A recent study in the New England Journal of Medicine (NEJM) showed that the average person gains 1lb per holiday. The study also suggests that this pound is usually not shed in the next year so people tend to accumulate more with every holiday season. With the holidays coming up I felt it was an appropriate time to discuss weight loss. I want all of my Wise Patients to have a healthy holiday season.

Lots of my patients ask my opinion about how to lose weight. Should we check any labs? What diet is best? Do you recommend any medications? Maintaining proper weight is incredibly important for your health, so I try to do whatever I can to help my patients reach that goal. Increasing amounts of data are coming out that show a clear link between obesity and poor health outcomes. One surprising example has to do with your liver. Obesity and fatty liver disease are now the number one cause of cirrhosis (permanent liver scarring), more than alcohol abuse and hepatitis C.

BMI

So when talking about weight, we should start by defining what is a healthy weight. The most useful calculation is the Body Mass Index or BMI. This is a ratio between your height and your weight. A normal BMI is 18.5-25. Overweight is 25-30. Obesity is >30. You can calculate your own BMI by dividing your weight in kilograms by your height in meters squared. If you prefer you can plug in your height and weight to this med calc calculator. BMI is not a perfect calculator because the weight from muscle mass may artificially raise your BMI.

What Should We Check?

When a patient tells me they are having trouble losing weight, I do like to check a few things. I like to start with blood work to check for thyroid disorders (TSH), low testosterone, and diabetes (A1c). I evaluate women for polycystic ovarian syndrome (PCOS) and I recommend a sleep study to look for sleep apnea. These should be ruled out or treated first because all of these conditions can make it very hard to maintain a healthy weight.

Medications That Prevent Weight Loss

The next thing that I do is evaluate my patients’ medication list and look for any medications that are known to cause weight gain. Lots of medications can cause weight gain. And some of these medications will cause weight gain in some people, but not others. The group that causes the most weight gain is steroids, like prednisone. A short course of prednisone taken for 1 week or so usually does not cause trouble, but some people take prednisone daily for months or years and experience significant weight gain.

Other offenders include antidepressants like sertraline (Zoloft), citalopram (celexa) and mirtazapine (Remeron). Fluoxetine (Prozac) is a commonly used antidepressant that does not cause weight gain as much as the others. Also mood stabilizers (quetiapine and lamictal), antipsychotics (risperdal and ziprasidone), antiseizure medications (depakote) insulin and birth control pills.

If I can switch patients to medications that may cause less or no weight gain, then I will try to do that. But that is not an option for all patients. Sometimes the benefits of these medications will outweigh the risk of weight gain. If you take any of these medications do not stop taking them without discussing with your doctor first.

Best Diet For Weight Loss

The most important aspect to any weight loss treatment is lifestyle change. You have to alter your daily routine if you want to lose weight. Eighty percent of weight loss is diet related, so let’s start there. You are probably familiar with a variety of popular diets: keto, paleo, vegan etc. The best diet for cardiovascular health is the mediterranean diet. But when it comes to weight loss, I don’t recommend one specific diet over another. You can reach your weight loss goals by continuing your current diet with just a few tweaks.

Daily Routine To Maximize Weight Loss

First thing to do is to eliminate the following: soda pop, sugary drinks, energy drinks, and alcohol. These drinks have a huge calorie burden, and taking these out of your diet will give you the biggest bang for your buck.

Starting with breakfast, you should make sure to include a little protein like an egg or peanut butter. This small amount of protein will stay with you longer than a pastry and will help to curb your appetite the rest of the day.

For dinner, make sure you eat at least 3 hours before going to bed. Eating a large meal and then going straight to bed will make it hard to lose weight. All of those calories that you ate for dinner will not be burned as energy, but will be stored directly into fat if you eat right before bed.

Never go for seconds; you don’t need them. If you have a strong sweet tooth, then try this trick: eat a small piece of dark chocolate before dinner. This will give you the feeling that you are more satisfied with a smaller amount of food and will help you to limit your portion sizes.

Drinking lots of water with your meals and throughout the day will provide a similar result with your portion control.

Read through these recommendations and start giving them a try. Talk with your doctor and/or dietician if you need help. In my next article, Staying Trim Around the Holidays: Part 2, I will write about what medical interventions we can try to help you lose weight, including medications, herbal supplements and even bariatric surgery.