Weight loss - it's hard but maybe a doctor can help!

 Weight loss is something that a lot of us struggle with.  As a Hospitalist, I always deal with the complications that arise from obesity: heart attacks, leg clots, strokes, bone erosion/pain, sleep apnea and a whole host of skin issues from the skin breakdown that occurs over time. When patients present with these problems, I always end up sharing the same 5 things that I think are a good starting point for weight loss.  My patients are sometimes shocked that no one has shared some of these things with them.

A. Dieting is depressing.  When you stop eating the sugar filled things, you get depressed because you aren't getting the serotonin filled "high" associated with high sugar intake.  This depression that sets in will definitely get in the way of any sustained weight loss that dieting will give you.  Here I suggest one of two things: either find something fun to replace the food with [sex? exercise? hiking? crochet?] or, take a multivitamin pill in the morning, eat what you enjoy but count your calories and eat less of it.  So, eat the cheesecake and skip the meal as long as you don't go over the calorie count.  

Of course, do not make the "desert for a meal" a daily habit!  The desserts lack a whole host of nutrients - protein, fiber etc but, once once or twice a week - nothing wrong with that.  (A good app to keep a calorie count is myfitnesspal - I promise I have no vested interest in that company!)

B. There is at least a 10 min delay from when you are full to when your brain knows it.  So, if you ever feel "stuffed" after a meal, you ate way too much. The really obese may have to wait even longer - their stomach is already fairly distended and because of that the stretch receptors can take longer to recognize this "full state." Next time, eat half of that plate and wait at least 10 mins to see if you still feel hungry - some might have to wait up to 30-40 mins.  This will allow you to cut down the calories you are taking in without really feeling too much hunger.

C. Someone who has always weighed 200lbs  can eat more than someone who lost weight to get there.  The person-who-lost-weight's body metabolism has actually slowed down with weight loss!  They have to eat less than the person-who-has-always-weighed-the-same to keep that weight off.  So if you plan to keep your weight off - be ready for this very real struggle.  Find fun things to do and keep going - eventually your metabolism will reset and your brain will stop telling you that you are starving!

D. All of the body's direct energy needs are meet via sugar mainly, glucose.  This glucose is first provided by the food you eat however, in the starvation state the body uses whatever it's got stored up and converts that into glucose. In the first 24-48 hours of starvation it uses up glycogen (a storage form of glucose kept in the liver and muscles) then, it breaks down fats from adipose tissue and finally (at around the 5-7 day mark) it goes after the proteins.  To put it simply, you want to force your body to have to convert fats & proteins into sugar - expending excess energy along they way.  

Now, this doesn't mean starve yourself but, if you are working out for weight loss - exercise first thing in the morning before eating.  Your 7-8 hours of sleep (you ARE sleeping that much right?) has used up most of your liver glycogen stores thus, during this "empty stomach exercise," your body will use up fat along with muscle-glycogen to generate it's energy.   At low to moderate levels of activity you burn more fat when working out on an empty stomach.  Of course, this is different than when you are trying to build muscle.  There you are going to need the nutrients to gain muscle.  Thus, being starved when working out is not gonna cut it. 

So my suggestion: initially when you start your weight loss program start with low levels of "empty stomach exercising" - walk an hour, jog 30 mins etc.  Just remember to hydrate well.  Once you have achieved a weight you are happy with then, start adding proteins and carbs to your pre-work out diet and start doing more strenuous exercises to build muscle.  Also, more protein after a work out is a good idea to build muscle.

E. Maybe, and this is a BIG maybe - take pro-biotics.  Mice given stool transplants from skinny people became skinny!  We have no idea why this happened. So until the scientific community figures out which pro-biotic is the best, go get one that has multiple bacteria in it and start taking it daily.  Talk to your doctor before you do this.  There are medical conditions that prohibit you from taking bacteria in a tablet - make sure you don't have one of those!  

E+. You could always try to convince a skinny healthy friend of yours to give you a stool transplant! ;)

That's it - slow and steady in everything!  Slowly build up exercise, slowly cut out sugary/caloric foods, slowly add more fun things in your life and realize that it's a struggle!  Nothing comes easy. Aim to lose no more than 1-2lbs/week.  VERY SLOW AND STEADY!  Anything in excess of this  generally ends up being water weight anyways!