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MEDICALIZING OBESITY

November 21, 2014

The Argument in support of the Rational Use of Prescription Medications

for

Treating Obesity

In  a 2009 report , Obesity in the United States carried the hefty price tag of $147 billion per year in direct medical costs, just over 9 percent of all medical spending. People who are obese spend almost $1,500 more each year on health care — about 41 percent more than an average-weight person. The biggest driver of these excess costs are prescription drugs, the author said. What that author did not say but this author believes is the upshot from this report is that virtually none of these medicines were prescribed to treat Obesity. Rather, they were prescribed to treat the health consequences (co-morbidities) of Obesity such as Diabetes, Hypertension and Osteoarthritis to mention a few. The good news is, effective and safe prescription medicines for treating Obesity have been in existence for several decades. The not so good news is that very few of these medications are actually approved by the US Food and Drug Administration (FDA) for treating obesity, and those that are FDA approved are rarely prescribed by US physicians.

As preposterous as it seems in light of this information about its medical costs,  the biggest obstacle to Medicalizing Obesity is the Medical Establishment. For starters, it was as recently as July 2013 that the American Medical Association (AMA) first officially recognized Obesity as a disease. For another example, in October of 2010 the FDA pulled the Obesity medication, Meridia (Sibutramine) from the market because in some patients it caused a rise in blood pressure and in some patients with pre-existing coronary artery disease, Meridia caused heart attacks, some of which were fatal. While high blood pressure and fatal heart attacks are by no means minor risks, they are risks that can be significantly reduced when prescribing physicians practice within the “standard-of-care” such as carefully screening their patients for heart disease before prescribing Meridia and closely monitoring their patients’ blood pressures after they start taking the medication. These are already firmly established practice standards for the general medical care of Obese patients regardless if they are intending to start on a weight loss medicine. Most conspicuous by its absence from the debate over removing Meridia from the marketplace was any consideration of the benefits of Meridia or the risks of not treating Obesity.

Contrast the Meridia story with that of Sudafed (pseudoephedrine), the over-the-counter decongestant taken by millions of Americans every day, which has similar pharmacologic properties as well as risks as Meridia for raising blood pressure and causing heart attacks in some people with pre-existing Coronary Artery Disease (CAD). Seemingly, according to the FDA the benefits of clearing our stuffy noses warrants us taking such risks while a clinically significant reduction in our body weight does not.

As a last example of the Medical Establishments “Hypocritical Oath” when it comes to Obesity is aspirin, brought to the US marketplace by Bayer in 1905 and the proliferation of the myriad other non-steroidal anti-inflammatory drugs (NSAIDs) that followed. A rarely mentioned fact is that this class of medications, available without a prescription, causes 7,500 deaths annually in the US, primarily from gastrointestinal hemorrhage, most of which occur spontaneously without warning. Why isn’t the FDA suggesting we take these medicines off the market, while a medicine that actually treats Obesity that carries the same and even lower risks,  is pulled from the market? Adding to the irony, the primary reason people take NSAIDs is for the treatment of the co-morbid condition of Osteoarthritis, a co-morbid condition of Obesity. So, according to the prevailing perspective of the Medical Establishment if you are an Obese patient and you call your “Care Provider” because you are suffering from arthritis pain, the advice you will likely be given is, “take two aspirin and call me when you are a contestant on The Biggest Loser.

As you may have noticed, this author’s primary argument in support of the rational use of prescription medications for the treatment obesity is their irrational disuse. Clearly the time for changing this antiquated perspective is long overdue. In my next post, I am giving my first comprehensive update since 2006   on the current prescription medicines for the treatment of the disease, Obesity, so please stay tuned.

End Post

Mitchell R. Weisberg, MD, MP

Internist-Psychopharmacologist-Corporate Wellness Consultant

Founder-CEO and Personal Physician at,

Optimal Performance MD LLC

 

C³-Cardio, Core and Cortical

Basic Principles

Just as I eliminated the word, diet from my vocabulary because of its common association with self deprivation, I similarly have banished the word, exercise for its masochistic association. Rather, I use the words, fitness or physical activity, which I liken to an essential nutrient which, for achieving and maintaining our optimal health and performance, we need to meet our minimal daily requirement. Just as we must eat to perform optimally and not to lose weight, we must get physical activity for the same purpose. The first step to take to meet our physical activity requirement is to overcome our own inertia. I recommend the following:

  • Drop the all or nothing approach to fitness. Not having the time to get to the health club for ninety minutes is not an excuse  for being sedentary.
  • Not having time to do physical activity is not a valid excuse; when we get our required physical activity we are more efficient in everything we do, so we actually gain time by doing it.
  • We must make every effort, and I assure you this will take effort, to get at least 10 minutes of moderate physical activity such as calisthenics or brisk walking within the first 60 minutes of waking up in the morning. The way I trick my brain into doing this is I get on my treadmill at a pace that is about half as fast as I walk normally, or at 1.8 mph. After about one minute of this, I am so annoyed at how slowly I am walking, I forget how tired I am and I crank the speed up to 4 mph and voilà, inertia gone!
  • Incorporate physical activity into you activities of daily living. In other words, embed physical activity into your daily activities. Make shower time fitness timeFor every hour throughout the day that you are sedentary, such as being at work or school, get 3 to 5 minutes of physical activity. Call it a bio-break.
  • If  you can get to the health club for a fitness class or a work out, consider it a luxury, but do not rely on this as the only means of getting our daily dosage of physical activity!

 

My fitness formula based upon the principles of cellular metabolism and its mission is for you to reach and keep up your optimal performance.

Cardio
From a rest, start your physical activity at a low intensity level and gradually increase it so you are at your target heart rate after 5 minutes; keep up your target heart rate for 10 to 30 minutes and then cool down so that you return back at your resting heart rate after 5 minutes. Try to do this 3 to 5 times per week. There are many ways to get your cardio fitness with equipment or without it.

Core
The core is our body’s center of gravity and is the area from the bottom of our rib cages to the top of our hips. The benefits of strengthening  the core is to improve our balance and prevent common injuries such as low back pain. As little as 5 minutes per day of core strengthening has significant health benefits. To begin strengthening your core, you simply need to get on the ball.

Cortical
This is the most important yet most neglected part of fitness especially in the western world. After all, it is the cerebral cortex that distinguishes humans from all other animals on the planet. It is our seat of reason and creativity and it is the part of our brain that most influences what we actually do in the course of our lives. Without cortical fitness, the lower centers of our Central Nervous Systems, such as the emotional limbic cortex, will have undue influence on our behaviors and place limitations on our reaching our personal potential and leading fulfilling lives.  It is my medical opinion, the lack of cortical fitness is the missing link to  why most people do not achieve and keep up their optimal health well-being and performance.

Now that you have the formula, apply it to your life for just 30 minutes per day and I am certain that you will see that this small investment of time will pay you significant dividends.

Good luck and keep your eye on the real prize; your optimal performance. I promise you that you will like the effects it will have on the scale and your body image.

End Post

Mitchell R. Weisberg, MD, MP

Internist-Psychopharmacologist-Corporate Wellness Consultant

Founder-CEO and Personal Physician at:

Optimal Performance MD

 

F²C³

My Nutrition and Fitness Recommendations with a Mission:

Optimal Performance

Based on the Principles of Cellular Metabolism and Neuroscience

F²-Fiber and Frequency is my formula for how to eat based upon the principles of cellular metabolism and neuroscience

  • Eat upon awakening in the morning: this does not mean that we have to cook or go out for breakfast; it’s as simple as opening an energy bar or pouring cereal and skim milk into a cup and drinking it.
  • Eat frequently: Eat at least at least 4 and as many as 6 times per day. Do not let 3 hours go by where you do not eat. The evidence shows that when we eat in response to being famished that we will consume more calories than if we eat before getting hungry. In addition, based on the principles that govern the process of cellular metabolism by the time that we feel hungry our cells’ efficiency at converting our nutrients into energy that we can actually use goes down and you know what that means? The cells will store more of the food that we eat as fat.
  • Consume 4 to 6 grams of Fiber each time that you eat:Fiber while classified as a carbohydrate, in the pure sense, is not a nutrient at all in that the human intestine does not have the necessary enzyme for absorbing fiber into the blood stream. Therefore, it is not metabolized, or used as a source of energy for life processes. However, due to its unique properties, fiber slows down the absorption rate of food from the intestines into the blood stream . This is why it is essential to consume fiber every time that we eat; as a result of this slower rate of absorption, the 40 trillion cells that make up our bodies can more efficiently capture the energy (calories) from the food that we eat for activities such as thinking, moving, growing our bones, our hair and our skin and leaving less total calories to store in our bodies in the form of fat. In addition, by not being absorbed and remaining in our digestive tracts, fiber enhances satiety, making us feel fuller from less food.

When people on fiber deficient diets gradually increase their fiber intake to the recommended level of 25 grams per day, they drop weight, they can sustain this weight loss, improve their blood levels of sugar and cholesterol, cut their risk of heart disease, improve their bowel regularity and cut their risk of developing Diverticulitis of the colon. 1 Pretty impressive effects for something that never even gets inside the human body. Isn’t it nice, for once that someone is telling you what you should eat instead of what you should not eat?

  • Eat before you are hungry! This sounds counterintuitive, and will make many dietitians cringe but, compare the task of learning to eat before you are hungry to the task of trying to not eat when you are hungry. It is a behavioral change that is readily achievable, and is more in synch with how our cells use energy most efficiently. In fact, hunger puts us off n a sub-optimal functional state in which we are more prone to make mistakes and to fly the handle. Eating often enough to preëmpt hunger, however, will keep your performance and your mood on a more even keel. Numerous studies have demonstrated that when people eat before they are hungry they eat fewer calories as compared to when they eat in response to being hungry.* In addition, more frequent eating leads to a higher rate of efficiency of our cellular metabolism, making it more likely that the food that we eat becomes energy used by our bodies and not stored as fat around our bodies. *

Sources of Fiber: Look at the nutrients labels and check out what you are getting. Here are my general guidance with a few personal recommendations:

  • Whole Grain Cereals: 3 to 6 grams of fiber per serving: the entire line of Kashi cereals ; there are many other Cereals on the market that have 3 to 6 grams of fiber per serving
  • Whole Grain Breads: 2 to 4 grams of fiber per slice.
  • Fruits and Vegetables in general are good sources of fiber.
  • Soy, which is a vegetable, is high in protein as well as fiber. Here are some soy recommendations:
  1. Edamame; try Melissa’s brand. It is in the frozen section. Microwave it for 2 minutes and add course kosher salt; it’s awesome.
  2. Boca Brand of burgers and sausages (it’s all soy and actually tastes great)
  3. Morning Star is another brand of the faux meat products (and I am not a vegetarian)
  • Trail Mixes: with 5 grams of fiber per serving these are extremely practical because of how portable they are. Trail mixes can vary in their content quite a bit; some are more candy than anything else. Just check the nutrient content for the  and go for it. This is something you can keep in the car at your desk in backpacks, purses, brief cases, etc.
  • Energy Bars: 3 to 6 grams of fiber per serving.
  1. Cliff Bars
  2. Kashi GoLean
  3. Many others

Here is a plug for Starbucks because they seem to get it. They have prepackaged trays such as their protein breakfast with apple, peanut butter, whole wheat bagel, hardboiled egg, cheeses and grapes.They make their sandwiches  on high fiber bread. They sell individual small packages of trail mixes. While on the pricey side, they deserve credit for offering truly healthy food.

What follows are some of the prerequisite habits you will need to develop to successfully follow the F² formula:

  1. Go grocery shopping at least once per week
    • Buy foods that are portable and contain  3 to 6 grams of fiber per serving.  to keep up its freshness, you can take or store it anywhere including in your car.
    • Make sure you buy enough to last you the entire week.
  2. Never be more than an arm’s length away from your food.
    • Keep it in your desk drawer, purse, backpack, briefcase, coat pocket and glove compartment.
  3. Find your new hunger equivalent
    • If we eat only when we are hungry we will always be in one of two states, famished or full; and, neither one is compatible with optimal functioning.
    • Eat for optimal function. The next time you have to read an e-mail twice or notice you are having a little difficulty keeping focused, eat something. Our function deteriorates before we feel hunger and we should respond to these functional signals by eating, well before we feel hunger. Start paying attention to your performance level and when you sense a slight drop, time to re-fuel. Find your new hunger equivalent, respond to it and you will start eating small amounts often, especially if you add fiber each time that you eat.

F² in summary: Eat 4 to 6 times per day and eat 4 to 6 grams of fiber each time that you eat. If you make   your focus, you will see that your dietary fats, carbohydrates and proteins will fall into place, your function (performance) and mood will improve and, the bathroom scale will most definitely do the right thing. Now let’s move on to my formula for fitness, .

C³-Cardio, Core and Cortical is my formula for how to move based upon the principles of cellular metabolism and neuroscience

Introduction:

Just as we eliminated the word, diet from our vocabulary because of its association with self deprivation, we must similarly excommunicate the word, exercise for its association with, self torture. In its place, I suggest, fitness or physical activity. Physical activity is no different from an essential nutrient of which we need our minimal daily need for achieving our optimal performance. Just as we eat primarily to perform optimally, not to lose weight, we need to merge physical activity into our daily lives for the same purpose. Just as it states in Chapter One of any Physics textbook,  the first step in getting the movement we need, we must first overcome our inertiafor which I recommend the following:

  • Drop the all or nothing approach to fitness. Our not having the time to get to the health club for ninety minutes is not a reason for us to be sedentary.
  • Get 10 minutes of moderate physical activity, such as calisthenics or taking a brisk walk, within the first 60 minutes of waking up in the morning.
  • Incorporate physical activity into you activities of daily living. For instance, turn  shower time into fitness time.
  • Instead of deluding ourselves into thinking we have 2 hours to go to the health club, here is a radical alternative; for every hour throughout the day that we are sedentary, such as sitting at work or school, we get 3 to 5 minutes of physical activity.
  • If  we can get to the health club for a fitness class or a work out, let’s consider it a luxury;  but we can not rely on this as the only means of getting our daily dosage of physical activity!!

 

C³  

My fitness formula based upon the principles of cellular metabolism;

designed for you to reach and keep up your optimal performance

Cardio
From a rest, start your physical activity at a low intensity level and gradually increase it so you are at your target heart rate after 5 minutes; keep up your target heart rate for 10 to 30 minutes and then cool down so that you return back at your resting heart rate after 5 minutes. Try to do this 3 to 5 times per week. There are many ways to get your cardio fitness with equipment or without it.


Core
The core is our body’s center of gravity and is the area from the bottom of our rib cages to the top of our hips. The benefits of strengthening  the core is to improve our balance and prevent common injuries such as low back pain. As little as 5 minutes per day of core strengthening has significant health benefits. To begin strengthening your core, you simply need to get on the ball.

Cortical
This is the most important yet most neglected part of fitness especially in the western world. After all, it is the cerebral cortex that distinguishes humans from all other animals on the planet. It is our seat of reason and creativity and it is the part of our brain that most influences what we actually do in the course of our lives. Without cortical fitness, the lower centers of our Central Nervous Systems will have undue influence on our behaviors and place limitations on our reaching our personal potential and leading fulfilling lives.  It is my professional opinion that cortical fitness is the missing link to achieving  and maintaining our optimal levels of health and performance.

Now that you have the formula, apply it to your life for just 30 minutes per day and I am certain that you will see that this small investment of time will pay you significant dividends.

Good luck and keep your eye on the prize; optimal performance.

End Post

Mitchell R. Weisberg, MD, MP

Internist-Psychopharmacologist

Founder-CEO and Personal Physician at:

Optimal Performance MD

How not recognizing success leads to failure

This evening, I received an e-mail from a 52-year-old male patient distressed that he has been on the Nutrisytem diet plan for four weeks and has only lost 10 pounds. I thought that the advice I offered him was worth sharing. I have deleted all references to my patient’s identity and pasted the e-mails here:

Distressed:

Doc,

I am just trying to figure out why my metabolism is so slow .
I am on nutri system for 4 wks and I am working out 5 days a week.

I promised myself I would lose 40 pounds by Christmas and I today I weighed 294 pounds.

I do not get it!!!!!!!

Doc:

Dear Distressed:

I looked at my records and before you started Nutrisystem you weighed 304 lb. That means, in your first month on the program you lost 10 lb., or 3.3% of your initial body weight. Listen up because I only want to tell you this one time; and what I am about to tell you is not meant to discourage you. To the contrary, I am giving you rational encouragement (as opposed to irrational optimism).
First, an ancient Yiddish quote, ” Mench Tracht Und Gut Lacht” which means, “Man plans and G-d laughs”. In other words, only Santa Claus can make outrageous promises about what we get on Christmas. So, please drop the 40 lb. weight loss by Christmas goal immediately. Thank you.

Now a quote by a locally famous Yiddish Doctor from the little Village of Skokie;
“The number one cause of failure in weight loss programs is people’s failure to recognize their own success”, which means exactly what I just said, so please read it as many times as you need to to fully comprehend it.

Now for the facts about weight loss:

  • < 40% of people on a diet program will ever lose 10% or more of their initial body weight.
  • < 10% of this group will keep the weight off for more than one year and most will gain back more weight than they lost
  • If we were to consider the entire population of the United States to be just one really obese person, and if this really obese person permanently lost just 5% of his initial body weight, there would be a 58% reduction in Type 2 Diabetes, which is the number one co-morbidity or complication of Obesity!
  • An person who permanently loses 5% of his initial body weight can reasonably expect to see a normalization of his blood pressure, cholesterol and blood sugar levels and a substantial reduction or even a complete remission of his Obstructive Sleep Apnea; not to mention he will simply feel better.
  • Among people who permanently lose 10% or more of their initial body weight, most of them lost just 3% of their initial body weight in the first three months of starting their diet and/or exercise programs.

In conclusion, my good friend and patient, you are two months ahead of schedule, do something to celebrate; doctor’s orders. Your success at losing weight hinges on your acquiring the right perspective, which I just gave you because after all, I love you man.
I urge you to keep up what you are doing. I promise you that you are on precisely the right path!

Your friend and personal physician,
Doc

End Post

Mitchell R. Weisberg, MD, MP

Founder-CEO

Internist-Psychopharmacologist-Personal Physician and,

Corporate Wellness Consultant at:

Optimal Performance MD

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