Loose weight-it can be done Loose weight - extend your life			A few weight loss suggestions from Dr. Malachovsky
Dear patient: Many patients come to us seeking advice on how to lose weight. Many of you have tried various diets, protocols, herbal supplements and even medications. Having an extra 10, 20, 30 or more pounds can be eventually hurtful both emotionally (lowering self esteem) and physically (developing illnesses such as generalized aches, fatigue, sleep apnea, arthritis, diabetes, high blood pressure, high cholesterol, cancers, etc).  Indeed, having excess weight has become a major health problem in this country.  A century ago, people were dying mostly due to consequences of poor sanitation and infectious diseases (dying from such afflictions as the plague, tuberculosis, cholera, etc.); whereas now, most of us can live more comfortably, as these threats are not as common. Thanks to having clean water and good communicable disease surveillance and control, contagious illnesses have become less of a threat. Yet, it has been observed that more and more people are dying as a consequence of their own poor diet and lifestyle.  It has been estimated that up to 75 percent of the causes of death in the United States are related to lifestyle.  High blood pressure, diabetes, heart attacks, strokes, and even cancers are in many ways related to our lifestyle.  Furthermore, many of these ailments are indeed preventable.  Recent studies indicate that if you eat in a healthy manner and exercise, you can extend your life significantly, even by up to 14 years. Studies about people in Japan, the country with highest life expectancy (longest living people),  show that what you eat and how much can have grea impact on how long and how well you are going to live. Having a normal weight significantly reduces your chances of many illnesses including arthritis, diabetes, high blood pressure and even some forms of cancer.  Some studies reveal that if you lose weight you can significantly reduce your risk of diabetes, heart disease and cancer.  If you are overweight, or even obese, and are considering losing weight and improving your health, or are simply wishing to reduce your risk of diabetes, heart disease or other illness, there are a few basic yet very important facts for you to know. I have written this to help you consider the options as to what you can do to improve your health and well-being.  Having a good understanding of some basic health facts may help you decide on how you approach your own body.  Though I provide some simple facts and techniques, it may indeed by you yourself that finds the strategies that work the best for your own body.  Even though there is an enormous amount of scientific data behind this, I wrote this simplified introduction to weight management and health promotion in a language to which I hope you can relate.  If you have any questions about this review, you may ask at any time! One Caveat: if you are considering lifestyle and dietary changes, consider thinking of them in a very long term? what should I do ( change) in my lifestyle for the next 30 or more years, which I would enjoy and would be still very beneficial to my health. the experience from any short term drastic changes usually does not have any long term benefits. Your body lives 24/7/365 and you should think of what would be good habits to have or develop which would be good for you, your body and you would enjoy in the long run.
What does it mean to have excess weight?	Your body was genetically designed to be able to handle only certain amount of weight. Your pancreas, kidneys, heart and other organs have limits as to what they can handle. Much like bicycles, cars or elevators are built to handle only weight to a certain limit, your body also has weight restrictions for proper performance. If you exceed these limits, your organs will have to either work harder, or at some point they will start giving up and you will develop an illness. Through research, international standards have been developed what a body can handle and what are the "upper limits of normal.”   By international standards, your upper limit is a Body Mass Index (BMI) of less than 25. You have excess weight if your body mass index (BMI) exceeds 25. ( In some Asian countries, the consensus is consider BMI less than 23 as normal.) If it is more than 30 you are considered obese and if you have BMI >40 you are considered morbidly obese. You also have to remember that BMI 24-25 is the UPPER limit of normal, and even though the scientists do not know exactly what is the "most ideal weight," it is somewhere between a BMI 19 and 24. Furthermore, recent study published in a major medical journal ( The Lancet) following close to 1 million people over long time, showed that: Above 25, every 5-unit increase in BMI translated to a: 30% increased risk for all-cause mortality; 40% higher risk for death from ischemic heart disease or stroke; 60% to 120% increase in renal, hepatic, or diabetic mortality; 10% increased risk for cancer-related deaths. having normal weight matters. having excess weight matters.
Why do people have extra weight?	Scientific observations show that overeating is the number one cause. Most people become overweight or obese simply because they ate more than they needed. If you have a large meal and do not allow more time for it to “burn”, it will get stored, and stored as fat.  If you have another meal and you do not burn it, it also will get stored.  If you do this for one, two, or more years, you will suddenly realize you have gained 10, 20 or more pounds.
What are the less common causes?	A very small percentage of people suffer from illnesses which may predispose them to excess weight.  Examples of such afflictions which lead people genetically to gain weight include hypothyroidism, excess corticosteroid production, sleep apnea, or other metabolic or organ dysfunction. If you have a suspicion that you may have a disease which predisposes you to become obese, please discuss this with your physician.
Why do we care about weight?	We care about weight because excess weight causes illnesses and reduces your chance of living full life without complications. Excess weight overwhelms various organs and systems of your body which are not designed to take care of extra bodily mass. If you have excess weight, you are asking some organs or body parts to work or bear forces beyond their limits.  Your pancreas may not be able to produce enough insulin to supply all the extra tissues and you will develop diabetes. Your knee cartilages may not be able to bear the extra pounds and you will develop arthritis.  Your heart and kidneys may not be able to handle excess weight or salt, and you may develop high blood pressure, heart dysfunction or kidney problems.  Moreover, there are now some cancers which are now considered to be directly related to obesity. as mentioned above: your risk of premature death, cancer, heart disease, kidney disease, diabetes goes proprotionately higher with every unit of BMI.
HOw much excess weight do you have?	BMI index calculator         ( click here if you wish to calculate or BMI) find out by looking up your own BMI. BMI 25- 29 .............overweight BMI 30-40 ..............obese BMI > 40 ................extremely (morbidly obese) Which category do you fit in?
how can you loose the extra weight?	Here are at least some data to help you decide about some popular known diets out there. One study was done on 311 women (age range, 25–50) with average BMI 32. The women were randomly assigned to one of the four diets: Atkins (very low carbohydrate); Zone (low carbohydrate); Traditional (lifestyle, exercise, attitudes, relationships, nutrition (LEARN); low fat, high carbohydrate); and Ornish (very high carbohydrate). After one year, only 75% of women were still on the diets. Women lost a mean of 4.7 kg on Atkins, 2.6 kg on Ornish, 2.2 kg on LEARN, and 1.6 kg on Zone, with a significant difference between the Atkins and Zone diets.  What this means is that the diets had relatively similar and modest effect on weight loss of the studied group of women. Interestingly, there was no statistically significant body fat percentage difference after one year of any of the diets. Cholesterol, interestingly, improved a little bit on Atkins (very low carbohydrate, higher fat) . Blood pressure improved slightly in all groups. In summary, we know that the effects of the four most common popular diets on weight loss and cardiovascular risk factors (studied in overweight, non-diabetic, premenopausal women), the Atkins diet had a slight benefit over doing nothing at all.  However, the changes were modest and relatively similar between all of the diets. In one year, women lost somewhere between 3-10 lbs, or 1.6-5 kilograms. Interestingly, their body fat contents remained unchanged. Current national guidelines recommend a reduced-calorie, low-fat, high-carbohydrate diet for weight loss.  Additionally, cardiologists recommend that one should have a low salt diet (less than 2grams of salt per day.) whether you choose atkins, low fat, high protein, or special shakes ask yourself if this is a diet you could adhere to for next 20-30 years? Also ask yourself if this is a diet you believe will in the long run make you healthier? Some studies and experts suggest that a Mediterranean diet may be the healthiest, but the composition of this diet still varies throughout region to region.  However, the Mediterranean diet rich in fruits, vegetables & fish is about the closest to what we consider a healthy diet.  You can obtain more information at: www.healthypeople.gov probably the most thought provoking information can be learned from those who truly live longest. People in Japan.  Life expectancy in Japan is longest in the world for both sexes: 85.23 years for women, 78.32 for men in 2002. Greg O'Neill, director of the US National Academy on an Ageing Society, says the only known factors that might prolong health, such as restricting calories, seem to be making a difference. People in Japan eat a third fewer calories than the typical North American. What they eat is also important: more seafood and, hence, healthy fish oils. Robert Arking, biology professor at Wayne State University, Detroit, says the Japanese are less sedentary than westerners, and Japan a less stressed society with more equity in income, status and workplace hierarchy. O'Neill adds that just after the war, the Japanese had one of the lowest life expectancies in the world. This suggests increases in lifespan are most probably unrelated to genetics. Putting it all together: how frequently/ how much you eat and what you eat can make a huge difference.
Undertsanding your habits and understanding your body?	Many people who come to us frequently start with "I dont understand why I cant loose weight. I dont eat too much but I cant loose weight".
how can you loose the extra weight?	Here is some advice we have found to have worked for many of our patients. 1. Train yourself that it is Ok to stay hungry for a few hours. People do not realize that due to excessive food availability, they go after something to eat after the first feeling of hunger. Yet, frequently, at this time, they have not been able to burn the calories from the last meal.  Thus, they store more and more calories.  If you allow yourself to go hungry for a while, a few things happen: you give the hormones which work on storing your calories (such as insulin) a break, and you allow the hormones which break down your stores to take some of the extra energy and use it. You achieve balance between storing and burning. Try it, it does work. Some people report to us that they did not even remember when the last time they had the feeling of hunger was, and that they actually feel great having this sensation once in a while.
concerns	The most common concern we hear is: I get dizzy, I get irritable, and I cannot take the feeling of being nervous. I will faint, I cannot do it.  For many of those who still gave this method a shot, they later went on to say, “I could not believe, I am actually fine.”  Try it and see if it really happens. No one who came back has fainted or reported anything serious. However, there are few things of which you should be aware.   As it was observed with people who undergo gastric bypass or stomach stapling procedures, a few things can happen when initiating weight loss.  The faster burning of calories and release of fats into your blood stream can lead to the extra fat being excreted into the bile.  Thus, when you are losing weight, there is a slightly higher chance of developing gallstones.  Furthermore, if you do not drink plenty of fluids, you can have an increased risk of developing kidney stones. Though these small risks are present, they are much smaller risks than those incurred if you are to remain obese and have the greater risk of developing diabetes, heart disease, or cancer.
Few thoughts:	There are approximately 1 billion people on this planet who do not have enough to eat. They are sometimes labeled in the literature as "chronically hungry" or malnourished.  They live in many places throughout the world (including the United States).  Most of the malnourished people live on less than 1 or 2 dollars a day, and they experience hunger every single day. They actually live in a state of hunger most of the time.  Even though they may suffer from some nutritional deficiencies, almost none of them suffers from high cholesterol, type II diabetes or high blood pressure that are linked with a high sodium/ processed food diet. If you can, please try to take a moment and feel what they feel every day.  Try to experience what they feel.  Try to see how it feels to go 2, 4, 6, 8 or 12 hours without the ability to have any food.  Remember, unlike you who will have a set time period to be hungry, the malnourished people of the world often never know when their next meal may be. If you are overweight or obese, they may envy you for the ability to have the food. Take at least a few hours in your life and see how it feels to be among those less fortunate. ,
Story of a man	The following is a story which began by chance when I hung a picture of this man on the wall in our office.  As I have told and retold this story to more and more patients, I came to notice that many people reported back to me how this story touched them and helped them to change their habits, to in turn loose many pounds and in turn change their lives.  Thus, I decided to post the photo of this man here.  This is an approximately 80 year old man, who is just one of the many malnourished people of the world.  He wakes up, has a small bowl of rice and a cup of water.  He works for 10 hours a day, comes home, has a small bowl of rice and occasionally a tomato, potato, and, if lucky, a few times a week has a small piece of meat or fish.  He lives in a small bamboo hut without electricity, water, or a bathroom. He does not have a TV, and he does not have a mattress.  He earns less than a dollar a day.  He is, however, strong as he beat the odds of extreme poverty, life without access to healthcare, money, health insurance and more. He beat the odds by surviving many infections and other adversities of life.  He did it with very little, much less than any of us.  He is poor and he is frequently hungry.  However, he does not have a high cholesterol, diabetes, or high blood pressure.  His Body Mass Index is 17.  More importantly, he is not alone.  There are many millions of people like him, some younger some older, some living in city slums, some surviving in poor huts in rural villages all around the world. They cannot afford a cholesterol pill, diabetic pill or even an aspirin.  Unfortunately, many of them die much younger because of simple infections, diarrhea, and lack of access to simple medical care.  Perhaps you have access to 100 times more food than he does. You can afford 100 times more care than he can. You have health insurance, food, and much more.  But he is a vivid example of a much stronger message. You need much less to survive than what you currently have, and you can do it with what you have as well. Perhaps you can appreciate that in order to live well, you do not need as much food as you thought.  Perhaps you can find a balance with eating less and enjoying life, even without needing more.  Sometimes having the extra just leads to unnecessary problems
before i go any further	It has been our fortunate experience that many of our patients have been an incredible example to us. It has been amazing to see their transformation and their incredible joy of feeling much better. We have seen the joyful faces of elated patients who lost 10, 20, 30 and even 60 or 70 pounds.  They started to eat healthier, walk, and exercise.  Many of them simply said: "I've cut out all the junk food, and I feel so much better.”  To our surprise, we even have patients who truly cured themselves of hypertension and/or diabetes.  For some, it is almost frightening as well as an exciting experience to see that after years of high blood pressure, their blood pressure is consistently normal.  Yes, you can do that too!  Mrs. B.L. of the Bronx, lost over 60 lbs in 10 months.  She became so happy and so proud of herself and set a wonderful example of the possibilities to all of us.  Thanks to a healthy diet consisting of vegetables and fruits, walking, and the ability to stay hungry from time to time, she was eventually able to stop her blood pressure pills altogether. Her blood pressure normalized, and has been below 120/80 consistently. Seeing her happiness makes our work even more enjoyable.  We have many other patients who continue to improve their weight, and in so doing likewise improve their overall health status.
You can do it too!	Here is another analogy we developed with one of our patients, who is on the road all the time. If you have a car and it needs gas (has a nearly empty tank), you go to the gas station and fill up the tank.  But after you drive for an hour or two, and consume a gallon or two, you do not go to the next gas station and again try to fill up the tank again, do you?  You usually wait until your gas is low, and then you refill.  If you try to fill it again as before, you would have to put the gas into an extra storage tank, and pull it with you.  If you did this for repeatedly, soon you would have a little oil tank trailer your car would have to pull behind you at all times.  What would you do if you had all the extra gas being pulled behind your car in a large storage "oil tanker?"  Would you stop at the next gas station and fill up more or would you keep driving until you burn the gas and get rid of your heavy tanker? The story is similar when we think of meals, snacks and food.  If you get the first feeling of hunger, many people jump to the next meal or at least a snack, a cup of coffee or a soda.  This is the crucial moment when you actually start to overfill your tank, as you have not even had a chance to burn what is in your "tank."  If you keep doing this, over time or over several years you come to find that suddenly you have gained 10, 20, 30, 40 or even 100 lbs.  Then, at this point, you not only have your own tank full, but you have a small "oil truck" that you are carrying with you.   What would you do now knowing this?   Would you keep refilling your tank, or would you want to try and burn some off first?
	If you have 10, 20 or more pounds over your limit, it means that the "extra oil tank" you carry with you needs to be burned off first.  Otherwise, you will always be filling up your extra "oil reserve" and never will have a chance to burn it.  That is why training yourself to stay a little bit hungry for a few hours will help you to start burning your extra calories and help you lose weight.  This is not a diet or magic, this is just asking people to develop a more healthy and balanced habit in their approach to nutrition and food.
	This is what I encourage you to do.  Wake up; eat some fresh fruits or vegetables of your choice. Have a drink of water or juice.  Go to school or work, or stay at home.  It will take you 2 -3 hours until you get hungry.  When you do, stay hungry for another 2-3-4, 5 or even 6 hours. Whatever you choose.  Train yourself that it is OK.  You are not going to die.  You will become healthier.  Many of our patients even report that when they do not eat, and feel slightly hungry, they feel more energetic, and actually enjoy being hungry for a little while. Once the next meal comes, make a choice: healthy or unhealthy.  From time to time, reward yourself.  Go for your big steak, french fries, 700 calorie pizza or pasta.  Enjoy your rice and beans, chicken, pork, lamb or fish.  Whatever it is, just enjoy it. But after you are done, think how long after a large meal you should you not eat in order to burn off that meal. It is usually 7-12 hours of not eating anything before you can consider such a large meal to be "burned.”  You will learn that you can enjoy the abundance of food, but with ability to enjoy it, without causing harm to yourself. You can be in control of your health, and you can improve the way you feel about yourself, and you can even directly have a part in controlling how long you will live.
Most recent studies....	The most recent studies indicate that if you eat fresh fruits and vegetables and exercise regularly, you can extend your life by more than 10 years.  Simple actions on your part, together with some self control are more powerful than any medication or supplement on the market. That is our food for thought! What do you think?  Please, provide us with feedback. We would like to hear your opinions, experiences, questions, as well as concerns.
	Copyright: Bodhi Medical Care, LLC / Martin Malachovsky, M.D., M.P.H.