I Can't Afford to Lose Weight Right Now

I was talking with Gloria, the manager of the Gottlieb Health and Fitness Center. GHFC partners with Chicago Weight Control in the near western Chicago suburbs. For the last two years we have had a highly successful comprehensive weight loss program. She was concerned about an alarming, if understandable, trend. Perhaps due to our current uncertain economic climate, people think that they cannot afford the program

Our program is called comprehensive because we attack the weight loss issue on every front. For three months people get:

• Appointments with physicians certified in weight loss medicine (bariatric medicine)
• They have their metabolism tested (indirect calorimetry)
• Two sets of blood chemistry
• A health club membership with 12 personal training sessions
• A meeting with a registered dietitian seven times
• Three group counseling sessions led by a professional psychologist.
  

The program does cost $2500, which initially seems like a lot of money. Insurances don’t cover it, although some of our patients have been able to get up to $600 back from their insurance companies.

I realize that $2500 sounds terribly expensive. However, let’s look at that a bit.

First off, what is the value of the services. The physician component, including the indirect calorimetry and the two sets of blood work, is worth about $1100. The 7 meetings with the dietitian are worth $600. The personal training is worth around $900. The health club membership is about another $500, and the three sessions with the psychologist are worth $300. That is roughly $3500 for $2500; it just isn’t possible for us to discount the service to any additional degree.

Secondly many of the patients are taking multiple medications. When they lose weight and no longer require these medicines, they are saving a fortune. Many patients can be on three medicines for diabetes, three for their blood pressure, one or more cholesterol medications, arthritis medications, etc. Even patients with insurance have costs for these medications. One of our patients who has lost more than 200 pounds states that in the past twelve months his savings on his insurance co-pays have already paid for the cost of the program.

The unfortunate truth is that being unhealthy is expensive. Not only are there medication expenses, but there are physician visits, medical equipment (wheelchairs, insulin pumps, walkers...the list goes on and on) that people have to pay for. Insurances are covering less and less of this, and as the economy falters, they will shift more of those costs to the patients.

From a financial planning perspective, one of the best investments that you can make is to protect your health. I would argue that money invested in our program will probably save you several times your initial investment. I would also argue that given the unreliability of every other investment vehicle out there, that if you need our program, investing in it is a lot more reliable investment than most other options.

All of the above is looking at this strictly from a financial planning standpoint. Finances alone are not the whole story. Can we put a price on being healthy enough to keep up with our grandchildren? Or being able to have children in the first place? How about living long enough to see our children raise their own children? At the risk of sounding like a Master Card commercial, there isn’t any price too high to pay for all of that.

I know that in times of great uncertainty, our program looks too steep. Honestly, I don’t think people can not afford our program. It is the best investment for both your health and finances that you could make.

The Number on the Scale Doesn't Mean What You Think it Does

Jill here. Just something I'd like to relate to those who read this.

We had a patient in recently (we'll call him Maverick to protect his identity) who was in for a check up. Maverick was looking much better in recent months than when I'd first met him. He was slimmer and definitely more buff. When he stepped onto the scale, he had gained almost five pounds in three weeks. When my dad saw that, his face was disappointed. I pointed out what I had noticed (Maverick was already in the room and my dad hadn't seen him) and that caused Dad to check his fat percentage. It was down by almost 10%.

Muscle is denser than fat and will weigh more. I have to tell patients this all the time when I weigh them. They'll have worked out, lifting weights, toning muscle, jogging, biking, whatever, and then gain weight. They get upset over this, but it turns out that their fat percentage is always down and they look much better than they had previously. But the number the scale shows always disappoints them. The number isn't always that important--what's important is that they're taking care of themselves and not turning their muscle and organs into fat.

Not everyone believes me though. They just want to weigh less. It's not about being healthy to some, it's about being thin. Baaaaaaaaaaaaaaaaaaaad idea. First goal should always be about being healthy. 10 overweight is better than underweight. If you get sick, this helps protect you. There's a little more cushion to break falls, run into corners, get hit by flying objects, etc. so nothing actually gets broken. And if it's all muscle, then that's even better. Except you might bruise more.

Anyway, that's all I have to say for now. Take care. Oh yeah, read my own blog. It's linked off to the left there. ^_^

Do I Really Have To Excercise?

The new patient (let’s call her Nancy) was not in any way unusual. She was fifty years-old and a life-long dieter. Five feet three inches tall, 189 pounds. Her body mass index (BMI), which is a persons' height divided by the square of their weight, was 32.

Normal BMIs are between 20 and 25. Between 25 and 30 is considered medically overweight, and obesity is defined as starting at a BMI of 30. 35 is the second stage of obesity. Morbid obesity (or as it is now politically correct to say, “extreme obesity”) begins with a BMI of 40. This last segment is the most rapidly growing segment of the
obesity epidemic.

Keep in mind that two thirds of the adults in this country are now either overweight or obese. I’ve come to think of a BMI of 32, while unhealthy, as garden variety obesity.

There was one thing about Nancy, however, that immediately jumped out, and that was her percentage of body fat. Our scale has a device called impedance plethmography, which means that it measures body fat percentage. A normal body fat percentage for a woman is less than 25% fat. Nancy was 52%. We routinely see patients with that degree of body fat, but usually they have BMIs that are much higher like over 40. I’m used to seeing a body fat in the 35 to 40% range for a BMI like Nancy.

I reviewed the nutritional history that we ask patients to fill out. It showed that she had lost and regained weight more times than she could count.

I asked her if she exercised regularly, either at the present time or in years past. She admitted that she had never exercised. Each time that she had lost weight in the past she had really deprived herself of food until she couldn’t stand it, then went back to her old ways and the weight rapidly returned.

Nancy’s body fat was so high because when she was starving herself to lose weight, she was losing a lot of that weight as protein, and when she was regaining it, and she was regaining it as fat. The protein that she was losing was coming out of her muscles and her internal organs (heart, liver, brain, etc); when she regained the weight those areas were filling up with fat.

Her subsequent physical exam and laboratory reports confirmed this. Her exam was really striking in her thighs. Both of her thighs had an hourglass shape; they tapered in at the middle and bowed out on both ends with squishy jelly-like material that was probably muscle completely interlaced with fat. Her blood work showed elevated liver enzymes, which is usually a sign of fat infiltrating the liver; a subsequent ultrasound of the liver confirmed this.

In short, Nancy was only modestly obese, but she was remarkably unfit and unhealthy.

A dirty little secret is that we can all lose weight without exercising. If we limit our calories to less than our bare needs, our bodies start breaking down tissues to supply the required energy, starting with our protein-laden muscles and organs. (Muscle can burn fat, but also weighs more on the scale.)

What people don’t tend to realize is that among other beneficial things exercise does, it preserves lean body mass. In other words, the weight you lose will be fat--which is the stuff we want to lose--and our muscles and internal organs will be preserved.

I love to exercise myself. I do it early in the morning and it lowers my stress levels for the rest of the day. I become much more tolerable to be around. If I don’t get a chance to do it, I get really crabby. My wife, kids, and my coworkers don’t want any part of me.

One of my kids is also pretty unbearable unless he is doing something physical, but my daughter, Jill, who also blogs here, hates to exercise unless properly motivated. Regrettably for those who hate to do it, it is pretty essential.

I always tell patients that I don’t have a pill labeled exercise. Even Bariatric Surgery patients are expected to exercise.

How much exercise should we do? And what type? That will be the subject of a future blog. The short answer--anything is better than nothing at all.