Weight Loss: You Are Not Alone
February 2020 Issue
If you’re overweight, you’re not alone. More than one-third of Americans are obese, and two-thirds are either obese or overweight. All 50 states in the US now have at least a 20 percent obesity rate, with five states at more than 35 percent of their population being obese (South Carolina is not one of them). Just two decades ago, not one state in our nation had over a 15 percents obesity rate. Being overweight and obese is an epidemic, one far more scary and imminent than headline viruses. Obesity is linked to 60 chronic illnesses, and has now surpassed smoking as the No. 1 preventable cause of death. The reason: We are eating more. Way more! We are consuming 23 percent more calories on a daily basis than we did in the 1970s. What that looks like in numbers is a standard 2,000 calorie per day consumption has increased to an average of almost 2,500 calories per day, all while physical activity has decreased. The result: We have become an unhealthy, sick country. Everyone knows losing weight is one of the hardest tasks to conquer. Sometimes we feel defeated before we even start. The good news is, if you are overweight or obese, losing even five percent of your current weight helps reduce your risks for disease. Many wonder where to start. It’s OK to ask for help, and that’s why we went to the experts to really talk about the ins and outs of weight loss and fat reduction, and what the difference is.
Dr. Yvette-Marie Pellegrino—Beaufort Memorial Hospital
Just looking slimmer is not motivating me to lose weight. Please get real with me about what extra weight is doing to my body and the health benefits of losing it?
You are absolutely right. Losing excess weight should be about feeling better and living longer. Those extra pounds damage nearly every organ system in our body, and obesity is about to pass smoking as the leading cause of preventable death in America. The stigma of obesity isolates you, but the health conditions arising from obesity cripple you.
Some obesity related conditions include several types of cancer, heart disease, diabetes, high blood pressure, heartburn, fatty liver, infertility, stroke, sleep apnea, arthritis and depression.
Carrying that weight around not only makes us sick, tired and unhappy, it also consumes a large portion of our income. Whether it’s spending money on diets, doctors and medications, or losing money for being ill and missing work, it definitely costs more to support those pounds.
Don’t think about looking slimmer, rather think about having more time, energy and money to spend doing things you enjoy with the ones you love for generations to come.
Get started by thinking small. It has been proven that losing just 5 percent of your weight will have significant benefit on your overall health and well-being.
Yvette-Marie Pellegrino, M.D., FAAFP, is a family medicine physician at Beaufort Memorial Lady’s Island Internal Medicine. Board-certified in both family medicine and obesity medicine, Dr. Pellegrino oversees Healthy Weight, the hospital’s medically supervised weight loss program.
James F. Gigante, M.D.
I’ve been prescribed an antidepressant.
I’ve heard it can make me gain weight.
Is this true?
Most antidepressants have no concerns regarding weight gain if taken for less than three months, but most patients will likely be on one for at least 6-12 months or more. If depression is causing weight loss as a symptom, then weight gain will actually be a success of the treatment. That being said, it is best to think in terms of families of antidepressants. Doctors often balance side effects that are wanted, such as inducing sleep for those with insomnia, or others that might give one a sense of more energy during the day if profound lethargy is a symptom. Other considerations include sexuality or chronic pain. It is a balancing act.
The SSRI class includes drugs such as Fluoxetine (Prozac). Evidence suggests this is the least problematic causing either a weight loss of 0.2% body mass to a weight gain of 0.9% body mass, or on average six pounds. However, the placebo in the 30-month study had a seven pound weight gain. Paxil (Paroxetine) seemed to be the most problematic, causing 1.6% to 3.6% of baseline body weight increase. Zoloft (Sertraline) had 1.0% to 1.6% weight gain effect, and Celexa (Citalopram) had a 2.5% weight gain effect. Lexapro (Escitalopram) was not in the study but is very similar in structure to Citalopram.
The SNRI class—Pristiq, Cymbalta (Duloxetine), Effexor (Venlafaxine)—tend to cause a slight weight loss but also have a different side effect profile one might consider desirable or undesirable. Nausea could also be a trade-off. In another study, a drug in another class (atypical)—Bupropion (Welbutrin) was compared to an SSRI that was considered “average in its weight gain of 1-2 pounds.” Bupropion was noted by this JAMA study to have close to no weight gain.
So, as with all drugs and classes of drugs, the burdens and benefits need to be weighed by you and your doctor.
James F. Gigante, MD is a Board Certified doctor of Internal Medicine and a fellow with the American College of Physicians. He has been practicing medicine for 25 years, the last 17 here in the Lowcountry. 843-681-2222; 35 Bill Fries Drive, Bldg H, HHI.
Holly Mlodzinski, MS, RD, LD—
Hilton Head Regional Healthcare
What are the dangers of losing weight too fast? What is a healthy pace of weight loss?
Obesity affects about one in four adult Americans. During any one year, over half of Americans go on a weight-loss diet, or are trying to maintain their weight. For many people who try to lose weight, it is difficult to lose more than a few pounds. However, even a few pounds can improve your overall health.
A weight-control strategy can begin with setting a realistic goal. A weight-loss program should be directed towards a slow, steady weight loss. Expect to lose about 1 to 2 pounds per week. To be safe and effective, a weight-loss program must address the long-term approach, or else the program is largely a waste of money and effort.
Keep in mind four common behaviors that can help ensure the success of your weight loss program:
> eat a plant based, low-calorie diet
> be physically active
> monitor your weight on a weekly basis
> don’t skip breakfast
Remember that losing weight, and keeping it off, requires major, long-lasting lifestyle changes.
Holly Mlodzinski, MS, RD, LD is a Registered Dietitian and the Health Promotions Coordinator at Hilton Head Regional Healthcare. To learn more, visit: Hiltonheadregional.com
Kerri Dodson, MCHC, CNT — NuBodia
Is there a one size fits all
weight loss program?
Absolutely not. When approaching weight loss, what works for one person may, and many times, does not work for another person. Bio-individuality dictates that we all have different issues and respond to things differently. Due to genetics, health issues, chronic illnesses, gender, hormones, age and body type, weight loss must be individualized. As a nutrition therapist, I work with patients to get healthy, and the weight loss follows. So many come to me saying they cannot lose weight, only to discover they have an autoimmune disease, or low thyroid, or hormone imbalance, or metabolize fat differently, or have severe systemic inflammation due to chronic health conditions. All of these issues and more will hinder weight loss. My theory is you do not lose weight and get healthy, you get healthy and lose weight. Holding onto excess weight is usually a symptom of other issues. The key is to correct those issues and weight loss follows. Dealing with chronic illness not only achieves overall health, but weight loss, as well. Nutritional programs need to be customized and individualized. There also needs to be a change in the paradigm when it comes to what is considered healthy. Most believe that skinny is healthy, or “I just need to lose some weight” and that is not the case. There is no one size fits all.
Kerri Dodson is a Certified Nutrition Therapist and Master Certified Health and Wellness Coach for NuBodia, LLC. Kerri specializes in Nutritional Counseling and nutritional protocols to help her clients overcome chronic diseases such as high cholesterol, high A1c, Type II Diabetes and all autoimmune diseases. Call today: 843-816-3733.
Barbara Moschitta MPS, RDN LD — PULSEology
It's not always about the food...
Emotional and stress eating behaviors are learned and used to soothe, comfort and protect us from what we are feeling in response to internal or external stressors. Emotional hunger and appetite increase with stress because stress triggers our fight or flight response, raises cortisol levels and leads to stressed-induced weight gain.
Mindful eating techniques are an effective way to combat emotional eating and weight loss. There’s no one diet that fits all, so learning these strategies and being present in the moment of eating—mindful verses mindless—facilitates awareness of why, what and when we eat.
Mindful eating removes self judgement and empowers one to develop a healthy relationship with food and understand what influences eating choices. This, along with nutrition education, exercise and stress reduction practices, can lead to a sustainable way of managing weight.
Barbara Moschitta MPS, RDN LD is a Registered Dietitian and practices with Pulseology Health. She combines mindful eating practices with Medical Nutrition Therapy in prevention and treatment of chronic conditions and weight management.
Frederick G. Weniger, M.D., F.A.C.S.—
Weniger Plastic Surgery
I don’t want to diet.
Can I just get a tummy tuck?
Diets stink. Actually, every way that I can think of where you need to burn more calories than you eat stinks. It’s hard, uncomfortable, and it takes commitment and discipline.
Of course there are even those people who lose massive amounts of weight through herculean effort and life-changing resolve… and then get “rewarded” by seeing something in the mirror that they never expected! They don’t see the old “them” they remembered. No, it’s someone else with loose and even sagging skin looking back at them. I see so many patients who continue to workout like crazy, follow the strictest diets and beat themselves up because they still see all of this “fat.” STOP! I need to tell them. You did your job, and that’s just loose skin that will get worse if you get any skinnier! It’s no different than your old clothes getting looser when you lose more weight. And you can’t exercise skin to “tighten” it, just like you can’t exercise your loose clothes.
So there it is: Weight loss isn’t always fair. It can lead to looser skin and more drooping. Just don’t beat yourself up. There are plenty of options to remove that extra skin and get things tight again. You did the hard work… now it’s time to get your body back!
Frederick G. Weniger, MD, MBA, FACS is a board-certified plastic surgeon who specializes strictly in cosmetic plastic surgery in Bluffton and Hilton Head. Learn more: 843-757-0123, www.wenigerplasticsurgery.com
Kelly Ogden — Orangetheory Fitness Hilton Head
Can you defeat your body’s
slowed metabolism after weight loss
by doing vigorous cardiovascular
Orangetheory Fitness' science-backed 5-Zone heart rate monitor based workout is the prefect way to keep your metabolism in check. Because of the use of heart rate monitors and the way the coach-led workouts are designed for all ages and all abilities, everyone will be sure to work to their advantage. Working in the five heart rate zones helps to make sure you don't under train, or over train. In a one hour class at Orange Theory Fitness, just 12-30 minutes in the orange and red zones create a scientific phenomenon that will burn fat and calories and stoke your metabolism for up to 36 hours after your workout! Walk, run, row and lift at your speed and your ability for more life!
Fitness guru, Kelly Ogden is the owner of Orangetheory Fitness Hilton Head. They focus in a total-body workout paired with the science of the Orange Zone, which ensures you maximize your time and track results. Learn more: 843-473-4505, hilton-head.orangetheoryfitness.com
I have lost weight but have some stubborn areas
that just won’t go away. Help!
What are my options?
Dr. Charles J. Nivens — Bluffton Aesthetics
Trusculpt iD is a FDA approved radiofrequency device that uses heat to target and eliminate fat cells. Anywhere that you can “pinch an inch” of unwanted fat can be treated, such as neck, chin, bra line, tummy, flanks, and back. Each treatment session takes 15 minutes and destroys 24 percent of the existing fat cells in the area treated. The added benefit of using the heat generated from the radiofrequency is the stimulation of collagen growth, which allows for skin tightening. After a TruSculpt iD treatment, you are able to resume all normal daily activities and there is no bruising or swelling. This treatment is ideal for people who exercise regularly and eat a healthy diet, but struggle with fatty areas that do not respond to exercise and diet.
Dr. Charles J Nivens, Medical Director of Bluffton Aesthetics is Board Certified in Physical Medicine and Rehab. Learn more: -843-505-0584, www.blufftonaesthetics.com.
Tracy Blusewicz, M.D. — Advanced Women’s Care
of the Lowcountry | The Medical Spa
CoolSculpting® is not a weight loss treatment: It’s the No. 1 nonsurgical fat reduction treatment used by doctors. The unique CoolSculpting® fat freezing technology is scientifically proven way to reduce pockets of fat in trouble spots such as the abdomen, thighs, flanks, or under the chin in as little as one session. It targets stubborn areas of fat that just won’t budge for many patients. You can expect up to 20 to 25 percent reduction in fat layer thickness after a single session. Coolsculpting results are permanent in the area treated. Results may be seen as early as one to three months after treatment. Coolsculpting is a wonderful treatment for anyone looking to address what’s spilling over the top of your pants or bra. With over 7 million treatments worldwide, we can safely say Coolsculpting works!
Tracy Blusewicz, M.D., F.A.C.O.G., compassionate, genuine bedside manner has earned her the trust of many women for their health care needs. She can be contacted at Advanced Women’s Care. 843-341-9700; www.awclc.com
Brendan E. Smith, M.D. — Smith Plastic Surgery
Evolve by InMode
There is a current focus in our society about weight loss and a healthier lifestyle. While Evolve is not a device for general weight loss, which still focuses on diet and exercise, it is used for targeted weight loss. Evolve (Evolve T3 Trim, Tight, Tone) uses radiofrequency energy in several different applications to directly reduce fat and can build muscle, which also reduces fat to promote weight loss. Radiofrequency energy is very effective in fat reduction because fat cells allow for more absorption of the energy and heat, resulting in death of the fat cell while avoiding many of the complications of other devices. The versatility of Evolve is that it can target relatively small areas, such as inner thighs or arms, to larger areas, such as the abdomen or love handles, all while being performed in a comfortable, non-operative setting. There is minimal to no downtime or pain associated with the procedures.
Brendan E. Smith, M.D. is board certified in general and plastic surgery and has served the Lowcountry for nearly 20 years. His medical areas of interest include breast surgery, cosmetic and reconstructive, facial, body contouring, and hand surgeries. He can be contacted at Smith Plastic Surgery, 843-705-8940; www.smithplasticsurgerysc.com
David S. Reid, IV, M.D. — Hilton Head Plastic Surgery, LLC
We are healthier people in general with all the medical technology and advances over the years. We are living longer and enjoying life to a greater extent than ever before. We want to look and feel fit. How do we achieve this?
We want to be very active and look our best. How do we lose the rest of the weight we gained during the holidays? We usually think of the holidays and Thanksgiving through New Years, but for me, overeating starts in October with Halloween candy.
So, for weight loss, what are my surgical and non-surgical options? Liposuction is the most effective treatment for reducing bulges. It is commonly done on the abdomen, hips, inner and outer thighs, back and even the inner knees and under the chin. Some of these body parts show better aesthetic results with an added source, such as “power assisted,” ultrasound-assisted, or laser assisted liposuction. For non-surgical options, there is Kybella, which is indicated for under the chin.
Coolsculpting is also a great bulge–reducer. It kills fat cells via freezing. As we learned from liposuction (and medical school), the body has no mechanism to replace missing fat cells, so for the fat that is gone, it is permanent. Regardless of the treatment you choose—surgical or non-surgical— your best, and safest, bet is to choose a surgeon certified by the American Board of Plastic Surgery.
What about weight loss? All the options above reduce bulges and fat. The weight lost via fat loss is disappointing. Fat is rather light. The best method to lose weight is via diet and exercise.
Weight Loss Quiz
1) Should you weigh yourself often?
__ Yes, it really helps. __ No, it’s too upsetting. __ It doesn’t matter
2) Which fats should you cut back on to lose weight?
__ Unsaturated Fat __ Saturated Fat __ All fats
3) To help lose weight faster, drink water when?
__ Mostly Before Noon __ Before Meals __ After Meals
4) If you eat too much lunch, should you skip dinner?
__ Yes __ No
5) How long after eating should it take before you feel full?
__ 5-10 Minutes __ 10-15 Minutes __ 15-20 Minutes
6) To lose weight, plan every meal.
__ Yes __ No
7) What should you do about fatty foods you love?
__ Banish them from your diet. __ Eat them in moderation.
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