At the beginning
of 2015, I thought I might share some thoughts about where my Obesity Medicine
practice is.
First, you have
to realize that I myself have undergone a transformation of sorts. I began treating overweight and obese
patients ten years ago in 2004. At the
time, I was practicing Emergency Medicine full time. Emergency Medicine is the field of my
residency training and first board certification. So, in 2004 I considered myself an ER Doc who
practices “weight loss” on the side.
Well, things changed. My practice
grew and eventually I stopped the ER altogether by January of 2008. I began attending conferences that kept me
up to date on the rapidly advancing science of obesity. Through this process, I became board
certified in Obesity Medicine in 2012. I
now have two board certifications: Obesity Medicine and Emergency
Medicine. Now, ten years later, I am an
Obesity Medicine Specialist who used to practice Emergency Medicine.
My practice used
to be described as “weight loss”, but now it is better characterized as the
treatment of a complex medical condition known as obesity. You see, weight (and by extension BMI) is
just one parameter that can be used to evaluate obesity. The truth is that obesity is a disease of
excess body fat, and the body fat is usually behaving in a diseased
manner. Think of it like this – your
body fat is an organ that can enlarge itself and become dysfunctional (this has
been well described by Dr. Harold Bays and the term he uses for it is
“adiposapathy”). You may, or may not be,
overweight. It’s about the amount of
body fat you have, the distribution of the body fat, and how the fat is
functioning biochemically. So, it is
possible to have a “correct weight” and have the disease of obesity or be
“overweight” and not have the disease of obesity.
The problem with
this condition of “adiposapathy” is that it eventually manifests itself in
multiple organ systems causing numerous health problems. Some of those health problems include (this
is only a partial list) : lipid abnormalities, type two diabetes, high blood
pressure, vascular disease, fatty liver disease, and multiple different
inflammatory conditions. In other words,
it creates a “toxic metabolic stew” that will take you to the grave early. My job as an Obesity Medicine Specialist is
to treat patient’s body fat mass. When I
do this, the risk of developing these multiple medical problems drops
profoundly. If a patient already has some
or all of these medical problems, and I can reduce their body fat, the
patient’s medical problems immediately began to correct themselves. Bottom line – treating the condition of
obesity results in better health and longer life. It is a form of “Ultra Prevention.” Once patients have lost a significant amount
of body mass, my goal is to prevent the regain of body fat.
So what is my
treatment approach to patients with excess body fat or a patient who has lost
body fat and is trying to prevent fat regain?
The first and most powerful tool
is diet. The teaching method I use
is based on 5 important principles:
1.
Protein Is Primary. It is the foundation to your diet
success. The key is to eat the correct type and amount of protein at the right
time intervals. The providers at Doctor Simonds Weight Loss will make a
specific recommendation to you about your total daily protein needs. Most
patients will need between 90 and 150 grams of protein daily while dieting.
Getting this correct amount of protein will
spare your lean muscle mass while losing weight, and force your body to
burn its own fat for energy. More
importantly, consuming 30-40 grams of protein in one meal raises your metabolic
rate by 40% for 3-4 hours after you do this. This is the same as running 30
minutes on a treadmill. Less than 30 grams will not evoke this response.
The best protein source to produce this change is protein from a milk source
like whey or calcium caseinate. Protein from eggs, meats (poultry, red meat,
and pork) and fish are acceptable also. Vegetable protein lacks the amino acid
composition to produce this effect. If you don’t eat a large portion of
carbohydrates (carbs) with it, your body will get the extra 40% of energy it
requires by burning abdominal fat stores –
in other words, it slims your waistline and who doesn’t want that?
2.
Fat is Filling and It Doesn’t Make You
Fat. The fullness,
or satiety, that fat produces helps you feel satisfied with much smaller
amounts of food. In addition, in the absence of carbs, fat serves as a great
energy source, raises good cholesterol (HDL) and lowers your triglycerides
(free floating fat in your blood). In the absence of high insulin levels
(which come from eating carbs), your body’s physiologic response to fat is to
burn it – not store it.
3.
Carbs Make You Crave, and They Make You
Fat. Flour, sugar,
rice, and potatoes, in most of their forms, are absorbed quickly by your GI
tract. This causes a surge in insulin levels. Elevated insulin levels
promote fat storage – particularly in your abdomen. Elevated insulin levels
will produce other evils: increased hunger, increased cravings, lower metabolic
rate, high blood pressure, cholesterol abnormalities, and blood sugar
abnormalities.
4.
Portions Are Powerful. I have already hinted that to lose
weight you have to reduce quantity/calories. The goal is to get the content of
the food you are eating correct, so that you can eat smaller portions and be
satisfied with that. If prescription medications are needed to reduce appetite
and help with this, we can provide them. Many people do well keeping track of
their food intake using an app such as My
Fitness Pal, which can help ensure you are consuming the proper amount of
protein each day and can also keep you accountable on your calorie and
carbohydrate intake.
5.
Timing Is Tantamount. One of the common problems I see is
patients skipping meals, eating one meal per day, etc. This creates a host of
problems. My recommendation is to get at least 3 “servings of protein” (30 -
40 grams each) spaced out 3-4 hours apart. By doing this, and limiting carb
intake, you will find that your weight loss will be greater, your satiety
(feeling of fullness) will be improved, your metabolism will work better, you
will lose more body fat, and you will be happier with the entire “diet
experience.”
The second tool I use is medication.
I use multiple medications and combinations of medicines to achieve the
treatment goal of fat loss or prevention of fat regain. Some of the medicines I regularly use are
phentermine, diethylpropion, phendimetrazine, metformin, topiramate, bleviq,
contrave, and numerous others. Each patient is different so it is my goal to
tailor a medication approach that works for you.
The third tool I use to decrease body fat
and enhance health is physical activity. So, in summary,
obesity is a complex disease characterized by excess, dysfunctional body
fat. It is my goal to help patients lose
this fat, and then keep it off. To
achieve this, I use a specific diet approach that encourages protein and fat,
limits carbohydrates, and encourages proper portion sizes, and the correct
timing of eating. I pair this with
medications if needed, and encourage patients to be physically active. For those of you who are active patients, I
say “thank you” and keep up the war on obesity.
For those of you who have
“fallen off the wagon”, I am here to help and encourage you. I will never be judgmental. If it was easy to be thin, we would all be
thin – I know it is hard and I am here to assist. If you are not a patient yet, I encourage you
to get serious about this disease if you have it. I am here to help you.
Dr. Simonds
