Options for Weight Management

Being overweight is not a crime

Most people, including physicians, judge overweight people to have poor will power. Insurance companies do not cover the condition, physicians who treat obesity have been looked down upon, and drugs for appetite control are looked upon with suspicion. Overweight individuals are less likely to be admitted to college, to receive financial aid, to be hired, to receive a fair wage, and to be seen as socially desirable.

If you are overweight, you need to be aware that losing weight isn't the only thing you need to do. You need to be aware that other people relate to you in a different way because of your weight and may resist, sabotage or hamper your work of losing weight. Your self-image has been altered by being overweight and your emotional self may have been injured. You have an illness which may engender shame in you because you have it and feelings of judgement and pity in those who see you.

Even when you have your weight under control, you live with the awareness that your excess weight could return, and those feelings could return. If you want to improve your health, and I believe you can, you need to face these and other unpleasant facts about being overweight. If you require the help of your physician, your pastor, or other professional to heal your inner self, please do it.

You are much more than the body and physiology you happen to have been born with.

Weight management - not weight loss

Anyone with any experience with weight loss knows that weight loss is too frequently followed by weight gain. Weight management is a life-long challenge if you tend to gain excessive weight. This is because your genetic tendency is to save calories as fat rather than to burn excess calories as fuel. And your genetic make-up isn't going to change no matter what your weight is.

Like the alcoholic, you need to realize that there are things the average person does that are very harmful for you.  Whatever efforts you make to improve your health are valuable.  If your weight goes up again, this does not mean that the initial effort was worthless. While your weight was down, that stress on your vascular system that contributes to stroke and heart attack was on vacation.

Options for weight loss

• Although exercise and lifestyle modification are important for weight loss and weight maintenance, most people need to modify their diet to lose weight. Many of our patients are on a "dysglycemic diet," intended to moderate glucose and insulin levels in the blood. This requires some change in your eating habits. Usually people lose weight without great difficulty, and find that this is a program that they can continue for some time without great distress.
• Another option is the protein-sparing modified fast. This is a lower-calorie diet for more rapid weight loss.
• Medications can help you change your habits of eating.
• Sibutramine (Meridia®)
• Phentermine
• Diethylpropion
• Fluoxetine (Prozac®)
• Certain nutrients can help break the cycle of fatigue and weight gain.
• Surgery

Requirements for weight loss

• Medical evaluation for treatable conditions, both metabolic and otherwise
• Proper nutrition
• Increased activity
• Knowledge about weight gain and the metabolism of obesity.
• Lifestyle modification

Requirements for health and weight maintenance

• Activity as a part of daily life -- someone without a weight problem can afford to be a couch potato for a few days. You cannot.
• Intelligent eating habits -- many people can get away with carelessness in what they put into their mouths. You cannot.
• Continuous lifestyle awareness -- many people are not aware of what you know because they have not faced the challenge you face. You don't have that luxury.
• Medication, diet, medical, or lifestyle changes if required by renewed weight gain. Being overweight is for life. As with any chronic condition, you always will want to have a knowledgeable and sympathetic physician on hand.

Being overweight is not a character defect.

The challenges that we are given in life make us stronger people. You have been given a particularly difficult challenge. The strength you gain in facing this challenge means that you will have more to give to those people you love.

Links

The American Society of Bariatric Physicians can refer you to a physician in your area.

Economic post-script

Obesity-related organizations have succeeded in convincing the IRS to allow weight-control treatment as a medical expense.

IRS publication 502 for the year 2000 provides on page 11 "You can include in medical expenses the cost of a weight-loss program undertaken at a physician's direction to treat an existing disease (such as heart disease). But you cannot include the cost of a weight-loss program if the purpose of the weight control is to maintain your general good health." (We obtained this information from the American Obesity Association.)

3/28/04

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