MESSAGE FROM A PATIENT ON MAINTENANCE

My goal with all my patients is always the same; Not only to LOSE the weight, but also to MAINTAIN the weight loss. Maintenance is the hardest part. It starts the day you hit goal, and ends the day you die. Hopefully that is a very very long time, but the triggers that got you into trouble (and made you overweight) are still out there calling your name.
We work very hard at maintenance in my office, we explain what is going to happen, and how to handle the many challenges. We have some follow up visits, further and further apart, until the patient feels confident that he or she can do this on his/her own. We support and help in every way we can.
We are very proud of our very high success rate on maintenance, which we estimate to be 92% to 95% at the 2 year after hitting goal mark. This means that most of our patients have made a life style change.
Here is an email I got, just a few moments ago, from a patient on maintenance:(patient lost 44 lbs.)

NAME REMOVED TO PROTECT THE PRIVACY OF THE PATIENT
To:
Dr. Winifred Constable

Apr 4 at 8:46 PM
Hi Dr. Constable,

I hope that you are doing well.
I was a patient of yours from January through August of last year and think you might be interested in an update on my weight loss.
At this point, almost eight months since I went on maintenance, I am a couple of pounds below my maintenance weight.
More importantly, as a result of the weight loss, my blood pressure is now down to low normal.
Even more exciting, I now no longer need to use the CPAP that I had used religiously for my sleep apnea since 1994!
So, thank you for your help in achieving this.

IT IS NOT HOPELESS

I remember the days when I was very overweight, and at times feeling so incredibly frustrated. I felt like nothing worked, no matter how hard I tried,I would never be able to get the weight off. After 15 years of struggling, losing some, then regaining, then partially losing the weight again, I gradually figured out how to lose weight and keep it off forever. It took hundreds of hours of studying, lights turning on in my head when I was learning biochemistry in grad school, going to medical school, seeing patients with the same issues, it finally happened. I lost my 90 pounds and kept it off for years, only gaining two to three pounds on occasions like birthdays. I was done.
A recent study by Time Magazine examined all the weight loss programs in the country, all the diets being followed in the last year, books on weight loss, doctors formulas, and finally the latest research conducted at large universities on obesity,and they concluded exactly what I tell all my patients.

And here it is:
1. There is no one size fits all diet that will work for everyone. People are very specific and varied in terms of what will make them successful at losing weight. A high fat low carb diet works for some, a very high in complex carbs and Balanced diet works for others, and so on.
2. Everyone that has lost a large amount of weight and keeps it off eats breakfast.
3. Everyone that has lost a large amount of weight and keeps it off exercises at least five days per week. It is not violent exercise. It is cardio.
4. Everyone that has permanent weight loss has a strong reason for wanting to be thin, and it is not just looks.
5. HERE IS THE MOST IMPORTANT MESSAGE:
EVERYONE WHO HAS LOST WEIGHT AND KEPT IT OFF DID NOT SUCCEED AFTER JUST ONE TRY. MOST PEOPLE TRIED AND FAILED AT LEAST SIX TIMES.

So, if you are reading this and have failed at several diets, and you really want to lose weight and be healthy and slim, please do not give up. If you keep trying, and you really care, you will at some point find the answer that is right for you, and you will achieve your goal. But please do not give up. Persistence is the key.

I DONT LIKE THE KETO DIET

Every week, every month, every year brings in a new diet idea, in this constant frenzied attempts to get control of our weight here in America. And no wonder, at least 70%, (and more by some figures,) of Americans are overweight, and at least 40% (or more of us) are obese. Everyone is trying to slim down.

The latest rage diet is the keto diet. What is this? It means eliminating almost all carbohydrates from your diet, such as cookies and ice cream, wine and bread, but also fruit and yogurt, virtually all foods that have carbohydrates. This means that your body will use fat as its energy source and you lose weight. In the process of breaking down fat, your body releases ketones into the blood.

Sounds great! Losing lots of weight, slimming down. But here is the problem. Every day that you are in ketosis, the body recognizes that you are in starvation mode, and it starts increasing the levels of a very powerful hormone called a ghrelin. This hormone goes to a very specific place in the brain called the arcuate nucleus of the hypothalamus. It triggers you to have hunger, cravings, and the “munchies.” The longer you are on the keto diet, the higher your ghrelin levels, and the stronger these feelings become. It is a matter of time before you are going to breakdown and eat some carb that is forbidden. And once you start eating carbs, it will be like an avalanche. You will find yourself spinning out of control, eating more and more.

The other thing that happens on the keto diet is that you body goes into starvation mode. In attempt to save itself, the body slows down your metabolism. You can burn 500 to 700 calories less per day than when you are not on the keto diet.
.
So on the keto diet, you have very high ghrelins, you have slowed down your metabolism, and now you breakdown and start eating carbs. Result? You gain back all your lost weight and probably more (remember, your metabolism has slowed down). You feel frustrated, defeated, and locked into a weight you cannot seem to get under control.

My advice, it if it seems too good to be true, if it is the latest fad, it is probably not the right answer.

What is the right answer? A diet with the right kind of carbs and the right amount of carbs; but it has to be personalized to you, because we are not all the same. There is no one size fits all formula for weight loss, or for how many carbs you need to eat. And that is exactly what we do here at Balance Medical Weight Loss.

PLEASE END THE MADNESS

If you are trying to lose weight, you might feel overwhelmed and confused. There is so much advise, so many diets out there, so many people telling you what to do. Everyone from weight lifters, to chiropractors, nutritionists, to trainers, and even doctors who dont work in the weight loss industry, everyone has an opinion. And yet if you look around America, all of this information is not helping, our obesity problem is worsening. There are many statistics, but most investigators agree that at least 70% of Americans today are overweight, and at least 30% are obese, and the situation is worsening. No matter how you look at it, it’s bad. With obesity comes diseases: diabetes, high blood pressure, arthritis, asthma, heart disease and heart attacks, and the monster in the closet no one talks about, cancer.

Most weight loss programs advocate a decrease in intake of calories, very clean and very simple, eat less calories than you burn, and you will lose weight. I am here to tell you, that if you are still counting calories, you are living in the dark ages. It does not work, it will probably not get you to your weight goal, and in the rare case that it does, you will live in a state of hunger, until you break down to return to eat the foods you miss and crave. Please, end the madness of counting calories. It is time to make a real change in your life.

Why does counting calories not work? Because all calories are not the same and don’t affect your weight the same way. Does anyone really believe that eating two hundred calories of chocolate chip cookies affects your weight the same way as eating two hundred calories of grilled tuna fish? Of course not, simple logic tells you this. But more importantly hundreds of medical studies have confirmed this fact. A recent study in a medical journal of JAMA (Journal of the American Medical Association) studied 50 obese adults, all put on diets with the exact same number of calories, but the diets had different compositions. The participants who ate the low carb diet burned 325 calores more per day than those on the moderate carb diet (40% to 60% carbs). On a a low carb diet, the patients lost a lot more weight.

Do I advocate a diet where you go into ketosis, that is a very very low carb diet, with high protein and high fat intake? No, I do not. Why? Because again it will not work long term. First of all, who can live that way? Who can live without every eating a piece of bread or fruit? Lets examine an all protein diet from a scientific standpoint: when you go into ketosis, that is you eliminate all carbs, you will lose weight; but two other things happen. Your metabolism slows down, because your body “knows” you are in starvation. And your nasty little hunger hormone starts to kick up, because your body needs carbs to run correctly. You get more and more hunger, cravings, and the munchies. At some point you will breakdown and start eating carbs. And when you do breakdown, there is going to be a landslide, you will find yourself out of control, eating more and more carbs, feeling like you cannot stop, and this will be followed by frustration. Before you know it, you will have gained back all the weight you lost and more. You will be worse off than when you started.

What do I advocate for permanent weight loss? I advocate the right amount of carbs for you, and the right kind of carbs. No processed foods. You also need to eat the right amount of fat and protein specific for you. I believe in a healthy balanced diet, eating three meals and at least one snack a day, all composed of real food, no meal replacements or frozen foods. In a good weight loss program, your hunger hormone should be quiet, you should not have that constant feeling of “fighting” your hunger.

Patients come into our office for their visits and are frequently surprised by how much weight they have lost. They did not feel hungry while they were losing weight,
instead they tell us that they have energy, they sleep better, have internal balance, and are happier. The average weight loss in our program is about 75 lbs, but some people only want to lose 5 lbs but want to know what they should be eating; others need to lose 200 to 300 lbs. What everyone here shares in common is that they never count or even think about calories but they also never feel hungry. They are learning about food, and what they need to nourish their bodies and be slim.

Please end the madness. Get out of the dark ages. Stop counting calories. It will never get you to where you need to go with weight loss. Instead learn about food and its chemistry, learn about what combinations you should be eating. Decide you are looking for permanent weight loss, not a constant roller coaster of losing and gaining it all back.

From a patient

Sometimes I feel that doctors say too much, write too much, lecture too much. Sometimes it is better just to say nothing and to listen to our patients, or for perspective patients to hear from other patients, who have been down in the trenches and struggled successfully with weight loss. These patients give a different perspective than I, as a doctor, give.
So here is a recent email I received from a patient of mine. She has lost about 80 lbs, she has about 70 lbs more to lose. But as a doctor who has seen so many patients make this journey, I know she is going to be a success story. How do I know this? Because she is in a routine of eating that she is comfortable with, that she knows she can live with for many many months, that also makes her lose weight steadily. Because we have discussed so many other issues in her life that impact her eating, and she is successfully coping most of the time (no one is ever perfect). And most importantly I know that she will never give up, even when she has set backs.
SO here is what she wrote:
(her name is taken out from here.)
To:Dr Constable
Sept 30 at 4:07 AM
Since I posted it on Instagram, I thought I’d share what I captioned this photo (photo not shown here):

“I have struggled so much over the years with pcos. Weight gain, messy hormones, no confidence, and just feeling lost and upset in my own body. A year ago I committed to making a real change. I’m so grateful my amazing doctor nutritionist (Balance medical weight loss!), and my incredible support system. It’s so much more than weight loss. It feels like I finally have life back.”

I really don’t have the right words to thank you for how far you’ve brought me and how excited I am to see how much farther I go. You’ve taught me balance and how to eat and cook and how to do this the right way and it’s impacting every other aspect of my life in a positive way. And I’m only about halfway to goal! It’s just going to keep getting better.

Thank you for your guidance and kindness in the process. It’s one of the first times in my life that I have felt strong, beautiful, and proud of my body.

(her name deleted)

> Sent from my iPhone