The Weight Loss Problem: The State of The Art
Obesity is epidemic in the United States. It's medical consequences, and its emotional and financial costs are enormous. Multiple killer diseases such as diabetes, coronary artery disease, and cancer all occur more frequently in obese individuals. Without splitting hairs on the term “obese”, my intent is to focus on individuals who have 20 pounds or more to lose. Each extra pound has its associated adverse health, vitality, and cosmetic consequences.
The public has been bombarded with “diets” that don't work, stop working, or work and then the original weight or more is regained in the post “diet” period. At odds with their desire to be slimmer are the multi-billion dollar marketing budgets of the food and drink industries, their own hopelessness, improper food choices, and tyrannical hunger pangs. Pharmaceutical approaches with “diet pills” have also failed, and left many innocent victims of adverse effects such as heart valve problems, drug dependency, and depression. Although used for this purpose because of their effects on brain chemistry, anti depressant drugs do not and cannot work in the long run. In general they affect brain chemistry in a negative way after chronic use, and therefore are not well adapted for use in appetite control. Everyone knows the magazine ads that promise effortless weight loss with an endless stream of over-the-counter supplements. None of them do what they claim to do. Surgery, of course, doesn't even come close to solving the problem, although many still fall prey to it's quick fix mentality. With all the supposed cures and weight loss aids, America continues to get more and more obese. It's clear that the over weight problem must be approached from the perspective of it's being a medical, emotional, and even cultural problem, with a likely medical (and non surgical, non orthodox) and attitudinal solution. America is the land of excess, where even too much is not enough. That goes for food, discretionary spending, government spending, our use of natural resources, and expectations of employers and of government, among other things.
Fifty years ago there were not many people with significant problems with obesity. Let us just say it was relatively unusual when Dr Simeons was practicing in Rome in the 1950's, and he made the observation that some people just seemed to have the knack for gaining and being unable to lose weight. He postulated that there was an abnormality in the hypothalamus of the brain. He called it a problem of metabolism, but was not referring to what we know today to be the basal metabolic calorie expenditure of the human body. From that perspective, though many there are that claim to have the problem, in reality there are very few people who would test out as having a true “slow metabolism”. Instead, he was making the observation, vehemently contested by many so called “experts” in bariatrics today and at the time, that people handle calories differently, and obese people may gain or fail to lose whether they are eating to excess, eating average amounts of food, or on a diet. The common experience of lay people as well as primary care physicians, including my own, clearly refutes the notion that all calories are the same, and that weight loss or gain can be reduced to a mathematical formula that when calories in are greater than calories out, weight is gained, and vice versa. The other variables appear to relate to the type of food comprising the calories, the water retention associated with the ingestion of certain patient-specific foods, the body composition (proportion of fat, water and muscle) of the patient, and some other factor(s) accounting for why some people can't lose weight by counting calories and exercising. Simeons theorized that a bona fide “disorder” was present in such patients, and proceeded with an attempt to identify and treat it.
At this point some of you may recognize the story which has been recently popularized by journalist Kevin Trudeau in his latest book “The Weight Loss Cure”. Essentially he resurrected Dr Simeons research in this area and added his own multiple speculations about weight loss blockages from his previous “research” in natural medicine to Simeons own protocol using injections of HCG. Though marketing it as a “simple” solution to the problem of excess weight, he so complicated the protocol so as to make it almost literally impossible for anyone to follow it. Dr Simeons successfully treated thousands of obese patients over a period of 16 years. People came from all over the world for treatment at his office. His success fortified his conclusion that he had developed a coherent theory explaining why some people have trouble with their weight, and others don't. His protocol WAS simple and easy to follow. And it worked. After reading Trudeau's book, I recognized so much of it as pure fluff and speculation. After reading Simeons original manuscript, I became convinced that he had discovered something important, and that since he was a front line practitioner (like I am), I trusted his observations, and his theories were in fact supported because of the success of the therapy derived from them. Anyone seriously interested in the riddle of obesity should do as I did and read his original manuscript. It can be found on my web site at :
www.robertcfilice.com
I have now had the opportunity to test Simeons treatment in my own practice, and can confirm that it is a very safe and effective method of managing overweight patients. Later I will provide the reader with a table showing some representative results from my patient population from the HCG protocol. But first, I want to summarize what I have learned in the modern era, and with almost 30 years practicing exclusively natural medicine behind me, about how I manage patients with weight concerns. HCG does not stand alone. It is not right for everyone, so I offer alternatives, and have blended some treatments into unique protocols. Each patient deserves a careful evaluation based on a complete medical history, and a physical and laboratory examination. And each deserves a personalized treatment plan which is reasonably easy to follow, and highly likely to produce quick and consistent, as well as long lasting, results.
Managing weight concerns in the 21st century:
Goal #1: Identify the carbohydrate intolerant
I am firmly convinced that the obesity epidemic in this country has to a great extent shadowed the increase in consumption of nutritionally deficient and metabolically stressful simple (sugars) and complex (starches).carbohydrates over the last 100 years Before Dr Atkins began writing about the low carb diet in the 1970's, Dr Simeons had already been employing it in the dietary portion of his treatment protocols, both during the active weight loss phase as well as during the initial maintenance phase. The predilection for dietary carb calories to become a permanent part of many patients' anatomy in the form of body fat, as opposed to protein in an equivalent number of calories, is probably the clearest proof that a calorie is not a calorie. Some calories are more likely to be stored as fat, and some more likely to be burned.
Therefore it is critical that we identify those patients at highest risk for this and other deleterious effects from dietary carbohydrates, and use this information in arriving at a dietary prescription for life. Today, medical laboratory science allows us to do this with very good precision. The three hour glucose tolerance test, and the fasting and one hour post glucose insulin levels are excellent at diagnosing early, incipient, impending, and existing problems from dietary carbs. As a side benefit, identification of individuals with “metabolic syndrome”, (as this carbohydrate intolerance and elevated insulin levels is called clinically) is a fantastic opportunity to reduce future health problems and extend quality and quantity of life in these patients.
These individuals may well be able to tolerate some carbs, but the proportion of carbohydrates
in these patients must be lower than in more tolerant patients. Up to 25% of calories from carbs may be allowed as long as the carbohydrates are healthy ones. It is futile to prescribe any dietary regimen without knowing the patient's carbohydrate tolerance. No dietitian, diet center, or physician dietary prescription has any long term clinical usefulness unless this information is knowledgeably considered.
Goal #2: Identify patient motivation and emotional interference
It is surprising how many people may be willing to start something without having assessed their motivation and determination. Also, despite Dr Simeon's confidence that obesity is a medical disorder, emotional eating can sabotage even the best formulated treatment plan. If food is a reward, a comfort, a defense, a weapon, or a slow form of suicide, a new eating and weight loss plan is not going to get the job done in the long term. Before I changed my practice to natural medicine in 1980, I practiced and became Board Certified in psychiatry. My patients find me to be a good listener, and I am an astute observer and student of human motivation. I do not do psychotherapy, but if I meet someone with emotional baggage which I feel is severe enough to block success, this will be discussed until the patient understands what is involved, or else treatment will not be initiated. Individuals who are using food as a tranquilizer or antidepressant will be encouraged to receive more appropriate, and less self defeating treatments, many of which are in the realm of my practice as well.
Goal #3: Assess patient dietary habits
Essentially I want to know what the patient is eating, and when. I also want to know whether the patient is suffering from hunger at any time, and whether there are any fasting/gorging behaviors. Medical history and questionnaires supply me with this information.
Goal #4: Understand the patient's entire medical situation
Although weight loss protocols are typically not covered under most insurance plans, it is important that the patient's medical “problem list” be before us at all times. Usually, overweight patients already have a list of medical issues that often relate directly to the obesity. These may include elevated blood fats, fatty liver, high blood pressure, back, knee, foot or hip pain. Progress with weight control often solves a myriad of other difficulties for the patient.
Goal #5: Get the patient out of their “stuck” position
Nothing succeeds like success, the old saying goes. And it is true. Many weight patients have given up and lost hope. And when they try a new approach, they lack the confidence that it will succeed and soon give up. They need success NOW. I prescribe protocols that are easy to follow and result in significant weight loss from the very first week. Preparation for the weight loss phase is not difficult, time consuming, or expensive. I want the new patient to come back in two weeks smiling with the glow of hope and success. They must not feel that they are suffering, only that they are moving toward a worthwhile and exciting goal. Either a change in the composition of the diet, or a dramatic nutrient supported drop in total caloric intake is what is needed. There is no such thing as a supplement that causes fat to “melt” off of you.
Goal #6: Suppress the patient's hunger
Although it's not ALL about calories, in order to create a program that will bring the patient all the way to their goal weight, it IS usually necessary to put the patient in a state of caloric deficit. So the problem of hunger must be dealt with. Fortunately there are now several very safe medical interventions that can handle this challenge with relative ease. In my practice I use either Hoodia (an herb), D5 (a proprietary amino acid blend that works on brain neurotransmitters), or the HCG protocol of Dr Simeons from the 1950's.
It is unclear how Hoodia works, but it is definitely an aid to many patients in reducing total food consumption. Apparently it fools the brain into thinking that you are not hungry. It is not a stimulating type of herb, and therefore does not share the danger of previous herbal products containing ephedra. It is important to use an effective formulation, because there are many inferior products on the market.
D5 is a combination of amino acids which increase levels of seratonin and dopamine in the brain. We know that the appetite center can be suppressed through the use of pharmaceuticals which are known to work on neurotransmitter levels. But the drugs of the past and the present have multiple side effects and often cause uncomfortable overstimulation or anxiety. Longer to intermediate term use of uch drugs can cause serious damage or dysfunction to the nervous system. D5 is safe and effective plus it supports mood and energy while it suppresses appetite. Although some people can get too energetic on D5, this is easily managed by a dose reduction.
HCG is the hormone of pregnancy that was discovered to do amazing things for overweight patients by Dr Simeon's work in Rome Italy several decades ago. For whatever reasons his work was suppressed and overlooked. The FDA had a role in stopping its use in weight patients, and to date still state unequivocally that it is not for treatment of weight conditions. After having put together a trial program using HCG on 15 of my patients, I can tell you unequivocally that the FDA is wrong. HCG works to help people lose stubborn fat comfortably by means of a very low calorie diet. Please read the details of this very successful program at
www.robertcfilice.com/loseweightwithHCG.html .
Goal #7: Help the patient retrain the way they think and act regarding food
Whichever method is used to lose substantial weight, we all know the tendency for people to gain it back. In order to avoid this I believe you must offer patients superlative rather than mediocre results on their weight loss program, a long enough successful interval to allow the development of new attitudes, and attention to the factors which tend to sabatoge their long term success. Amino acids can be used safely and long term. The HCG protocol actually changes the set point in the hypothalamus of the brain, and the associated body detox innately re-educates the patient about what food is sensible to eat, and what is not. The rule of body wisdom is restored.. Wise food selection and planning further reduces cravings and hunger pangs.
This article is not complete. Please check back regularly for the rest of it!
