65 Frequently Asked Questions About Weight Loss

Question: Why should I lose weight?
Answer: According to the CDC (Center for Disease Control and Prevention) 33% of American adults and 17% of American children are considered obese.

Question: So?
Answer: Being overweight increases the risk of hypertension, diabetes, hyperlipidemia, coronary artery disease, stroke, gall bladder disease and some cancers. Simply put, losing weight will make you feel better and live longer. If you are onmedication for any of the above diseases, you may find that you might actually have to decrease or stop taking your medications all together.

Question: O.K. I’ve decided to lose weight so I can be healthier. What kind of diet will I be on?
Answer: Losing weight is only part of leading a healthier life. Life style changes include proper nutritional choices and regular exercise. To address weight loss issues we use a high protein and low carbohydrate diet. Your initial caloric intake will be approximately 500 calories per day.

Question: That doesn’t seem like a lot of calories. Are you trying to starve me to death?
Answer: You will be, in fact, on a severe calorie restricted deficit diet. Under proper medical supervision it is our belief that eliminating sugars and carbohydrates from your diet, when combined with high protein intake, will facilitate weight loss. Your body will mobilize its fat stores to use as energy when it compensates for the loss of sugars and carbohydrates that are normally ingested in a standard 2000 calorie American diet.

Question: No way I can do this on my own. Are you going to help me?
Answer: As part of this program we use appetite suppressants. They make it a relatively painless process to transition you from where you are to where you want to be.

Question: Your program emphasizes the point “Don’t eat unless you are hungry. So I’m just going to not eat, right?
Answer: The mantra “Don’t eat unless you are hungry” is a theme we use to reinforce the idea that most Americans eat out of habit not out of hunger. We don’t want you skipping meals; just use more Saran wrap and throw the popcorn, candy and ice cream away for now. When you feel full, STOP EATING.

Question: Can you tell me about the kind of calories I will be eating?
Answer: The initial phase or STAGE I consists of approximately 500 calories of protein only a day. After entering a state of “ketosis” the addition of fruits and vegetables will increase that calorie count to approximately 650 to 750 calories per day.

Question: Can you prove this kind of diet will work?
Answer: There is very little that has been scientifically proven in any weight loss management. Atkins, Zone, Weight Watchers, Cookie Dough, South Beach, Cabbage Soup, Grapefruit, Slim Fast, high carb, low carb, no carb are just a few examples. Most legitimate programs for weight loss are founded on EVIDENCE BASED rather than SCIENTIFIC BASED medicine. In other words, we, as clinicians see the results in our average patients, but, because there are so many variables in human beings and we cannot isolate what a human being may eat or drink 24/7 like we can a laboratory rat, we cannot scientifically prove our results (the ability to perform the same experiment and end up with the same results over and over again.) because human motivation is non quantifiable.

Question: What is this “KETOSIS” thing you mention?
Answer: Most living organisms obtain their energy by way of the Krebs cycle where sugars are converted to energy units called ATP. When your body is denied elemental sugars and carbohydrates, fat is broken down to substitute in the Krebs cycle. One by-product of this biochemical reaction is Acetic Acid. The liver converts this acetic acid, which it cannot use, into acetoacetic acid. These are removed by your kidneys in the form of mild Ketone bodies. This stage is called KETOSIS.

Question: Isn’t that dangerous? Don’t diabetics end up in the hospital when they are in Ketosis?
Answer: Your desired goal of modified KETOSIS is different from diabetic KETOACIDOSIS when the blood sugar of diabetics gets unacceptably elevated and the blood becomes acidotic. That is a medical emergency.

Question: If this is about calories, then why can’t I just eat 500 calories of candy a day?
Answer: The physiology and biochemistry of the body is more complicated than that. Many small children seem to eat nothing but sweets and somehow, much to their parent’s surprise, survive just fine. But this program is not about surviving or maintaining the status quo of your body. It is about getting healthier. Remember our previous discussion of the Krebs cycle. The primary fuel source for the body’s engine is SUGAR. If no SUGAR is available to burn then the body converts CARBOHYDRATES into SUGAR. If neither CARBS nor SUGAR are available then the body breaks down FATS to convert into energy. This is much more inefficient BUT THIS IS HOW YOU LOSE WEIGHT…. converting FAT into energy.

Question: But this diet is still about calorie counting?
Answer: Yes and no. In the end, you can pretty much base your future diet expectations on “calories IN and calories OUT.” Eat your chocolate, but understand that one piece represents an hour on the treadmill. It is the same thing with alcohol. Two glasses of wine IN (at 175 calories per glass) equals one hour on the treadmill OUT. So more importantly, the diet portion of our program is about CHOICES. Learn how to make the right choices, change your life style and live a healthier happier life.

Question: What happens in STAGE II?
Answer: After the first week of 100% protein diet we introduce carbohydrates in the form of fruits and vegetables based on the food’s glycemic index. Those food items permitted in this portion of our diet have a relatively low glycemic index. At this point your protein to carbohydrate ration will change to 70:30.

Question: What is a glycemic index?
Answer: Developed in 1981 by Dr. David Jenkins at the University of Toronto, it is a ranking of carbohydrates based on their effect on blood sugar levels. Candy would have a higher glycemic index then an apple or squash because the sugars in candy are available almost immediately in the blood stream while it may take the body hours to process the carbohydrates in a vegetable like squash to raise your blood sugar.

Question: I think I can almost stick to this diet. I’ll give it a try, OK?
Answer: ALMOST sticking to the diet means you’re ALMOST going to lose weight. Expect results accordingly.

Question: What about the drugs you are giving me?
Answer: The three primary medications we use are appetite suppressants, supplemental vitamins and fat burners.

Question: I’ve heard of appetite suppressants. What are they?
Answer: Appetite suppressants are one of the three cornerstones of our program. They take away your hunger. They are, as a class, mostly amphetamine based.

Question: Aren’t amphetamines dangerous?
Answer: We do not prescribe amphetamines casually nor do we ask you to take them casually. These medications have been around for many years and are all FDA approved. Be aware all medications have the potential for adverse reactions. It is our job to keep you informed, to screen you for any contraindications in advance and to identify any problems should they arise. Taking this class of medications involves making a decision as to RISK: BENEFIT ratio. The risks of taking amphetamines are far less than having diabetes or a heart attack from untreated obesity.

Question: A friend of mine was on Fen-Phen years ago but had to stop because it was dangerous. Are you giving that stuff to me?
Answer: Fen-Phen was a combination of Fenfluramine and Phentermine and was successfully used as an appetite suppressant for years. Phentermine is an amphetamine and is still on the market. Fenfluramine was taken off the market in 1997 because of an association with valvular heart disease and pulmonary hypertension. This combination of drugs is no longer available.

Question: Are amphetamines addicting?
Answer: Amphetamines are not addicting like heroin or cocaine. Your body may get use to and adapt to them over time, but you will not have seizures or heart attacks on their withdrawal. You will not break out in cold sweats or have muscle cramps when you stop taking these medications. You will just go back to having your normal appetite.

Question: So what do these appetite suppressants do?
Answer: Amphetamines are central nervous system (CNS) stimulants. They work by enhancing dopamine activity, one of the main chemicals in the brain. One side effect of these chemicals is that they take away your desire to eat. Your heart may beat faster and you may feel like you have more energy.

Question: My friends call Amphetamines “speed”. Do they speed up your metabolism?
Answer: No. You might stay awake longer and be more alert when you are awake. In the grand scheme of your metabolism, they do not affect your metabolic rate.

Question: If Amphetamines are safe like you say, then why do you have to do a medical screen on me?
Answer: There are several contraindications for using this class of medication. These include uncontrolled hypertension (high blood pressure), a history of arrhythmias (irregular heartbeats), glaucoma, certain psychiatric disorders, history of drug abuse, a history of strokes and the current use of a class of drugs called MAO inhibitors. Amphetamines can aggravate these conditions if they are preexisting and, in some patients, precipitate them in an otherwise asymptomatic patient. We routinely perform an EKG, a physical exam, and a battery of blood test to evaluate, among several things, baseline kidneys, liver, and thyroid functions. We also monitor you medically during the duration of this program.

Question: Should I expect any side effects from using Amphetamines?
Answer: There are no absolutes in the practice of medicine. Many patients have difficulty falling asleep the first few nights when initially placed on these medications. A rapid heart rate is not uncommon and is safe as long as it is less than 100 beats a minute at rest. Dry mouth, dry eyes, blurry vision, mood changes, a mild headache, difficulty starting a urine stream are some other less common side effects. This does not mean you will experience any of these; but it is possible you may.

Question: One of your program disclosures mentions “OFF LABEL USE” of Amphetamines. What does that mean?
Answer: The FDA (Food and Drug Administration) has approved the use of Amphetamines for up to 12 weeks in weight loss programs. We believe and have successful experience in demonstrating the safe and effective use of this class of drugs for much longer than that. The use of medication for periods longer then the FDA advises or for reasons different then these medications were originally developed or approved for is called “OFF LABEL USE” and is very common in the practice of medicine.

Question: You said the appetite suppressants are one of the three cornerstones of this program. What are the other two?
Answer: Drinking a gallon of fluids a day and exercise.

Question: I take thyroid pills every morning. When can I take your appetite suppressants?
Answer: Both these medications can be taken them together. As you know your thyroid medicine as well as appetite suppressants must be taken on an empty stomach.

Question: What is Xenical?
Answer: Xenical blocks absorption of dietary fat where they pass through the intestines unabsorbed. Carbohydrates and protein absorption is not affected. It is contraindicated in patients with chronic malabsorption syndrome or impaired bile flow (gall bladder or pancreas problems). The most common adverse events are related to the gastrointestinal system and include fecal urgency, fatty/oily stools, diarrhea and fecal incontinence.

Question: What other chemicals or medications are you going to be giving me?
Answer: You will be receiving a substance called Calcium Pyruvate. This is a calcium salt of a natural substance, pyruvic acid. You can find this compound at the beginning of the Krebs cycle referred to earlier. It is NOT a calcium supplement so do not stop taking calcium if you have been previously prescribed that medication. It is believed to work by accelerating the Krebs cycle.

Question: Is this just another pill you are trying to sell me that has no foundation in scientific research?
Answer: In fact, the use of this compound originates with a series of studies at the University of Pittsburg in the mid 1990’s by Dr. Robert Stanko. Researchers found that those patients who were given these compounds lost an average of 20% more weight than those who did not receive them. It is believed that they work as a substrate in the Krebs cycle mentioned previously.

Question: What else do you typically prescribe?
Answer: We use vitamin supplements.

Question: I always read that vitamins in most American diets are superfluous and end up being excreted in the toilet. Aren’t you just trying to sell me something I don’t need?
Answer: When you eat a typical American diet, most vitamins Americans consume do, in fact, end up in the toilet. However, when you are on a calorically restricted diet (which is a mainstay of our program) the use of vitamins is critical to replacing water and fat soluble essential vitamins.

Question: What is an “essential” vitamin?
Answer: An essential vitamin is one that cannot be made by the body.
Therefore it is “essential” that those vitamins be obtained on a daily basis from external sources. B6 and B12 are examples of essential vitamins.

Question: What happens if I don’t get enough B6 or B12?
Answer: This is another fact proven by scientific research. The myelin sheaths (outer protective layer) that cover nerve fibers are particularly sensitive to B6 and B12 deficiencies. Alcoholics typically display this deficiency when they drink their calories instead of eat them. When you lose your myelin sheaths (the bun) covering the nerve (the hot dog), nerve fibers get wounded. One of the first signs of this damage is the loss of proprioception. You lose the ability to feel the ground with your feet or find things with your fingers. That is why alcoholics typically walk with such a wide-based gait or stance and appear to lose their coordination.

Question: Your program offers supplemental B6 and B12 shots. If I’m taking a vitamin pill, why do I need these extra shots?
Answer: The U.S. Recommended Daily Allowance (RDA) for B6 is between 1.3 and 2 mg depending on age, sex and pregnancy status. The RDA for B12 is 2.4 micrograms per day. The vitamin pills alone should bridge the gap between our diet and the minimum FDA suggested requirements. A small minority of patients will benefit from the supplemental injections because of preexisting medical or malabsorption issues. Unfortunately we cannot monitor your caloric or vitamin intake 24/7. The extra injections guarantee the availability of these vitamins and prevent adverse consequences of vitamin deprivation in this small subset of patients.

Question: What else can I expect from these extra shots?
Answer: Many patients feel there are extra benefits with these injections including but not limited to extra energy, decreased fatigue, decreased bloating, relieving stress and decreased headaches often associated with dieting or taking appetite suppressants. These claims are ANECDOTAL and not SCIENTIFICALLY QUANTIFIABLE.

Question: Why can’t I use my own vitamins instead of buying yours?
Answer: As discussed there are many manufacturers and brands of vitamins on the market. Your brand may be just perfectly fine. It is critically important that you take vitamins that are pharmaceutical grade (guaranteed ingredients) as well as standardized (guaranteed to have a certain bioavailability in the body).

Question: Why do you want me to drink so much water?
Answer: Water helps flush out the Ketone bodies discussed in an earlier question on KETOSIS. The production of Ketone bodies is a natural side effect of a calorically restricted diet. Renal clearance and healthy renal function is maintained when these toxins are flushed out. To this end the kidneys will automatically mobilize its water reserves from intravascular volume (fluid in your blood vessels). Drinking a gallon of water a day will replenish the body’s fluid reserves lost during this process and prevent you from getting dehydrated. In addition drinking water helps to relieve oral mucosa (inside of the mouth) dryness, a side effect of amphetamine use.

Question: What about exercise? How much and for how long?
Answer: Remember, our medications do not make you lose weight. They give you the tools to lose weight. Without regular exercise you will be disappointed with your eventual outcome and success. We suggest core training. If you’re a couch potato, begin with mild exercises such as stretching, Pilates or Yoga. Progress to walking and eventually work your way up to bicycling, jogging, elliptical or Nordic track machines for aerobic workouts. If you have joint or back issues, then we recommend pool activities such as water aerobics or even something as simple as walking in the pool to create resistance exercises. If you are unaccustomed to exercising then start with something as simple as 15 minutes per day, three times per week. Our suggested target is 30-45 minutes per day 4 – 5 times per week.

Question: I’m going to get a personal trainer. He wants me to lift weights. Is that O.K.?
Answer: Typical serious weight lifters consume 150-200 grams of protein a day. Our diet provides only about 50 grams of protein a day. If you do weight training on this diet you will BREAK DOWN MUSCLE MASS. The byproducts of this process are filtered by the kidneys and, in extreme cases, could result in kidney damage and the need for dialysis. So please don’t do strenuous weight training.

Question: What is a BMI?
Answer: BMI or Body Mass Index is a measure of weight taking height into account. The formula for this calculation is BMI = weight/ (height x height).

Question: What is Body Fat %?
Answer: Body Fat percent or BF% is simply the percent of fat your body contains. “Weight” consists of both lean body mass and body fat. In the past this was measured by submerging an individual in a tank of water and measuring water displacement. Now we most commonly measure BF% by electrical impedance. A small electrical current is sent through one part of the body and measured as it comes out of the other (typically a scale where each foot becomes a separate electrode.) BF% is important because weight loss doesn’t always mean fat loss.

Question: How much weight can I expect to lose the first week?
Answer: Everyone is different. You are a human being, not a car and therefore accurate predictions are often problematic. A realistic target is 2-3% of your body weight. Someone weighing 200 lb might realistically expect to lose 4-6 lbs the first week.

Question: What can I expect for the second week?
Answer: Anticipate 1% of your body weight each week thereafter if you don’t exercise BUT DO stick to the diet.

Question: And if I do exercise?
Answer: Then you can maintain the 2-3% loss each week thereafter.

Question: Maybe I should just cut out a breakfast or lunch. I want to lose as much weight as fast as I can. If I eat less or skip a meal I should lose weight faster, right?
Answer: In fact, just the opposite is true. The brain will respond to a missed meal as another indicator of “starvation” and force your metabolism to slow further. In addition the FDA reminds us that rapid weight loss can easily put your health at risk.

Question: That doesn’t make sense to me. Can you prove it?
Answer: Religious sects who observe the practice of fasting for certain months of the year typically eat only one meal after sunset. Caloric intake was accurately measured. Those who ate only one meal a day, when compared to those who ate the same calories but spread over three meals a day, ACTUALLY PUT ON WEIGHT.

Question: Still, the faster I’m done with your program, the more money I’m going to save for myself, right?
Answer: Rapid weight loss is associated with floppy skin in areas such as the arms and abdomen. Trying to lose large quantities of weight rapidly will only end up sending you to the plastic surgeon for a very expensive surgical revision to cosmetically trim that skin.

Question: So I should eat three times a day?
Answer: At a minimum. We believe that the concept of “grazing”, eating and snacking at least 5-6 times a day, is more efficient and effective in consistent weight loss management.

Question: What about coffee? Can I still have my coffee?
Answer: Amphetamines are stimulates. Caffeine is a stimulant. Try to limit yourself to no more then 2 cups of any caffeinated beverages per day. Limit your chocolate, too. At the same time please don’t suddenly stop your caffeine intake if you are use to large amounts. If you do you will precipitate a caffeine withdrawal headache.

Question: What about alcohol?
Answer: A light beer has 110 calories. An 8ounce glass of wine has about 175 calories. There is little wiggle room in this diet for any extra calories.

Question: What happens when I’m done with your program? Won’t I just balloon right back up again?
Answer: Our program is not just about losing weight or hitting some fantasy number on a chart. It is about maintaining your ideal weight FOR YOU and being healthy. Invariably it is also about choices. When you reach your goal, we will slowly taper you off your appetite suppressants so that your appetite can return naturally. Regular exercise must be part of the new you. Skip a few days or a week of exercising and you will have no right to complain about the way you look or feel. Eat properly and you’ll be fine. Eat at the buffet table and you’ll be forced to spend hours on the treadmill or be satisfied with letting out your belt another notch. Portion control and you can have your spaghetti and meatballs. Most importantly stop eating out of habit.

Question: I’ve been on the diet for a while. The appetite suppressants were working just fine. Now I’m finding myself hungry. Why?
Answer: Regular users of amphetamines experience tolerance and may require increased dosages to achieve the same level of effects. This plateau is a relative “speed bump” and cannot be accurately predicted. We may suggest switching medication within the same drug family or taking a drug free hiatus to permit your body to readjust.

Question: Why am I losing hair?
Answer: It is not uncommon for individuals on a calorie restricted deficit diet to lose hair. Hair grows in 3 to 6 month cycles. Hair loss will stop when your diet returns to normal. In the meanwhile you can use Rogaine (over the counter).

Question: Why are my menstrual periods irregular?
Answer: It is not uncommon for individuals on a calorie restricted deficit diet to have changes in their menstrual cycles. Vigorous exercise such as marathon running can also contribute to this issue. Most women find their periods return to normal when their dieting stops or when they decrease aggressive exercise routines.

Question: My friend sees another doctor for weight loss. He is getting shots of methionine, inositil and choline. Why aren’t you giving me those?
Answer: Methionine is an amino acid. Inositil and Choline are part of the vitamin B family complex found in most oral vitamin supplements. Many weight loss programs use supplemental injections involving these substances but the scientific basis for their use is suspect at best.

Question: Ever since I started this diet I’ve been constipated. What can I do about that?
Answer: Constipation is a common side effect of a calorie restricted diet… nothing in so nothing out. We suggest any senna product (teas, senokot tablets etc) as natural bowel stimulants. Other sugar free laxatives such as Dulcolax are appropriate. Bulk fiber products such as Sugar Free Metamucil or Citrucel contain sugar but are acceptable if judiciously used. Magnesium Citrate is appropriate if you are severely constipated. Recently we’ve had success with a new compound, Amitiza (lubiprostone). The recommended dose is 24 mcg twice a day with food.

Question: Why is it that I often weigh less on my scale at home then when I come to the office for my weigh-in?
Answer: The most common reason involves time. If you follow our recommendations, you will be drinking about a gallon of fluids a day. A gallon of water is 128 ounces; but, it also weighs 8.4 pounds. Although you will be urinating more frequently when you drink a gallon of water, it takes an average of 4-6 hours for your kidneys to respond to that fluid load before the excess fluid is cleared from the body. Depending on how much water you’ve consumed prior to your office visit, you might actually have up to 8 lbs of temporary water weight in you, thus accounting for the apparent discrepancy in your weigh-ins.

Question: I’ve been watching my BF% (body fat percent) and, as I get closer to my goal, I see that the number isn’t changing very much. Why?
Answer: As an approximate guide male athletes have an average range of 12 - 18% BF. Female tri-athletes have an average of 18 - 24% BF. Body Fat fluctuates with muscle mass, fat and water ingestion. Muscle weighs more than fat. The leaner you become the less fat you have to lose and the more muscle you have in proportion to that fat. If you drank a significant portion of water prior to your weekly weigh-in, your body fat will artificially decrease. One warning for our female patients is to remember the less body fat you have, the less curves, breasts and buttock tissue you will have.

Question: I exercise the same every week. I eat the same every week. Why do I find my weight loss decreasing the longer I stay in this program?
Answer: The brain has the chemical ability and, more importantly, the genetic imperative to maintain you fluffy, hibernating and “well marbled” in anticipation of the next coming ice age. It responds to your weight loss efforts by lowering your metabolic rate to preserve your current weight, whatever that may be. Think of it as a steam locomotive going uphill. The closer it gets to the top, the steeper the incline it has to transverse. The hypothalamus (part of the brain) has the ability to control that incline by adjusting your body’s metabolism. A hamburger eaten today will be metabolized much more slowly and its nutrients extracted much more efficiently than one eaten at the beginning of your diet.

Question: I’ve been getting a lot of leg cramps since I’ve started this diet. What is that from?
Answer: It is not uncommon to experience mild electrolyte disturbances when on our diet, most probably from drinking the amount of water we recommend. It is impractical to obtain a blood test at three o’clock in the morning to measure your electrolytes if you have leg cramps to confirm the etiology of your symptoms. We suggest drinking ½ cup of chicken bouillon if you get muscle cramps. If you have a mild electrolyte abnormality, you will notice a resolution of your cramps within minutes. If this is the case, taking over the counter potassium or magnesium may be helpful.

Question: I’ve been getting headaches since I’ve started the appetite suppressants. What should I do?
Answer: Mild headaches in the front or the back of the head are not uncommon in the first few days of our program. These should be well controlled with Tylenol, aspirin or any anti-inflammatory such as Motrin or Advil and should spontaneously resolve within 48 hours. If you have a headache associated with any neurological deficit such as vision disturbances or difficulty speaking or thinking then you must stop your medicine immediately and seek medical care in the emergency department.

Question: These pills are keeping me awake at night. Do you have any suggestions?
Answer: About 50% of patients who take amphetamines have mild sleep disruptions. This usually resolves within 48 hours. Make sure you take your last appetite suppressant at least 6 hours before your usual bedtime. Otherwise over thecounter sleep aids such as Benadryl are quite safe to use on a short term basis.

Question: Since I’ve started your diet I’ve noticed I’m having problems with my teeth. Is this from the appetite suppressants?
Answer: Jaw tension and teeth grinding have been described with amphetamine use. Reducing your dose may result in resolution of these symptoms.

Question: Do you think I can really change my bad eating and exercising habits, or am I just wasting my time and money?
Answer: Only if YOU want to. This is really all about YOU. It is YOUR time, YOUR money and YOUR body. No one else can do this for YOU.


home  •  why mdwlc  •  we care  •  about mdwlc  •  in the news  •  faqs  •  contact us
medically supervised weight loss  •  self managed weight loss  •  surgical weight loss  •  lifestyle self maintenance
privacy policy  •  terms of use  •  sitemap  •  patient log in  •  physician log in

copyright © 2008 MD Weight Loss Centers  •  web presence and online marketing tools developed and maintained by vision2media and voodooviral