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Weight Management
(Glenridge Weight Management Center)
In my profession as a physician and in the various roles I've filled-general
practitioner, general surgeon, cardiac surgeon, and now cosmetic surgeon-I've
been appalled, dismayed, and frustrated by the harmful effects overeating
and unfavorable lifestyle has upon our health. When young and filled with
energy and naturally active, I had no trouble keeping my weight down. If
my clothes got tight, I could simply make a decision to drop five or ten
pounds and within a few weeks, achieve my goal. I was not very sympathetic
toward overweight people. As I became older, busier, more preoccupied with
life's necessities, and developed the usual aches and pains associated with
living, I found that excesses of weight were much more difficult with which
to deal. If enough pain was generated by the tight clothes, the loss of
self-esteem, and the general lack of feeling well, I could still periodically
muster up the courage to deal with the problem. It was increasingly difficult,
however. A fair amount of my problem lay in feeling of resentment against
the necessity to undergo a painful dieting experience when it seemed so
natural to simply overeat and under exercise. I also felt guilty about my
inability to control myself and do the things I knew were good for me. For
years I was the typical "YO-YO." My weight was up and down, my
state of physical fitness varied accordingly and I seldom maintained a feeling
of good health and well being.
When I become a heart, lung, and blood vessel surgeon the harmful effects
of obesity and smoking were blatantly apparent. However, I had little to
offer my patients from the stand point of changing a lifestyle which had
contributed to their serious illnesses. The various medications used for
appetite suppression were contraindicated and I did not have the resources
to devote the time to alternate therapies such as behavior modification
and counseling.
As a practicing cosmetic surgeon, I again found a great need for weight
management. Many people who come for evaluation relative to tummy tuck or
liposuction are much overweight and are not good candidates for surgery
until a degree of reduction has been obtained. By this time my own personal
up and down YO-YO cycle had come to rest more in the up position, and I
was considerably more sympathetic towards those people who told me they
simply could not lose weight. I began to come to terms with the truth that
a lot of things in life truly are not fair, and then it suddenly dawned
on me that there is a very good reason why being overweight is so common!
It is totally normal! People are DRIVEN to eat!
Certainly dieting has become a social event. Certainly eating may be
a means to fulfill unmet emotional needs, certainly habit and familial role
model playing are major factors, however, the bottom line is that in the
beginning, at least, activities of eating and storing energy in the form
of fat were directed toward survival of the species.
Think about it! When Ork and his tribe brought down a Mammoth there weren't
any refrigerators available to preserve the excess meat. They either ate
it or it spoiled, and should it be wasted they might not have another chance
to secure food for long time. When the berries and nuts came in season,
everyone ate as much as they could, stored the energy in the form of fat
under the skin, and lived off that store during the times when food was
not so readily available. This of course is common activity throughout the
animal kingdom. Bears and other hibernating animals illustrate refinement
of this point.
So all the guilt associated with being overweight is ridiculous our brain
is driving us to eat. It is as basic an instinct as sleep or sex or breathing.
The problem is that food - particularly high energy food is now always available
and yet our brain keeps pushing us to store up any excess that we can secure.
In other words, we live in a society where our natural instincts work against
us. Ork and his kin did not live long enough to suffer problems of obesity
even if they were able to get fat. They were either eaten by a Saber-Tooth
tiger or died of chicken pox, a common cold or the flu and didn't live long
enough to get high blood pressure or diabetes or stroke, heart attack, or
arthritis or any other diseases associated with being overweight.
Having discovered the cause of obesity, I began to approach the management
in a different light. Since the cause is mainly a function of our biological
drives and inborn programming, I began to use the appetite suppressants
more to negate those causative forces. I found that phen-fen worked extremely
well for appetite control and I was able use these medications to achieve
desired weight goals. However, as everyone knows this is a temporary fix
and as soon as medications are discontinued the inborn drive to eat is released
again. The patient regains the weight, feels guilty, eats more to get Some
satisfaction and winds up worse than ever. Now also we find that some appetite
suppressants carry great risk of serious problems.
Appetite suppressants cannot be continued forever. Further, there are
very real health concerns about the effects of fenfluoramine (Pondamin)
and dexfenfluoramine (Redux) in the development of primary pulmonary hypertension
and certain valvular heart diseases and these are no longer on the market.
The problem is that the drive to overeat is like an addiction. Its like
being hooked on alcohol or cigarettes or any other things which seem so
good but which in excess are so bad for us. We know how unhealthy it is
to be overweight yet we cannot seem to control our appetite and overeat
in spite of every good intention. This leads to feelings of guilt and frustration
which need to be relieved. Anything that is a pleasant experience or feels
good will give temporary relief and somewhat offset these feelings of guilt
and frustration. Eating feel . good. Feeling of satisfaction occurs with
eating. At least until one reaches a point of engorgement and gets the after
dinner "bloats". So it gets to be a self perpetuating vicious
cycle. We feel guilty because we overeat and we overeat to get some relief
of guilty feelings. most people understand all these causative relationships,
what they don't understand is that ingestion of food is an inborn drive.
Some drives like breathing are so strong that the individual cannot overcome
or in any meaningful way modify their activities. one Simply has to breathe.
Other drives such as sex, while extremely strong, may be modifiable and
one can to a certain extent control one's sexual activity. Eating falls
in this latter category and certainly with effort and training can be modified
to a certain extent.Certain habits can be superimposed upon our activities
and drives which in the end makes them more healthy but one must realize
that the basic drive to overeat will be present all one's life and that
it is an on going never ending battle. The extent to which one is unable
to accept this lifelong battle defines the extent and magnitude of success
in most cases. |
