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The following article was published in Your Health Magazine. Our mission is to empower people to live healthier.
Kavian S. Milani, MD
Good News In Weight Management
Virginia Family Medicine
. http://www.virginiafamilymed.com/

Good News In Weight Management

The good news is that everyone who wants to lose weight can do so with some help. The critical element here is calorie restriction. The diet is the most difficult part of weight management. Weight management is essentially a calorie consumed vs. calorie expenditure balance.

In general, any medically managed program should provide an additional 4-5 pounds of weight loss per month. The pitfall here is not the first 10 pounds, but it is how to sustain the weight management over the next 12 months, and how to avoid the “yo-yo” effect. After the first successful period of weight loss the body reacts in a number of ways and metabolism actually slows down. Thebody produces a hormone called ghrelin which increases appetite to negate anyweight loss to restore the original (non-desired) weight.

After 20 pounds of weight lossghrelin increases by about 30% creating a ravenous appetite that will quicklyforce one to regain the weight back, negating any success. This can last up toa year. Patients losemomentum and become discouraged when any success is reversed despite their besteffort.

Recent studies have uncovered some interesting characteristics of ghrelin. First, ghrelin increases with
decreasing BMI and decreases with increasing BMI. The former is fundamental in explaining the aforementioned compensatory hunger drive that accompanies weight loss and, interestingly enough, the latter may explain why patients with anorexia have a difficult time maintaining a normal appetite after attempts to gain weight. Another study found that patients that are weight cycling (losing more than 10 pounds multiple times within the span of several years) have higher average blood concentrations of ghrelin.

Most importantly, researchers have found that even one year after aweight loss program, levels of circulating ghrelin remained higher than beforeweight loss program was instituted. Thisfinding is key to helping ensure a successful weight loss regimen. We currently have no drugs that can directlytarget the ghrelin signaling system, but we do have access to medications, suchas Saxenda and/or phentermine, that have different mechanisms of suppressingappetite and opposing the ghrelin tide that swells during weight loss. When willpower alone may fail in weightmanagement, countering the effects of ghrelin will prevent our fundamentalphysiology from undermining our progress.

The really good news is that the correct use of medications can really enhance the original weight loss, and counter the body's attempts to reverse the weight loss. However, weight loss medications need to be highly personalized and there are no “cookie-cutter” approaches or shortcuts.

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