Chicago Weight Control

New Update

2011-09-08T09:22:00.000-07:00

Hey there.
I know that we haven't been blogging a lot to inform you of what is new in the world of Chicago Weight Loss, but it isn't because we haven't been busy!

Dr. Bartfield and I have been working hard with Loyola University Medical Center. We are working to create a truly comprehensive weight loss center that will be combining the best of medical weight loss and bariatric surgery.

The plan is to have surgical cases done at Loyola but use a space that is being adapted at Gottlieb Hospital for everything else. We will offer people both surgical and non-surgical options for losing weight. We will have a full support team including the Gottlieb Health and Fitness Center, psychologist, dieticians, and more.

Loyola and Gottlieb Hospital are very committed to this project. Loyola and Gottlieb merged a few years ago and Loyola has now recently merged with Trinity Health Network. This has led to an infusion of resources and enthusiasm.

We have been interviewing bariatric surgeons from around the country; several are enthusiastic about developing a program in Chicago for weight loss that offers people both surgical and non-surgical alternatives.

One criticism I have of many surgical programs is that they don't offer their patients a real alternative to surgery. Loyola has emphasized that they are not interested in "Drive By Surgery". They have emphasized that medical baratricians such as Dr. Bartfield and myself will be very much involved in the care of the patients.

We'll be posting additional updates as they occur. In the meantime we are still seeing patients in our offices and helping people with their weight issues.

Dr. R. Finegold.

Wii Follow Up

2009-04-27T13:06:00.000-07:00

Hello again! Your faithful receptionist Jill reporting for Chicago Weight Control once more!

Dr. Finegold is a big fan of the Wii, especially the Wii Fit. There are also actual games for the Wii that will help you to stay active outside of Wii Fit as well. My friends and I are video game enthusiasts and have experimented with the Wii for some time now. There are games on there that require a lot of physical activity that might be passing over. Also, these games can be a little more engrossing.

Any of the sports games for the Wii will often involve a lot of movement. Tennis, baseball, bowling, what-have-you will try to mimic the sport as closely as possible which means that you will be swinging, running, etc. Just make sure the Wiimote strap is over your wrist or you will have it go flying at your television/window/someone's head.

A real gem that can be easily overlooked is Rayman's Raving Rabbids with good reason. It's a game that was developed by one of my personal favorite developers (Ubisoft), but in spite of that it's still a game I would've overlooked just because it is weird. It involves cartoon "rabbids" (rabbits) that kidnap the main character and make him entertain them. They are screaming, babbling idiots. However, the game is loaded with humor and activity. There are dance-offs with the Wiimote, races with the Wiimote (you run in place and shake your hands while holding the Wiimote), water gun races, lasso tests, etc. Loaded with fun music, crazy humor, and blazing colors, Rayman's Raving Rabbids is ideal for those who want to further enjoy their Wii. The first game is available for $16.99 and there is a sequel that also involves you playing with your butt.

Another great game is WarioWare: Smooth Moves, another crazy game that involves a lot of Wii movement. This is a game that is all minigames that involve a lot of movement in a short amount of time. This one is not exactly intended for older audiences, but probably more up until mid-30's. The visual style might be difficult for those older than 37 to understand, but maybe not. It's fun, crazy, and can hurt your eyes at times, so be careful. I would suggest this for the younger Wii owners. ^_^

These games are all approved for young children in the house as well, should there be any. :)

WIN Products

2009-04-24T12:33:00.000-07:00

I’ve always been very wary of the claims of the supplement industry.

“Lose 80 pounds in 5 minutes while scratching your nose!” Or, “Our magic ingredient from sea shells makes you lose weight, have more energy, and jump higher than Michael Jordan!” Then there is, “Our pill makes your sex drive increase more than Bill Clinton!”

The rules regulating the supplement industry are much more forgiving than the rules that the prescription drug manufacturers have to play by. The prescription drug people have to produce something called a product insert (PI), which is then carried in the publication called the Physician’s Drug Registry (PDR). The PI is supposed to list,among other things, the research supporting the drugs claims, as well what exactly the drug can be used for. Unless there is solid research to back every claim, the manufacturer can’t make claims about what their drug can be used for. Companies that violate this policy due so at their peril, as Eli Lilly discovered recently when they had to pay a fine over 1 billion dollars for making unsubstantiated claims about their drug Zyprexa.

The supplement industry, by comparison, gets a pretty free ride. As long as they aren’t killing anyone, they can pretty much make any claim that they want about their product, without being required to produce proof to back up their claims. Thus you see the wild claims that many supplement manufacturers have made over time without a shred of supportive proof.

So with this in mind, I was pretty skeptical when some of my colleagues, whom I respect, approached me about a supplement company that they deal with, called WIN
(Wellness International Network).

WIN makes a variety of supplements for weight loss and energy, among other things.
When I first looked at their product line I was skeptical--it just looked like a classier supplement line, but still a supplement line, making unsubstantiated claims.

When I looked further, however, I was pleasantly surprised by some things that I discovered, such as the fact that WIN has several products listed in the non-prescription version of the PDR. There are a million supplement companies out there, but only a few get this privilege. In order to be in the PDR, a supplement has to meet minimum manufacturing and product quality control standards.

For example, consider their Omega 3 pill. Omega 3s are a supplement that I have supported for years. There is great epidemiological data supporting that they decrease the risk of sudden death and heart disease, as well as being useful and safer for arthritis.

Omega 3s are high in poly unsaturated fatty acids. Some supplement manufacturers have been caught putting up to 30% saturated fats in their pills. As a consumer, that is akin to putting your mouth directly on the french fryer vat and your local burger chain.

There is a prescription version of Omega 3, called LoVaza. It meets FDA standards for purity. It is marketed by Glaxo, the world’s biggest pharmaceutical company. However, Glaxo doesn’t manufacture the fish oil. It turns out an independent company makes it. They send half of their output to Glaxo and the other half to WIN. The WIN omega 3 sells for about half of the prescription version and is identical to it, literally coming off the same assembly line as Lovaza.

We have been trying many of the WIN weight loss and metabolism products and
much to my surprise--they work! People lose weight, have no side effects, and have more energy. They are a great alternative for our patients that don’t want or have maxed out on the benefit or prescription drugs. So the first time WIN makes a product that looks to good to be true, I’ll be the first one to jump on it. However, as for now, we have become a WIN distributor, able to offer their products to our patients at a steep discount, and I’m excited.

Nintendo Wii Fit

2009-04-24T12:26:00.000-07:00

OK, I guess that I need to put this disclaimer out front and center: I am not a paid spokesperson for Nintendo. I haven’t gotten one lousy nickel to tout their product, but here I go.

I have to start by saying that I am as allergic to video games as one can be. Besides their other objectionable qualities, their contribution to our Pediatric Obesity problem cannot be minimized. As I have written elsewhere in this blog, as much as 1/5 of our kids aged 11-19 are now obese, about a 4 four fold increase from two decades ago. Video games can’t be blamed for all of this, but it is no secret that as these games have become increasingly popular, more kids (and now adults) sit on their rear ends and exercise only their thumbs.

For a while, I have been hearing people talk about the Nintendo Wii. I had heard that it was more interactive than the competitors (namely Sony Playstation and Microsoft XBox). What really made me notice was a radio segment that I heard on NPR about how popular the Wii and Wii Fit have gotten with seniors, particularly in assisted living type arrangements. Shortly after hearing this story, this point was graphically reinforced in my practice.

I have a senior citizen in my general internal medicine practice, an 85-year-old gentleman who has congestive heart failure and COPD (Emphysema) living in an assisted living facility. This patient has to use oxygen continiously but remains quite active despite all of these limitations.

One day I received a call from the head nurse at the facility. It seems that my patient had gotten into an argument with another resident in their activities area. Apparently there was a dispute over whose turn it was to use the bowling console on the Wii, and my patient reinforced his claim by punching the other resident in the kisser. According to the rules of the facility, we had to have the patient sent for an evaluation at the Geriatric Behaviorial Unit at Gottlieb Hospital (a Pysch Unit), where the psychiatrist in charge of the unit concluded he wasn’t crazy, just angry that someone was stealing his turn.

I then became aware that several of my weight loss patients were resisting my entreaties to join a formal exercise program and stating that the Wii Fit was their only form of exercise. I had to resist sniggering at these patients and told them that they needed a formal program.

As it turned out, they are the ones entitled to snicker. I now have had several patients lose up to 30 pounds each with the Wii as their only form of exercise. They are all woman in their 40s with families. They can’t find time in their lives to join a fitness center but their kids have helped them use the Wii and the Wii Fit. They enjoy it, wind up spending more time with their families, and are losing weight. What the heck can I complain about?

I became curious enough to buy a Wii and a Wii Fit. Actually I wasn’t able to at first, because the stores were completely sold out, and had to wait a few months until stocks were replenished.

At the time of the purchase I had a 23-year-old son living with me while he was recuperating from surgery for a workman compensation injury. He is a very active young adult, always into hiking, mountain climbing, and other activities. After his surgery it was a struggle for him to walk across the room, which was depressing him and us greatly.

Pretty soon my wife and I were fighting him for access to the Wii. I came home one day and found him running in place while the screen showed an image of him jogging through a park. There was a female image (or, in Wiispeak, a “Mii”) running ahead of him. Periodically she turns and beckons him on, and damned if he didn’t start running faster every time.

My wife loves the hoola hoop and the ski program. I love sitting on the couch behind her and watching her shake her bootie while she does these, but that is probably more information than I should be letting out.

My wife in general does not like to exercise, but with the Wii she has passed many an hour, highly entertained the whole while, and while I am not allowed to know the results on the scale, she is clearly having a good outcome. I am a home theater buff and an audiophile, and I wasn’t a bit surprised to read in one my magazines recently that Nintendo has kicked both Sony and Microsoft’s corporate butts with their sales. If I had younger kids I would definitely get the Wii instead of letting them play Grand Theft Auto for hours. And as my stories relate, it isn’t just for kids.

Willingness to Change

2009-04-24T09:36:00.000-07:00

Before my wife and I were married the clergyman performing the ceremony gave us personality inventory surveys. This is a survey where you are asked many questions and are given a range of answers to choose from. One example would be as follows:
Q: When driving to work every day you choose to:
A) Take the same, known route every day.
B) Try different routes to see if you can find one that is best, and then settle on that one.
C) Take different routes all the time for the sake of variety.
D) Point the car in any old direction and let it do its thing.

My wife turned out to be a person who likes to be cautious and do the safe and predictable. I, on the other hand, fit the profile of the "Commandant". I had to be in charge, telling everyone else how to do things.

I wasn't surprised at my outcome. I do tend to think that I am the Tsar of the World and that all other people are laboring on this planet for the sake of my amusement. My wife keeps reminding me that the world doesn't revolve around me, and I'm always stunned to realize that she's right.

I was kind of surprised at her results. I know that no one would ever characterize her as wild and crazy, but she can be pretty adventurous. For example, she she is always willing to try all ethnic cuisines: Thai, Indian, Ethiopian, West African, Caribbean, etc. On the other hand, there are some limits there. Whenever we have Indian food, she tends to like to order the same two or three dishes: chicken tikki masala, saag paneer, lamb pasanda. She tends to shy from branching out to new items if it means not being able to get her favorites. And while she likes using our meal replacement bars to help curb her appetite, she eats the same bar every time (Peanut Butter Crunch bar).

My wife is a very reasonable person, one capable of self reflection, who can recognize when something she's doing isn't working for her and needs to be changed in order to reach a desired result.

It's too bad that more weight loss patients can't come to the same conclusions. It is surprising how many people are displeased with their weight, but not willing to examine what habits they have in their lives that led to them becoming that weight and what they would have to do to change it.

For example, when it comes to eating the weight loss plans that work the best emphasize taking small, frequent meals. This includes eating breakfast. There are many reasons why these plans are more effective at helping people lose weight, but I will list the most important reasons:

Frequent meals keep us from getting too hungry and therefore over-eating at a later time.
Our bodies can only process a limited amount of calories at any given time. Once one exceeds the 400-600 calorie limit, the body immediately stores extra calories as fat.

The second part of that is critical for I've seen patients who eat 1500 calories a day gain weight simply because they eat two big meals throughout the day rather than others who spread it over six smaller meals.

When we discuss meal plans with our patients many of the react by saying: "I can't do that! I don't eat breakfast!" or "I can't stop eating fast food three times a day!" or "I can't wake up half an hour earlier just to exercise, because I don't do that now!"

There is a study in the current issue of the Journal of Obesity. It looked at patients who were having Lap Band surgery. It required that these patients undergo the same psychological profile testing that my wife and I took before their insurance companies would pay for the surgery. The main point of the test is to assess the patients' willingness to make lifestyle changes. Presumably if a patient isn't willing to change any of their habits then they won't succeed in losing weight after the surgery.

This study found just the opposite. Readiness to change in no way correlated with how well people did after the surgery. The authors concluded the profile assessment for patients was a waste of time.

Should we be surprised? Think about patient who want surgery. In general, they want a quick fix with the knife. Change the way they eat? Exercise? Either they can't envisage doing it or they have made some attempts and discovered that they can't. They would rather have a surgeon alter their God-given anatomy and lose some pounds, and any changes that they make are enforced on them by the nature of the surgery.

It is interesting that this study only followed the Lap Band patients for two years. I have seen many patients who had surgery, didn't change anything in their lifestyle, and have regained the weight. Ultimately the body can readjust to the effects of the surgery and if nothing else has changed, well...funny how that problem reoccurs.

Change. It isn't just a political slogan. If you have habits that have led you to develop a problem such as excess weight, you need to look within yourself to find out what you are doing wrong. Ask yourself what you have to do to change it. We can help, but without that willingness to examine oneself there is only so much that we can do.

Free Consult vs. Actual Visit: Where the Line is Drawn

2009-02-18T08:17:00.000-08:00

Hello out there! Once again, this is your faithful receptionist Jill here to report on tidbits that may or may not be helpful. Your choice!

I get an awful lot of questions about this one, so I think I should clarify now in writing.

When new patients see the free consult we offer, they get really excited (as well they should). An experienced doctor of internal and bariatric medicine giving a free visit? Is this too good to be true? Doctors normally charge out the wazoo for things, how can this be?

The answer is simple: until any testing is done, the visit remains free. We will ask you ahead of time to fill out the necessary papers from our website (especially the nutrition evaluation--very important if you don't want to do anything beyond the "free" part of the visit) and make up a chart for you in the office. You can ask all the questions you want to the doctors, and they use everything you filled out for them (the medical history and nutrition evaluation) to try and tailor their advice as specifically to you as possible. They'll answer any questions on past medical events in your life, why it seems that you can't lose weight now, what habits you've formed and why, and advise you as much as they can.

When the visit stops being a free one is when the Indirect Calorimetry machine gets pulled out. This nifty machine is a ten minute breathing test that measures your Resting Metabolic Rate (RMR). What this means is it tests how many calories you'd burn if you just sat around all day. This is an $80.00 test. BCBS HMO patients, your plan doesn't cover the test and you will have to pay upfront. The rest of you it is dependent on your personal plan whether or not you're covered. If you're a self-pay you also have to pay up front. This is an important test because it helps the doctors to realize how fast your metabolism is and how to work with it for effective weight loss. It also determines how many calories the doctors would like you to eat per day, and the minimal amount of exercise you would need to do to start losing weight.

After patients take the IC (and those who are serious about healthy weight loss do so right away) the free consult turns into an actual visit. So yes, we do charge for the visit at that point. We try to let you know all this ahead of time or during the visit, but some patients are still suprised when they hear that they were charged.

Don't blame me, though. The doctor is the one who determines who gets charged. Don't complain to them either--they're just doing their job.

So now you know. And if you ask me on the phone, you'll hear this same spiel. I will let you in on a little secret: those who "skip" the free consult and go ahead with the IC test lose at least three pounds in the first week. After that it's up to ten pounds the next time we see them. It continues from there. So while the first visit may not always be free, you do get your money's worth. ^_^

Excercising and Prairie Stone

2009-02-11T12:25:00.000-08:00

I looked at the nice lady in front of me and sighed. “I’m sorry, ma’am, I just don’t have a pill that is called exercise.”

The patient was a very nice lady of about 70. She had lost about 16 pounds but nothing for the past several months. She was at the Dieters dreaded plateau. She was adamant about not wanting to exercise. She had arthritis of the hip, exercise bored her, she didn’t like the way that she looked in workout clothes, she didn’t have the time and every other excuse in the book she could think of.

The problem is that there is no weight loss program that has any chance of long term success without incorporating exercise. It is possible to lose a few pounds without exercising, but what we lose will be a mixture of fat and protein (from our muscles and our internal organs). If we regain that weight, which almost always happens, it comes back as fat. Exercise combined with weight loss makes our body preferentially dump extra pounds as fat, not as protein. And studies show that the people who manage not to regain weight overtime average an hour of exercise a day.

Most weight loss programs will succeed temporarily but ultimately fail because they are lacking one component or another. Last week I saw two patients that had regained tremendous amounts of weight after having gastric bypass surgery. Neither of these patients had ever changed their lifestyles to incorporate exercise. They wanted the quick fix of surgery because someone else did all the work for them. They still had their couch potato lifestyles and despite the fact that they couldn’t eat like they formerly had because the effects of the surgery would make them throw up if they did, they still managed to regain most of the weight they had lost over time. When I pointed this out to them, and suggested that they should finally begin adopting regular exercise, they turned away, uninterested. Just give me a pill, doc. Another quick fix for my problems. Don’t make me do any work or make any changes.

All of this is an introduction for something that I am excited to announce. Our practice, Chicago Weight Control, is about to expand our comprehensive Medical Weight Loss Program to a new location. We are starting an affiliation with Prairie Stone Health and Fitness Center (hereafter referred to as PS). PS is actually a Hoffman Estates Park District facility, but I’ve never seen a park district facility that looks anything like it. It is a truly state of the art health facility. The fact that it is a park district facility makes it feel less like a money hungry health club and reminds me much more of other partner in comprehensive programming, the Gottlieb Memorial Hospital Health and Fitness Center. Both facilities have a genuine interest in improving the wellbeing and fitness of their members. While they both have facilities that compare nicely to the glitziest commercial health clubs, they are the kind of places where normal, out of shape people who don’t have perfect physiques to begin with won’t feel out of place in.

The program that we have had with Gottlieb has been in place for a few years and has been a great success. We have had over a hundred patients go through it and the average 12 week weight loss is 28 pounds. We have seen people who continue in the program lose over two hundred pounds over time and learn to keep it off.

The Gottlieb program was created as a “dream weight loss program.” Patients see a physician trained in weight loss (myself or Dr. Elhag); they have their metabolism and laboratories checked; they meet with a dietician to craft a diet specific for their needs;
they have monthly group meetings to review behavioral issues in weight loss; and most importantly they meet with a trainer once a week and are required to visit the health club at least three times a week. At the end of the program, most have found the exercise to not only be beneficial but fun, and join the facility.

I am sure that we will be able to duplicate the program at PS and look forward to its initiation.
We have informational meetings scheduled at Gottlieb on Wednesday 2/11/09 and at PS on 02/25/09. Call us at (708) 452 5809 for information about registering for either meeting.

Where Am I?

2009-02-09T14:27:00.001-08:00

Hello again. Jill here, your faithful receptionist. For those not in the know, we (and by "we" I mean our valiant medical assistant Donna, our beautiful office manager Sherry, and their spouses) moved the Hoffman Estates Office from Algonquin to 1585 Barrington Road, St. Alexius Doctor Building #2 Ste. 601. And believe you me, a lot of people are having a really hard time finding it.

Last Friday we made one of our poor patients literally drive around in circles as we rattled off directions from where we thought she was, and she found us despite our best efforts to get her seriously lost. Poor thing, took her almost two hours to find us, but she claims it was worth it. She also had Mapquest to aid her, but Mapquest (and most GPS machines) only leads people to an approximation of where St. Alexius is.

When patients finally do arrive, they find parking to be somewhat less than pleasant. Parking spaces are not always to be had in front of the building, but there is additional parking to the side. It is quite a walk. If that is unappealing, I suggest stalking patients as they come out of the building to their cars and attack for a space. Adds some excitement to the day! As one of my favorite patients related to me: "I fought a handicapped woman for the spot I found. We faced off and I knew she was going down. 'Mine!' And boom. Down she went." I was very proud of her.

The end effort is worth it. The office here is really beautiful and just being here makes you feel more relaxed. There's a huge tank with fish swimming, marble floors, a television, and water. Also a great view...of the parking lot. Now you can see all the spaces that aren't available!

So when coming to see us for the first time in our new (and really nice) digs, try leaving yourself a lot of time if you're coming from further away. Otherwise you might have to face down old ladies for prime parking and deal with our horrific direction giving. If that sounds like fun for you than I don't want to take that away from you. ^_^

Gone Fishin'

2009-02-09T13:23:00.000-08:00

“If I get hungry when I have to wait for you, I’m going to bring my fishing gear and catch something from your fish tank.”

This was one of the ironic comments that one of my less reverent patients made in our new office surroundings. Some exciting things have been happening with our practice lately and we’d like to share them with everyone.

For one, we’ve moved our Hoffman Estates office. We formerly had been at 1626 W. Algonquin Rd., which is in the middle of a Strip Mall with no other medical practices or facilities in the area. On one side of us was a hair salon, and on the other was a restaurant. The restaurant used to be a bar when I was shown the property by a real estate rental agent, at 9:00 A.M. on weekday it was a nice quiet location. I have Tuesday night hours and that was when I discovered the walls were paper thin as the bar music regularly drowned out any conversations that I could have with a patient.

The old location was pretty isolated and we had prospective patients that could never find it. One common problem is that they would go to 1626 East Algonquin Rd which apparently is a Mexican restaurant in Arlington Heights. When the aforementioned bar next to us went out of business it was replaced by yet another Mexican restaurant. This made for some amusing but frustrating scenarios where patients who had gone to 1626 East Algonquin Rd would be calling and saying that they were at the Mexican restaurant and couldn’t find us. Jill thought they meant they were at the restaurant next door and told them to walk over.

Our new digs are at St. Alexius Hospital (Doctor Building Two). We are sharing space with a plastic surgery group (Dr. Frank Madda is named several times as a top plastic surgeon in the Chicago Magazine Poll). Dr. Madda apparently is a tropical fish lover and we have a nice tank in the waiting room, leading to my irreverent patient’s comment.

The main reason that I am excited by the move is that it puts us at a major medical center! This is useful for many reasons but the one that I like the best is that it reinforces that we are a medically based weight loss program. When you come to our office you will see a physician every visit, one that has been highly trained in weight loss medicine. We treat obesity like a disease, the same way we treat diabetes, hypertension, sleep apnea, heart disease, arthritis, and all the other diseases
that are caused by obesity. We figure out how many calories you need, devise a diet to help you lose, offer medication to help if you need and want it, and try to assist in treating the other medical problems linked to obesity.

Obesity is a medical problem, after all. Sometimes the seriousness of that message could get lost when we were in a less than serious location, like a suburban strip mall.

SAD

2009-01-15T13:28:00.000-08:00

It is January here in Chicago. The holidays are past and we seem to be perpetually buried in snow this year. Although I have many items on my agenda I just don’t seem to be able to muster any enthusiasm for doing any of them.

I’m beginning to wonder if I don’t have a small case of Seasonal Affective Disorder (SAD). This is a Psychiatric condition where the affected person becomes sad and lethargic in the winter months. It is thought that the lack of sunlight during the short winter days causes a chemical imbalance in the brain, and that the condition resolves as the days grow longer.

Looking back at my life, it does seem that when I have accomplished major goals--including dieting--, it is more likely to have occurred in the warmer months. I do seem to have more energy and need less sleep then. A few of my kids have also noticed that the cold Midwestern winters seem to affect them emotionally, although they aren’t necessarily averse to doing cold weather events such as skiing.

Many people have this issue. Many try to overcome some of the blahs with food.
Over the years I’ve noticed that most patients in my internal practice will put on several pounds in the winter months and lose it in the summer. They blame it on the lack of activity during the winter. I’m sure that is a part of the story, but I think the more likely explanation is that we tend to eat a lot of comfort food during the dreary winters.

I’ve been musing about this because there is also the well known phenomenon of people wanting to start diets after the holidays, the “New Years Resolution” phenomenon. It seems like the worst time to attempt such a feat, but perhaps it makes sense, since the willpower is being ratcheted up during a time when one is otherwise most likely to gain weight. If we succeed in the winter, hopefully in the summer we won’t need so much will power because our natural tendency is to eat less anyway.

Anyway, I guess that I should say this is a good time to come to our office for a free consultation. We have all kinds of weight loss plans and I know that we can help you. If nothing else it will get you out of the house.

Pediatric Obesity

2008-11-07T12:34:00.000-08:00

The patient (let’s call him Jake) had been referred to me by his local pediatrician. He was 17 years old and weighs 497 pounds. He came with his father who must have weighed at least 400 pounds.

There was a lot going on here and the family dynamics could be the subject of another blog entry. However, after they left, I couldn’t help reflecting. I’m 50 years old; did I ever know families like this when I grew up?

I remember the heaviest kid in our class when I was growing up. He was the target of endless abuse. His last name started with the same first five letters as mine; I tended to sit next to him because we were frequently assigned seating alphabetically. This included gym class, which meant that I had to sit next to him in the locker room. He was terribly ashamed of his body. I felt sorry for Larry, who was a gentle soul, and tried to act as if his corpulence didn’t exist, while many others would taunt him. I remember trying to avoid looking at his body while we undressed or showered in gym, both to save him further embarrassment but also because I was repelled by his rolls of fat.

For some reason, they once weighed us all in gym--publicly. I was 6’3” and 155 lbs., and Larry was 5’8” and 240 lbs. He was devastated because he hadn’t known how much he weighed.

Yet for all his corpulence, I believe Larry wouldn’t even stand out compared to what I see in adolescents today. 17% of our teenagers are obese. And to be considered an obese teenager you have to be pretty big. A child isn’t considered obese until he or she is above the 95th percentile for height and weight. Between the 85th and 95th percentile considers are classified as “overweight” and “at risk” for Obesity. Even by this incredibly lax standard, about 1 in 6 kids today is obese.

Furthermore, these kids already have the adult illnesses that accompany obesity. The rates of diabetes in children are at alarming levels. 10% of the kids in our country already have liver disease. Hypertension in kids is skyrocketing. It isn’t unusual for kids under 20 to be having heart attacks and strokes.

Despite all these health issues, the biggest issue still troubling these kids is what most bothered Larry--peer rejection. Despite the fact that they are now much more numerous, they still feel ostracized and very self conscious of their body image.

The biggest predictor of whether a child will become obese is if they have obese parents. Think of that the next time you evaluate your weight and health. Parents that make the time and effort to control their weight are the best role models for these children.

I last saw Larry over 10 years ago, at our 20th High School reunion. While he was still struggling with his weight he probably hadn’t gained more than 20 pounds since then. Meanwhile it was shocking to see how many of our classmates had overtaken him. I remember one of his worst tormentors, who was a small wiry kid. He now was a policeman somewhere in Florida and must have weighed 300 pounds. I remember the look on both of their faces when they greeted each other. Larry was too polite to say anything but one didn’t need to be psychic to know what he must have been thinking.

Gottlieb Lecture

2008-11-04T12:00:00.000-08:00

Hey, Jill here again. I meant to post about this on my patient blog but kept forgetting to do so. So, since this hasn't been updated in a while, I thought I'd do it here.

Dr. Finegold gives a lecture at Gottlieb Hospital (and will be starting this at Prairie Stone as well) about the weight loss program. I was dragged into helping with this when one of our MAs couldn't make it because her daughter was getting married. I was prepared to hear everything I'd heard before and quite frankly to be bored out of my mind.

I was so very, very wrong. Now, understand that Dr. Finegold is indeed a man I've known all my life, and consider him to not be the most charismatic person I've ever been around. Despite that, he makes an excellent public speaker. I was truly inspired to renounce fast food (something I hold near and dear to my way of life) and to get to a frickin' gym and work out. I hate gyms and working out. But this lecture made me quit dragging my feet and contact the gym for a personal trainer, and I've been happier ever since. It actually scares me how well this talk worked.

He brings up some interesting points on how as a species we evolved to be a hunter/gatherer biology and how modern convience goes against this. We used to have to physically hunt our meat and live off of berries/roots/fruit/etc. We were lean, mean, low I.Q. machines. Culture wasn't at its height, but physically we were awesome. Technology and civilization has served to work against our natural physiology. Think about it: we no longer traverse the land on our own two feet but use cars to get places, even if it's five minutes away. Food is readily available in the supermarket, pre-killed (and packaged!) for us--or worse, we can get it "freshly prepared" in front of us in five minutes in a fast food line. Yet our biology is still rigged to the early days of hunting with sharpened sticks after lean deer or foxes or whatever-four-footed creature you could catch. Or fish. Or whatever. Anyway, he tells this better than I do. And with slides and pictures!

Next lecture is November 12th at Gottlieb Hospital. It should start at seven at night...though I'll double check that.

"Does My Insurance Cover This?"

2008-10-03T13:50:00.000-07:00

Hey, Jill here again.

I get asked this question a lot. Half the calls made to the office are potential patients who won't consider coming in until they have this question answered. So I finally decided to post about it.

The answer is this:

It depends on your insurance plan. So there. Whatever your insurance, Blue Cross Blue Shield, Humana, Cigna, HMO, PPO, whatever--sometimes it's covered depending on what you're paying for.

So give them a call. The number is on your card somewhere. I know it is. All you have to do is muster the courage and patience to sit through the automated system until you talk to a real person. It's annoying, I realize that. That's part of life.

So does your insurance cover this? I don't know. But ask yourself this instead: "Can I afford to keep living the way I do now for much longer? Or will my health begin to deteriorate faster?"

Oh yeah, we don't take Public Aid. Everything else (HMO sites have to be Gottlieb West Town site 133) is acceptable. So you guys can relax about that, at least.

I will say most insurances do cover us, though. We have a small percentage of patients who aren't covered who never come back, but about 94% are.

So please, if you're going to call us, at least think of a creative way to phrase this question. I like creative thinkers. ^_^

I Can't Afford to Lose Weight Right Now

2008-09-26T18:25:00.000-07:00

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

2008-09-03T09:13:00.000-07:00

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?

2008-09-02T13:03:00.000-07:00

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.

Does Bariatric Surgery Turn You into a Sex Maniac?

2008-08-26T11:22:00.000-07:00

I was surprised when I walked into the exam room to see my next patient. Her chart identified her as a new patient, although her name was vaguely familiar. I realized why when I saw Susan (not her real name) waiting for me on the exam table. She was a pharmaceutical salesperson (we call them “Drug Reps”) who had only recently started calling on me. About two weeks ago her company had hired me as a speaker to promote one of their (non weight loss) drugs that I prescribe in my general practice. The meeting was held in a private dining room of a trendy restaurant. Very few physicians showed up and there was a lot of time to kill with me chatting with the reps from this company. Naturally a lot of the conversation centered around weight loss, since that is my specialty .

Susan met me for the first time at that meeting. She was about thirty years-old, very articulate and intelligent. She had an attractive face and she appeared to be just a smidge over ideal weight. I remember thinking that her interest in weight loss seemed out of proportion to her own situation, but that is not common, especially with women.

She was very tense and tearful, totally at odds with the very professional and relaxed appearing woman that I had chatted with recently. “Can you take Wellbutrin and Phentermine together?” she blurted out, choking back tears. “Does Wellbutrin cause you to act crazy?”

I should explain here that Wellbutrin is anti-depressant, the only anti-depressant that doesn’t cause weight gain (and may cause a small weight loss). Phentremine is an appetite suppressant that I commonly prescribe.

This was an unusual way to start a physician/patient relationship, to say the least. I asked her to back up and explain why she wanted to know, and also why she was so upset.

Her story was hair-raising. It seems that immediately after my meeting with her, her husband and her own parents had had her committed for a few days to a psychiatric hospital. She had just gotten out before our visit.

After the birth of her daughter, now aged eight, her husband had stopped having sexual relations with her. She ate out of depression and her rate ballooned to almost 300 pounds. Unable to lose the weight, she had bariatric surgery and went down to 150.

Then it got interesting. She began to participate in Internet groups looking for sexual partners. After a few months she let herself be filmed having sex with three men simultaneously. As what happens every time something like this occurs someone who knew her and her family saw these pictures and alerted her family.

She had been placed on Wellbutrin a few months prior to the surgery for depression and her family was trying to blame this drug for her behavior. She had regained 15 pounds during her week in the Psych hospital, wanted to take Phentermine and continue her Wellbutrin (thus her opening question to me).

Her story interested me even more than it normally would because of a few other patients that I have seen recently. Another one had had bariatric surgery in Ohio, had moved to Chicago and wanted me to follow her. She had asked for an HIV test and in the course of counseling her, she let slip that since she had lost weight in surgery she was participating in orgies (her husband also participated--at least this time it was a family activity).

Another patient was seeing me because her husband had had bariatric surgery and was losing weight rapidly and she wanted to lose some weight non surgically. On her third visit she was crying because two nights before she had caught him on the Internet entering his info into E-harmony. She proceeded to divorce him.

The psychiatric literature is replete with articles about patients who after bariatric surgery become addicted to alcohol, cocaine and other drugs, or compulsive gamblers. The speculation by the various authors is that some obese people tend to engage in compulsive behaviors (such as overeating). When they can no longer overeat because of the surgery, they find other outlets for their compulsions.

I have to say that after many years of helping people lose weight non-surgically I haven’t seen that kind of problem in my patients. Perhaps because these people have to work at it, and as part of that they wind up examining what makes themselves tick, and they learn how to deal with their compulsions rationally. The patients who go for surgery tend not to be to introspective: they want the quick fix and they don’t really want to examine their lives and make changes. I’m not going to pretend that I have all the answers. However, I do think examining the question is very interesting...

New Blog to Start...

2008-08-25T14:47:00.000-07:00

We're starting a new blog that'll be like a sister-blog to this one. It'll be written by me (sorry folks) about my experiences of going through the weight loss program. It's guarenteed to be somewhat snarky at the least, so if you like that sort of thing check it out. It's on the list of blogs on the side of this very page. ^_^

If you don't know who "me" is, I'm Jill, the receptionist at the Hoffman Estates office. I work in the Elmwood Park office Monday mornings as well, though any of the patients who remember me are scary-good at remembering tiny details and may want to look into becoming detectives for a living. Or something. I'm also Dr. Finegold's daughter, so when he asks (nicely) that I do something I really have no reason to say "no". So...here we are. I'll go update the other blog now.

Are You a Real Doctor Too?

2008-08-11T14:40:00.000-07:00

I love it when I hear patients say: “I didn’t keep my appointment with you last week doctor because I was sick.” Or when they describe their other medical problems and I start making comments, if they say “Are you a real doctor, just like my doctor?”

I guess I can’t blame patients for their confusion. Most physicians who deal with weight loss--and there aren’t that many of them--do nothing else. Dr. Elhag and I are somewhat unique in that we have kind of a dual practice. We are primary care physicians who have done extra training in weight loss medicine. We still practice primary care internal medicine.

I know that we are all specialized these days, and perhaps patients like the idea of seeing a doctor who does nothing but weight loss medicine all of the time. However, from my standpoint, I think that primary care physicians are the best physicians capable of dealing with weight loss issues.

First of all, we see all the complications that come from obesity. I first became interested in this because for many years I’ve been treating people for diabetes, coronary artery disease, sleep apnea, hypertension, breast, prostate, and uterine cancers, back pain, knee and hip arthritis, infertility, and many of weight related illnesses. You get tired of treating each problem independently with a plethora of medications. Eventually you’d like to treat the root cause of all these problems and make them go away.

We also get to see the side effects of many medications prescribed by other physicians. I don’t know how many psychiatrists that I’ve had to inform that our mutual patient has gained fifty pounds because of the medications that that doctor has used, only to have the shrink deny that their medication was the culprit. Now there is an increased awareness of this in the psychiatric community but it took years. The same can be said for estrogen replacement therapy, many blood pressure medications, seizure medications, and a host of others. As PCPs we are aware of what medications can cause these problems, what may perhaps be a better alternative, and how to coordinate these issues.

Another issue is how to deal with the favorable effects of weight loss. For example, diabetics on insulin make dramatic improvements in their blood sugar with small amounts of weight loss. Since as PCPs we prescribe diabetic medications constantly, it is easy for us to advise the patient what to do as they lose weight. The same can be said for the cholesterol and blood pressure medications.

Many times I’ve had a patient in for their routine weight loss checkup with a bad cold, or asthma attack, or some other acute problem. It is both gratifying and amusing to have them realize that we aren’t just “weight loss doctors” when we treat that other problem as well.
Our weight impacts our entire health. I think that primary care physicians are in the best position to deal with that whole person.

Shakes, Bars, and Less Expensive Groceries. Oh My!

2008-08-01T16:20:00.000-07:00

Jill was telling me a story the other day. It was about a patient of ours who had started the weight loss program as a less-than-enthusiastic participant. She had tried Weight Watchers, Jenny Craig, and every fad diet under the sun and ended up gaining weight in some instances. She'd just about had it with even trying to lose weight.

She'd come in for a free consult two months ago and asked a lot of questions with little hope in her voice. After conducting an IC on her we saw that her metabolism was actually normal which did little to make her happy. When I had Jill show her the supplements she had heaved a weary sigh and glumly bought three items (two sets of protein bars and one set of strawberry shakes; this should last any patient for two weeks).

When I was with another patient about a month later this lady stepped in to be weighed. We let our patients use our scale all the time at no cost as long as someone is here to input the data. It sends an elecetric current through the human body through the feet at a current so low you can't even feel it. The current bounces off of fat and muscle which have different densities and tell the doctor and patient how much of either substance is contributing to the number the scale reads for their weight. With diet and exercise a patient might not lose weight because what was once fat is now muscle (which weighs more), but the muscle burns fat and is in fact much healthier.

Anyway, the patient had stepped in to hop on the scale to see what, if anything, had happened. It turns out she had lost almost ten pounds in about three weeks, a healthy weight loss, and was feeling more energentic than she had in years. She quickly bought ten supplement and meal replacement items with a big smile on her face.

While on I'm on vacation, Jill is still in the office selling supplements. The patient stopped back in to be weighed (this is now almost two months after her initial visit) and lost nearly ten more pounds. Jill said she was having trouble understanding her because she was so excited that she was talking in a constant stream. The patient bought nearly twenty items, and when Jill questioned it she said this:

"I've lost so much weight and am so happy just by having a bar or two a day and walking around more that even my husband started sneaking my bars. I just figured I'd buy more. We've stopped buying as much stuff at the grocerey store because we're not as hungry with these bars around now!"

Jill says that the patient says she currently saves almost three hundred dollars on groceries now. I was floored, and can't wait to congratulate her on her next appointment. All this without the appetite suppresent too!

Patient Plateau

2008-07-22T17:46:00.000-07:00

Before I walk into the exam room where my patient is waiting for me I grab the chart and look at the weight slip the scale printed up. My staff is instructed to put little symbols next to the patient's weight. A smiley face indicates weight loss, frowny faces are weight gain, and an indifferent face (flat line) means no change. Jill, my receptionist who weighed this patient, had drawn a frowny face with two big tears rolling down its cheeks.

The patient had only gained one pound in a whole month, so I was puzzled: why such a big deal? After all, this patient had lost forty pounds since joining our practice and was able to stop taking the blood pressure and diabetes meds that she had been on when she started. From my perspective she was a real success story.

When I walked into the room, I discovered that the patient didn't see it at all. Arlene had started at 200 lbs., was down to 160 lbs., but in the last four months had lost only two pounds. She was angry because she wanted to weigh 140 lbs. and it didn't seem like she would ever get there.

"I just don't understand. I'm doing the same amount of exercise and I haven't really changed the way that I eat much, but I'm at a plateau."

This is the part that frustrates everyone who is trying to lose weight. You can have success and then it just seems to stop. Even bariatric surgery patients hit a plateau.

Let's look at why that occurs. As I mentioned in my last blog, we do metabolism testing in our practice. Now, when Arlene started she weighed 200 lbs., which is about 90 kilograms. The equation for predicting the RMR of a woman is to multiply her weight in kg by 24 and then take 90% of that number. That's about 1960 calories for Arlene. When we measured her metabolism she was exactly 2,000 calories (10 calories/pound).

Arlene followed a 1200 calorie/day meal replacement diet and began walking four miles/day and lost the forty pounds. However, at her new weight of 160 lbs. her RMR is 1570 calories. We repeated her metabolism test and she was 1580.

This means in order to keep losing weight, Arlene now has to account for over 400 calories that she didn't have to account for before. Simply put, since there is less of her she now needs less calories to stay baseline.

Arlene has to now eighter increase her exercise to account for those calories (walk six miles a day?) or eat 400 calories less than she had been before. Neither option looked particularly attractive but that's the way it goes.

In her case we tried adjusting one of her meds and we got her to increase her activities in daily life--parking farther away at work/shopping mall, not using elevators but stairs instead, using a bike instead of walking, etc.

She lost another seven pounds in her next two appointments and is happy to see some progress. It's become easier for her to remain enthusiastic about the program again.

Metabolism

2008-07-09T14:15:00.000-07:00

The new patient sat there looking at me with a facial expression that was a mixture of frustration and bemusement.

"I really don't eat that much" she said. "I don't know why I have trouble keeping my weight down."

We ask patients to provide us with food diaries. For breakfast she had written yogurt. Lunch was a salad, and dinner was a boneless skinless chicken breast with vegetables. No snacks or alcohol were listed.

This patient is a sister of another patient who had lost 80 pounds in less than a year. I knew that the sister was a reliable person, but I figured this new lady must be lying through her teeth.

She was 42 years old, weighed 357 pounds, and was seeing a fertility specialist who told her that her chances of ovulating were greatly enhanced if she lost weight.

I tried to probe without letting on that I didn't believe her. "Is this a sample of the way that you have recently been eating? Perhaps you have only been seriously dieting for only a few weeks and prior to that you took in more calories?"

She looked annoyed. "No doctor, I've been trying to lose weight my whole life. I'm not that

hungry, but I just can't seem to lose anything."

She admitted that she didn't exercise, but continued to insist that her intake was not excessive. On her history form, she stated that she had been in Weight watchers for 20 weeks, was placed on a 20 point/day diet (1000 calories) and lost only two pounds.

An individual's Resting Metabolic Rate (RMR) is how many calories someone needs to consume to either not gain or lose weight, assuming that they sat in one place all day and did

not move. There are equations to predict the RMR, and her predicted RMR was close to 3000

calories. If her metabolism was normal, she should have lost plenty of weight on a 1000 calorie diet.

That turned out to be a big "if". In our office, we can measure peoples metabolism with a piece of technology called an Indirect Calorimeter. It is a machine that you breathe into for about 10 minutes.

Most of our patients think their metabolisms must be slow, but when we measure most of them they aren't. A careful diet history will usually reveal that people are taking in many more

calories than they suspect.

Not this woman. When we measured her her RMR turned out to be just over 1000 calories a day, or almost one third what it should have been. No wonder she couldn't lose weight. I should not have doubted her.

She took some comfort in knowing that her metabolism is slow. She is going to be a tough patient to treat, but as long as she is willing to be patient and work at it, she will do well.

Everyone is different. We all have different metabolisms, and having a tool t measure it is a great asset in customizing a weight loss plan.