Dr. Moghissi's Sure-Fire Weight Loss System (Well, sort of)

One of the most frequent issues that my patients deal with is the issue of weight loss. Many billions of dollars are spent on the diet industry annually, but the population in this country continues to become fatter and fatter. Obviously the money is not making a significant difference. If there really was a magic pill or other cure to deal with this, we’d all know about it. So what to do?

I’d like to start by explaining how the body processes energy. This is, after all, an energy issue.

• If energy in is equal to energy out, then weight is maintained.
• If energy in is greater than energy out, then weight is gained.
• If energy in is less than energy out, then weight is lost.

This is the basic premise that needs to be understood. If you want to lose weight, you need to either decrease energy in, or increase energy out. Simple, right?

In this country, we measure the energy in calories. Energy in is the simplest part of the equation to measure and control. You just count up everything that goes in your mouth and gets swallowed. There are reference books and websites that can assist you with this. If the intake is too high, you just take in less, and the weight comes off! More about that later.

Energy out is a little more complicated. Everyone has a basal metabolic rate. That tells you how much energy you use by just being alive. Theoretically, that is measurable and calculable. It is generally more of an estimate, but really is probably close enough for most purposes. Any physical activity that is done will add to and increase the energy out. In addition, the metabolic rate will vary from person to person. If two people are doing the same activity, the one with a higher metabolic rate will use more energy than the one with the lower metabolic rate.

Approximately 3500 calories is equal to one pound of body fat. That means than you need to have a 3500 calorie deficit to lose one pound. Most adults require somewhere between 1500 and 2500 calories per day to maintain their weight. So even if someone ate nothing, they could not lose more than a pound every 2 days, unless they increased their activity, or altered their metabolism. Losing quicker than that cannot be permanent (it’s “water weight,” as people like to say).

Most people understand that to lose weight they need to take in less. There has been a lot of confusion as to the many types of diets out there. Low fat, high fiber, low carb, high protein – which is better? Any diet which causes you to take in fewer calories will help you lose weight. Does the time of day you eat, or what type of food you eat more or less of change your metabolism? Nobody knows. That is one of the reasons there is so much controversy about many of the popular diets.

There are also many medications on the market which claim to help people lose weight. Most decrease appetite, so people find it easier to take in less. Phen-fen was a combination of two drugs that together were very powerful appetite suppressants. Phenteramine (Phen) is still available. Meridia is another prescription appetite suppressant. Xenical decreases absorption of high calorie foods (fats). Ephedra increases metabolism, which we have learned can be a very dangerous thing. Some of these medications can also be used in combination for greater effects. I have prescribed quite a few of these over the years, and although they do work, I do have reservations about them.

Most people can lose weight with whatever method they use, be it medications or the current most popular diet. The real issue is keeping the weight off. We have several things working against us here.

For thousands of years (or even longer) humans have had to work hard for food. We expended much energy gathering, growing, and hunting for our food. Most of what we ate was generally low calorie, high fiber (plant matter), with occasional high fat, high protein (meat) as a bonus. The humans who survived needed to be very efficient, especially during times of starvation. Our bodies learned to become more efficient during times of scarcity and starvation, piling on the fat stores as soon as food was available again, preparing for the next time of scarcity.

In the last 50-100 years, this was no longer an issue. Now we no longer expend energy to obtain food (we can even order groceries over the Internet and have them delivered to our home!), and we have access to unlimited amounts of high calorie foods. But our bodies are still responding to ancient cues, wanting to take in as much high calorie food as possible, laying on the fat stores. When we diet, we put our bodies into starvation mode (artificially causing a food scarcity), and we essentially become more efficient. As soon as we stop dieting, our bodies try to get those fat stores back. That’s why most people gain their weight back after dieting; they are genetically programmed to do so.

We don’t really know how to prevent genetics from sabotaging our good intentions. Losing a large amount of weight in a short period of time does seem to make things worse though (i.e. crash diets). Most patients I put on phen/fen lost a lot of weight quickly, not a single one kept any of the weight off. The only patients that I’ve seen be successful are the ones that decrease their intake moderately, and increase their activity. They also follow a diet of foods that they prefer, which makes it easier to continue this once they’ve lost weight. In other words, if you lose weight following a diet that only allows you to eat bananas, celery, and butter, how long do you think you’re going to do this after you’ve lost the weight?

Another aspect is to increase activity. Many of us spend 8-10 hours a day basically sitting. We might go to the gym a 2-3 times per week, and wonder why we are not losing weight. I noted earlier that 3500 calories equals one pound of body fat. Compare your favorite gym activity to what you would otherwise be doing at that time. Remember that most people do not have the stamina to exercise an entire hour!

I usually recommend trying to modify lifestyle by no more that 500 calories a day. This would be done using a combination of decreasing intake and increasing activity. For someone of stable weight (currently at daily maintenance level), that would give up to one pound per week weight loss. As the weight comes off though, you will need less calories to maintain that weight, and you will need to modify your lifestyle further to continue to lose weight at the same rate. This is to avoid hitting a plateau, where the weight loss stops. You may still experience one though, because your body will attempt to become more efficient to prevent further starvation.

Here are a couple of simple calorie counting sites, just to give an idea as to how much you may be taking in: Calorie Counter Charts and The Washington Post. There are also small handheld computers on the market that may be more convenient.

This just some of the information I’d like to convey on the topic, so I will continue to add new information to my Web site and address this issue again in future newsletters. I hope I have given enough information so you can make some educated decisions. I think if people know what they’re up against, they are more willing to stick with it and not get discouraged. This is one of the most difficult things for people to do, and I wish good luck to all of those who are trying!

Remember – it’s all about energy...