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Healthy Monday: Lose some weight the smart way this year

POSTED: January 4, 2009 11:54 p.m.
SCOTT ROGERS/The Times

Shirlice Irick performs split squats under the watchful eye of Pedro Ferrer, the Fitness Forum's director of personal training, on Friday morning. It's early January, and that means many people have resolved to lose weight. Losing weight through exercise and sensible eating takes longer, but experts say you're more likely to keep the weight off and learn new habits that will last a lifetime.

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It should come as no surprise that losing weight is the most common New Year’s resolution. With the long season of holiday indulgence finally over, many people aren’t happy about what their bathroom scale is telling them.

But some are so motivated to drop those excess pounds that they’ll do just about anything to achieve their goal sooner. Sometimes they resort to taking "herbal" pills that claim to help them "burn fat" and boost metabolism.

What the pills actually boost, however, is your blood pressure. Dr. Andy Jaffal, an internal medicine physician at the Longstreet Clinic in Gainesville, said though these pills may help control hunger, he doesn’t recommend them.

"Appetite suppressants are stimulants, which can be dangerous," he said. "Also, these supplements are not regulated by the FDA, and they may contain substances that interfere with other medications you’re taking."

In fact, the U.S. Food and Drug Administration recently analyzed a number of these products and found that they are not necessarily herbal or natural. Some contained active pharmaceutical drugs with potentially harmful side effects.

The FDA doesn’t have jurisdiction over herbal supplements. But because these products contain prescription drugs, they are illegal and can be recalled by the FDA.

On Dec. 22, the agency issued an advisory on more than 25 weight loss products, calling them "tainted." Most of the pills are manufactured in China, and most have the words "slim," "trim," or "diet" in their names.

The FDA has not yet issued a recall on any of these pills, but consumers are urged not to buy or use them.

The list does not include two of the most popular diet pills, Hydroxycut and hoodia. But even when products aren’t reportedly contaminated, the only thing they’re likely to slim down is your wallet.

"Those supplements are very expensive," said Debbie Wilburn, consumer science agent with the Hall County Extension Service. "For the same price, you could get a gym membership. People try to take the easy way out by popping a pill."

Dr. Jill Ferguson, a Cleveland bariatric physician, also called a weight loss specialist, said no pill is a substitute for exercise.

"These products can suppress your appetite and you may eat less, but you may also lose muscle mass," she said. "It is absolutely paramount to have a regular exercise program. Exercise is a tried-and-true mechanism for increasing metabolism."

Even prescription diet drugs aren’t particularly helpful. Ferguson said she has never written a prescription for Orlistat, a "fat-blocker" drug that is also available in an over-the-counter form called Alli.

Jaffal said he’s not enthusiastic about it, either.

"Drugs that prevent the absorption of fat from the intestines are not very effective," he said. "They don’t work on carbohydrates, which is where most people get the majority of their calories."

Jaffal said a lot of his patients do ask him for advice about weight loss, especially at this time of the year. He has to tell them that he doesn’t have a magic pill.

"There’s no quick solution," he said. "Some people hit the gym so hard, and when they don’t get immediate results, they get frustrated and quit. But this is a lifelong process, and only the patients who change their lifestyle are successful."

When people are unwilling to make those changes, Jaffal said, even surgery doesn’t work. "I’ve had patients who gained the weight back after gastric bypass because they didn’t follow the surgeon’s instructions."

Some experts also take a dim view of diet programs that provide ready-to-eat meals, because customers never learn how to select and prepare their own healthy foods.

"Any good weight reduction program must have behavior modification," said Ferguson. "That’s why Jenny Craig and NutriSystem tend not to work over the long term. You’re not learning new behavior."

On the other hand, programs such as Weight Watchers have a higher success rate, because participants are taught how to choose the right foods and monitor their food intake.

There’s also the peer pressure factor.

"For some people, joining a group such as Weight Watchers is motivating, because they know they’re going to have to weigh in," said Wilburn.

The truth is, dieting can be almost painless if people are willing to do it slowly.

"It took years to put the weight on. You can’t expect to drop it all in a month or two," said Wilburn. "A realistic goal is a pound or two a week. You can lose a pound by eliminating 3,500 calories, and that can be as simple as cutting out second helpings."

Ferguson said she sometimes takes a more aggressive approach if a patient needs to lose weight quickly because of medical problems.

"You can lose eight to 10 pounds in a month, or you can lose more than 20," she said. "We do it with a ketogenic diet, which is only about 500 to 800 calories per day, high protein, low fat, low carb. If monitored, it can be very effective, because it burns stored fat, not lean muscle mass."

Ferguson emphasizes that patients on such a restricted diet must be under medical supervision. "If you go to a weight loss clinic, ask whether the doctor is a member of the American College of Bariatric Physicians," she said.

The drastic calorie reduction generally doesn’t last more than a few months, she said. "After you come off the protocol, you can slowly add carbs back to your diet," she said. "But don’t reintroduce high-fat, high-sugar foods."

But the problem with any low-calorie diet is that people usually can’t tolerate it for very long.

"They feel like they’re starving themselves, and they can’t stick with it," said Wilburn. "The secret to fighting the hunger is to fill up on fruits and vegetables."

Jaffal recommends eating several small meals throughout the day. "Patients do the wrong thing by starving themselves," he said. "The body responds to that by slowing down metabolism."

Exercise can increase metabolism, but only if there’s fuel available. "If you’re exercising but you’re not eating, your body starts burning muscle," said Pedro Ferrer, a personal trainer at Fitness Forum in Gainesville.

Ferguson said she writes an exercise prescription for each patient, based on what they’re currently capable of doing. Morbidly obese patients are sometimes so heavy they can scarcely walk, and this inability to move causes them to gain even more weight. Ferguson starts them off with exercises that can be done sitting or lying down, if necessary.

She said there has to be a partnership between the patient and physician, and no weight loss program can work if the patient isn’t motivated.

"Frankly, most people don’t like to be told what to do," Ferguson said. "My role is to encourage patients to think differently about what they’re doing and see how they can help themselves."



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