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On January 17, visitors to www.Turnto10.com received online advice about weight loss from Vincent Pera, MD, medical and program director of The Miriam Hospital Weight Management Program. Pera chatted with more than 25 visitors. Below are excerpts from the chat. Moderator: Welcome to the NBC10 Doc chat. Vincent Pera, MD, is here to chat about weight loss. Please submit your questions. Dr. Pera: Good afternoon, everyone. Debi: I recently lost 32 pounds and have kept it off for 6 months. How often should I weigh myself and how much will my weight fluctuate normally? Dr. Pera: Congratulations on your 32-pound weight loss, and on keeping it off for six months. I feel that a weekly weight check on the scale is the most beneficial for someone who has lost weight and is now trying to keep weight off. Doing it less often might allow behaviors to slip in that will result in some weight gain. It's very important to keep behavioral changes that led to the weight loss active. Debi: Thanks. Dr. Pera: Weight will typically fluctuate from 1 to 3 pounds in a given week, and that fluctuation is primarily due to fluid level changes. Monthly, weight should not change significantly. Therefore, if your weight has not changed on a monthly basis you are doing well maintaining the weight loss. Debi: Thank you. Junni: Dr. Pera, may I say something...I joined The Miriam Hospital weight program with you and your staff. I lost 98 pounds. Rosey: How does the program work, meeting times, and cost? Dr. Pera: The program that we have at The Miriam
Hospital has specific protocols for people suffering from all levels of
obesity. Rosey: That was good, Junni. Debi: Good job, Junni!!!!! Junni: The staff at The Miriam are wonderful...willing to help you in every way. Dr. Pera: You can attend an orientation session that explains the program in detail; call 401-444-4800. Eb12: How do you feel about the NutriSystem diet? Junni: And, Dr. Pera, ...you are my hero...you believed in me.. Dr. Pera: I really don't know specifics about how NutriSystem works. Junni, thanks for the comments. I will pass them along to the staff. Junni: Dr. Pera, I have to leave for work.but I wanted to let everyone in this room know what a wonderful program this is...and what a great staff you have ...Thank you so much for your confidence in me...you have helped me tremendously... Mina: How safe is Xenecal? Dr. Pera: Xenecal is a medication that prevents the absorption of fat in the intestine. It's been approved by the FDA, and has undergone rigorous testing. I think it is very safe when prescribed appropriately by a physician. Mina: Thank you, Doc. Debi: Do you suggest taking a multivitamin everyday while dieting? Dr. Pera: Debi, It makes sense to use a multi-vitamin on a daily basis when dieting. Patty: Which diets do you think are the safest and best? Mina: Does one need to be very overweight to use Xenecal? Dr. Pera: It is extremely important to follow a caloric restriction that ensures all nutritional needs are being met. It is not good to cut calories if that means cutting nutrition. I think that diets that make sense are safest and best. That is, anything that seems very trendy or excessive in one direction or another, probably won't work very well, and may not be very safe. The FDA recommendation for the use of Xenecal is a BMI level of greater than 30. This corresponds to a moderate level of obesity. It is not recommended for individuals who need to lose 15 or 20 pounds. There is a BMI calculator on Lifespan.org. Mina: I see. Mercedes: What is a safe amount of calories for a woman to consume to lose weight at a moderate rate? Dr. Pera: Mercedes, that is a complicated question because the number of calories is a function of height, starting weight, muscle mass, age and other variables. Generally, cutting calories by approximately 500 below one's daily requirement to maintain their current weight is a good starting point. Mercedes: Thank you. Patti: could you please tell me about gastric bypass surgery...who's a good candidate...what are the risks...etc. Dr. Pera: Patti, gastric bypass surgery is still viewed as a procedure that should be considered after less risky interventions have been tried without success. BMI greater than 45 would be a starting point to consider bypass surgery. Patti: Thanks, Dr... Dr. Pera: The presence of additional medical conditions,
such as diabetes, heart disease, breathing problems, etc., would point
against an individual as a candidate for surgical intervention. Currently,
the risk of mortality from these procedures remains at 1 percent, and
morbidity ranges anywhere from 10 to 40 percent. This procedure, however,
can be a valuable intervention for someone who has not done well with
other approaches and meets appropriate criteria for surgery. ElizJ: I'd like to begin exercising as part of my weight loss program. Do you have any suggestions for how to get started? Dr. Pera: ElizJ, exercise is probably the most important component of any weight management program. To start an exercise program, you should discuss it with your physician to determine if there are any risks involved. Once clearance is obtained, then it is important to start exercise at a low level, and build up to higher levels gradually. Exercise ideas Dr. Pera: It's important to choose exercises that help to elevate the heart rate, as aerobic activity is the best type of activity to promote and to maintain weight loss. Another consideration is to choose an activity that you enjoy doing, an activity you can do without great difficulty, such as having a treadmill at home. One final point: studies have shown that you do not need to do a long period of exercise, such as one hour at one time, to derive the benefits of exercise regarding weight loss. Multiple short periods of exercise, such as 10 to 15 minutes, can give almost the same benefit. Tracy: Would water aerobics burn enough calories? Dr. Pera: Tracy, the number of calories burned during an
exercise is a function of the work being done and the duration of the
exercise. Water aerobics is one of the very best exercises for weight
management because it does a good job of getting the heart rate up, and it
minimizes wear and tear on joints and muscles, because it takes place in
the water. Hopeful: What diet do you promote? Dr. Pera: Hopeful, there isn't a specific diet that I promote. I recommend weight management intervention that is customized to the needs of the individual patient. Somebody who may need to lose 20 to 40 pounds would benefit from an intervention that is very different from an intervention that would be appropriate for an individual who needs to lose 150 to 200 pounds. The foundation of weight management always includes nutritional education and caloric restriction, behavior modification and lifestyle change, appropriate exercise, and a coordinated program with a goal and a time-frame. Hopeful: So, there needs to be a consult. I have a brother who is extremely large. He has no drive to lose weight. He has medical problems because of his weight. How can I convince him to help himself? Dr. Pera: We do use, in The Miriam program, a
liquid supplement intervention (either partial or total) for individuals
whose weight requirements mandate this type of approach. However, this is
always accompanied by a more traditional, three-meal-per-day maintenance
intervention that is the key to long-term success. Hopeful, you raise an
issue that is central to success in weight management. That issue is
readiness to lose weight. Many studies show that to be successful, the
individual needs to be ready to lose weight. If the individual doesn't
appear to be ready, attempting intervention at this time would most likely
not be successful. With someone like this, one should focus on trying to
move him towards being ready, which often involves discussing the pluses
and minuses of being overweight, pointing out individuals who have been
overweight and have been successful in losing weight, and discussing how
their lives may have improved due to their successful weight loss. Hopeful: What is the cost of liquid supplements? Are there any risks? Dr. Pera: Hopeful, liquid diet protocols do have risks associated with them. In our program at The Miriam Hospital, we attempt to minimize those risks by performing a medical evaluation on all patients and providing ongoing medical intervention throughout the program. Depending on the specific situation of a given patient, we also need to follow laboratory studies and assess for certain symptoms as patients progress through the program. When this is done by a physician who is trained in this area, the use of liquid supplementation has been shown to be very safe, with minimal risk. As with most caloric restriction interventions, assessment for gall bladder dysfunction must take place prior to and during the intervention. This is probably the most likely area of complication that needs to be watched for during this type of intervention. For information regarding costs of the liquid supplement and programs at The Miriam Hospital, I would recommend attending an orientation session. Call 401-444-4800 for information. Find out about the program online Tracy: When is the next orientation session? Do most insurance companies cover your program? Dr. Pera: Orientation sessions take place weekly. Reservations are required. Call 401-444-4800 to reserve your place. There's a spectrum of coverage from various insurance companies. Some cover no aspects of the program and some cover portions of the program. Once you've attended an orientation session, we can provide information about what we think will be covered and what the cost will be. Hopeful: Could you please repeat the answer to my last question? My computer went down. I believe I wanted to know about study programs. Dr. Pera: Hopeful, what specifically did you want to know about study programs? Hopeful: Are there any study programs that are more cost effective? I think that money is a big part of my brother's problem. Dr. Pera: Hopeful, at various times throughout the year there are studies that we are involved in. Currently, we are not in the process of recruiting subjects for weight management studies. To find out about future studies as they are being initiated, try calling 401-444-4800, look for advertisements in the newspaper and log on to the clinical trials section of Lifespan.org. Hopeful: Thank you for your advice. Dr. Pera: Thank you for joining us. Find out more: |
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