Sunday, February 2, 2014


F.A.T. - Food Addiction Treatment
Obesity is at epidemic proportions in North America.  Obesity is certainly not good for morbidity or mortality. The fat we see on the outside is also surrounding and clogging all our internal organs. The heart is constricted with fat. The weight of the body is destroying joints.  The weight of the chest is obstructing breathing.
All manner of illness is more prominent among fat people.  Obesity is roughly 50 lbs over what one’s projected normal weight to height should be.  In the past this was done with routine height and weight charts. I still prefer this to fancier (Body Mass Index) but more complicated methods of assessing how fat one is.
The worst indicated is the pear shape at the middle. This is associated most with development of disease.  Diabetes, hypertension, just another couple of examples.  Success is reducing waist size.  Being tall I hide that I really 'should' be 4 to 6 inches less at the middle.  I love to kid myself, that it's posture. I can 'suck it' in the belt is supposed to be 'straight' not curved at the front.
Obviously it’s a black box equation.  Too much food in and not enough exercise out.  There are those who say they have ‘slow metabolism’. Maybe, rarely. There are countless excuses.  The fact remains, obesity is unhealthy. Fat is unhealthy.
See your family physician and get a complete physical to make sure you're not fat because you're suffering from some disease like hypothyroidism.
I recommend Overeaters Anonymous. There are a variety of self help 12 step programs. They are all beneficial.  Mostly they focus one on being ‘honest’ and ‘accountable’.  They recognize that food addiction, overeating, is done for emotional reasons, to stuff emotions, such as fear or resentment.  Expectations are pre formed resentments. Fat people are commonly passive aggressive, angry on the inside, smiling on the outside, people pleasers.
The most common mental illness associated with fat is depression.  Unfortunately a lot of antidepressants cause increased weight.  Wellbutrin and Cymbalta are neutral medications that are least likely to cause weight gain. If you do gain weight with an antidepressant this can be counteracted by the addition of dexedrine to treat the 'side effect' of therapy. Other psychiatrists would add synthroid to counteract the weight gain effect of those antidepressants that cause weight gain in susceptible populations.
Often fat people are bipolar too.  They've not uncommonly had a lot of trauma.  More often than not a lot of it's been sexual.  Since sex is an athletic activity fat people aren't very good at it.  They don't like being on top and might crush their partner if they were.  They can be loving but are often hurt and hurtful lovers.
There are very important ways to reevaluate one’s life and ambition and look for more positive ways to achieve realistic goals without becoming the Michelin Man in the process and having an early death.
I recommend Fat is a Family Affair by Judy Hollis.  Excellent book. Good ideas and tools.  There are other good books out there.  Therapeutic reading is helpful
Fasting at least a day a week or by missing meals with good education and therapeutic plan is a great diet approach.  If one is on medication discuss it with a doctor knowledgeable of fasting. The principle problem is that people don't drink enough fluids when fasting. It's amazing how much fluid one gets in food so this has to be compensated for by literally forcing down a couple more glasses of liquid than one feels they wants.
There are a variety of diets. None of them is good enough alone. They must be coupled with a whole change of life and lifestyle.  People usually diet like drunks change from drinking vodka to beer without really addressing the problem.  Fat and obesity are life long problems.  The failure of diets is that one doesn’t follow them or returns to previous behaviour the first stress one encounters.
I recommend 500 calorie diets. In my obesity clinic, everyone lost 50 lbs or more in a matter of months to a year.  However, though I recommended 500 calories everyone cheated . When I had a sweet little silly headed nutritionist come in and recommend 2500 calorie diet all my big boys and girls took that to mean 5000 calories. People lie and cheat with diets.  Best recommend 500 and be done with it.  Aim for perfection and be thankful you hit the target even if you’re way off the bull’s eye.
To understand the principles of what is 'good nutrition' understand the Mediterranean Diet and the Zone Diet. All the rest is gooblygook and confusing.  There are no obese people over 100 and the diets of longevity are in the long run the best diet. If you are rich you can be a vegetarian. Rich vegetarians live long but poor vegetarians die young.  Being rich is more associated with longevity than diet. But fat rich people die the same horrible deaths that fat poor people do.
I knock 'fad' diets but there are good people out there like the Jenny Craig folk and others. Check them out and do something.
Obviously seeing a psychiatrist is a good idea.  I’m a psychiatrist and a whole lot of my obese patients had underlying ‘issues’ which had to be  addressed for the various other tactics and strategies to work.  I don't think seeing a slim counsellor is that helpful unless the slim counsellor used to have a problem with fat and now is and remains slim. Ask to see their fat pictures.  Given counsellors have the least education it's best if they have the most experience. I've got the most education and it helps that I have a little of my own experience.  I've seen too many people talking about things which never came hard for them and what they're saying only works for others like them. It doesn't work for the obese.  Obese people are resistant to learning. They're not stupid. They 'know' what's good for them. They just have difficulty 'doing' what's good.
Exercise and coaches and physiotherapists are all very helpful.  Aquafit exercise program is the best program for the really obese.  Obviously jogging is great exercise but if you're five hundred pounds and start jogging you're going to cripple yourself.  Start slow , go slow and don't hurt yourself with whatever exercises you under take.  I like martial arts. Tai Chi is great. Yoga is good for flexibility but not that good for losing weight.  Group therapy, some kind of group exercise program, is the least expensive but also the most effective long term.
An american military study showed that once a certain level of exercise was achieved, a few hours  on the military obstacle course for instance, then force feeding wasn’t associated with weight gain. This study showed that diet came second to exercise.  Most people are too fat to exercise or like exercise hence the benefit of personal coaches and beginning in the safety of ones home only to progress to the group experience.
When you lose weight, 10 lbs or 20 lbs, a size or two, then buy new clothes and burn the old ones, or at least give them to the Sally Ann.
Now having done all this there are medications which help.
First and foremost consider what medications you are taking that might be adding to the problem. High dose antipsychotics, like seroquel, often used for sleep  or anxiety often increase appetite and put on weight.  Discuss medications with the doctor and make sure if possible you’re not on anything that will be complicating matters if possible. Don’t stop medications just because they can cause weight gain by affecting appetite.  The worst medication for obesity is so called 'medical marijuana'.
Don’t drink or smoke dope.  Face it, alcohol is empty calories, leads to poor judgement and marijuana, especially ‘medical marijuania’ causes the munchies.  We used it with AIDS patients to improve their appetite and increase their weight,  for that reason.
Xenical is an interesting and relatively safe medication. It works by reducing the absorption of fats. Several of my patients swear by it. The only side effect they noticed was a little bit of loose stool and they had to be more careful about farting in public, not because of leakage but the smell was noticeable or something like that, as I remember. Didn’t stop them from using it.  There’s a whole list of side effects but compared to obesity they’re all minor.
Dexedrine and other appetite suppressants are what the models and such use. These are essentially ‘prescription’ speed.  They are excellent for appetite suppression however they are also highly addictive. When I ran an obesity clinic I used them for 6 week bursts , when people on a regular exercise and diet program got ‘stuck’. Weight loss tends to go in steps and sometimes the use of an appetite suppressant helped one over that ‘hump’.  The critical factor here is that the doctor be working closely with you and also be monitoring your weight. No sense taking these if there’s not significant weight lost. The cost of addiction then outweighs any benefit. Further the risk is that people will continue them and want increased amounts. That’s a danger sign. Further they shouldn’t be continued if they cause sleep problems.  However if a person is already on sleep aids they can be tried because they won’t necessarily be making a sleep disorder worse if taken early in the day.
I don't think it's a coincidence that a whole lot of people who got fat suddenly got 'adult attention deficit disorder and got their hands on medical speed for appetite suppression.  The tragedy of this approach is that it means the doctor isn't working with you on the obesity problem and merrily going along with the idea that you can't concentrate.  Which might be true, given how distracted you are by the munches.
Revia is a novel medication with great promise. I’ve had success with this and really should use it more. It’s not a cheap medication and I’ve thought about cost prescribing it however when I consider the fortunes that people use on unproven alternative health aids and silly fad diets, Revia is far superior. It was found that it reduced craving in alcoholics and addicts. From that it followed that it might reduce food craving. And that’s what it does. Reduces craving for foods by 50% .  It’s a relatively safe drug with great benefit .It’s really worth a trial with any obese people where the safety is assured.  It’s benefit is seen in a 3 month trial for instance and the potential of negative side effects aren’t as bad as the hazards of obesity in general.  My patients haven't had negative side effects to date.  Everyone knows about 'negative side effects' these days because it's a lawyer thing and it's out there for the ambulance chasers and as a medical disclaimer for the manufacturer. In a lot of cases these long lists are about as useful as coffee cups which say on the side ,be careful ,cup may be hot.
If these don't help really consider boot camp and a 1-4 week treatment spa where one goes for the sake of losing weight and getting healthy.  Alcoholics have embraced Betty Ford so I don't know why the fat church ladies aren't getting on the wagon too. There are many out there and they do work.  So if one remains obese for a year or two, think of the drunk husband who keeps falling off the wagon, then consider the fat farms.
It's easy to treat obesity earlier than later.  That's the case with all diseases.  Nipping them in the bud is what one does before consider nip and tuck.
After one has failed with exercise and diet and programs  one really should consider surgery though. 30 years ago I was assisting a surgeon doing stomach stapling.  It was relatively experimental back then but today it’s fairly routine with the safety of the surgery pretty much overall established compared to the risks of gross obesity.  The first step is to talk to your family physician about surgery and get a consult to a surgeon who does surgery for obesity.  You don't get the surgery that visit. He tells you about and assesses your risks and lets you know if surgery would be for you.  You don't have to decide then.  But now you know. If you're grossly obese and have been for awhile then you're kidding yourself if you haven't talked to a surgeon. It's like a person who complains about having to walk to the bus who has never even talked to a car dealer to see if there might well be a car they can buy.
I’m a little overweight. I wouldn’t mind a little liposuction but I’m not planning on stomach stapling. But if I was a couple of hundred pounds overweight and had failed at a variety of approaches I’d certainly give it a go. Several of my patients have had long term benefits from it and I’ve seen them and been surprised to hear they once were grossly obese. Their lives are going well today only they can’t gorge on food. Regular servings is as much as they can take.
The key is to get a ‘plan’ and go with it. Don’t do it alone. Work with your doctor and better still surround yourself with a ‘team’ of people including family and friends who are on board with your plans and know your goals.  Imagine how stupid the world would be still if we didn’t have schools and take a regimented approach to learning.  Stupidity can be ‘cured’ . Education even treats arrogance because the more you learn the more you realize how much more there is to learn.  Sloth and gluttony are treatable.  You don’t have to be ashamed.  It’s a life long process with no easy quick cure. Plans involve life style changes that occur for years even after making the ideal weights. My patients commonly tell me of ‘relapses’ that occurred after five or ten years of maintaining a healthy weight.  Then they go back to basics and progress through to advanced weight maintenance learning all over again.  Success is normal if you follow the steps.
With an aging population and the improvement in the comfort of the couch and the advent of the tv channel changer we’ve got more to face than the previous generations that had to chop wood for their heat and use a pump to get water.  We’re adapting as a civilization to the digital age.  And yes, just like we know that Goldman Sachs were developmentally challenged as human beings so are the folk that produce those disgusting fast food vending machines for schools.  We collectively dealt with the tobacco companies and the psychopathic CEO and their vampire disgusting children and collectively we’ll have to eventually deal with the folks ‘pushing’ sugar salt fake food substances on us and their degenerate young.  That comes later.
Before we can kick ass we've  got to deal with our own lard asses,  get out and exercise, ask for help, network, plan, strategise, and lose weight and get healthy.
What use are you going to be to the rest of us when the zombie wars start. We’ll be dragging your ass and the zombies will be charging for the greatest mass of flesh which is you.   If you want help then start helping yourself now.


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