When it comes time to lose weight, you can be your own best friend or worst enemy. Your attitude has a lot to do with the weight loss success you will experience. A medical weight loss program can present you with proven strategies and tools to make changes in your life, but it is a positive attitude and solid sense of accountability that will keep you sticking with the tools you’re provided.

Accountability ensures a task is carried out as planned. To become accountable is to take responsibility for an action. In terms of weight loss, this often means accepting responsibility for your progress instead of looking to external factors that might have tempted you to stray from your weight loss plan.

Accountability can be tough to self-generate. Workout buddies, support groups and regular meetings with Dr. Lazarus are all great sources of external accountability that can help you stay on track towards your weight loss goals, but they aren’t always enough. You are the only one who is ultimately responsible for your actions. Adopting certain strategies can improve your self-accountability and help you become more in-tune with your weight loss efforts.

Here are a few tips to improve your weight loss accountability:

• Keep a journal: Keeping close track of your weight loss progress can help you maintain accountability. A journal makes it easy to go back and evaluate what you ate yesterday, how often you worked out last week and what stressors might have interfered with your weight loss program.
• Use social resources: In this day and age, social resources are available 24/7 and can provide a personal strategy for accountability. Using tools like Facebook, Twitter and blogging websites like WordPress to announce your progress to the world can boost your motivation to stay healthy. Update your status with your exercise plans and let your Twitter feed know when you’ve enjoyed a dinner that met the requirements of your meal plan.
• Mark your calendar: By looking at your calendar every day you can be constantly reminded that you have a goal you need to concentrate on. Use X’s to mark off days where you fulfilled your fitness requirement, or circle days where you stayed within your calorie allotment. The more you are noting on your calendar, the better you are doing at working towards your goals.

There are plenty of other ways to boost your weight loss accountability, too. Challenge yourself to get more active by wearing a pedometer, or create a weight loss contest with a coworker and spend a month urging each other on as you lose weight. The more accountable you become during your weight loss program, the better your weight loss experience is bound to be.

If you live in Denver and struggle with obesity, then medical weight loss is one of the best things you can do for your body. Every inch of your body inside and out will be affected by your weight loss. For many, these health benefits provide added motivation in the journey to a slimmer waistline.

Come On, Get Healthy

Excess weight affects your physical and mental health in many ways. It can put you at an increased risk for obesity-related conditions like heart disease, type 2 diabetes, and sleep apnea, all of which can greatly interfere with your quality of life. Treatment options for these conditions often include medications and sometimes even surgery, especially if a heart condition grows severe.

Living a healthy lifestyle can reduce your risk of developing these conditions. For those who are already coping with these concerns or others like them, losing weight can help. Sleep apnea, type 2 diabetes and cardiovascular disease have all been shown to improve with weight loss.

Other health conditions that can be positively impacted by losing weight include:

• Arthritis
• High blood pressure (hypertension)
• Certain kinds of cancer
• Depression
• Anxiety
• Digestive troubles
• Heartburn and acid reflux

Medical weight loss programs can improve your health by introducing healthy lifestyle habits that you can practice long-term. These include diet and exercise changes that will help you shed pounds as you engage in an overall healthier way of life.

Some of these healthier lifestyle habits include:

• Eating smaller portions: Cutting portion sizes back down to size will cut calories from your diet before you even start making food choice changes. Reducing portions can also reduce your risk of heartburn and acid reflux by reducing the pressure on the valve that separates the stomach from the esophagus.
• Exercising regularly: Whatever you do, exercising everyday can improve your health. Cardiovascular activities like walking, biking, swimming and jogging are especially great. These can enhance blood circulation, thus reducing blood pressure and improving heart health. Exercise can also tame anxiety.
• Drink more water: Your body needs water to thrive, yet so many people switch out water for sugary sodas, juices and teas. Switch back to water to cut down on calories as you lose weight and you can improve your health significantly by practicing better hydration habits.

Medical weight loss programs are a great investment for improved health. As you lose weight, think of all the ways you wish you could change your health for the better. Talk with your weight loss doctor about your health and wellness goals to customize a program for your needs.

Belviq (Lorcaserin)

So, what’s the fuss?

Late last year, the FDA approved 2 new weight loss medications – Qsymia and Belviq. Qsymia has been available for several months, Belviq has been awaiting clearance by the DEA. It has now received clearance and should be available in about a month.

Belviq works in the brain by increasing serotonin. It is called a selective seratonin agonist. It is a completely new approach to help suppress appetite. We have long known that seratonin plays an important role in weight regulation. For example, most anti-depressant medications that work through seratonin increase appetite. Belviq works on the opposite end of the seratonin system and inhibits appetite.

We all remember not in the too distant past a drug called fenfluramine, which when used with Phentermine produced significant weight loss (Phen-Fen). Fenfluramine also worked by increasing seratonin levels; however, it was non-specific. Because we have seratonin receptors in our heart, Fenfluramine was responsible for heart valve damage and was taken off the market.

Belviq is a selective seratonin agonist that works primarily in the brain, and has been well studied for safety showing that it does not have activity in the heart.

Like other available weight loss drugs (Phentermine, Tenuate, Qsymia), in clinical studies, about half of those treated with Belviq lost 5% or more of their body weight. And, in 2 years of follow-up studies for safety, there was no evidence of heart valve damage in over 1000 patients. Another study showed significantly more weight loss – this study was done in heavier patients with more risk factors. Of those responding to the drug at its highest dose, the average weight loss was 22.6%.

Stay tuned to our blog, newsletter and facebook page – we will let you know the details of Belviq’s release as soon as it is on Denver pharmacy store shelves.

To improve recognition of dietitians as our nation’s nutrition experts, the ADA has renamed themselves to the Academy of Nutrition and Dietetics. In addition, registered dietitians now have the option to use the credential registered dietitian nutritionist (RDN).

Why did this happen?

While all registered dietitians are nutritionists, not all nutritionists are registered dietitians. The new RDN credential recognizes registered dietitian nutritionists as being experts in regards to both diet and nutrition. This term more accurately reflects what registered dietitian nutritionists do.

Adding “nutritionist” to the registered dietitian credential is consistent with the addition of the word nutrition in the Academy’s new name, Academy of Nutrition and Dietetics. It also communicates to everyone the broader concept of wellness and preventive health that are part of practice for many RDs.

The RDN credential is offered as an option to RDs who want to convey the nutrition aspect of the credential. Use of the RDN credential is optional.

Home and work are places we spend huge chunks of time, and making these places more conducive to your medical weight loss program can be a big help in staying on target. To begin turning your environment into a place that works for weight loss, it’s time to:

Banish Junk Food

It doesn’t matter which of our weight loss programs you’ve started—there are some things that have no place in your healthy diet, and they may still be hanging around. Now is the time to purge every unhealthy food that may stand between you and your goals. Dig through your fridge, freezer and pantry and clear out any sugary, fatty snacks that may still be sitting on your desk at work. These can be donated to a food bank or another organization that feeds the less fortunate.

At home, you may face resistance to this task from your roommates, children or significant other, especially if you’re trying to remove their favorite snacks. It’s important to respect their dietary decisions, but you should also remind them that a healthy environment is an asset as you lose weight. Request that unhealthy foods be kept somewhere you can’t access them easily.

Make Good Choices Easier

Getting bad stuff out of the way should leave you with plenty of room for better options. If you’re on a full meal replacement diet, keep healthy foods front and center in your pantry and fridge—this will make them easy to grab whenever you need a meal. Otherwise, you’ll need to start filling your space with the fresh foods that will help you prepare nutritious, low-calorie meals. Do your best to make this a reality at work and home.

Your environment can also make it easier to get the exercise you need. Consider investing in a few simple workout tools like free weights, resistance bands and an exercise ball for your home and office. This equipment may not be your go-to choice for a serious workout, but just having it around can encourage you to squeeze exercise in at every opportunity.

Only you can decide to maintain the healthy habits of your medical weight loss program, but your environment in Denver can have a serious influence on the way you behave. If you start now, you can make sure your surroundings help you more than they hurt.

I’m going to be here for my kids, and I’m going to be here for my husband. To know that I have a group cheering me on, and helping me with every piece of it is amazing.

This used to be me, and the new me is five sizes smaller. I’ve lost 73 pounds in five months’ time. It was a very easy experience; I was very surprised at how easy it was to lose the weight. I thought it would be more difficult than it was, but with all of the support and help. A really great program to follow, it was very simple to do. I am very proud of myself. I celebrate this much weight loss as much as I celebrated beating my cancer.

As a cancer survivor I was on five different medications to help myself to just get through the day and feel okay and to help my health. Halfway through at the Clinical Nutrition Center I was off all five medications, and I no longer need medication to feel good to get through the day. Now when I go to see my oncologist and get my blood work done and get my tests done, I no longer worry day to day that my cancer is going to return because with the amount of weight that I’ve lost on this diet my chance of cancer recurrence has dropped by 85 percent.

I am very excited about this summer. For the first time in 15 years I would say I can wear shorts. I have avoided wearing shorts… anything shorter than a Capri pant because I was overweight. Things didn’t look good. So this summer I actually get to wear shorts and be cooler like the rest of the world. I also get to wear cute summer dresses. I’ve already purchased three of them and can’t wait for it to get warm enough to wear them.

It’s very fun to go shopping now, which in the past was always a tearful session for me. Now when I go in and shop I have lots of selection and choices. When I try clothes on everything fits, and I have to make choices of what I want to bring home and not have to take home what only fit me.

I have more energy to be able to do the things we want to do. I feel more attractive myself which is a huge plus, before I didn’t feel that attractive. And when you feel good about yourself it makes all the difference in the world.

The way to help yourself through a program like this and to keep a healthy mental outlook, to be able to look forward is to know that you’re saving your life by doing this.

Not all weight loss programs are the same, because I’ve tried so many different programs. Working with the Clinical Nutrition Center is different because you have a group, a team of people cheering you on and helping you. My doctor, Dr. Lazarus, is not only a doctor but he’s board certified to help treat obesity. He knows about you specifically and how to help you specifically. You’re not grouped in with a bunch of people; you are one person that he can help one on one. You’re not getting a box of food delivered to your house and following a piece of paper, you’re not logging online to read an article to help yourself feel better, your speaking with people every single week or as often as you need to speak with them to get help. It’s specified for you.

Kristi after 5 months on the program lost 73 lbs.

Medical weight loss in Denver might not physically relocate you in the way a big move might, but the mental journey is the same. The decision to embark on a healthier lifestyle is not one to be taken lightly. Countless people wake up, decide they would like to lose weight or be healthier and start making small, temporary changes only to return to their former habits feeling unsuccessful. But what did this accomplish? This is the start of the endless yo-yo cycle. You lose some modest amount of weight, gain it back plus some and then start over again.

But not all weight loss goals are created equally. There is such a thing as being overly-ambitious with your goal making, just as it is possible to be too lenient. When setting your weight loss goals, remember to be SMART:

• Specific: Your goal should be simple and straightforward. Set a weight you would like to reach, a number of miles you’d like to run or a dress size you’d like to fit into once again.
• Measurable: If you can’t measure your goals you’ll never know how you are doing in relation to them. A goal like “losing weight” is unclear and immeasurable. Your goal should be quantitative in some way.
• Achievable: Your weight loss goal needs to be realistic. Don’t work endlessly towards something you can’t achieve—start small and work your way up.
• Result driven: A goal like losing weight is nondescript. This is not a result, it is a process. Your goal should be something you can work towards.
• Timely: Give your weight loss goals some time constraints. Create milestones along the way so you can gauge your progress as you lose weight. Scheduled weigh-ins at your physician’s office are one great tool to regulate timeliness during weight loss.

A good goal can give you a greater understanding of what you are trying to accomplish, and will give you more insight into your overall progress. Setting concrete goals will give you a defined destination towards which you can work. However, a weight loss goal isn’t a finish line—once you cross it you will need to maintain all of the healthy habits you adopted to reach it.

This is a continuation of our discussion of weight loss myths, perceptions, and facts. Now it’s time to change gears again. In part one and part two of this series, we discussed myths (things that are believed but simply aren’t true), and in part three and part four we talked about presumptions (things we think are true but we can’t really prove it one way or the other – so, unsubstantiated beliefs). Let’s talk about some obesity FACTS that we KNOW are true (according to the NEJM):

1. Although genetics plays a large role in our weight, they do not determine our destiny. Moderate environmental changes can promote very significant weight loss.
2. Diets effectively reduce weight but generally don’t work in the long term. In the long term, there must be a significant reduction in energy intake (calories eaten).
3. Regardless of body weight or weight loss, exercise improves health. Even if no weight is lost, an obese individual who increases physical activity can significantly reduce their health risk from their weight.
4. If the amount is sufficient, physical activity and exercise aid in long-term maintenance of weight loss.
5. To promote long term maintenance of weight loss, the conditions that led to the weight loss must be continued indefinitely. Because obesity is a chronic disease, when we treat it, it gets better. If treatment is stopped, it comes back.
6. Treatment of overweight and obese children is best accomplished with a program that involves the parents and the home setting. This is why we wrote our “Healthy Steps for Healthy Kids” program as a family-based intervention – parents and kids working together on improving the home environment in a specific, structured way.
7. Meal replacement products promote greater weight loss. Although this may seem counterintuitive (many patients I treat request more “holistic” or “natural” treatment), meal replacement programs (like Optifast, offered at CNC) offer greater weight loss than those promoting “balance,” “variety,” and “moderation.” In my experience, the fewer decisions an individual has to make throughout the day, the more weight loss is achieved. This strategy works well in maintenance, too.
   (I always enjoy seeing my pleasantly surprised patients who show me their careful food journals documenting that they have been eating 1000 calories a day with no weight loss for months. I put them on 1000 calories per day of a full Optifast meal replacement program and we can see 50 pounds of weight loss in less than 6 months. They frequently argue that the calories I am putting them on won’t be low enough – I argue that the converse is true. There is really no good way to estimate the calories we eat in prepared foods, and trying to count calories is so inaccurate it is probably not worth the time it takes. The food journal is still critical! Just not as a tool to assess caloric intake. For more discussion on this topic, set up a meeting with Dr. Lazarus, Heather Thomas, or your dietitian).
8. FDA approved prescription medications used by obesity medicine specialists help patients with clinically meaningful weight loss. At Clinical Nutrition Center, our patients have had great results with both Phentermine and Tenuate, but only when combined with a behavioral program. Patients are also experiencing good results on the new weight loss drug approved by the FDA for long-term use, Qsymia, and we are excited that Belviq (another new weight loss drug approved by the FDA for long-term use) will be available hopefully by the time you read this.
   The weight loss is maintained as long as the medications are continued. Unfortunately, discontinuation of the weight loss medication, especially if done too soon after losing weight often results in regain of what was lost. Another study earlier this year (POUNDS Lost) suggests that treatment, in the opinion of Dr. Lazarus, should be discussed in terms of years of maintenance, not weeks or months. In fact, POUNDS Lost suggests that a new set point is beginning to be established 2 years after maintaining a stable weight, and that at this point the risk of regaining what was lost is significantly reduced.
9. Bariatric surgery, for some patients, results in long-term weight loss and reductions in the risk of diabetes and mortality. It is important to remember that obesity is a deadly disease. For severely obese patients, gastric bypass surgery can offer a life-changing and sometimes lifesaving treatment.

That concludes this series of articles on myths, presumptions, and facts about obesity. We’d love your comments on these articles!

Written by Dr. Ethan Lazarus

This is a continuation of our discussion of weight loss myths, perceptions and facts. In part one and part two of this series, we touched on myths about obesity and factors like goal-setting, physical education and sexual activity. Now, we continue our discussion of presumptions about obesity—the things we believe to be true about obesity that scientific evidence has not made certain.

Presumption #4:  We learn our exercise and eating habits in early childhood and these habits influence our weight for the rest of our lives.

Current evidence suggests that how our BMI’s track over our lives is more a function of genetics than of learning.  There is no data that provides evidence to the contrary.

Interestingly, there is evidence suggesting that for a child at the high end of their BMI percentile, the earlier we start working with them on healthy habits and achieving a healthier BMI, the less likely their weight problem is to persist into adolescence and adulthood.  The longer we wait, the higher the likelihood of a life-long problem.  That’s why when we wrote our new kids program, “Healthy Steps for Healthy Kids,” we focused on kids as young as 6 and as old as 16.  In spite of NEJM calling this a presumption, research supports early intervention as a research strategy!  We can’t change a child’s genetics; however, we CAN work together to change their environment.

Presumption #5:  Snacking contributes to weight gain and obesity.

Randomized controlled trials do not support this presumption.  In fact at CNC, we recommend eating 5-6 smaller meals a day (or 3 meals, 2 snacks) and have found this to be helpful in preventing late afternoon and early evening hunger.  Many of our most successful patients continue eating more often and report this to be helpful, not harmful.  More frequent eating is also one of the most common habits reported by participants in the NWCR (National Weight Control Registry).

So, while there is no evidence that snacking contributes to weight gain and obesity, our experience is that SMART snacking is a helpful treatment strategy (hmmm – no evidence on this, either though).

Presumption #6:  The presence of sidewalks and parks influences the risk of obesity.

No well-done study has proven this; therefore, no conclusions on this can be drawn.

Interestingly, this supports what I have long told patients – that obesity is primarily affected by calories IN, not calories out.  While going to parks and using recreational trails is helpful in getting us more active, because activity has not been proven to be an effective treatment strategy (in the absence of addressing caloric intake), it is not surprising that there does not appear to be a correlation between access to sidewalk and parks (or the lack thereof) and a population’s weight.

Next time, we’ll discuss things about obesity that we know to be true.

Written by Dr. Ethan Lazarus

Presumption #1: Regularly eating breakfast prevents obesity.

Two good studies have been done to assess this. Although we definitely recommend eating a good breakfast, especially one with protein, and individuals maintaining large amounts of weight loss from the National Weight Control Registry report breakfast eating as a primary habit, studies were unable to show that eating or skipping breakfast impacted weight. My belief and experience is that eating breakfast is important; however, we don’t have the scientific evidence to prove this.

Presumption #2: Eating more fruits and vegetables will result in weight loss.

It is true that eating fruits and vegetables has health benefits; however, in the absence of other behavioral changes, simply increasing fruit and vegetable consumption has not been shown to result in weight loss. In fact, some of our most effective weight loss strategies like the use of meal replacements produce large amounts of weight loss quickly while reducing or eliminating fruit and vegetable consumption. Optifast full meal replacement programs are one example of this, which we have successfully used to achieve weight losses of 50, 100, 150 and even 193 pounds without the individual consuming fruits or vegetables.

While it would stand to reason that filling up on low-calorie, healthy natural foods leaves less room for all the junk that most Americans eat, increasing fruit and vegetable consumption has unfortunately not been shown to be an effective treatment strategy for an individual with a weight problem.

I find this discussion in the NEJM to be very interesting. I often meet very heavy individuals eating tons of fruits and vegetables, often in the form of a “smoothie” with their fancy new blender. A lot of these smoothie concoctions can have 500-1000 calories or even more, and unfortunately don’t offer a lot in terms of increasing satiety (sense of fullness). I often advise those individuals that eating all these healthy foods is great, but to concentrate on eating whole foods, not blending them, and on combining them with protein.

While I don’t have the scientific evidence to show that this is more effective than other approaches, it has certainly been our experience that eating protein with every meal and snack is very satiating and seems to stave off the late afternoon and evening munchies. So, what is my take? That’s easy. Shoot for 5 servings of non-starchy vegetables, have at least 30 grams of protein for breakfast, lunch and dinner, 15 g in a morning snack and 15 g more in an afternoon snack. Oh, and maybe a fruit.

Presumption #3: Weight cycling (“yo-yo dieting”) is associated with increased risk of dying.

Current studies do not support this association. Another study published last year dispelled the myth that “yo-yo dieters” were less likely to be successful with future weight loss attempts. Indeed, most individuals battling with the chronic disease of obesity have lost and gained weight numerous times in their lives – current data suggest no association between prior weight loss attempts and the ability to lose weight on the current attempt. This NEJM article also casts doubt on the presumption that losing and gaining would result in worsened health outcome. Telling an individual this is like telling somebody battling with nicotine addiction that stopping and restarting is actually worse than just continuing to smoke! I say that because even small amounts of weight loss provide huge health benefits. For an individual who keeps gaining and losing, health benefits are at least accruing while the weight is down. Psychologically, it may be another story…

Remember, for an individual who has a weight problem, weight gain is a normal part of EVERY weight loss program. Let’s try and keep those gains to a minimum and the losses to a maximum. It is my opinion that a regular weighing schedule and carefully written out action plan is worth its weight in gold during weight loss maintenance. If you haven’t devised an active maintenance strategy, or if you are an individual who has regained some or all of what was lost, there is no better time than now to see me, set some new goals and objectives that are appropriate for you and draw up an active maintenance strategy so you can enjoy the benefits of maintaining a lower weight again this year.

Next time, we’ll continue our discussion of the presumptions we have about weight loss.

Written by Dr. Ethan Lazarus