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The government's answer to the growing epidemic of obesity has been to recommend more exercise and a balanced diet. While there is no doubt these strategies are important, they also display an incomplete understanding of the biological and hormonal changes that underlie obesity among aging adults. The fact is that as we age, we undergo physiological changes that encourage weight gain. These include hormonal changes and alterations in the way our bodies process nutrients.
At our center, we believe that in addition to a sensible, balanced diet and exercise, the only way to successfully lose weight is to address the underlying hormonal imbalances that promote weight gain. Ideally, by using bioidentical hormone replacement, dieters can restore their hormonal profile to what it was when they were in their 20’s and 30’s, an age during which weight gain is less often a problem.
There is clearly a link between low hormone levels and weight loss. Low thyroid levels indicate that your metabolism has slowed to the point where you are unable to burn sufficient calories despite your rigorous exercise. As a rule of thumb, 20% of weight loss is due to exercise and 80% is a result of diet. No amount of exercise can compensate for poor dietary habits.
Low thyroid levels make it nearly impossible to lose fat. Here is a good example: your best friend eats anything she wants and never exercises, yet she never seems to gain a pound. You, on the other hand, exercise daily and nearly starve yourself, yet you still gain weight. In all likelihood you are hypothyroid or “insulin resistant.” Insulin resistance means that your body needs more insulin to control your blood sugar; therefore, your insulin levels increase causing your body to store more fat.
We screen all patients for hypothyroidism and insulin resistance, and instruct them in detail about what and how to eat. In contrast, many diet centers simply prescribe appetite suppressants, or recommend dietary changes only. If patients use appetite suppressants only, without regard to hormone levels or diet, their weight usually returns when they stop the drugs.
Treatment
When it comes to treatment, our philosophy is to balance hormones first, and then incorporate a combination of natural and prescriptive remedies which is individualized for each patient in order to assure success. We offer a wide variety of options, starting with natural supplements.
There are many natural remedies that have been shown to be helpful with weight loss. Adequate intake of water is the most important thing other than a proper diet and exercise for losing weight. Green tea has been shown to increase fat oxidation and energy expenditure. It decreases lipolysis of triglycerides, resulting in reduced fat absorption. Green tea also has antioxidants, protecting the body from cancer. Chromium is important in helping regulate blood glucose levels. Studies have shown that taking chromium increases weight loss, especially fat weight. Many Americans are deficient in chromium. Chromium lowers triglycerides and probably lowers cholesterol levels. 5-hydroxytryptophan (5-HTP) is another natural remedy that aids in weight loss. 5-HTP increases serotonin levels. Adequate serotonin levels have been shown to decrease appetite, whereas low serotonin levels can cause carbohydrate cravings and binge eating. Calcium has also shown to be helpful in weight loss. Calcium decreases fat production and increases the metabolism of fat.
Proper will power is also very important. It is natural for us to crave foods high in fat and sugar. These are comforting foods, which is why we often eat them during times of stress. They cause us to relax by calming the brain. These foods cause the release of dopamine which temporarily counteracts the stress hormone, cortisol. It is imperative to fight these cravings because over time the desire for these foods diminishes. We use supplemental neurotransmitter precursors such as 5-HTP and tyrosine to help diminish these cravings. Unfortunately foods high in fat and sugar often taste better when they have been avoided, so if one falls off the wagon, it becomes that much harder to get back on.
Prescription and over-the-counter medicines for weight loss are either classified as central-acting appetite suppressants, bulk forming agents, or fat absorption blocking drugs. The over-the-counter central-acting appetite suppressants either have ephedra, ma huang, and/or caffeine. These drugs are stimulants and can have adverse effects on the cardiovascular system. Ephedra contains ephedrine and pseudoephedrine. Their stimulant effect on the central nervous system can result in decreased appetite. Recently the Food and Drug Administration (FDA) banned ephedra secondary to complications from the drug leading to more than 150 deaths. Ephedra caused sudden death secondary to heart attacks and strokes.
The most popular prescription appetite suppressants are Phentermine, Tenuate and Sibutramine (Meridia). Phentermine acts like amphetamine so it is no different than speed. The danger with phentermine and Meridia is they both can raise blood pressure. Meridia inhibits the reuptake of the neurotransmitters, serotonin and norepinephrine. Meridia works in a similar fashion as the SSRI drugs for depression. The long term risk of these drugs often outweighs the possible benefit.
The most commonly used bulk forming agent is methylcellulose which is insoluble fiber. The purpose of this agent is to give a feeling of satiety, so less food is consumed. Side effects can be abdominal distension and flatulence. Xenical is a prescription drug that blocks an enzyme involved in fat absorption. As a result fat is not digested and fat is excreted in the stool resulting in symptoms of gas and steatorrhea (fatty diarrhea). Diuretics are often abused and they can result in electrolyte imbalances. Laxatives are also commonly used and if abused severe bloating and constipation can result when the medication is stopped.
There are new medications, Byetta and Symlin, which decrease leptin and insulin resistance. These can be very beneficial treatments and can produce dramatic weight loss if given in conjunction with other metabolic treatments in patients who are clearly insulin and leptin resistant. While these medications are approved for type II diabetes and are showing significant weight loss in this patient population, they are showing promise in the non-diabetic population as well. The amount of weight loss varies according to the study design, but a significant percent of patients are having dramatic weight loss, despite little or no change in diet. Again, this demonstrates that many overweight patients have a metabolic problem rather than a problem of will-power. While these medications, by themselves, typically result in modest weight loss, combining these medications with metabolic treatments and a healthy lifestyle can allow for significant sustained weight loss.
In addition, we have successfully used Human Chorionic Gonadotropin (HCG) specifically for weight loss. Our program is based on the Simeon Protocol, a weight-loss theory that utilizes daily injections of HCG. Combined with a strict diet and medical supervision, we have seen great success in those patients who are typically unable to lose weight despite strenuous exercise and any number of diets. While the program is available to everyone looking to lose weight, applicants must have specific blood tests performed, undergo a personal consultation, and sign a consent form in order to fully understand the program’s complexities and requirements. The program is designed for those who are overweight or obese and is not intended for those not normally classified as such. Contact our office for more details.
Finally, procedures such as bariatric surgery (stomach stapling) or the lap band are viable options for the morbidly obese, when diet, exercise, hormones, prescriptions and supplements have failed. Liposuction is for cosmetic reasons not for health benefits. Liposuction removes only the superficial fat, not the internal fat that promotes heart disease. Bariatric surgery shrinks the size of the stomach from two quarts to one ounce. Bariatric surgery should never be done for cosmetic reasons because of the high risk of complications associated with the procedure. More than 10% of people have a serious complication such as internal bleeding or blood clots following surgery and even 1% to 2% die. Malnutrition secondary to rapid weight loss can cause peripheral nerve damage so these patients need to be monitored closely. Over 100,000 people undergo these procedures yearly.
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Perimenopause and 