Frequently Asked Questions
Every time I go on a low calorie diet and exercise, I never seem to lose any weight. Is it because I have a very efficient metabolism?
This is a very common problem that was addressed in a 1992 scientific study (Lichtman, et. al. Discrepancy Between Self-Reported and Actual Calorie Intake and Exercise in Obese Subjects. NEJM 327:1893-98 [December 31], 1992). In this study, sophisticated techniques to measure actual calorie intake and exercise were utilized to compare to the reported calorie intake and exercise in individuals who reported diet resistant obesity. To quote the conclusion..."the failure of some obese subjects to lose weight while eating a diet they report as low in calories is due to an energy intake substantially higher than reported and an overestimation of physical activity, not to an abnormality in thermogenesis (calorie burning)." The dietary resistance that these individuals reported was related to a misperception in calorie intake, exercise expenditure, or both. There was no conscious deception on the part of the subjects.
Does this mean obese individuals do not have a more efficient metabolism?
Absolutely NOT. Obesity is a metabolic disorder, just like diabetes or elevated cholesterol . Very small differences in metabolic rate can, over a period of years, become manifest as a major difference in weight. What the above study says is that obese individuals are like the rest of humanity -- not always aware of what they are doing (like driving down the freeway and realizing you missed your off ramp).
Will liposuction assist with weight reduction?
Liposuction is primarily a cosmetic procedure where localized areas of fat are removed through a suction cannula. The amount of fat removed is generally in the 5-7 lb. range. It is NOT considered a treatment for obesity. Incidentally, when fat is removed surgically, there is a tendency for the body to attempt to replace the "missing" fat tissue. It appears to involved various hormones produced by fat tissue.
Are the new variations of Dr. Atkins' Weight Reduction Diet helpful with weight reduction?
These diets are generally considered low carbohydrate and high protein but usually are high fat. The premise is that by avoiding carbohydrates, you will decrease your appetite. By avoiding some of the food groups (like vegetables), one can develop deficiencies of vitamins, especially Vitamin A, the B group, C, and occasionally K. Additionally, since the diet is generally high in fat, serum lipids (cholesterol and triglycerides) tend to be higher. In my opinion, a balanced calorie-deficit diet is safer and more likely to assist for a longer period of time.What is a "protein-sparing modified fast?"
The body is composed of protein, carbohydrates, and fat tissue. In the treatment of obesity, one would like to (ideally) lose only the fat tissue and not lose any lean body mass (protein tissues such as muscle or internal organs such as the heart). Whenever an individual loses weight with any diet, there is always some loss of lean body mass. The loss of lean body mass is generally more pronounced with more severe caloric restriction. In a protein-sparing modified fast, calorie intake is generally less than 900 (kcal)/day. However, loss of lean body mass is minimized by the maintaining an intake of 70 to 90 grams/day of high quality protein. These diets are also known as Low Calorie Diets (LCDs) if they contain at least 800 kcal/day or Very Low Calorie Diets (VLCDs) if they contain less than 800 kcal/day. These diets are frequently liquid diets (given the requirements of low calorie and high protein content) and should be medically supervised in all individuals. Examples of commercially available LCDs and VLCDs include Optifast, Medifast, and HMR.
Why should I spend the time, effort, and expense of being in a weight reduction program with behavior modification and dietary instruction when all I really want (need) are pills to lose weight?
In virtually every study, appetite suppressant medications were used as a adjunct to behavior modification and dietary instruction. ALL of the current anorexic medications lose effectiveness with time and thus your weight will gradually increase even though you are taking the medication(s). Behavior modification will help to identify and change behaviors that may have become associated with eating while the dietary instruction helps in understanding the nutritional composition of food (unlike men, not all calories are created equal!). Each component will help in losing and maintaining weight loss but (especially) medications do not work well in the long-term without the other components.My husband (wife, father, mother, etc.) wants me to lose weight but I just can't seem to do it. What can you recommend?
The only person who can decide to eat or not to eat is you. If you try to lose weight for somebody else, chances are you will have temporary success but it won't work long-term. This type of situation can lead to eating disorders. Don't diet for somebody else...do it only for you.
I have heard of grapefruit juice and cabbage soup diets. My friends have done this and have lost weight. How safe and effective are these?
Anytime you consume fewer calories than you expend, you will lose weight. A diet that causes weight reduction does not necessarily mean that it is a healthy diet. Going on a grapefruit juice diet or a cabbage soup diet will definitely (over time) lead to what is referred to as protein calorie malnutrition. This means your protein intake is inadequate for your usual body needs. This will lead to breakdown of protein tissue, such as muscle tissue and internal organs, including your heart. Obviously, one would prefer to not lose weight by "losing" heart muscle but this can happen by going on such a diet. Additionally, you will not be getting the vitamins and minerals that you need for normal daily activities. You will, however, have a large and rapid weight loss since you will be losing a lot of water (initially). Cabbage soup or grapefruit juice diets can cause permanent damage to your body. The long term effectiveness of these diets is essentially zero.My child is overweight. What treatment options are available?
Childhood obesity is occurring with increasing frequency and it is a major health concern. Individuals may have genetic predisposition's to it with obesity being more common in children when one parent is obese and much more common when both parents are obese. Additionally, activity levels of children are generally lower now than in earlier generations. This, combined with the ready availability of palatable, high fat foods, is leading to the increase in childhood obesity. At this time, the treatment of childhood obesity primarily involves attempts at increasing exercise, decreasing the fat content of the diet, and working on behavioral changes. Medications may play a role in the future.Why is it recommended to limit fat intake when attempting to lose weight?
Fat is higher in calories than carbohydrates or protein. Protein and carbohydrates have approximately 4 calories per gram vs. 9 calories per gram of fat. There is evidence that ingestion of fat has less of an effect on satiation (the internal state that leads to termination of eating activity) than do carbohydrates or proteins. Additionally, there is experimental evidence that obese individuals tend to oxidize (metabolize) fat less effectively than lean individuals, which may predispose to fat being stored rather than used as an energy source. Thus it is best to limit fat intake in order to lose and maintain a lower body weight.What methods do you recommend for weight reduction?
With any weight reduction program, screening and treatment of underlying eating disorders (especially binge eating disorder) are imperative. In general, my recommendations are as follows.BMI under 30: Dietary instruction with behavior modification and exercise. Addition of medications may be helpful for appropriate individuals.
BMI over 30 (or over 27 with medical complications): Medically supervised Protein Sparing Modified fasting program combining behavior modification, dietary instruction, and exercise. Alternatively, dietary instruction with a registered dietician with medications (orlistat or sibutramine) used (as appropriate) as an adjunct to treatment.
BMI over 35 (with significant medical complications) or over 40 without medical complications: Consideration of surgical intervention only if have been evaluated and treated by appropriate obesity experts.
Last modified: August 2001.
Copyright © 1996 -2001
Michael D. Myers M.D. Inc.
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The above information is for general purposes only and should not be construed as definitive or binding medical advice. Because each person is medically different, individuals should consult their own personal physicians for specific information and/or treatment recommendations.