Ask Dr. Rybicki: Basic Weight Loss Procedures

This time of year many of my patients come to me requesting information on weight loss. There is a lot of information, and misinformation, available to the public which often times is contradictory and confusing. My very first comments to patients wanting to go on a weight loss program, are, that there are no “miracle methods” to weight loss. To achieve long-term and sustainable weight loss, there are still only two important factors: proper diet and exercise. Nevertheless, patients ask me what they can do to at least get started on weight loss. I’ve compiled some basic weight loss procedures, and my thoughts on them. If you have any more specific questions about the topics, post them in the comments and I will try to address the ones that I can.

The first aspect to address is diet. Many patients want to know which diet is the best. Companies, doctors, and researchers have made numerous recommendations from low-fat, to low carbohydrate, to cabbage soup. I find that the most sustainable is low fat, and relatively low carbohydrate diets. I also recommend trying to place a daily calorie intake limit. This depends upon the size and age of the patient when they first come in. Patients also want to know about some of the structured programs that provide all of the food. These programs depend upon a specific fat, carbohydrate and calorie intake per day. These often work well, but this depends upon the patient’s motivation, and willingness to pay for the meals. Some people need to be regimented and eat only pre-packaged food that is specifically portioned. This is fine, but the food program must be strictly adhered to. Cheating will negate any benefits. There are medically prescribed “liquid diets” that also work very well. Once again, however, these must be followed perfectly, or they will not work. Sneaking in other food will make the diet less useful. No matter what diet is chosen, you need to make a long-term commitment to sticking with it. Healthy eating is a life-time process.

Patients also want to know about weight loss medications. Once again, these can be useful to get a start, but are not long-term solutions. One example of a prescription weight loss medication is Phenteramine, which is an appetite suppressant. This seems to work somewhat for a short period of time. It can have some side-effects such as an upset stomach. The effectiveness of phenteramine is usually only for one to three months. Meridia is another appetite suppressant that may work for some individuals. Xenical is a fat absorption inhibitor that keeps people from eating fatty foods, because when doing so, they can feel bad with diarrhea and abdominal pain. Patients often ask about the numerous over-the-counter weight loss medicines. Many of these contain ephedrine, a stimulant, which I do not recommend.

Patients commonly ask be about weight loss surgery, which is also referred to as bariatric surgery. Recent advances in techniques for this surgery have made it much safer and successful. Some examples of this surgery include stomach stapling, gastric bands, and gastric bypass. These procedures are performed by qualified surgeons and require extensive pre-operative testing, as well as aggressive weight loss attempts prior to even considering surgery.

Exercise is the cornerstone of weight loss. I advise patients to start slow and develop an exercise program that includes both core strengthening and aerobic exercise. I recommend that they work their way up to aerobic exercise for a period of 30 to 40 minutes three times a week. Common examples of aerobic exercise include running on a treadmill, riding an exercise bicycle, or using elliptical trainers.

To summarize, while there are ways to get a fast start to weight loss, these will all fail unless you develop a good nutrition and exercise program that can be adhered to for a lifetime.