Education                   CAUSES, TREATMENT (OPTIONS), AND TREATMENT OF COMPLICATIONS                             

   

"Knowledge is Power"               

 

 

 

 

Slimmer Success Founder

Cary Fechter, M.D. 

( taken from National PTA Convention of 3500 attendees)

 * National Keynote speaker on Adult and Childhood Obesity since 2001

 *Cardiopulmonary Medicine, Internist and Metabolic Specialist, Sleep Disorder Specialist

* Behavioral Modification Clinics since 1983                   *Research Physician since 1981

*Founder of the National Student Body Challenge – A broad approach to the many factors that lead to childhood obesity

* American Diabetic Association advocate for a multi-factorial approach to reversing the obesity and diabetic epidemic
 

There are weight-related conditions so serious that you are too sick, have to much joint pain, or are too depressed
to exercise at all or sustain a diet. The depression alone gives the patient the wrong impression that they have "passed a point of no return." Some heart conditions, or stages of cancer are that way, but obesity should always have solutions if patient desire is combined with medical professional training.

You may feel that you have already passed "that point of no return." GOOD NEWS we have had over 1000 patients who have changed their lives by re-focusing on the best that life still offers. So many obese patients are depressed, in fact as the charts below indicate it is the NUMBER ONE association or cause of obesity. So much of our approach starts with perceptions and is guided by medical safety.

For those of you who are modestly overweight and fatigued or have other symptoms, it's our goal to identify the reasons (etiology) of
your weight gain. Usually it's as simple as time-management to get out and exercise, lack of a "weight loss buddy" who wants to be part of your success. We refer to this buddy often, he, she, or the group will "be there" to help you eat right, exercise, and even laugh-away the many daily stresses that lead to comfort-food consumption.

 

We link to the USDA's  EXCELLENT DAILY RECORDING AND CHARTS, which visually reinforces your efforts.
                                                         go to www.
choosemyplate/tools.html
We're all are seeking SUCCESS!!! We  and the USDA and other reputable sources will be your
INTERNET
"Progress Buddies".

But with all the enormous number of on-line articles and tools for weight loss, Americans are still enlarging.

                                    It's been hard to do it alone, so  PLEASE, PLEASE, PLEASE FIND
                          
YOUR REAL-LIFE, CAREFULLY SELECTED, "PROGRESS BUDDY." IT WORKS AND CAN BE FOREVER!!!

   What should buddies do? Start off as friends and just get out and find pleasurable things to do...it starts that simply.
   Then find ACTIVITIES that expend a little energy and calories, then you'll find simple movement an "expression of freedom". Maybe its freedom from the
   embarrassment of your weight or maybe its a freedom to rise above whatever has chained your physical confidence to snacks, a sofa, or  the dinner table. But once you start     enjoying movement and freedom, both your confidence and your food selection will change.
     NOW we have conquered the two essentials of weight loss: diet and exercise.

Athletes, one of which this author was once considered, take it another step: they make exercise a competition. Initially, a competition within themselves, but at least in my case, there was a great pleasure, reinforcement, and CONFIDENCE that came in beating expectations. This is why, in my observations, so many athletes excel in business, relationships, and so many facets of life. I find them typically more spiritual, thankful, and helpful-they expect more of themselves.

At least in my case, I now see obstacles are really just "accomplishments-soon-to-be-attained" that needed to re-emerge after some real hardships. Those previous victories and friends' encouragement is what made me watch my meals carefully the last month, and will make me go swim as hard and long as I can when I finish this section! It's Saturday and the water's warm. NOW, THERE'S NO REASON WHY YOU CAN'T BE THE SAME!!!

You may still be at the stage of finding a reliable buddy, going through the lifestyle contract, identifying the many stressors we all have or "take-on" instead of prioritizing our health. My buddy and I laugh about how many of the stressors have no possible solutions (we call them "eye-rollers") and we just accept them or try to minimize their negative effects. But there are a lot of stressors that can be fully erased, without any repercussions. Go to the lifestyle section which is the key.

Testimonial: For 2 decades, I have given too much to medical rounds and, while my family expected me to manage time and my physical care, priorities were askew and, from a purely body image perspective,  I have a lot more than "love handles" and fatigue issues. But, this is a challenge, less difficult than previous ones, which will make my family and myself quite proud. So, I'm already in my yellow non-speedo® swim trunks and will even giggle about today's writings while flipping back and forth up and down the pool.

Our doctors and testing regimen is carefully designed to recognize medical conditions which have lead to your weight gain. The great thing is that once they are identified, you have changed your lifestyle and/or priorities, and committed yourself to change, then you will NEVER need us again.

However, that mistaken "point of no return" does at times require physician intervention that can range from simple counseling, to sleep condition repair, to typical 6 month courses of appetite suppressants, to either gastric surgery or orthopedic surgery. All these get you up and able to once again enjoy a more mobile-energy expending nature. We promise your family will be proud and pleased, a few creeps might be jealous of your success, and some may even undermine your efforts (misery can enjoy company). You'll also socialize more frequently, and for those without medical conditions...your sex life should be much better with an enhanced self-image, self confidence, and the rejuvenation that comes with healthiness.

 

Disclaimer: The following information, while updated frequently, is not intended to replace physician visits, knowledge or experience. Questions about sections could be further researched by physicians or yourself. These sections provide basic and detailed relationships between weight gain and medical conditions which will help you recognize conditions and potential interventions.

Your browser may not support display of this image.

     THE FOLLOWING ARE GENERAL, BUT VERY IMPORTANT FACTS OR REFERENCE MATERIALS WHICH
     WILL HELP YOU OR YOUR DOCTOR GUIDE YOU TO A LONGER, HEALTHIER, AND SLIMMER FUTURE

 
SECTION ONE

CAUSES OF WEIGHT GAIN: 
OBESITY-RELATED CONDITIONS BY FREQUENCY IN THE USA

THE BASIC CAUSES OF WEIGHT GAIN 

MAJOR MEDICATIONS THAT ARE ASSOCIATED WITH WEIGHT GAIN- BY CLASSES AND ALPHABETICALLY 

DIABETIC MEDICATIONS THAT OFTEN WORSEN WEIGHT GAIN 

SECTION TWO

DIAGNOSIS AND TREATMENT OF THE SERIOUSLY OBESE PATIENT

SECTION THREE

MEDICATION MANAGEMENT:  
SUMMARY OF THE ORAL DIABETIC MEDICATIONS 

SUMMARY OF THE INSULIN PREPARATIONS 
 
SUMMARY OF LIPID MEDICATIONS AND MANAGEMENT 
 
HEART SMART DIET

EXCELLENT FREE HEALTH SUPPORT FROM THE GOVERNMENT/OTHERS   

 
SECTION FOUR

GENERAL EDUCATION: 
THE METABOLIC SYNDROME (Insulin Resistance Syndrome) 
 
 
OBESITY HYPOVENTILATION AND PULMONARY HYPERTENTION 
 
 
OUR FAVORITE FREE ON-LINE HEALTH CALCULATORS

 
____________________________________________________________________________________________________________________   
 

ALL ABOUT US

SECTION ONE

CAUSES OF OBESITY- BY FREQUENCY

Medical Conditions that Cause Obesity that are Very Common

The following causes of Obesity are diseases or medical conditions that affect  
more than 10 million people in the USA:

      Depression         Diabetes

      Dysthymia              Metabolic Syndrome

      Premenstrual Syndrome       Thyroid disorders   
       

Medical Conditions that cause Obesity that are common  
 
The following causes of Obesity are diseases or conditions that affect 
 
more than 1 million people in the USA:

      Autoimmune thyroid diseases           Binge eating disorder

      Bipolar disorder          Cancer – USUALLY associated with weight loss however in early stages patients may develop peripheral edema, effusions, etc.

      Congestive Heart Failure    Eating disorders   Polycystic ovarian syndrome

Causes of Obesity that are less common The following causes of Obesity are diseases or conditions that affect  
more than 200,000 people, but less than 1 million people in the USA
:

      Klinefelter’s syndrome - rounded body type

      Postpartum depression - weight gain

Causes of Weight Gain by Category

Eating more

o Overeating Pregnancy

o Recent childbirth - retaining weight after giving birth

o Aging – often due to changes in activity and metabolism.

o Appetite changes

o High-fat diet High-carbohydrate diet Excessive snacking

o

Page 3

o Sedentary lifestyle

o Reduced exercise or activity level

o Quitting smoking - or other type of tobacco withdrawal

o Rebound after prior dieting Comfort eating Stress eating

Depressive disorders - some people eat more (some eat less)

Several mental illnesses- such as bi-polar disease with excessive appetite,

when in the manic phase

o Compulsive eating

o Genetic tendency to obesity - Familial obesity

· Water retention - retaining fluid rather than true weight gain.

o Premenstrual bloating  
Edema -

o Congestive heart failure Kidney failure Nephrosis

o Cirrhosis of the liver

Lymphatic obstruction

Hormonal conditions

o Hypothyroidism Growth hormone excess AND Growth hormone failure

· PCOS-Poly cystic ovarian syndrome

· Hypopituitarism Excessive Androgens

Postmenopause Orchidectomy Hypogonadotrophic hypogonadism

Non-pathological conditions

      · Smoking cessation Pregnancy Athletes-Weightlifters in particular

       

Medications or Substances That Cause Weight Gain

 (by class-with examples)

PSYCHOLOGICAL

· Depression and Anti-Depresants-Wellbutrin appears to have the least weight gain

· Mania

· Sedatives such as Clonazepam

NEUROLOGICAL ANXIETY /DEPRESSION

Gabapentim Ambilify

Dilantin

ANTI-HYPERTENTIVES

Calcium blockers

DIABETIC MEDS 
 In general, most oral diabetic medications , except Metformin and Januvia, cause weight gain.

        ·  Byetta, Victoza, and Januvia are our favorite weight-related medications. These originally were recommended en AFTER oral diabetics have failed. They are associated with WEIGHT LOSS-but are more expensive (however, managed care plans typically cover the cost) 
        ALL INSULINS are generally associated with weight gain

         

MEDICATIONS ASSOCIATED WITH WEIGHT GAIN                        Your browser may not support display of this image.

                      Your browser may not support display of this image.   
 

 

 

 

 

Oral Diabetic Medications 

 Obese patients frequently have diabetes. Several
diabetic medications CAUSE FURTHER WEIGHT GAIN. Metformin is generally considered the
first choice to avoid weight gain and still control blood sugars. Metformin has other side effects
such as a very rare, but very serious acidosis reaction.
So medication choices require a knowledgeable physician.

Generic Name Action Brand Name Comments WEIGHT EFFECTS
Chlorpropamide

 (older drug)

Stimulates the pancreas to secrete or make more Insulin Diabinese Generally taken one to two times daily, before meals; can have interactions with other drugs. Weight NEUTRAL
Glipizide same Glucotrol   Weight NEUTRAL
Glyburide same DiaBeta/ Micronase/Glynase   Weight NEUTRAL
Glimepiride same Amaryl   Cardiac side effects…to be likely totally removed from the market
Meglitinide Works with similar action to sulfonylureas Repaglinide Prandin Novo Nordisk Taken before each of three meals  
WEIGHT GAIN
Nateglinide Works with similar action to sulfonylureas Nateglinide Starlix Taken before each of three meals WEIGHT GAIN
Metformin Glucophage     Many believe the best oral sulfonalurea for weight  control-NEUTRAL
Metformin (long lasting) Glucophage XR     NEUTRAL
Metformin with glyburide Glucovance     Combination medication
Rosiglitazone Avandia     NEUTRAL
Pioglitazone Actos     MAJOR FLUID AND WEIGHT GAIN
 
 

Byetta, and Victoza are our favorite weight-related type II medication. They are not insulin. They typically should be given AFTER oral diabetics have failed, but before beginning insulin (according AACE guidelines). Byetta is associated with WEIGHT LOSS as opposed to weight gain (managed care plans typically cover the increased cost). They use a much smaller injectable needle, but are NOT insulins.

Januvia is an oral member of the same class of medications. There is weight loss, but some initial reports sugest a lesser weight loss effect.

Insulin Preparations 
Which insulin to choose is based on an patient's lifestyle, your medical preferences and experience, and the patient's blood sugar levels. Among the criteria considered in choosing insulin are:

      · how soon it starts working (onset)

      · when it works the hardest (peak time)

      · how long it lasts in the body (duration)

Since 1982, most of the newly approved insulin preparations have been produced by inserting portions of DNA ("recombinant DNA").. The following table lists some of the more common insulin preparations available today. Onset, peak, and duration of action are approximate for each insulin product, as there may be variability depending on each individual, the injection site, and the individual's exercise program.

Type of Insulin Examples Onset of Action Peak of Action Duration of Action
fast-acting insulin
 
Humalog (lispro)  15 minutes 30-90 minutes 3-5 hours
fast-acting insulin NovoLog (aspart) 
Novo Nordisk
15 minutes 40-50 minutes 3-5 hours
Short-acting (Regular)   Humulin R 
Eli Lilly Novolin R 
Novo Nordisk
30-60 minutes 50-120 minutes 5-8 hours
Intermediate to Long-acting Insulins Humulin N 
Novolin N 
Novo Nordisk
1-3 hours 8 hours 20 hours
  Humulin L 
 Novolin L 
Novo Nordisk
1-2.5 hours 7-15 hours 18-24 hours
Intermediate- and short-acting mixtures Humulin 50/50 
and 70/30 Humalog Mix 75/25 and 50/50 
 Novolin
70/30 
Novolog Mix 70/30 
Novo Nordisk
The onset, peak, and duration of action of these mixtures would reflect a composite of the intermediate and short- or rapid-acting components, with one peak of action.
Long Acting Insulins Ultralente 
 
4-8 hours 8-12 hours 36 hours

 
Lantus (glargine)  1 hour none 24 hours
         
  

Benefit: Lantus Insulin
M
arketed by Sanofi-Aventis is a long-acting basal
insulin analogue, given once daily to help control the blood sugar level of those with diabetes.

When standard NPH is administered at night, its peak of action can coincide with the lower serum glucose levels associated with nocturnal metabolism potentially setting the stage for nocturnal hypoglycaemia. Lantus is associated with a lower risk of nocturnal hypoglycaemia.
This insulin glargine to forms a precipitate (hexamer) when injected subcutaneously into the patient. It can achieve a peakless level for at least 24 hours.

A Synopsis of Lipid Management- Critical Treatment Common in Both Diabetes and Obesity

Treatment Options High Cholesterol *Further comparisons and study is suggested, however the following is a time-saving physician’s tool. It is taken from the ADA, AHA, and other creditable sources intended to be a quick, smart guide to a challenging science which is now America’s foremost clinical problem in morbidity and mortality.

 
Why be aggressive? 
Decreasing total cholesterol by 10% can result in a 30% reduction in coronary heart disease incidence. For every 1% decrease in LDL (bad cholesterol levels), heart disease rates drop 2%. On the other hand, for every 1% decrease in HDL, there is a 2 to 3% increase in the risk of heart disease. 
Patients with established cardiac disease and multiple risk factors (metabolic syndrome, diabetes, or smoking and COMPLIANCE ISSUES) are sometimes given more intense lifestyle changes. Diet and exercise are basic interventions, Healthier Choices’ goal is to summarize medication choices

The decision to start a patient with dietary therapy or drug therapy is usually based on a patient's LDL cholesterol levels, presence of heart disease, and risk factors. Your doctor should calculate your "10-year risk" (also known as a Framingham Risks) for developing heart disease and use that risk estimation to decide if and when to start cholesterol-lowering therapy either through dietary modifications or medications.  
First think LDL not total cholesterol, though relative risks for each are reviewed above. Goal LDL level will also depend on the below listed factors. The following table illustrates guidelines

 

          LDL LEVEL- "The Bad Cholesterol"

          LDL Goal:

          Without heart disease and with less than 2 risk factors:

                  LDL greater than 160 mg/dL start diet therapy+ exercise 
 
                  LDL greater than 190 mg/dL start drug therapy (160 to 189 mg/dL: LDL-lowering drug optional)

                  LDL less than 160 mg/Dl Without heart disease and with 2 or more risk factors with a 10- year risk less than 10%*

                  LDL greater than 130 mg/dL start diet therapy + exercise  
                  LDL greater than 160 mg/dL start drug therapy

                  LDL less than 130 mg/dL Without heart disease and with 2 or more risk factors with a 10- year risk 10 to 20%*

                  LDL greater than 130 mg/dL start diet therapy + exercise 
 
                  LDL greater than 130 mg/dL start drug therapy

                  (LDL 100 to 129 mg/dL: drug therapy optional)

                   LDL less than 130 mg/dL (optional goal: less than 100 mg/dL)

                   With heart disease:

                            LDL greater than 100 mg/dL start diet therapy + exercise  
                            LDL less than 100 mg/dL: drug therapy optional

                   With Type 2 Diabetes Mellitus

                             LDL greater than 100 mg/dL start diet therapy + exercise 
                             (LDL less than 100 mg/dL: drug therapy optional)

                             LDL less than 100 mg/dL (optional goal: less than 70mg/dL**)

*10-year risk calculators are available at on DrugDigest under the ?Interactive Tools? tab. 
**In patients that are ?very high risk? (those with established heart disease and multiple major risk factors including diabetes, metabolic syndrome, and current smokers), a more aggressive LDL goal of less than 70 mg/dL may be encouraged

 
  
 
 

 

        Detailed Discussion 
        For the initial drug treatment of hypercholesterolemia, HMG-CoA reductase inhibitors, "statins", are often used because of their effectiveness and lower incidence of side effects. Currently, six statin drug classes are available. The choice of which to use will depend on how much cholesterol reduction is needed, your preferences (read below for help), and prescription insurance benefits

        Cholesterol absorption inhibitors are a new class of cholesterol lowering agents and work together with statins to lower cholesterol. This class of drugs works to lower blood cholesterol levels by absorbing excess cholesterol (from foods) in the intestines and thus blocking cholesterol's entry into the bloodstream. In a study published by the Mayo Clinic in May 2005, it was found that the addition of Zetia (a cholesterol absorption inhibitor) to statin therapy may cause a further reduction in a patient’s cholesterol levels. It is thought that this reduction may be the result of the two drugs working together but at different areas of the cholesterol production pathway. In fact, one pharmacy manufacturer combined Zetia with a commonly used statin known as Zocor. This combination product is called Vytorin. However, as with any medications, there can be conflicting data. A study released this year (2008) said that objective control of plaque formation in the carotids was NOT seen with Zetia. 
         

    Beyond the basics: Cholesterol Subclasses taken from Berkeley Heart Labs 
    We now know that cholesterol can be broken down beyond just LDL and HDL. Within both LDL and HDL, there exist particles that vary in their characteristics and therefore in their risk (in the case of LDL) and protective (in the case of HDL) factors for CAD. A much better assessment of CAD risk is achieved by enlarging the spectrum of testing to includeadditional disorders, such as a predominance of small particles within the LDL family (small LDL trait), and low levels of HDL2b, the most heart-protective type of HDL. 
     
    This more comprehensive approach can point to treatment that differs from traditional therapy and is more effective in slowing, halting, or reversing the progression of CAD. 
    LDL particles contribute to the harmful buildup of fat inside artery walls, a process called atherosclerosis. The LDL particles contribute to atherosclerosis partly by slipping through the spaces between the cells of the artery0-wall lining and unloading their cargoes of cholesterol inside the wall. LDL particles floating in the blood of the same person vary in size and small particles penetrate the artery wall with relative ease! Making matters worse, they are also more susceptible to oxidation, a chemical process that intensifies the atherosclerotic activity of LDL.  
    People with a predominance of small LDL particles have an increased risk of developing CAD and suffering a heart attack. The small LDL trait is found in 50% of men and postmenopausal women, and in 30% of pre-menopausal women with CAD. The small LDL trait is also present in 50% of their first-degree relatives, who may or may not have CAD symptoms.  
    HDL particles, on the other hand, inhibit atherosclerosis in part by carrying cholesterol out of the arterial wall and, the liver, via the circulation, which can dispose of it. The process is called reverse cholesterol transport. HDL2b is the most active of all the HDL particles in such transport. The more HDL2b you have the better.

    HMG-CoA Reductase Inhibitors -the most commonly prescribed

               HMG-CoA Reductase is a chemical made in our bodies that helps the liver produce cholesterol. HMG CoA reductase inhibitors get in the way of that process, reducing the amount and frequency of cholesterol being produced. These medications cause the greatest reduction in cholesterol at the lowest doses and are used in many individuals at high risk of heart disease, or to help prevent those that have had a heart attack or stroke from having another one.  
    Drugs in the class  
    Atorvastatin (Lipitor) Lovastatin (Mevacor) Fluvastatin Extended-Release (Lescol XL) Fluvastatin (Lescol) Rosuvastatin (Crestor) Simvastatin (Zocor) Lovastatin Extended Release (Altocor, Altoprev) Pravastatin (Pravachol)  Crestor (upda
    Cerivastatin - Withdrawn From The Market (Baycol - Withdrawn From The Market) Cholesterol Absorption Inhibitors  
    Drugs in this class work to lower blood cholesterol levels by absorbing excess cholesterol (from foods) in the intestines and thus blocking cholesterol entry into the bloodstream.  
    Drugs in the class  
    Ezetimibe (Zetia)- see carotid study results discussed above-this drug has a generally very low side-effect profile and continues to be prescribed by cardiologists and other physicians. 
    Page 9

     
    Anti-lipidemic Agents How niacin lowers cholesterol levels is not well understood, but it seems to inhibit production of VLDL, and significantly lowers levels of triglycerides (primary indication) as well as LDLs. Niacin can also raise levels of HDL, the good cholesterol. Fibric acid derivatives affect the breakdown of body fats and reduce the amountof triglyceride manufactured by the liver. A very common side effect called ?flushing? (redness, burning,  
    and tingling of the skin) causes may individuals to stop using this medication.  
    Drugs in the class 
     
    Niacin (Niacor, Nicolar, Nicotinic Acid)
      
    Bile Acid Resins Particles made up of bile and fat are reabsorbed by the small intestine, go into the blood, and travel directly to the liver where the bile is recycled. Bile acid resins absorb bile acid in the intestinal tract rather than let it be reabsorbed and reused by the body. This decrease in bile causes the liver to produce more bile. Since the liver uses cholesterol to produce bile, bile acid resins reduce cholesterol levels in the blood stream. Use of bile acid resins is a conservative approach to treating high cholesterol because the drug's action is limited to the intestinal tract. However, because they are known to be safe and have few side-effects, they are used to treat patients with moderately elevated LDL- cholesterol, in people who do not already have heart disease, and when drug therapy is necessary in young adult men and premenopausal women. They are also used in combination with other drugs (such as statins) to treat more severe forms of hypercholesterolemia. 
     
    Drugs in the class
     
     
    Colesevelam (Welchol)  
    Colestipol (Colestid)  
    Cholestyramine Powder for Suspension (Prevalite, Questran, Questran Light)

     
    Combination HMG-CoA Reductase and Cholesterol Absorption Inhibitors  
    This class combines the most potent cholesterol reducers (HMG-CoA reductase inhibitors statins) with another cholesterol lowering medication (Cholesterol Absorption Inhibitors) in one tablet to give those who take it that extra decrease in cholesterol they may not be able to achieve with one of the medications alone. 
    HMG-CoA reductase is a chemical made in our bodies that helps the liver produce cholesterol. HMG-CoA reductase inhibitors get in the way of that process, reducing the amount and frequency of cholesterol being produced.Cholesterol Absorption Inhibitors block cholesterol found in food from being absorbed into the blood stream from the intestinesThe combination works by blocking cholesterol production by the body and well as blocking absorption of cholesterol from the food we eat.  
    Drugs in the class  
    Ezetimibe and Simvastatin (Vytorin)

     
    Treatment Options Elevated Triglyceride Levels 
    Fibric acid derivative or niacin may be most effective. Both medications work by decreasing the liver's production of triglycerides.  
    Additionally, fibric acid derivatives (or "fibrates") such as gemfibrozil also increase HDL-C production.
    Clofibrate (No Longer Available) (Atromid-S (No Longer Available)) 
    Fenofibrate (Micronized) Capsules (Antara, Lofibra)  
    Gemfibrozil (Lopid)  
    Fenofibrate Tablets (Tricor, Triglide)  
     
     
     

"RE-CROSSING THE LINE"-losing enough weight to  physically exercise and have the resolve to change habits permanently
SUGGESTED TESTING FOR THE SERIOUSLY OVERWEIGHT PATIENT

  • CARDIO-PULMONARY STRESS TESTING  
    FOR EXERCISE CAPABILITY , EXERCISE AND DIET PRESCRIPTIONS-
  • SLEEP-RELATED DISORDERS/LAB- AASM certified sleep lab-with typical symptoms such as excessive daytime sleepiness, snoring, witnessed apnea and preferably with physical findings most common of which are LARGE NECK SIZE (over 17.5 men) , small oral airway passage, retracted chin, usually obese BUT NOT NECESSARILY OBESE!!!
  • PFT’S AND ECHOCARDIOGRAMS FOR PULMONARY HTN, OBESITY- INDUCED ASTHMA- if indicated
  • VASCULAR STUDIES- if indicated ( hypercholesterolemia, OR symptoms)
  • LIPID, DIABETIC, AND THYROID TESTING your lab if requested-if not done within 6 months

Stressing lifestyle changes, exercise, reduced intake, and motivation

  • MATERIALS:  
    Web-site support Lifestyle contracts
  • Fractional cost meal replacements via direct pick-up in Charleston or through internet sales
  • Our favorite diet plans: South Beach, Adkins, Nutri-systems, and Healthy Choice
  • Contracted discounts to local fitness centers
 
 

     Heart-Healthy Diet and Information for the High Cholesterol Patient

         Learn how to eat a heart-healthy diet and reduce your risk of heart disease.

         By paying close attention to what you eat, you can reduce your chance of developing atherosclerosis, the blocked arteries that cause heart disease. If the artery-clogging process has already begun, you can slow the rate at which it progresses. With very careful lifestyle modifications, you can even stop or reverse the narrowing of arteries.

While this is very important for everyone at risk for heart disease, it is even more important if you have had a heart attack and/or procedure to restore blood flow to your heart or other areas of your body, such as angioplasty, bypass surgery or carotid surgery. Following prevention advice can protect against re-stenosis (re-blockage), or the re-narrowing of your arteries.

Feed Your Heart Well

Feeding your heart well is a powerful way to reduce or even eliminate some risk factors. Adopting a heart-healthy diet can help reduce total and LDL cholesterol (the "bad" cholesterol), lower blood pressure, lower blood sugars, and reduce body weight. While most dietary plans just tell you what you CAN'T eat (usually your favorite foods!), the most powerful nutrition strategy helps you focus on what you CAN eat. In fact, heart disease research has shown that adding heart-saving foods is just as important as cutting back on others.

  These are 5 nutrition strategies to lower your cholesterol and reduce your risk of heart disease:

1. Eat more vegetables, fruits, whole grains and legumes. These wonders of nature may be one of the most powerful strategies in fighting heart disease.

2. Choose fat calories wisely. Keep these goals in mind: Limit total fat grams; Eat a bare minimum of saturated fats and trans-fatty acids (for example, fats found in butter, salad dressing, sweets and desserts); When you use added fat, use fats high in monounsaturated fats (for example, fats found in olive and peanut oil).

3. Eat a variety -- and just the right amount -- of protein foods. Commonly eaten protein foods (meat, dairy products) are among the main culprits in increasing heart disease risk. Reduce this nutritional risk factor by balancing animal, fish and vegetable sources of protein.

4. Limit cholesterol consumption. Dietary cholesterol can raise blood cholesterol levels, especially in high-risk people. Limiting dietary cholesterol has an added bonus: You'll also cut out saturated fat, as cholesterol and saturated fat are usually found in the same foods. Get energy by eating complex carbohydrates (whole wheat pasta, brown or wild rice, whole-grain breads) and limit simple carbohydrates (regular soft drinks, sugar, sweets). If you have high cholesterol, these simple carbohydrates exacerbate the condition and may increase your risk for heart disease.

5. Feed your body regularly. Skipping meals often leads to overeating. For some, eating five to six mini-meals may help keep cravings in check, help control blood sugars and regulatemetabolism. This approach may not be as effective for those who are tempted to overeat every time they are exposed to food. For these individuals, three balanced meals a day may be a better approach.

    Other Heart-Healthy Strategies: 
    Reduce salt intake. This will help control your blood pressure.  
    Exercise. The human body was meant to be active. Exercise strengthens the heart muscle, improves blood flow, reduces high blood pressure,          raises HDL cholesterol ("good" cholesterol), and helps control blood sugars and body weight.  
    Hydrate. Water is vital to life. Staying hydrated makes you feel energetic and eat less. Drink 32 to 64 ounces (one to two liters) of water daily (unless you are fluid restricted).  
    Enjoy every bite. Your motto should be dietary enhancement, not deprivation. When you enjoy what you eat, you feel more positive about life, which helps you feel better and less likely to overindulge. 
 
 

EXCELLENT FREE HEALTH SUPPORT FROM THE GOVERNMENT/OTHERS  

http://www.health.gov/ A great free US government website for general health issue…use the healthfindrer to learn what IS RECOMMENDED for American by age, sex and if pregnant

Your browser may not support display of this image.

http://www.healthfinder.gov/ a very good search engine with supportive links

 

GENERAL EDUCATION:
SERIOUS CONDITIONS ASSOCIATED WITH SEVERE OBESITY WHICH YOUR MD MUST BE AWARE AND ADDRESS

The Metabolic Syndrome 
(Insulin Resistance Syndrome)

http://www.americanheart.org/presenter.jhtml?identifier=4756 Characteristics according to The American Heart Association  
Central obesity (excessive fat tissue in and around the abdomen)- Elevated waist circumference: Men: Equal to or greater than 40 inches (102 cm) Women : Equal to or greater than 35 inches (88 cm)

· Dyslipidemia (blood fat disorders — mainly high triglycerides (Equal to or greater than 150 mg/dL) and Reduced HDL ("good") cholesterol: Men — Less than 40 mg/dL Women — Less than 50 mg/dL Insulin resistance or glucose intolerance (the body can’t properly use insulin for blood sugar) Elevated fasting glucose: Equal to or greater than 100 mg/dL (5.6 mmol/L) or use of medication for hyperglycemia Hypertension (130/85 mm Hg or higher) 
Some studies include:  
Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor)Proinflammatory state (e.g., elevated C-reactive protein) 
CAUSES overweight/obesity physical inactivity genetic factors RESULTS coronary heart disease type 2 diabetes stroke and peripheral vascular disease 
Obesity is now more serious than smoking and is very treatable. Management should NOW be a major goal for every great physician.

Obesity Hypoventilation Syndrome

The obesity hypoventilation syndrome, also known as Pickwickian syndrome, is the combination of obesity , falling oxygen levels in blood (hypoxia) during sleep and increasing carbon dioxide levels (hypercapnia); this is the result of hypoventilation (excessively slow or shallow breathing) during sleep. Obstructive sleep apnea is often but not necessarily present. Pulmonary hypertension is common and later causes cardiac arrhythmias.  
SIGNS AND SYMPTOMS

Most people with obesity hypoventilation syndrome have concurrent obstructive sleep apnea, a condition characterized by snoring, brief episodes of apnea (cessation of breathing) during the night, interrupted sleep and excessive daytime sleepiness. In OHS, sleepiness may be worsened by elevated blood levels of carbon dioxide, which causes drowsiness ("CO2 narcosis"). Other symptoms present in both conditions are depression, hypertension (high blood pressure) that is difficult to control with medication and headaches occurring in the morning. Blurring of vision and visual changes may result from papilledema (swelling of the optic disc) in response to the raised carbon dioxide levels.

Diagnosis

If OHS is suspected, various tests are required for its confirmation. Arterial blood gas levels are determined to measure oxygen and carbon dioxide levels; this requires a blood sample from an artery, usually the radial Page 14

artery. To distinguish various subtypes, polysomnography is required. To distinguish between OHS and various other lung diseases that can cause similar symptoms, CT scan, PFT’s and echocardiography may be performed. Criteria

Formal criteria for diagnosis of Obesity Hypoventilation Syndrome are:

Body mass index over 30 kg/m2 , Arterial carbon dioxide level over 45 mmHg , No alternative explanation for hypoventilation-such as use of narcotics

 
Treatment

Reduction in weight, either through a regimen of diet and exercise, medication or sometimes through bariatric surgery, has been shown to improve the symptoms of OHS and resolution of the high carbon dioxide levels. Weight loss may take a long time and is not always successful.

Overnight mask ventilation with positive airway pressure may lead to an improvement in most symptoms of OHS. 
 

Our Favorite On-line FREE Weight Loss calculators: tools are also available through the USDA website                          www.choosemyplate.gov


Measure Your Metabolism

http://health.msn.com/weight-loss/measure-your-metabolism.aspx

Calculate your daily caloric needs. You will find by comparing light activity to moderate activity…that increased activity will greatly reduce weight if done regularly!!!!

This chart is taken from the web page: there is about 700 calories per day difference between a very light and moderate activity level (that’s one pound a week!!! Activity Level:

Choose an activity level below to determine how many calories you burn a day.

  Very Light Seated and standing activities, painting, driving, laboratory work, typing, sewing, ironing, cooking, playing cards, playing a musical instrument
  Light Walking on a level surface at two-and-a-half to three mph, garage work, electrical trades, carpentry, restaurant trades, housecleaning, child care, golfing, sailing, table tennis
  Moderate Walking three-and-a-half to four mph, weeding and hoeing, carrying a load, cycling, skiing, tennis, dancing
  Heavy Carrying a load uphill, felling a tree, heavy manual digging, basketball, climbing, football, soccer
  
 

Typically a higher activity category will burn on average about 550 additional calories per day!

Weight Loss Calculator

http://health.msn.com/weight-loss/weight-loss-calculator.aspx

Find out how long it will take to reach your healthy weight loss goal, and how many calories you should consume each day.

We use this calculator to also show how many days it would take to lose to a target (or desired) weight—given that you burn or exercise different calories each day

FOR MORE OF OUR FAVORITE GREAT CALCULATORS .....http://health.msn.com/tools-and-resources 
                  

 

 

           OUR LOCATIONS:              Your browser may not support display of this image.

                 MOUNT PLEASANT 
                                                                                      EDUCATIONAL MATERIALS, DIETARY SUPPORT,  
                                                                                      MEAL PLAN REPLACEMENTS, TESTING AND  
                                                                                      MEDICATION PRESCRIPTION DISTRIBUTION
Your browser may not support display of this image.   Your browser may not support display of this image.  

                                                           

        TURN RIGHT AFTER THE BANK IF HEADING TOWARD THE BEACH,
               THE
STREET SIGN WILL READ “GROVES OFFICE BUILDING”

 

  JAMES ISLAND LOCATION
                                                                                      EDUCATIONAL MATERIALS, DIETARY SUPPORT,  
                                                                                      MEAL PLAN REPLACEMENTS, TESTING AND  
                                                                                      MEDICATION PRESCRIPTION DISTRIBUTION
Your browser may not support display of this image.

 

   NEXT TO THE WACHOVIA BANK, NEAR THE FOLLY AND MAYBANK INTERSECTIONS

  Your browser may not support display of this image.

                  

   
 
If you have any questions about Slimmer Success email: info@slimmersuccess.com or call 843-795-1025
Website questions or comments may be directed to: webmaster@slimmersuccess.com
Copyright 2006. Slimmer Success, Inc. All rights reserved
DISCLAIMER: ALL ADVICE MUST BE REVIEWED BY YOUR LOCAL MEDICAL PROVIDER. THIS WEBSITE IS INTENDED TO GUIDE
THE READER TOWARD A HEALTHIER FUTURE AND DOES NOT REPLACE DIRECT MEDICAL SUPERVISION. ENROLLMENT AT THE  SLIMMER SUCCESS WEIGHT CENTERS WILL ESTABLISH A PHYSICIAN-PATIENT RELATIONSHIP.   DIRECT PHONE :843-795-1025
 
 

 
 
 
 
 
Your browser may not support display of this image.
Your browser may not support display of this image.
Your browser may not support display of this image.