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Weight Problems

Question: What's the best way for a person who has diabetes and heart problems to lose weight?

Answer: If you have both of these conditions, you should try to lose weight only under the direct supervision of your doctor.

Obesity is a leading cause of health problems and preventable deaths in the United States. Among the conditions it helps cause are:

• High blood pressure.
• High cholesterol.
• Type 2 diabetes.
• Coronary artery disease.
• Stroke.
• Osteoarthritis.
• Sleep apnea.

Losing weight is critical to controlling many of these diseases.

It is tough to lose weight, and unfortunately, there are no quick fixes. It has to be done gradually to be successful. People who also have other health problems, such as heart disease, should be particularly careful when starting a weight-loss program.

The keys to lasting, safe weight loss are diet and exercise. Most overweight patients are referred to a dietician, and those with heart disease are often encouraged to start an exercise program as well. Doctors may also prescribe weight-loss medications such as sibutramine (Meridia) and orlistat (Xenical) to certain patients. Most doctors advise patients to lose no more than 1 to 2 pounds a week.

At first the goal of weight loss for obese patients is to lose 10% of their body weight. Six months is a reasonable amount of time to spend losing that weight. When you've lost that much and kept it off for a while, you can set a new goal.

Once you lose the weight, the biggest challenge is keeping it off. You're only going to be able to do this if your weight-loss plan extends for a lifetime. Lasting weight loss occurs when people permanently change how they eat and live.

If you are interested in losing weight, talk to your doctor about which options are right for you.

Question: Can you tell me about stomach surgery as a weight-loss method? Does it work?

Answer: With each year that passes, more and more people are becoming obese in the United States. In some cases where other types of weight loss efforts have failed, surgery may be an option.

Surgery to promote weight loss works by limiting the amount of food the stomach can hold (restriction surgery), or by interrupting the digestion of that food. The BMI (body mass index) is a measure of a person's weight relative to their height. A BMI over 24 is considered overweight. Patients who have BMI of more than 40 (about 100 pounds overweight for men or 80 pounds overweight for women) are candidates for surgery. Patients with lower BMIs who have other chronic life-threatening illnesses may be candidates for surgery as well.

The most common type of surgery for weight loss is restriction surgery. There are different types of this surgery--for example, gastric banding or vertical-banded gastroplasty (stomach stapling)--but all work by limiting the amount of food that can enter the stomach at one time. This leads to an early sensation of fullness, which limits the amount of food consumed.

Restrictive operations lead to weight loss in almost all patients, but some patients do regain their weight. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), about 30% of patients who undergo vertical-banded gastroplasty achieve normal weight, and around 80% lose some weight.

Gastric bypass surgery creates a connection from the stomach to a part of the small intestine that is farther down from where the usual connection occurs. Since food is primarily absorbed in the small intestines, this type of surgery prevents food from being completely digested, and leads to malabsorption (poor absorption of food) and weight loss.

According to the NIDDK, patients who have gastric bypass operations usually lose two-thirds of their excess weight within 2 years.

The operations are not risk-free. In bypass operations, nutritional deficiencies and a condition known as "dumping syndrome" (rapid nausea, sweating, faintness, and diarrhea after eating) may occur. Both types of operations often lead to other complications that require more surgery. Results are not guaranteed either. You must be motivated to improve your eating and exercise habits.

Question: Can weight gain be related to a woman's use of antidepressants like Zoloft?

Answer: Depression alone can sometimes cause weight gain or weight loss. If depression has led to loss of appetite and weight loss, successful treatment will likely lead to better appetite and weight gain.

Drugs used to treat depression may also be related to weight gain or weight loss. Tricyclic antidepressants like nortriptyline (Elavil) are sometimes linked to weight gain. Selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) are more often linked to mild weight loss. In fact, sertraline has been used in some weight-loss programs.

Some studies have suggested that sertraline has no real effect on weight. But a more recent study showed that sertraline modestly improved weight loss in obese patients in a weight-loss program.

If you have more questions about sertraline or other antidepressants, talk to your doctor or pharmacist.

Question: Do diet pills like Metabolife and Xenadrine really work for permanent weight loss?

Answer: No. Unfortunately there is no magic pill for permanent weight loss.

Recommendations for successful weight loss include following a balanced, reduced- calorie diet, exercising, behavioral therapy, and sometimes medications. At the moment, there are only two drugs approved by the US Food and Drug Administration (FDA) for weight loss. These are Meridia (sibutramine) and Xenical (orlistat). Even the proper use of prescribed medications does not guarantee permanent weight loss. Many people lose weight only to find that they regain it shortly thereafter. Therefore, a weight maintenance program is suggested to help keep the weight off.

Many over-the-counter herbal products are touted as weight loss products. These include ma huang (Chinese ephedra), caffeine, chitosan, and combination products like Metabolife and Xenadrine. Many of these compounds are untested and are linked to health risks. Adverse effects that may be caused by diet pills include insomnia, hypertension, palpitations, dizziness, and being jittery. Some of these drugs can even be life-threatening. Most physicians do not support the use of such products, and would suggest other methods for losing weight.

Remember that it is always best to discuss your weight loss plans with your doctor. If you are trying to lose weight, speak to your doctor before using any over-the-counter supplements. The risks of such products can outweigh the benefits in the end.

Question: Can green tea help me lose weight?

Answer: Green tea has been getting a lot of good press lately--primarily because of preliminary studies that suggest that drinking it may help protect against certain types of cancer. Green tea is rich in phytochemicals--non-nutritive substances that may produce health-protective effects. Most of the phytochemicals in green tea are called polyphenols. Vegetables also contain high concentrations of certain phytochemicals. You might think of drinking a cup of green tea as similar to eating a small portion of some vegetable. There is no evidence that green tea produces weight loss.

Caffeine is found in many popular drinks including green tea. Caffeine is known for its ability to increase mental alertness. At first, it was thought that caffeine alone might help people lose weight, but studies have not supported this theory. However, several small studies in the last few years have combined caffeine with other stimulating Chinese herbs. Early studies in humans suggested that specific combinations may be safe and effective in promoting small amounts of weight loss when combined with other important lifestyle changes. However, these are preliminary studies, and it is possible that such combinations of "stimulants" may prove to cause serious adverse effects when larger trials have been done. (That's what happened recently in the cases of some well-advertised weight-loss drugs.)

No scientific evidence suggests that green tea can help you lose weight. Usually you lose weight when you burn more calories than you eat, and you do that best by changing your diet and exercising regularly. Speak to your doctor about designing a plan especially for you to help you lose weight.

Question: How can I gain weight in a healthy way?

Answer: The proper way to gain weight depends on the reason you are underweight. If you are naturally thin, your needs will differ from those of someone who is underweight because of an illness or eating disorder (like anorexia nervosa). If you are underweight because of an illness or eating disorder, you should talk to your doctor about the best way to gain weight, especially since eating too much and too fast can cause additional problems. In addition, if you have started to lose weight for no apparent reason, or if you feel unwell, a visit to your doctor is needed. Many illnesses can cause weight loss.

If you are healthy but simply thin, you may not be consuming enough calories to meet your caloric needs. The best way to gain weight is to increase your caloric intake. However, regularly feasting on milkshakes and bacon cheeseburgers is not advised. It is better to add one or two healthy snacks every day (like a piece of fruit, a cup of yogurt, or a slice of toast with peanut butter) to gradually increase your caloric intake. The best kind of snack depends on what you are currently eating now.

Probably the easiest and best way to properly increase your caloric intake is to see a dietician. (You can ask your doctor for a referral). A dietician can assess what you are eating and help you decide how best to increase your caloric intake. You can try to do this on your own, but it can be difficult.

Typically, a dietary evaluation starts with evaluation of your daily caloric intake. You can do this yourself by keeping a food diary for 24 hours (writing down everything you eat in a 24-hour period) or doing a 24-hour recall (when someone else asks you what you ate during the last 24 hours) and then assessing the number of calories you are consuming. You can find out how many calories are in your food by talking to a dietician, reading the nutrition labels on your food, or investing in a book that lists the caloric content of common foods.

The next step is to figure out how many calories your body needs in a day. This depends on your age, height, health, and activity level. A complex equation called the Harris-Benedict equation can be used to determine this number. The dietician will talk to you about the foods you like to eat and the best ways to healthfully increase your caloric intake.

If you are interested in gaining weight, talk to your doctor to find out what is right for you.

Question:I am interested in losing weight, and I recently heard that there are new diet drugs on the market. Do these drugs really work? How safe are they? How can I tell if they are appropriate for me?

Answer: The US Food and Drug Administration (FDA) recently approved new diet drugs for long-term use. The first, sibutramine (Meridia), works by suppressing the appetite. Sibutramine works by slowing down the clearance of chemicals in the brain, norepinephrine and serotonin, that affect appetite. Dexfenfluramine (Redux) also slows down the clearance of serotonin; however, unlike sibutramine, dexfenfluramine causes an increase in the release of serotonin as well. Dexfenfluramine was recently taken off the market because of concerns over its potential effects on heart valves. Because sibutramine does not increase the release of serotonin, it is unlikely to cause heart valve damage.

When used in combination with a low-calorie diet in one study, patients on sibutramine lost an average of 10-14 pounds over the course of a year compared with 3.5 pounds with diet alone. Common side effects of taking sibutramine include dry mouth, headache, constipation, nausea, dizziness, and insomnia. In a small number of patients, this drug can also cause an increase in blood pressure, so people with uncontrolled blood pressure are discouraged from taking it.

The second diet drug recently approved for long-term use is orlistat (Xenical). Orlistat works by preventing the digestive system from digesting and absorbing fat. In general, studies show that over the course of a year, patients taking orlistat can lose an additional 6-10 pounds more than what those who diet alone lose. The major side effects of orlistat include oily spotting, gas, diarrhea, and bowel incontinence. Because orlistat may also decrease the absorption of certain vitamins, it is recommended that patients take supplements containing vitamins A, D, E, and K.

To lose weight and keep weight off with these drugs requires lifelong treatment. Therefore, the decision to start diet drug treatment is a serious one and should be made together with a doctor with whom you plan to maintain an ongoing relationship. These drugs are currently recommended only for patients whose weight poses a serious medical risk and should be used with a well-balanced and reduced-calorie diet. Although these drugs are approved for long-term use, researchers have studied patients for only 1-2 years. These drugs, however, are not believed to cause heart valve problems or serious lung disease.

Question: Does hypnosis really work to control weight?

Answer: Maybe.

Hypnosis is a deep state of relaxation in which the subconscious mind is susceptible to suggestions made by the hypnotist. Hypnosis has been used to treat phobias and anxiety, and has also been used to manage pain.

There have not been many studies evaluating hypnosis and weight loss. There is some evidence that hypnosis plus behavioral weight loss therapies can help people lose weight. But the hypnosis is only one part of a whole weight-loss program.

It is not clear why hypnosis may work for weight loss. It may be that it increases a person's attention to suggestions made by a healthcare provider. It does not work by "brain washing." Studies so far do show some improvement in weight loss with hypnosis, but not much.

If you are interested in learning more about hypnosis and weight loss, talk to your doctor to find out what is right for you.

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