Tag Archives: weight loss

Debunking 3 Weight Management Myths

Overweight? You have lots of company. It is one of the greatest public health issues of the last 20 years. Let’s discuss a few myths, as well as a few ideas.

Myth: Eat three meals a day.
Not so! Three meals a day is a modern concept. Historically there never was enough food for the average person to eat three meals a day. In many parts of the world, that is still true. If you eat three “reasonable” meals a day, you will be overweight.

Chinese Food Macro 12-6-08 7

Myth: The kind of food you eat dramatically affects your weight.

That also is more myth than science. Your body needs somewhere in the neighborhood of 2,500 calories per day. If you take in more calories, you gain weight; taking in less means you lose weight. If you eat 4,000 calories of carrots per day, you will gain weight (and turn orange – I’m not kidding). The body happily converts protein, carbohydrates and fat in your diet to whatever the body needs. Carbohydrates are not the great Satan, nor are fats. Fats do happen to be twice as calorie-rich per weight as everything else. So you can only eat half as much fat. On that thought, it really is too bad that the body stores extra calories as fat (4,100 calories per pound). If it stored excess as carbohydrate or protein, it would only take 1,800 calories to burn a pound.

What is a calorie anyway? The calorie is a certain amount of energy that is contained in food. It can be thought of as “stored work.” You use it when you exercise or to keep your heart beating. Calories are good stuff, in moderation.

Myth: Exercise absolves you of food sin.
Unfortunately, there is no absolution. You need to exercise, and it is one of the most important health habits you can have. Exercise will burn 200-500 calories per session. That will help you lose weight or keep you trim. Keep in mind that 200-500 calories isn’t even a candy bar’s worth of calories. So exercise alone won’t do the job.

Now I would like to suggest the concept of dining for enjoyment vs. for fuel. I define fuel as calories I take in only to keep going. These are not tasted, savored or enjoyed. They are simply thrown down my throat hastily. Here is the important thing, in my opinion: if I am not going to savor and enjoy a meal, I might as well throw down something good for me (a protein or yogurt drink). If I have time to sit down and really enjoy a meal, I might as well eat something tasty, even if it’s not that great for me.

So get some exercise and don’t throw down bad food without enjoying it. If you are trim, it will help you stay that way, and if not, you will make steadily progress toward a lesser you.

Stay well,

Dr. B

Donald Bucklin, MD (Dr. B) is a Regional Medical Director for U.S. HealthWorks and has been practicing clinical occupational medicine for more than 25 years. Dr. B. works in our Scottsdale, Arizona clinic.

photo © 2008 Steven Depolo | more info (via: Wylio)

Qsymia: Weight-Loss Drug Ready For Prime Time

Obesity, euphemistically known as “puffy” to my 14-year-old, is the most talked about health problem in America today.

'Scale-Gina' photo (c) 2011, Twentyfour Students - license: http://creativecommons.org/licenses/by-sa/2.0/And what a problem it is. Blame it on fast food, too much television, too little activity, or your root-gathering ancestors. Between a third and a half of us are overweight today. And every year the problem gets bigger (sorry).

Obesity is tangled up in every major cardiovascular problem and arterial disease. Heart attacks, strokes, peripheral vascular disease, kidney failure (renal vascular), eye disease (retinal vascular) – you get the idea. Anything with blood vessels are affected, but try to find a body part without blood vessels. Fingernails and hair might be the only ones. You can have good hair when you are dead!

Obesity increases plugging in the arteries, known as atherosclerosis. Other causes of atherosclerosis are high blood pressure, smoking, high cholesterol, diabetes, or poor diet. Add obesity to any of these and the damage is multiplied.

Obesity is the last bastion of “socially acceptable” bigotry (thankfully that is changing, see “puffy”). The emotional cost of obesity is unimaginable, unless you have lived it.

Fix obesity and you have really done something for the collective health of America. It might go a long way to balancing the budget. Those are the kind of healthcare dollars that a really efficient and beneficial obesity drug could save.

Enter Qnexa. Now it’s called Qsymia due to some legal mumbo-jumbo (where do they get these names?). Qsymia is a long-acting combination of phentermine (the harmless one of the Fen-Phen mess) and Topamax (topiramate).

Phentermine is an older stimulant class drug that is well tolerated and doesn’t have any dangerous habits that we know about. Topiramate is an anticonvulsant that is used to control seizures, migraines and sometimes chronic pain. This is also a drug that has been around a while, and is rather innocent as medications go.

The magic seems to be in the dose. The ratio of phentermine to topiramate is approximately 1 to 6. Additionally, both drugs are used in much less than the maximum daily dosage. They are generally well tolerated. A few people had some nausea or constipation, but not bad enough to be treatment-limiting.

Qsymia works by suppressing the appetite. The combination is a much stronger appetite suppressant than phentermine alone. This is the easiest way to lose weight because you don’t get hungry.

The FDA requires 5 percent measured weight loss in clinical trials. Qsymia managed to get well beyond that, up to 15 percent weight loss in several large clinical trials. It also seems to be useful in Type 2 diabetes.

When can I get it? That’s what everyone wants to know. It will be available by mail order with a prescription from a doctor that has some special training in this medication. If that seems unduly cautious, remember that more weight loss medications have been taken off the market, due to safety concerns, than added in the last 10 years.

Qsymia looks like a very promising medication for weight loss. If the medication is proficient enough, it might even get over the name handicap. Now that it has received FDA approval, it should be in the hands of patients in the very near future.

Take care,

Dr. B.

Qnexa – Better Mousetrap or Hype?

Obesity is a huge problem in this country (sorry). One third of Americans are significantly overweight, and overweight people have a whole Pandora’s Box of health problems.

Obesity causes elevated blood pressure, heart attacks, strokes and kidney failure. The extra weight wears out the joints in the legs so total knee and hip replacements are performed more frequently, and at a younger age, in the obese. Reassemble this box and the price tag adds up to $150 billion per year for obesity-caused disease, just in this country.

Think a few people are looking for an answer? We may have found one.

Qnexa is a combination of two older medications that appears to have somewhat magical and unexpected properties when put together in just the right amount.

The two medications that make up Qnexa are Phentermine (of fen-phen fame) and Topamax. Phentermine is an older diet medication, which is in the family of stimulants. Don’t worry, the heart problems in Fen-phen were all because of the Fenfluramine, which is no longer available.

Topamax is an anti-convulsant (anti-epileptic) that has been around a while and is used to treat migraines and chronic pain, as well as epilepsy. So you add these two medications, experiment with the right amount, and duration of each, and almost like magic, people start losing weight.

The magic seems to be in the details. The phentermine-to-Topamax ratio that is used is roughly 1 to 6. The actual dosages studied are anywhere from roughly 50% of maximum doses of each to merely 10%.

They have also adjusted the release of the medications to prolong the effect in the body (also allows once daily dosing).

Now, more than a few people will be thinking of making “do it yourself” Qnexa by getting a prescription for both medications – that would be a very bad idea.

The actual medication has been approved by the FDA advisory panel; but it took two times through to get that. The full FDA hasn’t approval this (necessary to allow your doctor to prescribe it). Approval is anticipated later this year. In the meantime, do-it-yourself pharmaceutical research is dicey at best.

Probably worth remembering that one of these medications has seen trouble before (fen-phen). There have also been a good dozen drugs taken off the market in the last 10 years for safety reasons, and they had been fully approved by the FDA.

Qnexa isn’t there yet.

But does it really work? Three large studies have looked into the safety and effectiveness of this medication. The FDA’s minimum “bar” for effectiveness (in a weight loss medication) is 5% weight loss after one year of therapy. Qnexa had no problem meeting that, and in fact had closer to 15% weight loss after a year’s therapy.

The mechanism of action is appetite suppression; you don’t get hungry.

There were no surprising side effects, most were mild and did not limit treatment. Side effects tended to be gastro-intestinal; some nausea, constipation and numbness and tingling in a rare patient.

Keep in mind that new medications and combinations are tested on a few thousand people, not the millions of people that a hot new prescription drug will see. Statistically rare occurrences require big numbers to identify. It is reassuring however, that there are no serious scientific concerns about this new combination medication.

Will Qnexa be the next big pharmaceutical wonder drug, the billion dollar pill? Will it undo some of the damage the fast food nation has done on our heart health? Or will having a good answer for weight loss just make us eat even less carefully?

I think next year’s New Year’s Resolution is going to be a lot easier to keep.

Take Care.

Dr B.

Image: Michelle Meiklejohn / FreeDigitalPhotos.net

The FDA Takes Action Against HCG for Weight Loss

As we mark the new year and the resolutions that go along with it, people will undoubtedly make the plan to lose weight in 2012.

'Scale-Gina' photo (c) 2011, Twentyfour Students - license: http://creativecommons.org/licenses/by-sa/2.0/Before you embark on a plan, here’s some useful information to be aware of.

The Food and Drug Administration recently sent warning letters to companies marketing over-the-counter human chorionic gonadotropin (HCG) products that claim to help people lose weight.

The FDA said the companies are violating federal law by selling drugs that have not been approved, and by making unsupported claims for the substances. There are no FDA-approved HCG drug products for weight loss.

Before everyone gets in an outrage, I would like to make the totally outrageous suggestion that the government is doing the right thing. That may be rare, but give credit where credit is due.

HCG and weight loss have a long and unholy alliance. HCG is a hormone present during pregnancy. It is the hormone used to test for pregnancy in both home and lab pregnancy tests.

What about dead rabbits? In the “old” days of medicine, a lab test involved injecting urine from a possibly pregnant woman into a rabbit. They cut open the rabbit and found swelling in the rabbit’s ovaries if the urine contained HCG; meaning the woman was pregnant. The rabbit actually died either way. Modern testing thankfully involves merely peeing on a stick (who says we’re not making progress!).

The belief that HCG assists weight loss came from some really bad data 50 years ago out of India. HCG was given to starving Indian pregnant women and seemed to cause protein-sparing weight loss. These poor women were doing the best their bodies could to maintain the pregnancy under conditions of extreme starvation. They were already full of HCG (as all pregnant women are) and this had nothing to do with the weight loss.

Countless tests in the last 30 years have proven that HCG does nothing to assist weight loss. Despite this, medical weight-loss programs using HCG have thrived. I’m sure you have heard the radio and TV advertising.

Now, is HCG a problem? It is not poisonous, or addicting, and doesn’t increase the crime or divorce rate. It has precious little effect on non-pregnant people.

The caloric restriction part of a diet works, as does the exercise part. HCG just adds nothing. We might ruminate about damage to the public trust. Should medical-sounding people be allowed to lie to you in advertising, and who should decide? Heavy questions for constitutional scholars to debate; I’m a simple doctor.

So don’t attempt to smuggle HCG supplements into to the country. Save your money, spend it on a gym membership or new walking shoes. Or buy yourself a new shirt and you will no doubt look trimmer.

Take care,

Dr. B

HCG and Weight Loss (Or Lack Thereof)

Where I work in Scottsdale, Arizona, is probably second only to Hollywood in the med-spa business. 

It’s reassuring to know that day or night, weekend or even holiday, in an emergency I can get a walk-in Botox shot or an HCG supplemented diet. I sleep better knowing these things.

Hypodermic Needle Stomach Injection 3-1-08 8278photo © 2008 Steven Depolo | more info (via: Wylio)

The HCG diet ads are so plentiful, I don’t even hear them anymore. It was with mild surprise one day when I realized they were actually talking about injecting people with HCG as part of a diet. HGH seemed plausible, but HCG?

For those that think acronyms are a silly, HCG is Human Corionic Gonadotrophin and HGH is human growth hormone. HCG is a pregnancy hormone, and it is secreted by the placenta and helps keep progesterone levels high to maintain the pregnancy. It’s the hormone that is tested to confirm pregnancy. HCG doesn’t seem a likely candidate for injecting non-pregnant people, even males, to assist in weight loss.

This is the second or third cycle for this particular medical diet fad. It tends to re-emerge roughly every 25 years, which perhaps not coincidentally, is about once every generation. If you remember HCG not working in the 70s, you are not likely to pay for it today. How in the world did this pregnancy hormone get hooked up with weight loss?

For that we have to travel back in time to the early 1950s and to India. India was a brand new country at that time, having just emerged from British rule. There were still some British medical types hanging around acting like they owned the place. One such British endocrinologist was Dr. Simeons. He did studies on pregnant Indian women on starvation diets (pleasant thought – not! There is no mention on why Dr. Simeons didn’t do this research on pregnant British women in London. Medicine was a lot more wild and wooly in those days, which are thankfully passed. But I digress…)

Anyway, he injected these starving pregnant women with HCG and they seemed to lose more fat than protein. He also studied overweight males with Froelich’s Syndrome (pituitary failure). They were also put on a 500 calorie diet and given HCG shots. They also managed to lose considerable weight. He theorized that giving supplemental HCG in extreme diets hastens weight loss and spares protein-producing for a more healthful weight loss. This doesn’t even make medical sense, but this became quite the fad in Italy where Dr. Simeons had a clinic. Pretty soon everyone was injecting all manner of HCG preparations in the pursuit of lean living.

Rapid weight loss that spares protein and preserves vigor is the holy grail of the dieting world. Many attempts to prove Dr. Simeons’ theories about HCG-assisted weight loss have failed to reproduce any measurable benefit from the HCG. It seems the severe 500 calories restriction diet was the actual cause of the weight loss, and it had nothing to do with HCG. That is not too surprising since HCG is a pregnancy hormone.

Lose weight nowphoto © 2009 Alan Cleaver | more info (via: Wylio)

Injecting HCG as part of a diet was popular in the 50s, in the 70s, and now in the first decade of the new millennium. HCG is still little more than an expensive placebo. Its popularity seems to be related to the income it produces rather that any measurable medical benefit, other than to fetuses. It’s really hard to sell an unusually harsh diet, but combine it with a magic weight loss shot with a medical name, and you have an industry.

Take care,

Dr. B

U.S. HealthWorks’ Dr. Thomas Miller recently spoke with KXLY-TV in Spokane about the HCG diet. His interview can be found here.