The American Medical Association (AMA) has finally acknowledged the elephant in the room and has declared obesity a disease. It seems we are a species that has evolved to survive starvation, but not to resist abundance. As a result, too many are taking medications for high blood pressure, high cholesterol, and high blood sugar. You’ve probably been advised to lose weight by simply eating less and exercising more.

Exercise is vitally important for over 100 reasons. Exercise can generate the same kind of chemical rewards in the brain that food does! But 6 minutes of unconscious eating can undo 2 hours with a personal trainer! Please exercise because when you stop moving you start rusting. When you rust, your body becomes inflamed. Have your hsCRP checked to determine your level of inflammation. Inflammation is the precursor to nearly every disease.

Two obesity medications have recently received FDA approval to help shed your excess girth, and a third California pharmaceutical company hopes to receive approval for a third medication in 2014.

Belviq was rejected by the FDA in 2010 due to the development of heart valvular defects, yet recently received FDA approval with acknowledged side effects of dizziness, headaches, and fatigue. Belviq isn’t an appetite suppressant, rather it works by activating a receptor in your brain that tells you that you are full with less food. Quality protein and good fats will also signal the ventromedial nucleus of your hypothalamus that you are full too!

The other weight loss medication, Qsymia is a combination of Phentermine (an appetite suppressant prescribed for decades) and Topirimate (aka Topamax, a seizure medication that purports to promote feelings of fullness). Qsymia is available only through a mail-order pharmacy, requires monthly pregnancy tests, and is contraindicated if you have glaucoma or hyperthyroidism (overactive thyroid). The cost is about $150/month. Studies report that most lose 5-10% of body weight if greater than 35 pounds overweight.

Taking a weight loss pill may be a start. Then, realizing that food is the major addiction which profoundly affects brain chemistry, learning how and why you gained weight and are unable to lose it or keep it off is a priceless investment. Obesity is richly layered with complexity, and has many causes that are unable to be “fixed” by one thing, one pill. With ejaculatory inevitability the FDA is attempting to conquer a disease as complex as obesity (also called diabesity) with a pill.

I suggest you aid your weight loss with learning the following:

Create your own lap band surgery by wearing a belt or tight clothing when you eat. Since your stomach is the size of 2 fists, you will feel uncomfortable after a few bites. Eat slowly with your non-dominant hand, put your fork down, chew until the food is liquid and don’t speak with food in your mouth………you will eat 50% less! It will take a while for your dining companions to realize they shouldn’t ask you a question while you are chewing. When dining out, ask the server to pack 1/2 of your meal.

Most seem to crave and love wheat. If you must eat bread, have a small piece at the end of your meal. With your tight clothing, you may not even want it. If you put flour in a bowl with water, you get paste….so consider a gluten free diet. Many of my patients are only able to lose their expanding midriff by restricting or eliminating wheat. Test sIgA Antigliadin Abs to see if your body is producing antibodies against wheat.

If you are overweight you are probably pre-diabetic. Have your doctor order a HgbA1C test to see what your average blood sugar has been over three months. I often prescribe a blood sugar monitor so patients can learn what happens after a momentary indiscretion or a large meal. How high is your blood sugar one hour after eating, let’s say, a Philadelphia soft pretzel that contains 70 grams of carbohydrates? Divide the 70 grams of carbs in that pretzel by 5 and you just ate 14 teaspoons of sugar.

Refined carbs require insulin to be released to lower your high blood sugar, then your blood sugar is low again, and then you are hungry again. You need protein and good fats to stabilize your blood sugar and appetite! If you are a member of the low fat is good club, if you eat too many carbs, the following is a common scenario:

Insulin is constantly spewing from your pancreas to lower your blood sugar, then you eventually develop insulin resistance, then insulin can’t get inside your cells to lower your blood sugar and merely hangs out, then your blood sugar is high, and since too much insulin is a fat storing hormone, your protruding abdomen is something you think and worry about all the time.

Ever since we’ve demonized fat, we have become fatter and fatter. Portion controlled fat and quality protein are not the enemy. Our refined diets full of carbs devoid of nutrition, the overabundance of nutritionally bereft food, and the fact that very few learn the basics of nutrition merits a rethink. I look forward to the day when we learn how to cook healthy meals in medical school.

Meanwhile, if you decide to try one of the new obesity medications, please learn how, why, where, and when to eat.