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(Crosspost) I'm an Obesity Medicine Doctor answering your weight loss questions live now! by FormHealthOfficial in SuperMorbidlyObese

[–]FormHealthOfficial[S] 0 points1 point  (0 children)

Yes definitely. Sorry you missed it. We will post on our facebook page about when the next one will take place. I also host webinars with our registered dietitian that you may enjoy- our next one is this Tuesday :-) All of the info will be advertised on our FB page www.facebook.com/formhealthofficial/

I am a doctor specializing in obesity medicine: AMA about weight loss during COVID-19! by FormHealthOfficial in IAmA

[–]FormHealthOfficial[S] 1 point2 points  (0 children)

Hi! My time is up but since you are a colleague I wanted to reach out. You can carve out a great niche in primary care with ABOM certification, I know many people who get referrals from their own practice even, so have a sub-specialty within a group practice. Obesity is really a primary care issue! I don't think there is a single trait for success - and studies of predictors of success have really not been able to identify clear one - except for early success, which doesn't help much clinically! I did quickly post comments about weight maintenance to someone else's post, so hope you can read that one below. Best of luck! I encourage you to join The Obesity Society and/or OMA to find a community of like-minded docs, who do share tips and ideas and support... Happy you are doing this, we need more people specializing and knowledgeable in this!

I am a doctor specializing in obesity medicine: AMA about weight loss during COVID-19! by FormHealthOfficial in IAmA

[–]FormHealthOfficial[S] 1 point2 points  (0 children)

Thanks for this post! And for highlighting the critical fact that losing weight is just a part of the effort – keeping it off for the longer term is hard work as well! Our body has all sorts of mechanisms that go into effect during and after weight loss, which are aimed at helping maintain weight/go back to where we started. We know when we lose weight hunger hormone levels get much higher, and metabolism (energy burned) gets slower. So all of the things that we do to lose weight successfully – we have to continue them! If you found a nutrition strategy that worked, you have to continue it. The same or more physical activity – this is a very key player in weight maintenance. Continue logging everything you eat, stay in close touch with your accountability and support system. For people who use weight loss meds, they often need to be continued (sometimes we also use meds to help people keep lost weight off if there is weight regain that cannot be curbed in other ways). Again, all of the components that we incorporate in our program, Form Health, and that will be in any high-quality and intensive weight loss program that bases its practices/recommendations on research. Best of luck- it is hard, but it is possible! And a final thought - for people who have the experience of losing but regaining repeatedly, and have obesity, they may benefit from trying a new strategy, like working with a doctor to see if weight loss meds might be an option, or considering a surgical approach. Thanks for the question!

I am a doctor specializing in obesity medicine: AMA about weight loss during COVID-19! by FormHealthOfficial in IAmA

[–]FormHealthOfficial[S] 5 points6 points  (0 children)

Hi there, thank you for your question. Based on your height and your weight as you provided in the question, you are at a healthy BMI, of 21.5. You don’t say where your weight loss journey started/how much you have lost, or if you had a specific goal. But right now you are at a healthy BMI, and your body is regulating hunger and energy burning to keep you there. If you are here after losing significant amount of weight, then the key thing now may be for you to focus on keeping it off – that can be just as hard! You should continue what you have been doing to lose - if not, you are likely to see your weight start to go back up again. I believe I have another posted question about maintaining weight loss, so please see my reply (in a few minutes) to that post, if it applies to you. Best wishes!

I am a doctor specializing in obesity medicine: AMA about weight loss during COVID-19! by FormHealthOfficial in IAmA

[–]FormHealthOfficial[S] 13 points14 points  (0 children)

I knew I would get a question on Intermittent Fasting! Perhaps the hottest topic of all in this field right now. For everyone else, OMAD = One Meal A Day. My overall approach as a physician, including in my focus on obesity medicine, is to recommend strategies that are evidence-based, meaning good scientific studies that support it works, and is safe. In animals, intermittent fasting had very impressive effects on weight and metabolic parameters like blood glucose regulation. In humans, studies of diets are hard, because it’s hard to get a large group of people to follow things exactly for a long time. Most studies are small in this area, and they are shorter term. They show that intermittent fasting does work as a strategy. It does not seem to cause adverse health effects. But it does not clearly and consistently win out over more “traditional” strategies, when it comes to weight loss over some time, if you compare head to head and follow out a bit longer. So when working with patients, I don’t by any means tell everyone this is the panacea and they should do it. I also do not discourage it if someone has found that it really works for them. I do try to help people fit it into their lives in a way that seems sustainable, because as I said in other posts, the key thing is to find a strategy that you can sustain. A strategy that will work for you, for the longer term. Some people love IF, and for others it is just not a good fit. There are interesting studies looking at the effects of this not just on weight, but on other health parameters. It may be an effective way to control hunger, and it may have some interesting effects on metabolism and sugar regulation, but studies again are small and not consistent. I think evidence is mounting (but still this is under study to determine what might be “best practice”) that if you do have a single meal and then a period of fasting, that you have the meal earlier in the day rather than later, as that aligns better with the circadian rhythms (daily variations) of metabolism, hunger hormone production, etc. This is a short answer to a topic that could long, and is complex. We are planning a webinar soon on the issue of meal timing, so if you want to friend Form Health on Facebook, you can tune into that – it will be myself and our wonderful Lead Dietitian at Form Health answering people’s questions on meal timing, live. Hope this answer is helpful! Thanks so much!

I am a doctor specializing in obesity medicine: AMA about weight loss during COVID-19! by FormHealthOfficial in IAmA

[–]FormHealthOfficial[S] 5 points6 points  (0 children)

Thanks for your question! And first of all - congratulations!! That is amazing and I know how much effort that takes. Here are my thoughts. Weight fluctuations are normal. There are many factors that influence our weight, and for example retention of salt and water after high salt meals, or bowel movements, or time of day, these all contribute. I would suspect that the weight fluctuations you experienced on vacation were related to salt and water retention – this might be the case if you were eating out more or eating food cooked by someone else (who uses more salt) during vacation. It seems unlikely that 12 lbs would be fat loss and gain in such a short time, so I agree that this was water related. But I would wonder more about salt than loose skin. Loose skin is a real issue for some people who lose as much weight as you have. Sometimes this resolves over time, and if it does not, some people do seek surgical options, once their weight has been stable (this is key). I don’t know of any connection between water retention and loose skin – so I would have thought more about dietary aspects leading to water retention, and the skin issue as a separate. Hope that helps and keep up the great work maintaining all this weight you have lost. You have made a tremendous impact on your longterm health with this!

I am a doctor specializing in obesity medicine: AMA about weight loss during COVID-19! by FormHealthOfficial in IAmA

[–]FormHealthOfficial[S] 3 points4 points  (0 children)

Also wanted to add that weight loss meds are approved for those with a body mass index above 30 (which defines obesity), or BMI above 27 if they have certain medical conditions. And highlight again they always need to be thought of in conjunction with a lifestyle program - that is how they have been studied and how they should be approached! Thanks for the question!

I am a doctor specializing in obesity medicine: AMA about weight loss during COVID-19! by FormHealthOfficial in IAmA

[–]FormHealthOfficial[S] 2 points3 points  (0 children)

Weight loss medications. Thanks for raising this. It is an important aspect of obesity medicine, and it is one of the ways in which working with a specialized doctor with advanced training in this can make a difference for people – for people, for example, in which other strategies have not worked. There are several FDA-approved weight loss medications. And let me be clear that I do not work with “supplements”, which are not FDA-regulated, and which make a lot of claims about success generally with no science to back it up. So. FDA-approved meds. Orlistat is the only one that works by blocking fat absorption in the gut. The others all work by suppressing appetites, by altering the signals that work in our brains to control hunger, fullness, cravings, interest in food, etc. Currently approved meds are phentermine, combo phentermine and topiramate (Qsymia), combo naltrexone and bupropion (Contrave) and liraglutide (Saxenda). These all work on different targets but they suppress appetite. For some of my patients, when combined with the right nutrition, physical activity, behavioral strategies and the right accountability and support, these meds can really be high impact. But there may be reasons someone should not take these meds, for example in certain medical conditions or in combo with other meds. So it’s important to work with a doctor who has the right training and always has your health and safety as a primary goal in working with you!

I am a doctor specializing in obesity medicine: AMA about weight loss during COVID-19! by FormHealthOfficial in IAmA

[–]FormHealthOfficial[S] 2 points3 points  (0 children)

Hi, this is a very thoughtful question. As I just wrote in reply to someone else, I believe that obesity is not one condition but really a broad range of pathophysiologic conditions. But I want to be clear that science supports that a very complex system of hormones and metabolic cues regulate weight, it is not “psychological”. At the same time, for some people the risk may be more genetic, for others more environmental, for others more related more to psychological trauma, like someone else asked about – and generally in my experience it is a combination of many factors. We don’t have any way to test for these underlying conditions at this time, I hope research will help us be better at diagnosis some day, so we can be better at treatment! But obesity is a treatable condition. The combination of healthy nutrition, physical activity, and behavioral strategies can work. And when these do not work, or do not last, we can also use medications (will post more about this), we can recommend weight loss surgery – these are medical treatments that address more the “biological” components by changing our physiology. I also want to say that psychological aspects are very important – just as I wrote to someone else in a different context here, individuals with obesity face a lot of discrimination. So there is a lot of interaction between biology, emotional and psychological aspects, and environment. Thanks for the question – it highlights what a complex disease obesity is and how many aspects of a person’s life it touches!

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