Tag Archive for: weight loss

The Ridiculous: Obesity and Weight Loss Scams

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As I planned this series of Memos, I wrestled with using the word “obesity” because everyone appears to hate that term—especially when directed at themselves. I decided to stick with it because it afflicts close to 40% of us in the United States. Before I get to ridiculous weight loss plans people are hawking, how did we get here?

Obesity is the product of success. We’ve been successful in creating so many labor-saving devices, we can’t burn enough calories in everyday activity anymore. We’ve successfully produced so much food, available just about everywhere, and made to appeal to all our tastes—sweet, salty, fatty, and umami. They’re hard to resist. The U.S. and Canada have worked hard to produce so much food. But with that success comes overconsumption. Pure and simple.

I question whether obesity is a disease. The dieticians and nutritionists have tried health education without success. Now the medical community has taken over with surgery and pharmaceuticals. And we’re still getting fatter, not because we’re failures but because we’re reaping the rewards of success. We have to change our approach to how we treat food if we’re going to be successful in changing the outcome.

In this series, I’m going to cover recent ads, commentaries, and research on obesity and weight loss. Let’s begin with a Facebook ad my daughter-in-law sent Paula the other day.

The Ridiculous

Paula got a text from Kerri that showed the benefits of MagnaGermanium earrings; these magnetic earrings will activate your lymphatic system, drain away toxins, detox your body, and allow you to lose weight naturally. I had to check it out—after all, it was FDA approved!

It was just a bunch of testimonials. No science, even though the ad referred to it. Claimed to be made in an FDA-approved facility, but there’s no such classification. It’s a pure scam but reasonably priced: just $22.97 a pair in the ad I reviewed. Look around a little, and you can find them for one cent; that tells you all you need to know about the quality.

I don’t think I have to say anything else. By the way, those Kelly Clarkson “ads” for Keto-ACV Gummies? Worst artificial intelligence effort I’ve seen so far. They’re also in the ridiculous category.

We’re just getting started. Next week, a look at fish oil and the potential for overweight children. You don’t want to miss it.

What are you prepared to do today?

        Dr. Chet

Find Your Way

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How are you doing with your 2024 weight loss efforts? Or your fitness regimen? Eating more vegetables and fruits? Taking your supplements regularly? Is it going smoothly at about three weeks in, or not so much? I know I’ve slipped up. Based on Dr. Barabási’s research, that doesn’t mean you’re doomed to failure. Remember what he found: it isn’t your age that determines your productivity, it’s your creativity.

Not Your First Rodeo

If you’ve been successful at changing a health habit, losing weight or getting fit, particularly when you were younger, you found a way to do it. Over the years, especially with weight loss and fitness, life happens, and your body changes; you go back to old habits and gain back weight or lose fitness.

There’s a tendency to try to recreate that experience again. In other words, you’re going to try the same workout routine, the same way to lower calories, whatever helped you achieve that goal. But life isn’t static and maybe it doesn’t work the same way. You decide to try another type of diet, such as the ketogenic diet, and that worked great—for a while. But you slowly returned to your old habits and gained back the weight. Because you’re older and with the change in metabolism that seems inevitable, you lose the passion for trying.

You just get tired of trying. You may be saying something like, “You’re just not into it,” or you make up some other excuse. But whatever the reason, you quit trying.

Never Stop Trying

At the end of his TED talk, Dr. Barabási’s said: Creativity has no age; only productivity does. What that means applies as much to health as it does to being a successful scientist or attaining any goal. Keep trying to find that one thing, that one way that will work for you. It doesn’t matter what diet you use, what aerobic workout you try, or what method you use to gain strength. The only thing that limits you is not your age but your willingness to keep trying until you figure it out. No matter your age, no matter your limitations, that way exists. You just must find it and make sure it’s sustainable for life.

The Bottom Line

Near the end of the movie “City Slickers” the character played by Jack Palance tells Billy Crystal’s character he knows the secret to life. Billy says, “Well, what is it?” Jack tells him that’s what he must figure out. Find that one thing and nothing else matters.

Whether it’s changing your weight, getting fit, lowering your blood pressure, or any other health goal you want to attain and maintain, that’s what you must figure out. No gimmicks, hacks, or short cuts. Find your way. I remain committed to helping you find it.

What are you prepared to do today?

        Dr. Chet

Reference: Ted Radio Hour. Late Bloomers. 9-1-2023

The Cause of Obesity

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On Tuesday, I said that I couldn’t get past the word disease in the statement from CDC Head of Disease Prevention and Health Promotion: “Obesity is a disease caused by many factors, including eating patterns, physical activity levels, sleep routines, genetics, and certain medications.” While we can agree that there may be a genetic or medication contribution to obesity, there is only one real cause.

The definition of disease is a disorder of structure or function in a human, animal, or plant, especially one that has a known cause, and a distinctive group of symptoms, signs, or anatomical change. There’s no question that obesity has anatomical changes that result in symptoms.

But understand the numbers of obesity. Not everyone is massively oversized; the average height for a man in the U.S. is 5’9” and over 202 pounds to be considered obese, while for the average height of a women is 5’4” and over 173 pounds. There are many people who can hide that weight well. My point is that it’s not the largest individuals who are tipping the scales in the increase in obesity; it’s all of us above normal weight contributing our share.

The disorder part of the definition is one that is clear.

The Cause of Obesity

The cause of obesity is the systematic overconsumption of calories, usually taking years, if not decades, to manifest itself.

The Evidence for the Cause

There are two examples I’ll cite, both related to World War II. The first was the Minnesota Starvation Experiment. Male conscientious objectors had to lose 25% of their body weight in six months. They were normal weight when the study began, and their caloric intake was adjusted weekly to maintain the required weight loss. The result was a linear loss of 25% of their weight in six months.

This one is extreme but applies nevertheless. No one walked out of concentration camps overweight after being liberated—no one. They were systematically starved until they no longer had the energy to work.

In both cases, there was not a change in structure or function; the people were simply starved. The result was weight loss. There’s no change in structure or function when we systematically overeat. However, once we’re overweight and obese, there are changes in the structure and function of our bodies that must be dealt with. But it still comes down to this: a calorie is a calorie. No matter what genetics we have or what medications we take or how little we move, we won’t get fat if we don’t overeat.

The Bottom Line

We are obese because we consistently eat too many calories. We can reduce our weight if we systematically eat less. Yes, there are challenges to overcome because of those structure and function changes caused by chronically overeating. You just have to find the way to reduce your caloric input that works for you. Eat less. Eat better. Move more.

I frequently am asked which calorie-counting app is best, and I don’t have an answer. Do you? Have you found one that’s easy to use? Drop me an email and let me know which app you like and why. I’ll give them a try and let you all know which ones perform best.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.cdc.gov/obesity/data/prevalence-maps.html

Is It Worth It?

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At an obesity conference, the report on the clinical trials for a pre-diabetes and diabetes medication left the crowd on their feet and cheering. There are reports of well-known personalities who’ve used the drug with great results. But the ultimate question about a pharmaceutical approach to obesity has to be this: is it worth the money? Let’s start by looking at the pharmaceutical and then the return on investment.

How It Works

The body makes proteins called incretins which can stimulate the release of insulin. One incretin hormone, GLP-1 (glucagon-like peptide-1), is manufactured in the upper digestive system in response to carbohydrate intake. In subjects with type 2 diabetes, this hormone effect is diminished or no longer present.

The ability to stimulate the production of insulin and prevent the release of glucose by glucagon can be stimulated pharmacologically by semaglutide, a receptor agonist—that means it turns on the glucagon. In subjects with type 2 diabetes, semaglutide stimulates GLP-1 receptors significantly, thereby reducing blood glucose and improving glycemic control. In addition, it has multiple effects on various organ systems; most relevant are a reduction in appetite and food intake, leading to weight loss in the long term. Since GLP-1 secretion from the gut seems to be impaired in obese subjects, it was logical to test it in obese populations. Those were the study results I reported on Tuesday.

All in all, this sounds like it might be a potential solution to our obesity crisis, but there are some unanswered questions. What is the long-term safety of regular use of the drug? How does the microbiome impact the effectiveness of the drug? But more than that, everything comes with a price, which begs the question: is it worth it?

The Price

The price of using semaglutide for obesity is really two-fold. First is the actual cost of the weekly injections which is about $1,400 per month at retail. If your insurance will cover it, I’ve seen prices as low as $25 per month. We know that people lost an average of 18% of their starting weight at 68 weeks—the length of the longest study to date—but the rate of weight loss declined near the end of the study. How long will insurance cover it beyond that, and will a person continue to lose weight? We don’t know.

After using the drug for 20 weeks, the placebo group was switched to a placebo and immediately began to gain weight. By the end of 68 weeks, they had regained all but 5% and were still gaining. Would an investment of close to $17,000 to lose about 20% of your weight be worth it if you began to gain it back? There are many questions around whether people can take this drug for the rest of their lives; every pharmaceutical intervention must have an end strategy. The researchers did not address the issue.

The Bottom Line

The research into this pharmaceutical intervention was well done. However, unless the intervention includes an exit strategy, it could be a waste of money. Perhaps a lower carbohydrate diet may be a partial solution because this drug impacts carbohydrate metabolism. But we don’t know whether the weight loss would be enough to have the body take over and do the same thing on GP-1 by itself.

I think this shows a hopeful approach and it may turn out to be a boost to someone who is absolutely willing to change their lifestyle or someone who needs to lose weight for a specific purpose, such as joint replacement surgery or preparing for IVF. But for most of us, maybe it’s better to save the time and money and do what we know works: Eat less. Eat better. Move more.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Happy New Year!

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It’s good to be back talking to all of you again. The New Year is a time of optimism, everything seems possible, and there’s an enthusiasm for achieving health goals. One thing many people want to do is to lose some weight. It seems appropriate to cover a couple of drugs that were recently approved by the FDA to treat obesity. They’re a pharmaceutical approach to weight loss, and they’ve gotten so much press I have to cover them.

You’ve probably seen the commercials for a pre-diabetes and diabetes medication called Ozempic. It also has a sister drug called Wegovy that was approved for use in teens. In at least two clinical trials, subjects who had weekly injections of the drug lost at least 15% or more of their body weight in 68 weeks. Those who were switched to placebo injections started to gain back the weight they lost. All subjects were supported with monthly consultations with dieticians to induce a 500-calorie reduction in food intake and to increase exercise levels. Markers for type 2 diabetes improved such as HbA1c and blood glucose.

Is this the be-all and end-all to the obesity epidemic? And exactly how does this drug work? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
2. JAMA. 2022;327(2):138-150. doi:10.1001/jama.2021.23619

Aging Stressor: Excess Body Weight

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The last major stressor that comes with age is excess body weight. The first book that I ever bought in grad school was about obesity. In it, there was a chart of almost 100 health issues that were linked by research to carrying extra body fat and one that was not. In the 40 years since then, the list of negative effects of obesity has grown.

If you remember my answer to the question from last week’s Memo about what one thing would I do differently in my life, that’s the reason I chose getting to a healthier weight and staying there. Pick a body system, any system, and you’ll find the deleterious impact of excess fat on that system. Immune system? Yes. Joints? Yes. Liver? That too. Pancreas? Yes—and on and on and on. That’s why it’s important to get to a healthy weight as young as you can and stay there.

But what about now? It’s been a 50-year fight for me, and I still have not succeeded to the extent I would like. Getting to a healthy weight is not about a specific diet or foods or anything other than one thing: the quantity of food we eat.

I’m going to give you the simplest approach to losing excess body fat I can with two ways to do it.

  • Use a smaller plate when you eat meals and fill it only once. Moving from a dinner plate to a salad plate will cut off about 20 to 25% of the calories you eat. You can use the same logic with smoothies or cereal or soups. Smaller portions yield fewer calories.
  • As an alternative, reduce your caloric intake by 250 to 500 calories per day if you already track your food intake. That’s it.

Can you work on the quality of food? Sure. How about fewer carbs or less fat? If you want. What I’m saying is that to attack the excess body weight you carry, you have to attack your number of calories and eat fewer of them. Start with the sledgehammer to break down the wall. You can get to the chisel later on to fine-tune your lifestyle.

That one benefit of being overweight? It reduces the risk of osteoporosis. I don’t think that’s worth the hundreds of other risks it increases.

Aging with a Vengeance

The first Aging with a Vengeance webinar will be on Super Bowl Sunday; the topic will be increasing muscle mass. I’ll be covering a specific strength training program together with nutrition approaches including diet and supplements. The approach is based on the practical application of the most recent research. The first Memo of 2023 will give details on how to sign up for the webinar and the materials you’ll get.

Have a Very Merry Christmas from all of us at DrChet.com! Talk to you again on January 1, 2023.

What are you prepared to do today?

        Dr. Chet

Worst Stressor: Split Decision

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I intended to talk about the single most negative stressor that we face as we age, but I couldn’t pick just one. When I say stressors, I mean things we have to deal with every day, not a singular event such as an auto accident. Smoking would be the easy choice, but it doesn’t impact as many people as it used to. Here are my two choices.

Too Much Weight

Someone asked me a simple question before an Insiders Conference Call: if you could do one thing differently when you were young to improve your health, what would it be? Without hesitation my answer was I would have gotten to a normal body weight and maintained it. Being overfat impacts you as soon as you try to get out of bed: you have to overcome gravity. And it doesn’t stop there.

Every system, every organ, and every cell in your body is impacted by excess fat. Some effects are worse than others, but every cell is impacted in some way. If you can avoid gaining the weight to begin with, that’s ideal. If you’re like me and you didn’t, it’s a lifetime challenge to get to a normal weight and maintain it. I’m still working at it.

If you’re still a youngster in your 20s, 30s, or 40s, don’t postpone weight loss. Do whatever it takes to get to a normal weight (short of drug abuse or eating disorders), then develop a healthy lifestyle to keep your weight down. Even if you’re older, you can still lose weight just as my mother-in-law did in her 80s.

Chronic Pain

There are some people who don’t know what it’s like to face pain every day, but the majority of people face the daily challenge of having their lives impacted by pain as they get older. It may be joint pain in the knees. Lower back pain afflicts many. It may be nerve damage from prior accidents. But as we age, pain is the stressor that may be present all day, every day.

There is no magic wand for this stressor. For some people, if they didn’t have to think about pain, they could do so much more. Instead, it’s trying to find the right everyday changes that can make life bearable.

The Bottom Line

I think you can understand why it was a split decision. In addition, these two stressors affect each other: being overfat can make the pain worse, and having pain can prevent us from exercising to help with weight loss. It doesn’t mean there are no stressors of aging we can deal with—there definitely are. That’s what we’ll talk about in my upcoming program Aging with a Vengeance.

On next week’s Insiders Conference Call, I’ll talk more specifically about the stressors of aging and what we can do about them. Become an Insider by 8 p.m. Wednesday, December 14, and you can join the Insider call at 9 p.m.

What are you prepared to do today?

        Dr. Chet

The Secret to Prevention

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Consistency.

I thought I’d lead with the secret to disease prevention instead of making you wait. Whatever you want to accomplish in taking charge of your health, you have to be consistent. The polypill study proved it although the scientists, being conservative in their conclusions, don’t come out and say it—but I will. Here’s why.

Why the Polypill Was the Difference

The subjects taking the polypill were more consistent in taking their medications than the subjects who took the exact same medications as individual pills. They didn’t ask the subjects whether it was easier to remember to take one versus three pills; that could be a factor as the mean age of the subjects was over 75. It’s also easier to keep one medication refilled rather than three. Whatever the reason, the subjects just took their medication on a more regular basis and thus saw a decrease in recurrence of cardiovascular disease events.

While this was a study about medication, it applies to reducing or changing your foods to eat healthier, reducing the risk of cardiovascular disease and diabetes, or any other health goal: we have to be consistent. Even getting a health benefit from taking a supplement requires you to take it regularly for weeks or months to see a benefit.

Weight Loss: A Special Case

Losing weight and maintaining the weight loss is the single most difficult thing humans can do. I know. I’ve been trying for decades. I don’t weigh what I used to weigh, but I’m not where I want to be. I know many of you are in that spot as well.

It’s not the losing that’s the problem—it’s the maintaining. When you consider the simplicity of it, why is it so difficult to sustain a way of eating that keeps you at a healthy weight? Scientists and physicians have examined genetics, proteomics, hormones, and more. They have looked at every psychological issue they can think of to try to help people lose the weight and keep it off. No luck so far.

I’ll go out on a limb and predict there won’t be any one answer. It’s really up to each individual to find a way to eat that can sustain a normal body weight. It will probably be slightly different for each of us as to the types of foods and exercise we use, but our solution exists. We just have to find a way to be consistent and in the case of weight loss, it has to be for life.

The Bottom Line

We face plenty of obstacles in our path to health. We may not have the best genes. We may have had a poor lifestyle for many years that we have to compensate for. We may not have all the resources we need. But if we can pick a couple of things at a time and make them our habits for life, we can begin the process. We just have to be consistent, day in, day out. Where we end up may not be perfect, but it can be better than you are right now. That’s what aging with a vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

What Not to Do When You Want to Lose Weight

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How did my mother-in-law lose 30 pounds when she was completely sedentary? I’ll tell you, but let me tell you first what not to do. Why begin there? Permanently changing your weight (or any other significant health goal) takes a lifetime commitment. You don’t know what life will bring, so the best way to attack the problem is by doing the best you can every day until you really have changed your habits permanently.

What You Don’t Have to Do

When you’re ready to make a change in your lifestyle, especially to lose weight, you don’t have to announce it on social media. If you want to keep track of your progress and do something with that information later, fine. But not everyone responds the same way to social scrutiny and it can be brutal. The only person you ever have to be accountable to is yourself.

You don’t have to throw out everything that’s in your refrigerator or freezer or clean out your pantry. It’s a good idea to get rid of the food that’s two years or more past its “best by” date, but that’s it.

You don’t have to follow any specific diet or exercise program when you start. Eat a little bit less and move a little bit more.

Understanding How to Start

Whether you want to lose weight, lower your cholesterol, reduce your risk of type 2 diabetes, you start slow and you add a little bit to it each day.

Think about this related to weight loss. You can’t fast (by the most common definition of fasting—abstaining from food) long enough to lose all the weight that you want to lose. It wouldn’t be healthy not to eat. Your body’s going to continue to produce waste products and you need nutrients, fresh nutrients, to help it do that.

What you can do is improve the quality of your diet a servings of grapes per day or a small salad before your meal to help suppress your appetite. Every small step is an important one. The catch is that you have to maintain it. So whether it’s a serving of grapes one day and strawberries the next and blueberries after that, add that serving of fruit every day. Or vegetables. Or nuts and seeds. You have to change your eating style permanently.

Turns out, losing weight that way takes some time. But let me ask you this question: did you sit down at a table one day and decide that you were going to overeat and overeat and overeat every second of every day so that you could put on 25, 50, or 100 pounds? Of course you didn’t. What makes you think you can take it off all at once? You have to do it one bite at a time, one meal at a time, one day at a time, just like you put it on.

The Bottom Line

I’m sure you’ve figured out why my mother-in-law was able to lose weight even though conventional exercise wasn’t an option: she consistently ate less than her body needed to maintain her weight. She stopped eating desserts and snacks and didn’t go back for seconds. Even though her body wasn’t as strong as it had been, she still had the mental toughness to stick to her plan, and it worked.

Consistency—what a concept! No fad diet, no keto or paleo, just consistently eating more of the healthier food and avoiding empty calories. I’ll say it again: it was, it is, and it will always be about the calories. It all comes down to a single question:

What are you prepared to do today?

        Dr. Chet

P.S. There’s a new Straight Talk on Health for Members and Insiders, and I’ve done something a little different. I took the Memos from the week and expanded on what I wrote. More about how my mother-in-law was able to lose weight while being sedentary and tips for other goals such as decreasing pre-diabetes and high blood pressure. If you don’t have a membership, this would be a good time to start.

Weight Loss Is Always Possible

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After last week’s Memos, you may think that you have to do something radical to address your body weight or some other health situation, but that’s not the case. You can lose weight under the most extreme conditions, even if you’re completely sedentary. Let me tell you about my mother-in-law, Ruth Jones.

My mother-in-law struggled with her weight for decades. I don’t know what her peak weight was, but I would estimate around 240 pounds. She maintained around 200 pounds for most of the time I knew her. She had severe arthritis in her knees and because she wouldn’t have been able to do the rehab, the decision was made to replace them both at once. She did great at lifestyle and occupational therapy, but she never quite got the complete mobility she thought she would get because the physical therapy was more of a challenge than she could handle. She was able to get around the house but used a wheelchair or scooter in public.

A few years later, she had a very bad reaction to a new statin that damaged a great deal of muscle mass, and she remained in long-term care until she died several years later. But here’s the thing. Even though wheelchair bound, she was able to lose 30 or so pounds; that’s discounting the last few months before she died when she lost interest in eating.

How? How was she able to do it?

How about you—are you ready to make a change in your weight? Blood pressure? Prediabetes? Then you really don’t want to miss Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet