Exercise 
(graphic compliments of Ricki Farrell)
There are various comprehensive programs in the United States that are run by physicians and hospitals. I personally direct a program in the Los Angeles/Orange County suburb of Los Alamitos. Our program at my office (Michael D. Myers M.D. Inc.) is primarily directed at the patient who is 50 to 100+ lbs. overweight. For such patients, I generally utilize a protein sparing modified fast for rapid weight loss and integrate the other elements needed to lose weight and to help maintain a healthier, lower weight.
The supplement that we use is a high-quality, nutritionally balanced protein supplement available in single portion servings that is taken in lieu of food. It provides all the minimum daily requirements of protein, vitamins and minerals while only providing 800 calories. After about 3 days, most patients develop a state of ketosis from fat metabolism that suppresses appetite without the need of medications. With our usual patient, weight loss will average 2 to 4 pounds each week while in the fasting phase of our program.
Because the obese individual often has significant (and silent) medical problems or may have undiagnosed and untreated depression or binge eating disorder, a comprehensive medical history and physical examination along with laboratory tests and an electrocardiogram are performed prior to beginning our program. Weekly examinations and evaluations are also an important part of the (modified) fasting phase of the program.
The key to positive weight loss at this time is behavior modification. We achieve this through weekly small-group sessions and individualized guidance provided by trained and licensed professionals. Behavior modification is not psychotherapy. Our behavioral programs have been developed by leading psychologists and physicians in the United States. Once an individual achieves his or her intended goal, a long-term maintenance program is instituted to help in long-term weight management.
There are excellent weight management programs in most major cities. If you are looking for assistance with weight management, please e-mail me at myersmd@weight.com and list the city/state/country in which you are located; I may be able to suggest a physician or program. If you are a professional and run a comprehensive program, please let us know (we do not charge individuals or clinics for referrals...our only interest is to assist individuals getting good, professional care).
The following brief list of cities and programs is included since I receive many requests for these locations. Although the methods of obesity management will differ among these programs, I recommend all unconditionally based on my personal knowledge of each of the program directors.
| New York City | Washington, DC | Los Angeles, CA |
| Louis J. Aronne, M.D. | Arthur Frank, M.D | Dave Heber, MD, PhD |
| New York Hospital | George Washington University | UCLA |
| Comprehensive
Weight Control Center (note: adult & pediatric obesity) |
Obesity Management Program | Center for Human Nutrition |
| Telephone: (212) 583-1000 | Telephone: (202) 223-3077 | Telephone: (310) 206-1987 |
Behavior modification deals with identifying behaviors that are associated with eating and working to change them. If eating results from stress, you have to work on learning stress reduction techniques. If it results from boredom, learning to structure your time constructively is a good approach.
Behavior modification is not psychotherapy. It is important to make this distinction. However, behavior modification should be an integral part of any comprehensive weight loss program and should be facilitated by trained and licensed professionals.
Sometimes, as people start to analyze their behaviors, they become aware of problems in their lives, not uncommonly involving their marital relationship. Problems such as this are not easy to deal with and require professional counseling. Even if a person is aware of his or her behaviors, it is unlikely that they will be able to modify them without professional guidance. This does not imply any type of weakness of character, but involves unhealthy coping mechanisms in today's stressful society.
Sometimes, a person may be doing well on a weight reduction program when people start to sabotage them. For example, a spouse may say, "Let's go out to dinner", although he or she may not have wanted to go out to dinner for the last 20 years. Perhaps suddenly people start bringing you boxes of candy. Many people have a vested interest in keeping you the way you are. It is human nature for people to become jealous whenever you do anything to better yourself.
Unfortunately, it is frequently the people closest to you who become the most jealous and do the most to sabotage your efforts. It is important to avoid getting angry at these individuals. Explain to them how you are trying to better yourself and help them understand what you are going through. This requires assertiveness. Remember, many of these people who are sabotaging you may have weight problems themselves. If you succeed, they may feel like failures, even though they should not.
Losing weight is an extremely difficult process and requires long-term changes with professional guidance to help you maintain long-term weight loss.
Exercise
(graphic compliments of Ricki Farrell)
In a study done of women who have lost weight (Kayman, et al. Maintenance and Relapse After Weight Loss in Women. Am. J. Clinical Nutrition. 1990; 52:800-807), 90% of the women who lost and maintained at least 20% of their body weight exercised at least three times per week for 1/2 hour while only about 1/3 of the women who regained their weight exercised that much. Exercising will not guarantee maintaining weight loss but it does help. Frequently, people who have maintained a substantial weight loss will first have problems with relapse (weight regain) when their exercise is reduced because of time constraints or illness.
Exercise can be divided into anaerobic and aerobic types. Anaerobic exercises use large groups of muscles very strenuously for short periods of time. Weight lifting is an example of anaerobic exercise. Anaerobic exercise does not burn a lot of calories, however, it results in increased muscle mass. Increasing muscle mass increases resting metabolic rate, or the number of calories you use while in a resting state.
The resting metabolic rate is an important component of the total number of calories required per day to maintain body weight. If your resting metabolic rate increases, you can consume more calories and continue to maintain your weight. If you consume the same number calories and start doing anaerobic exercise, your proportion of fat will decrease.
However, for most individuals, the preferred type of exercise is aerobic exercise. Aerobic exercise requires continuous movement, such as walking, running, or biking, and your respiratory rate and heart rate will increase. Aerobic exercise increases your calorie requirements (you burn calories during the exercise) and also leads to a mild buildup of muscle mass, which, in turn, increases your resting metabolic rate.
To be successful on a weight reduction program, you must exercise. For example, if a 180 lbs. man does 30 minutes of brisk walking per day, he will burn about an extra 200 calories per day. That may not sound like very much, especially when one pound of body fat is 3500 calories. However, over one year, the calories add up to over a 20-lbs. weight loss -- by doing something as simple as walking for 30 minutes a day.
Remember that anaerobic exercise involves activities that are start-and-stop and will result in increased muscle mass, whereas aerobic exercise involves a continuous exercise process.
As noted above, aerobic exercise will increase your heart rate. To determine a target heart rate, take 200, subtract your age, and multiply by 0.7. For example, a 30-year old would have a target heart rate of 200 - 30 = 170 X 0.7, or 119. Again, exercise results in weight loss if maintained consistently.
The optimal combination of anaerobic and aerobic exercise to both help reduce and maintain a lower body weight varies among individuals. The important thing is to do what is you are both comfortable with and what you will continue into the future.
Before beginning any exercise program, you should consult with your own physician since it is possible that you may have developed potentially dangerous yet silent medical conditions that may make exercising hazardous (e.g., angina or other heart problems). This is especially true for males over 35 years of age.
Last modified: December 2000.
Copyright © 1996 - 2000 by Michael D. Myers M.D. Inc. All rights reserved.
For comments, please click HERE.