In my last post, we discussed my basic weight loss recommendations and some of the things you can do to maintain healthy weight this holiday season. This post will focus on some of the more advanced options that you can explore in order to lose weight. In general, if you do not implement the recommendations from the previous article, then these advanced medical options will not likely be beneficial. The following recommendations are aids to help you reach your goals, but if you don’t have a healthy lifestyle to begin with, then these just wont work.

Weight Loss Supplements

For quite a while, there has been a fair bit of hype in the media about weight loss supplements. Two of the most common are hydroxycut and garcinia cambogia, which was even endorsed by Dr. Oz. I imagine these are appealing to people for two reasons: First of all, because it seems that society is enthralled with the idea of an easy fix for everything. Second of all, because these are not considered medications, and therefore people do not think they have side effects. These are two misconceptions that drive a large market for these kinds of supplements. I would like to dispel these two myths.

I am pulling the following statement from the front page of the hydroxycut website: Average weight loss with the key ingredient (C. canephora robusta) was 10.95 lbs. in 60 days with low-calorie diet, and 3.7 lbs. in 8 weeks with a calorie-reduced diet and moderate exercise hydroxycut.com I think you would agree with me that these results seem like modest benefits at best.

When deciding whether to take any drug, I always recommend patients weigh the risks versus the benefits. One surprising side effect of most supplements is the rare potential for liver damage. About once per year I see a patient in clinic with acute liver injury from supplements. They will come in with nausea, vomiting, diarrhea, yellow skin and yellow eyes. No cause is found and the symptoms resolve once they stop all the supplements. In general, I do not recommend any supplements for weight loss as I do not believe the modest benefits outweigh the severity of the potential risks.

Phentermine

I will consider treating patients with prescription medications in certain situations. The most common weight loss medication that I prescribe is called phentermine. Phentermine is a stimulant that works to suppress your appetite.

Side effects include elevated blood pressure and heart rate, and increased anxiety. These side effects must be monitored closely, and will resolve once the medication has been stopped. As with any side effect, these do not occur in everyone.

Generally, phentermine can help you to lose 5-10% of your body weight. If, after 3 months, you have not maintained a 5% reduction in peak body weight, then I will recommend stopping the medication as the benefit of <5% weight reduction is not worth the risks. Some patients use phentermine short term for 3-6 months and some patients prefer to take this on a long term basis. As long as weight loss is maintained and the patient is not experiencing side effects, then we can continue the medication long term. Again, without diet and lifestyle modifications, phentermine will not work.

Bariatric Surgery

Weight loss surgery is an attractive option for people struggling with obesity. Over time, the practice of weight loss surgery has become safer, more effective and cheaper as it is now being covered by more insurances.

The first weight loss surgery developed was the Roux-n-y procedure. In this operation, the surgeon will re-route your digestive tract to decrease the size of your stomach. Long term complications include vitamin deficiencies due to the decreased total absorption in the GI tract. Vitamin levels must be monitored yearly after having this done and some patients have to take specific vitamins daily. This is still being done, but only if the newer procedures are contraindicated.

Gastric sleeve is the most commonly performed bariatric surgery today. The operation will remove a side of the stomach to decrease its size. This can be done laparoscopically and carries a similar peri-operative complication rate as having your gallbladder removed. Vitamin levels do not have to be monitored as aggressively with this procedure.

I consider bariatric surgeries for my patients who have a BMI >35 and who have other complications from obesity, including diabetes, high blood pressure, breathing disorders from obesity and orthopedic issues.

Obesity is such a difficult condition to manage, from both a doctor’s perspective and from the patient’s. I want you to have the facts you need to make wise decisions about healthy eating and weight loss. The information in this article is the same information that I give my patients in clinic. If you need help with weight loss, talk to your doctor or seek out a dietician for further advice.

Did you miss out on the first article? Follow this link to Staying Trim Around the Holidays: Part 1