. ARE THESE MEDICATIONS ADDICTIVE?
No, there has been no evidence that they are.
23. CAN I TAKE THESE MEDICATIONS IF I HAVE HIGH BLOOD PRESSURE, DIABETES OR TAKE ANTIDEPRESSANTS?
Dr. Weinstock will review your medical history with you in detail. If your blood pressure and diabetes are under good control, there are medications that will work for you. These drugs are not recommended for Type I diabetes. SSRI variety of antidepressants (such as Prozac, Paxil, Zoloft, etc,) and Tricyclics (such as Elavil) are compatible with these drugs. You may not take these drugs if you are on a MAO inhibitor such as Eldepryl, Parnate, Marplan and Nardil.
24. CAN MY PRESCRIPTIONS BE PHONED IN?
No. It has been our experience that when phone-in prescriptions are left on pharmacy voice-mail recorders, it poses an unacceptable risk of error. It is also office policy to NOT phone in prescriptions for diet pills, sleeping pills, pain pills, or any controlled substance. Patients must be seen in the office by the doctor for medications.
25. WHAT ABOUT SIDE EFFECTS?
Side effects are possible with any medication. With this in mind, we work hard to select medications that will work best for you. We will continue to adjust your prescription to best fit your needs.
26. WHAT ABOUT EXERCISE PROGRAMS?
All of our patients are given a realistic exercise program to follow. These recommendations are made taking into account your needs and the safest route for you to increase your physical activity level. In most cases recommended exercises will include walking, swimming, or some other activity that is likely to be of assistance in treating you. Please note that exercise will be prescribed in regulated amounts. It is important that you adhere closely to these recommendations. Exercise helps burn some extra calories, however, research has shown that a sensible diet along with a minimal increase in exercise is the most effective means of regulating body fat. Daily exercise in small yet vigorous amounts is far more effective and healthful than sporadic heavy exercise. (Daily 30 minute walks at 2 miles per hour)
27. WHY EXERCISE AT ALL?
Exercise is good because it increases the amount of time that your metabolism is activated and slightly elevated. Theoretically, you should burn calories at a more constant rate when you exercise. It is important to note that exceeding your recommended exercise limit will not raise this metabolic limit any further than that derived by small amounts of exercise. We must also consider that developing a daily exercise routine is a key factor in maintaining weight and preventing cardiac disease.
28. IS INCREASED EXERCISE GOING TO HELP CONTROL WEIGHT?
It’s important to exercise while trying to lose weight. Walking is the key. The bike manufacturers and spa owners would like you to think that heavy exercise is the key, but research is recommending less vigorous and stressful physical activities for those of us who wish to lose or control our weight. Studies from the University of Pennsylvania, Department of Exercise Physiology reveal that significant increases in exercise while actively participating in a weight loss program may undermine results several different ways.
Exercising to lose weight tends to be a slow and boring process. Boredom was a key factor in limiting the individual’s desire to repetitively participate in an exercise. Evidence is growing which supports the idea that less strenuous exercise and shorter, more frequent exercise periods for individuals attempting to lose weight is a better and more effective means of assisting in weight loss than a heavy exercise schedule. Obviously choosing an exercise which you find interesting or exciting will help defend against boredom. WALK WALK WALK!!!
We must recognize that the amount of weight we can expect to lose is relatively small in consideration of the amount of effort we must expend. Exercise increases our lean body (muscle) mass, which weighs more than fat. You cannot exercise fat. Only muscle can be exercised. This can actually tilt the scales in the wrong direction making us gain by increasing our muscle mass and exceeding the smaller amount of fat weight lost. Nothing is more detrimental to a dieter than a week of restrictive eating and heavy exercise, punctuated by a gain on the scale!!
29. HOW MUCH CAN EXERCISE HELP ME LOSE?
All of our patients have had a body composition analysis during their initial exam. This evaluation helps us to determine the net number of calories you can expect to lose with exercise. This calculation is applicable specifically to you and is based on the measurements made by our equipment. Many patients exercise 3-4 hours weekly, usually ever other day. Although this effort is commendable, research shows that 30 minutes of exercise daily instead of 1 hour every other day is more effective raising metabolic rate and burning fat. Look at the body composition profile done at your initial visit. Four important calculations are listed on this profile. These are your percentage of body water, lean body mass, percentage of body fat as well as a calculation of your lean to fat ratio. These numbers are important in determining the amount of exercise that will be helpful in controlling weight loss. Most of our patients have adequate amounts of lean body mass. In many overweight individuals this mass will be very close to or exceed their ideal weight range. This means that they do not need additional muscle and need to lose fat. Remember you cannot exercise fat and can only exercise muscle. Our body responds to exercise by increasing muscle size and thereby increasing lean body mass. Adding additional lean body mass to an individual who is trying to loose fat undermines the whole process. It is quite likely that you will gain weight if you exercise extensively. This will be more pronounced if your protein intake is increased while dieting.
30. HOW LONG DO I MAINTAIN MY EXERCISE PROGRAM?
Once a goal weight has been reached increased exercise is recommended for maintenance and increased cardio-vascular health. Increased aerobic exercise at this point will be beneficial to you and help you establish the healthy lifestyle we are striving to achieve. Repeating your body composition profile at this time will be helpful in determining how much increased exercise you should do.
31. HOW MANY CALORIES GET BURNED WITH EXERCISES?
The number of calories expended during exercise varies depending on the type of exercise, the temperature where the exercise is performed, and the body weight and fitness of the individual who is exercising. An obese, out of shape person will burn more calories performing the same task than will a thin, physically fit person. Most obese persons fail at exercise simply because they start too quickly and expect too much (“crash exercising” is as bad as “crash dieting”). An exercise program begins with a medical examination and progresses from walking or another mild exercise to more vigorous activities. In general, one might expect to burn 300 calories an hour walking or playing golf, 400 calories an hour riding a bicycle or playing tennis, 500 calories an hour swimming, and 600 calories an hour jogging.