For years doctors have been telling their patients to cut out 3500 calories and they will lose 1 pound of fat. By cutting 500 calories daily, one should lose a pound each week. The calculation came from simple thermodynamics: If one burns a pound of fat in a bomb calorimeter, it releases 3500 Kcals. [Read more]
It has been previously shown that 5% weight loss leads to a 50% reduction hypertension and diabetes risk, or 15 pounds for a 200 lb. individual. Long term weight loss is difficult as it leads to compensatory reduction of Leptin, which reduces metabolism and increases appetite at the level of the hypothalamus. Also, weight loss causes an increase in baseline and peak levels of the appetite stimulating hormone ghrelin. These changes persist for at least one year, and likely lifelong. [Read more]
One of the most common diseases treated in our obese/overweight populations is Diabetes. Why are we hesitant to using Metformin early? Early use of Metformin has been a topic for years with the US Diabetes Prevention Program (DPP) results and the follow-up DPP Outcomes Study (DPPOS). Both of these studies have shown the decrease in the prevalence of diabetes developing with the addition of metformin. Combined with lifestyle modifications, results were even better. [Read more]
As Obesity Medicine physicians, we see patients with NAFLD/NASH every day. I have seen many patients with elevations in LFTs that normalize within several months of treatment. Not to mention the resolution of hypertension and DM2 as risk factors for NAFLD/NASH. [Read more]
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide. It can be divided into 2 types. Non-alcoholic fatty liver (NAFL) is characterized by isolated steatosis. Non-alcoholic Steatohepatitis (NASH) is more aggressive and is characterized by cell injury, inflammation, ballooning of the hepatocyte and may lead to fibrosis, cirrhosis, and hepatocellular carcinoma. At the root of NAFLD is an unhealthy lifestyle and obesity. Weight loss is the only known treatment at present. [Read more]
Phentermine was approved for use in 1959 and for a period of 12 weeks. As obesity has been identified as a chronic disease, the long term use of phentermine has become mainstream amongst physicians who practice full-time obesity medicine. 97% of obesity medicine specialists indicate phentermine is their drug of choice among the current medication options available. Reasons for this include efficacy, safety, tolerability, low cost and low addiction potential. Despite this, concerns regarding safety and addiction potential have continued to limit the use by some physicians. [Read more]
These are results from a prospective cohort of over 16,000 mom-child pairs followed over the years from childhood to adolescence.
This study found that:
Risk was lower in mom’s who maintained:
A normal BMI, Engaged in at least 150 min/week activities, Did not smoke, Consumed alcohol in Moderation. [Read more]
It seems nearly everything we learned about obesity in training was wrong if we were taught anything at all. Medical schools and residencies teach the essentials of nutrition for the critically ill patients. When someone is hospitalized, they need adequate nutrition for healing: protein, essential fatty acids, electrolytes, vitamins, minerals, trace elements and water for recovery and healing. Then when we began outpatient medicine, we were flooded with patients with obesity and its consequences of diabetes, hypertension, hyperlipidemia, sleep apnea, fatty liver disease, cancers, and arthritis. Many of those conditions resolve with weight loss. Unfortunately, we were ill prepared to manage the underlying disease of obesity. If we had the knowledge, we never had the time to dedicate during a busy office visit to implement a successful weight loss plan. That is why the specialty of obesity medicine exists. [Read more]
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