Sharon
asks:
I am a 54 year old woman who has been on the chubby side most of my life.
About 15 years ago I began treatment for an irregular heart beat. I currently
take 100mg Toprol xl once a day. At the same time I stopped smoking.
My weight jumped 30 pounds almost instantly. Since that time I have tried
almost every diet known to man. I have worked out with a trainer 3 -
5 times a week for a year at a time and always maintained a minimum of
three times a week exercise program. My eating habits are extremely healthy
and I never go off my regiman of 1200-1500 calories a day. I don't eat
sweets, have minimum carbs, don't binge and never eat a single thing
after dinner. I don't eat red meat, lamb, veal or pork. I don't have
real mayo, butter, cheese or oils. I have gained weight on weight watchers
and LA weightloss. I do drink a glass of wine with dinner. A typical
days menu might be:
- Breakfast: a bowl of cut-up
fresh fruit or a fiber cereal with
skim milk
- Lunch: a small chef salad,
no calorie dressing, or steamed shrimp
and vegetables from the Chinese Restaurant
with black bean sauce on the side.
(no rice, of course.
- Dinner: Usually a salad with
protein, or a bowl of soup and a glass
of wine. I may have a rice cake, popcorn,
or a piece of fruit between meals.
I drink 2-3 diet sodas a day.
I worked with a nutritionists for 6
months using prscribed shakes for two
meals a day and also gained weight. It
appears that my body is just incapable
of losing weight. I am 5ft 3in and weigh
around 178. I go up to 182 and down to
175. Despite all efforts, I have not
been below 175 in 15 years.
I am a PhD and work in a professional
capacity with children.
My inability to control my weight leaves me frustrated and miserable.
I feel like I repeatedly hit my head against the wall and fail over and
over again. My thyroid has been tested many times and always comes back
okay.
I have been told to get a book on body
image and learn acceptance. I won't accept
that as an answer. Can you help?
|
Dr.
Wadden responds:
I can really hear how frustrated you are with your weight. You deserve
high marks for trying. Weight can be so frustrating. A couple of things
may be helpful. You could ask your doctor about having your resting metabolic
rate measured. This test would confirm that you have low calorie needs
as you expect. Second, you may want to try a weight loss medication.
Meridia would probably be your best bet. It produces about a 10% loss
of initial weight. Your doctor could prescribe another medication, TOPOMAX,
off label. It is not approved for weight loss but is being used by some
physicians with good results. Unfortunately, weight loss medications
are not covered by most prescriptions plans. In addition, I highly recommend
consulting with your physician to find out which weight loss program
is right for you.
|
AZ asks:
Does the University of Pennsylvania Health System have any weight loss
programs for persons more than 100 pounds overweight?
|
Dr.
Wadden responds:
The most effective intervention to lose 100 lbs is gastric bypass surgery.
This operation is appropriate for persons who have tried to reduce using
more traditional approaches, such as diet and exercise, but have not
been able to lose weight. Alternatively, they may not be able to maintain
their weight loss. Penn has a very active surgery program that is led
by Dr. Noel Williams. If you would like to make an appointment, please
call 1-800-789-PENN or use the online appointment
request form.
|
Dino asks:
Getting started with a weight-loss/diabetes control program is not a
problem. Staying with a program is what I have the most difficulty
with. I do so well for a short time and think that I can cheat "just
a little" and then I go back to my old ways. I can keep my blood
sugar under control with medication and my weight keeps flip flopping.
How can I stay motivated?
|
Dr.
Wadden responds:
You're not alone with the problem of staying motivated. A few things
may help:
- Consider going to Weight Watchers
(or a program like it). This program
helps you to be accountable to yourself
with the weekly weigh-in.
- Weigh yourself every day, to ensure
that you are weight stable.
- Consider partnering with a family
member or friend.
Pick a day to review your weight and
efforts to control it. Social support
can go a long way, whether it's a formal
or informal program. Good luck,
|
Sue asks:
I have Graves Disease and my thyroid was ablated with RAI in April 2001.
It took me 2 years before I found the correct thyroid hormone replacement
dosage so my TSH was within the normal range. My TSH has been in
the normal range for about 4 months and I still find it almost impossible
to lose weight. Most of my family members are overweight. Could my
problem with losing weight be genetics since my TSH is okay, I'm
exercising and eating moderately? I am 5"7' and weigh 205 and
I struggle to stay at 205. I also have many other immune disorders.
Do any immune disorders effect weight control? Any suggestions?
|
Dr.
Wadden responds:
It sounds like you've had a frustrating time with your thyroid and weight.
If you have a family history of being overweight, that could contribute
to your difficulty reaching a lower weight. I suggest, however, that
you try a week on a portion-controlled diet in which you eat precisely
1100-1300 calories a day. You can do this by consuming liquid shakes,
such as SlimFast, and eating frozen food entrees. If you stick to such
a diet, you should lose at least 1 lb. That will help you know whether
your difficulty is metabolic or may be related to trouble counting calories.
It's hard to judge portion sizes and to know the calories in foods consumed.
So, give the portion-controlled diet a try.
|
CuteyPie
asks:
I was on a low carbohydrate, high fat diet for about one year and lost
about 50 pounds. After going back on it, I cannot lose one pound. Is
there some type of medical reason as to why I cannot lose any weight
after going back on this diet?
|
Dr.
Wadden responds:
Congratulations on losing 50 lbs. That's great. Have you kept it off?
If so, you will have difficulty losing more, simply because the body
fights the loss of more than 10% to 15% of initial weight. There are
a whole set of biological mechanisms that keep weight at a stable level,
just as blood pressure or heart rate remain constant. You can lose 10%
to15% of starting weight but any greater loss triggers responses designed
to prevent further weight loss. If you have regained weight since losing
the 50 lbs, it may be hard to lose again on the same diet "because
the thrill is gone." People often have trouble losing weight the
second time on a diet. I would try a new one - perhaps "South Beach." It
will give you some novelty.
|
Patlar
asks:
How does obesity relate to fragmented sleep? What surgery is appropriate
for a 17 year old?
|
Dr.
Wadden responds:
Obesity may be associated with sleep apnea (interrupted breathing while
sleeping). Persons with sleep apnea usually snore loudly. A spouse will
also know that the individual stops breathing and then gasps for breath.
If sleep apnea is supected, the individual should be referred for a sleep
test.
In terms of surgery for a 17 year old,
surgical treatment is not recommended
for children and adolescents. A few doctors
have reported favorable results in such
persons but only a few dozen operations
have been performed.
|
Sharon
asks:
Will a bypass help to control obesity?
|
Dr.
Wadden responds:
Gastric bypass is a very effective procedure for persons who have 100
lbs to lose (or more) and have not been successful with more traditional
diet and exercise approaches. If you wish to pursue it, make sure you
go to a surgeon who performs a large number of operations each year.
You can expect to lose 25% to 30% of your starting weight.
|
Kim asks:
My 65 year old wife, after an extensive physical exam including a heart
catherization (negative results) and sleep studies under went Roux-en
Y gastric bypass. This was done in late March and she has lost 70
lbs. She has taken up exercise and is doing physical things that
she would not have done before such as walking upstairs rather than
taking an elevator. What complications might we expect as she gets
older and what should we do to avoid these problems? For example,
she takes calcium supliments to avoid osteoperosis. What other prophylactic
things should she do?
|
Response:
Dr. Williams and our program are very pleased to hear she is doing well.
Our nutritionist, Rachel Griehs has written the following response
to your question:
At this point, there has been no research
to indicate what the long term problems,
if any, might occur after the surgery.
Because of a smaller intake and some
malabsorption of some vitamins and minerals,
we would expect deficiencies without
supplementation.
Most of the supplements should be taken
for life. A daily multivitamin is required.
Calcium citrate supplementation is needed
to help prevent osteoporosis--it specifically
should be the "citrate" form
of calcium, as this is the easiest to
absorb following gastric bypass. We generally
recommend approximately 1500mg daily.
Vitamin B12 monthly injections or sublingual
(under the tongue) tablets should be
supplemented as well due to poor absorption
in the gastrointestinal tract following
surgery (there is no intrinsic factor,
an enzyme made in the stomach to help
with absorption). Bloodwork should be
done annually or semi-annually to help
determine if any other supplements will
be needed
|
Kim asks:
I have had abdominal pain for 3 weeks now. Last friday I had a ct scan
and have placed several calls into my doctor as to what's going on?
No response. The pain has now gone in to my back and ovaries. Are
you able to steer me in the right direction as to what I should be
insisting on from my doctor?
|
Response:
Without an in person examination, we are unable to make a recommendation
for you. We suggest you continue to try to contact your doctor for
more information.
|
