On the obstacle course of weight loss, many people get caught in the same spot again and again. Members of the medical community can help when trying to navigate the way to healthier living.
Whether asking for help from a family physician or visiting an institute dedicated to bariatric issues, there are ways patients can find the help they need.
Kidanu Birhanu, a doctor board certified in internal medicine, said his approach is multidisciplinary and he doesn’t put patients on a diet. He asks them questions, evaluates their eating and exercise or lack of exercise and helps them change certain behaviors.
“One has to know that not all people eat because they are hungry,” he said. “We have to identify the environment that predisposes them to overeating. Food is an addiction you cannot get rid of easily. A multidisciplinary approach is essential to help the person who wants to help himself or herself. We cannot force people to lose weight. The reason why people gain weight is complicated.”
Birhanu works at Midwest Bariatric Institute in Dyer affiliated with St. Margaret Mercy Franciscan Hospital.
The most important thing is to identify why a patient overeats. “If the reason is boredom they need to occupy their time with something that will please them. Some people work swing shifts and they keep eating to be awake.” They need help in a different way.
“When we are too hungry or stressed, we eat high-calorie, high-carbohydrate foods. Sometimes preventing the sugar from becoming too low and create too much hunger will help the person avoid over eating.”
“We also identify certain medications that are known to increase the patient's appetite and suggest to the primary physician to change such medications,” Birhanu said.
Issues such as being bullied or sexually abused can also lead to patients being overweight, he said. These patients will need counseling by an appropriate psychologist.
Appetite suppressant medications can be used in conjunction with behavior modification. Birhanu uses Phentermine, Diethylpropion and Phendimetrazine. Other medications that were manufactured for conditions other than obesity can also be used for obesity management, such Topiramate and Zonisamide. Anti-diabetic medications such as Victoza can be used to control blood sugar and also decrease the appetite. Wellbutrin, an antidepressant, can be used for eating disorder. People with night eating disorder need a different kind of medication and approach.
Not all patients may be ready for exercise he said. They may have shortness of breath or joint pain and need another plan.
Exercise may be in the form of walking or even dancing, anything they enjoy. “If a person does not enjoy exercise, they will eat more after they exercise. If they enjoy exercise they get the high or happiness from the exercise,” Birhanu said.
Curtis Bejes also helps patients work through their weight loss, which can take up to six months of changing their habits to work.
Bejes is an MD board certified in family practice and holistic medicine and an employee of IU Health La Porte Physicians.
When patients ask him about weight loss, he works with them to change the way their bodies work. People are told to put less in and burn more off to lose weight, he said.
“That’s true but it is more complex than that. There is more and more being learned about how we’re all different. One person can eat a lousy diet and still be a normal weight and another person can be really careful and not lose weight.
Bejes explains this is how the “energy factories” in our bodies work. Those cells need to be reprogrammed for weight loss to occur.
He talks to patients about what they’re eating and what their exercise habits are like. He gives them tips to try and tells them they have to stick with it for six months before they may see results.
“When we work on it for six months, we’re getting their energy factories working. When you get people who can make those changes, to reprogram the energy, they can have great effects.”
Sometimes patients ask about nutritional supplements or prescription medications.
He said nutritional supplements are mostly safe but in most cases will not be effective. The products currently available are a combination of different vitamins, “but there really isn’t anything in particular that makes them drastically effective for weight loss.”
If a patient isn’t getting all the vitamins and minerals needed, the supplements may help the energy factories work better.
In the prescription area, he said that products designed for weight loss are frequently removed from the market, mostly due to serious side effects.
“So in general, I never prescribe anything for weight loss as far as medication.”
Instead he focuses on nutrition and physical activity.
“If you can get somebody to really stick with the recommendations, they will start losing weight. If you just change eating habits, it can happen but if you can add the physical activity, it can make a huge difference.”