Trying to lose weight?

  • Published
  • By Capt. Ryan Barenchi, MD
  • 47th Medical Group
LAUGHLIN AIR FORCE BASE, Texas --  Remember the goal of your weight loss should be both to lose weight and maintain that weight loss over time. You should start with a reasonable goal which should be to lose 10% of your current body weight at a rate of one to two pounds per week and then when you've accomplished that you can move on to larger weight loss goals. 

Let's talk about dieting first. The only way to effectively do this is to count calories. You want to cut out 500 to 1000 calories per day to lose 1 to 2 lbs per week. Using a low-fat diet or a low-carbohydrate diet alone without cutting calories will not work. Fad diets that boast of quick weight loss will usually work over the short term, but the diet regimens are hard to maintain and once people stop the plan they gain their weight back. The best way to approach your diet plan is to aim for the reduction in calories described above by reducing both fat and carbohydrates in your diet. I find that most people aren't willing to count calories religiously so another good option is to go to your local grocery store and for one week buy low calorie microwavable meals like "Lean Cuisine" or "Smart Ones" to substitute for your usual meals. The purpose of this is to get a better grasp on what a true serving size is and what a 300- to 600-calorie meal looks like so you can eyeball it if you have to. If you don't feel like this is enough to satisfy your hunger then you can have small healthy snacks in between meals. 

If you're trying to lose weight without exercising then you're wasting your time. Exercise is crucial when it comes to weight loss and maintaining your weight loss. It also may decrease abdominal fat and increase your cardiovascular fitness. I would recommend starting your exercise routine with a mixture of cardiovascular activity (e.g. running, biking or swimming) and weight training. Aim for 30 to 45 minutes three to five days per week and increase to six or seven days a week over the course of a few months. Adding lean muscle mass will increase your basal metabolic rate and you'll burn more calories at rest. 

If you're faithful with calorie counting and exercising, but are having trouble losing weight you may be a candidate for medical therapy. Currently, there are two drugs approved by the FDA for long term use in weight loss; Meridia and Xenical. Meridia is an appetite suppressant and Xenical blocks fat absorption in the gut. The monthly cost for these medications is around $120 a month and $300 a month respectively and many insurance companies won't cover these so you can expect to pay out of pocket. Both come with side effects and both need at least monthly follow-up with your physician to continually assess their effectiveness. In order to start these medications you must have a BMI of 30 or greater without other obesity related conditions or 27 or greater with obesity related conditions. I do not recommend any over the counter medications for weight loss as they are not regulated and are poorly studied. 

Last, surgery is available to those who are severely obese (BMI of greater than 40 without any obesity related conditions or greater than 35 with obesity-related conditions) when conservative measures have failed. The surgeries available are gastric bypass and gastric banding. In a gastric bypass surgery the stomach is essentially turned into a small pouch and part of the small intestine is bypassed surgically to strictly limit the amount of food or liquid somebody can take in at one time and causing some limited malabsorption thereby limiting caloric intake. This is considered an irreversible procedure. Gastric banding is similar in that a small pouch is made out of the stomach, but in this case it is done with a banding device that can be removed in the future if need be. Both are usually done using laparoscopic surgery with a few small incisions along with special instruments and cameras to view the internal anatomy. Like any surgery there are risks, but for somebody who is a candidate for one of these procedures, the risk of ongoing obesity is generally greater than the risk of the operation. 

The road to your goal weight is going to be rough I assure you. It takes a commitment to change your lifestyle and lose that weight, but there are a lot of resources available to you. Set reasonable goals and take advantage of the internet, the HAWC on base and your physician, especially if you know you've been faithful with your lifestyle change and nothing is happening. So if you're already on your way stay with it and if you're thinking about getting started; do it! Get ready to look better and feel better than you have in a long time.