OTC: Specialists in Obesity

Good Night, Good Health

From: John Hernried, M.D.

It wasn’t even 7 o’clock on a Saturday morning when I was jolted awake by my two boys after a miserly 3 hours of sleep.  My “to-do” list was a mile long and I resolved to complete it before I “allowed” myself to go to bed.

The result? A fog as I returned to consciousness and also a sense of discomfort as I realized there was no way I was going to stretch my slumber.  Afterall, I had to have both my children ready to play soccer by 7:45 and my wife was out of town.

I recall the feeling of coldness—not relieved by my morning coffee/Hot Chocolate supplement and a very hot shower.  I als o recall a sense of irritabability that followed me through the whole day.  My focus was on “getting through” to the end so that I could get to bed.  I even warned my children that “dad was cranky” as I was hauling two children between two different soccer fields and  three games.

I also remember lunchtime.  I was very mindful of seeking food that was quick, easy, high carb, and high fat.  "In and Out Burger" actually called to me (even though I don’t like "In and Out").  Instead, I chose a Vietnamese sandwich and recall how temporarily satisfying it was for me as I bit into the soft French bread.   The satisfying sensation was temporary and was soon taken over by a strong desire to frequent Starbucks for a latte.  Since there is a Starbucks on every corner in my small town, resistance was futile.  While a non-fat latte provided much needed caffeine and 160 calories, the dancing pastries in the display case were inviting me to consume them.  I don’t want that puny little apple in the display case, I want that 450 calorie scone, damnit!

I had just been reading up about the effect of sleep on weight management.   I was mindful of the processes in the body that occur as a result of a lack of sleep.  I could almost feel the squeezing of my adrenal glands as they pumped out adrenaline and cortisol to keep my body going.  I sensed my stomach was releasing massive doses of Ghrelin that drove me to consume high caloric foods. My leptin level was in retreat.  My blood sugar levels must have looked like a roller-coaster at Six Flags as I ate high carb foods, only to seek more as my blood sugar dropped in a scary trajectory.

Later,  my wife returned home and sensed my dreariness. She kindly took over as I sought the bed at 8 PM.  The next morning was a return to normal for me: my morning New Direction Hot Cocoa/Coffee, working out, and the minimal sounds of high calorie foods that called out to me in a manageable way.

My experience is one that many Americans experience, some many times per week. Americans are sleeping less, and I suspect based on the scientific evidence and my personal experience, that this is contributing to the obesity epidemic.

Sleep Well!

IT’S ALL IN A NAME

From: Maureen Allen, M.P.H.

   

My husband’s grandfather Edgar Allen was a brilliant medical doctor and an award winning research scientist. In 1960 he won the Lasker Award www.laskerfoundation.org for his work on anticoagulant (coumadin) therapy in  humans. Although he died more than 40 years ago, another discovery, the Allen Test, is still used by doctors to detect blocked blood vessels.

   

When the Lasker was recently awarded I got curious about this relative I never had the pleasure to know. Was I in for a surprise.

One of his lesser known discoveries is the Allen-Hines Syndrome. According to www.whonamedit.com, it is “A syndrome of accumulation of fat and fluid causing bilateral enlargement of buttocks and legs. Usually the fat accumulation is limited to legs and the rest of the body appears normal. Symptoms and signs increase in warm weather. The condition is almost exclusively seen in women and causes emotional and physical distress because of the appearance.

Imagine that. There’s a medical term for that distressful condition most women experience at the start of swimsuit season.

I’m not a medical doctor, but from now on instead of saying, “Honey, does this make me look fat?”  I recommend women say, “Honey, does this make me look like I have the Allen-Hines Syndrome?” It just sounds better.

The Doughnut Test

From: John Hernried, M.D.

        

I was perusing a medical practice journal when a particular story caught my eye.  It was about an internist around my age who found herself overweight one day without even being aware of it.  She had been busy in her life and she consumed calories in a way most doctors do—quickly eating high fat lunches and rewarding herself with ice cream when the long day was done.  The doctor became aware of her weight issue after a particularly sadistic colleague did not offer her a doughnut.

This is a story that hits home.  With a family history of heart disease and high cholesterol, I found myself at increased risk—sedentary, rapidly gaining weight, and fearful that I would not be available for my family.  Three years later, I am 30 pounds lighter and am in better physical shape by exercising 200 minutes per week.  I have maintained this weight loss over the last 2 ½ years—but not without ups and downs. For those of you who are curious, yes, I did use my own program’s diet.  I think it is important to practice what I preach.

The same should be the case for the rest of the medical community.  I see my colleagues who are overweight or obese inhale three pieces of pizza at a lunch mee ting. “Eat Whenever You Can” was the motto we all learned in medical school.  I worry about my fellow physicians and am sure they feel uncomfortable as they are expected to counsel their patients about lifestyle changes.   I have treated several physicians at OTC, and I feel good about helping them with their challenge.  I know if I can help the healers, they will be better able to help others.  They will also be more sensitive to the struggles of their patients.

For the particular doctor in the story, she worked hard to change her lifestyle, and relates how far she has come:

“Recently the partner who’d brought in the doughnuts complimented me on how great I looked.  I teasingly asked if I could have a doughnut now and he gave me a smiling “Yes.” If he brought some in, I’d probably not indulge, but it’s nice to know that I’d pass the doughnut test!”

Passing the doughnut test means that you are empowered to control your environment and the firm knowledge that you choose to live in good health!  Are you ready to pass the doughnut test?

The Wrong Question

From: Maureen Allen, M.P.H.

      

Getting and staying motivated to exercise is a full-time job www.ivillage.co.uk. Just this morning as I was half walking, half jogging (wogging?) around the park I was thinking about a dozen other things I’d rather be doing while my little one was at preschool.

I have a hunch that people who don’t exercise think the rest of us joyfully spring from our beds to prod our muscles into submission. We don’t. Even if you exercise regularly, it doesn’t mean you always love it.

Mostly exercise is like going to work. You do it now to get paid later. In our instant gratification universe we want to get in shape yesterday, with little or no work on our part.

What makes it a bit easier is asking ourselves the right question. If you ask, “Do I want to leave my cocoon, change my clothes, waste an hour, get all sweaty, have to shower, neglect other things and be uncomfortable, or would I rather hit the snooze button?” Hmm, that’s a toughie.

The appropriate question is; do I want to feel better, look better, be less flabby and healthier? The answer is invariably yes. 

Pinch an Inch Revisited

From: John Hernried, M.D.

A recent article in The Lancet brings back the importance of looking at more than just BMI (Body Mass Index).  The BMI is a mathematical calculation that looks at weight adjusted to height. If you want to calculate your BMI, just click here.  If you have a BMI over 30, you are classified as “obese.” The BMI is a vast improvement over Ideal Body Weight, created many moons ago by mathematicians at the Metropolitan Life Insurance Company.

But BMI is a rough estimate.  Many muscular people have a BMI over 30 but are truly not obese and not at increased risk for complications such as obesity.

We now know that the fat inside the abdominal cavity or visceral fat, is responsible for most associated diseases such as diabetes.    By measuring our waist circumference, we can get a good idea how much of this fat surrounds our organs.  The article in the Lancet used an older technique of measuring the waist and the hips and coming up with a ratio.

Recently, physicians have come to use the waist circumference because we believe that the single measurement of the waist circumference is just as good as the more complicated ratio.   It is an important part of our measurements at OTC and it is great to watch those inches melt away.

What is the correct technique to measure waist circumference?  First, place a tape measure around your bare abdomen just above your hip bone. Be sure that the tape is snug, but does not compress your skin, and is parallel to the floor.  Relax, exhale, and measure your waist.  Men should never use their belt or waist sizes since most men tend to wear them low and miss most of the fat in the measurement.  Increased risk for complications occurs when men have a waist circumference over 40 inches and women have a waist circumference of 35 inches.

What about the old Special K “pinch an inch?”  Turns out this is great for selling cereal (I remember this line after 20 years), but not great for telling you if you are at risk.  Besides pinching mostly skin, the fat underneath the skin does not increase your risks of medical complications.  This is why liposuction has not worked to improve obesity complications.

So…instead of pinching your skin or staring at your closet to determine what fits, why not take a simple tape measure and check your number.  It’s a great start in making your plan to improve your health.

On The Radio

From: Maureen Allen, M.P.H.

   

I was sick earlier this week and spent a lot of time in bed listening to the radio. I couldn’t focus on a book and will always choose the radio over television. In the middle of the night I heard a public service announcement that sounded intriguing. But I was too groggy and there was too much Theraflu coursing through my veins to jump up and scribble it on a Kleenex.

The next morning I knew I’d heard something good but the only thing I remembered was that it was a wellness program promoted by a coalition of the American Heart Association, the American Diabetes Association and the American Cancer Society. That much I knew. 

I called the radio station with no luck. But when I called the American Heart Association I found it. It was so obvious considering that the choices we make everyday count. It’s called www.everydaychoices.org.  It links you up to resources and programs within the three organizations. One I linked up with was www.choosetomove.org. It helps you track your exercise and has an on-line handbook for your use. The free, interactive programs it offers make it easier to make healthy steps to a better life. It’s well worth the visit.

What is Failure?

From: John Hernried, M.D.

"Doctor Hernried, please don't tell my primary care physician that I failed!"

I was stunned. 

Sitting before me was a woman who had lost 100 pounds and walked into my office. Prior to starting her weight loss journey with us, she was in a wheelchair and was told she needed to lose 150 pounds to get pain relieving surgery.  This amazing woman had also survived end-stage cancer five years ago.  Yet, this chapter in her journey was coming to a close and my job was to tell her it was time to move to the next chapter.

Why did she think of herself as a failure?  She mentioned several reasons:  She didn't quite meet her goal weight, she was not going to get pain-reducing surgery, she still required narcotics, she is still unable to work.  Yet, her primary fear was that she failed in the eyes of her doctor.  She related that surviving cancer was an exercise in proving to her doctors that she was strong and with her weight loss she came up short.

Whether one loses 5 pounds or 500 pounds, one always needs to listen to thoughts of failure.  It is these thoughts that will drive one to a series of relapses and then a collapse and weight regain.  Instead, realize you will have these thoughts, note them, and turn them completely around.

From a scientific point of view, the negative thoughts are likely driving metabolic processes that will actually trigger weight regain. This complicated diagram shows the connections between the thinking part of the brain (the cortex),  the hypothalamus (the weigh station of the brain) and a connection to our intestinal tract.  Why would you want to hold onto thoughts that cause you to gain weight?

The human brain has 60,000 independent thoughts every day.  Some of these are bound to be negative thoughts.  How Good are You at Converting Thoughts of Failure to Thoughts of Success?  Could you come up with suggestions for my patient?

Soccer Season

From Maureen Allen, M.P.H.

I’ll be sorry to see soccer season end. There’s nothing like spending a crisp fall morning watching healthy kids run up and down a field chasing a ball. And now that they’re older they actually aim for the right goal.

 

What I won’t miss are the sugar-laden snacks that parents bring after the game.  Don’t get me wrong. These are great parents who love their kids. Half-time, re-fueling snacks are usually pretty good. It’s after the game. Donuts, chocolate, soda – empty calories all.

When it was my snack turn, I just couldn’t hand out candy bars and blue drinks.  That may be what they want, but not what they need.  On my Saturday I brought grapes for half-time and Nutrigrain bars for after the game.

It wasn’t a complete success. Some of the boys actually refused the snack with smug, “Eww, too healthy.”  My own son said, “It’s so boring living with a nutritionist.”

 

I am not a kid's nutrition expert and I'm probably not the most popular soccer mom either.  But I know that these kids get lots of snacks and treats.  I want to be kind to my children, but I want them to live long and healthy lives.

 

A child who weighs 75 pounds will burn about 150 calories playing a soccer game. With a "juice" box, a package of cookies and a bag of chips, the child will consume about 500 calories.  If you would like to offer your child healthier alternatives, http://www.westfieldyouthsoccer.com/id39.html offers some good options.

Curiosity

Why would I start a weight loss blog without a topic on weight loss?

The answer is curiosity...which is vital in rediscovering your future.  It certainly is for me and it must be for anyone who is looking to lose weight and keep it off.  Being curious allows you to find answers and move towards goals in a safe and effective manner.  This is opposed to just believing what you read, then feeling lost after it fails to work; or worse, after it has harmed you.

A recent study in the Journal of the American Medical Association (Contradicted and Initially Stronger Effects in Highly Cited Clinical Research) points to the importance of being curious.  It showed that half of the important medical proclamations in prestigious medical journals ended up untrue or untested.  When a major finding is reported in a journal, it is usually accompanied by extensive media coverage.  It is after being published in the newspapers (often the newspapers had the information before the journal is released to physicians), that I receive dozens of phone calls from frightened patients.

 

In particular, I recall when an article was published about the dangers of one commonly used hypertension medicine called nifedipene.  In the following weeks, I saw several patients who had stopped the medicine based on the newspaper reports.  They came in with medically severe hypertension and one presented with stroke symptoms as a result of his sudden rise in high blood pressure.  As it turns out, it was a tiny study presented at a conference and used a different formulation of nifedipene than what doctors commonly prescribed.  Follow-up studies failed to show the danger and nifedipene is commonly used today.  I wonder how many strokes, heart attacks, kidney failure, ruptured aneurysms resulted in patients suddenly discontinuing nifedipene?

We live in a confusing age of consumerism.  As it applies to medical knowledge it is especially confusing.  The media presents any medical study and it comes across as fact.  As a physician, it is my responsibility to sift through the information and decide whether I should change the way I help my patients.  Often, physicians are criticized for being too slow to incorporate new medical information.  It is important for physicians to be up to date.  However, we also know that there is a yellow caution light flashing in our mind when brand new information is published.

When should your caution light flash?

1.   A study appears too good to be true

2.   A single study overturns all previous advice in one fell swoop

3.   The information is based upon a collection of user opinions and not a randomized trial

4.   Pretty much any infomercial or large advertisement in popular magazines

5.   When someone presents it to you as “scientifically proven”