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Pound for Pound

Author: Karen Hart
October, 2013 Issue

Weight loss is always easier with support. Here’s where to find it in the North Bay.

Have you heard about the cheeseburger that comes served on a glazed donut? Maybe you even tried one. But even if you passed on it, chances are you have your own vicewhether it’s a deluxe cheeseburger of your own creation, fried food, soda, desserts or chips. America’s obsession with food and trying to keep the pounds off has become a national pastime.
Oh, the irony. The constant struggle to indulge in these guilty pleasures but to also keep the calories from forming fat cells in your body that just won’t budge. “Food is entertainment, and we’ve become expert dieters, especially women,” says Lynn Mortensen, M.D., assistant physician-in-chief and chief of health education at Kaiser Permanente Medical Group in Santa Rosa and Rohnert Park.
According to Mortensen, the question to ask yourself is this: What drives you to eat?
“People eat for myriad reasons, and 90 percent of us eat emotionally at least some of the time,” she says.
In a recent survey, the Food Research Action Center reported that 68.8 percent of Americans are overweight or obese. According to the Center for Disease Control, more than 60 percent of Californians are overweight and 24 percent of those are considered obese. The obesity rate is expected to double by 2030.
What’s more, obesity is a key factor driving up health care costs in California, according to a report issued by the California Association of Health Plans. In fact, obesity alone adds $12.8 billion to the state’s $230 billion annual health care bill. Being overweight or obese can lead to serious chronic conditions such as diabetes, high blood pressure and high cholesterol that need to be routinely monitored.
So how do you go about getting the weight off? There are so many weight loss programsJenny Craig and Weight Watchers, for example. And so many dietsthe Atkins Diet, the Cabbage Soup Diet, the Military Diet, the Paleolithic Diet and more. There are also a variety of medical procedures that can help you get rid of excess fat.
The annual revenue of the U.S. weight loss industry is $20 billion. But what works and what doesn’t? How do you go about deciding on a plan to manage or lose the pounds? Here are the local trends, programs and philosophies helping those who need to get a handle on weight loss or management from North Bay medical professionals.

The emotional component

There’s a natural instinct to focus on the number of calories and the number on your scale, but, at Kaiser Permanente, the focus is more on the emotional component of eating. Do you eat to comfort yourself? When you’re sad? Happy? Depressed? Anxious?
“The goal is to help people understand why they’re struggling with their weight and to decrease the emotional reasons that drive us to eat,” says Mortensen.
As a result, Kaiser offers several classes. One, Overcoming Emotional Eating, is a four-week series that addresses why and how you eat. A second class, Pathways to Emotional Well-Being, is a single-session that addresses anxiety, depression and stress and how it can cause you to not eat well when you’re feeling frayed around the edges. A third class, Managing Your Weight, is a one-session overview that looks at different weight-loss strategies.
Kaiser also places an emphasis on exercise. “You can’t come to Kaiser Permanente without a medical assistant asking about exercise,” says Mortensen. “We discuss your exercise program the same way we would discuss your blood pressure.” As a general rule, Kaiser recommends that adults exercise at least 150 minutes per week and children exercise 60 minutes or more per day. And if you lift weights for 30 minutes twice per week, you can raise your basal metabolic rate, adds Mortensen.
As for how to follow a healthy diet, Mortensen offers straightforward advice.
Follow the United States Department of Agriculture’s nutrition guidelines as illustrated by MyPlate, she says, and make sure half your plate is brimming with greens. Generally, aim for five servings of fruits or vegetables per day, don’t drink your calories (unless it’s a green smoothie), stay away from fast food and processed food, and treat meat as a condiment. If you need inspiration about how to serve meat in smaller portions, study the diets of other countries. “We have much to learn from them,” says Mortensen.
“Our goal is to help people understand why they’re struggling with their weight,” she says. “We have a comprehensive plan. If you want to make a change, we’re here to help.”

Making changes one step at a time

The goal at Santa Rosa Memorial Hospital is to educate people about healthier habits and to encourage them to make lifestyle changes one small step at a time. “We’re making good strides in Sonoma County around childhood obesity,” says Chelene Lopez, health educator and manager of health promotion programs at the hospital. However, keeping the pounds off is still a struggle for the adult population.
“We’re looking at life-sustaining programs to help adults and young adults,” says Lopez. “It’s hard when you’ve maintained certain habits for 35 or 40 years.” If you grew up in a family where eating salad was rare, she says, it’s often difficult to start eating differently.
Your Heart, Your Life is a 10-week class that covers risk factors for heart disease, how to be more physically active, reduce high blood pressure and salt intake, how to maintain a healthy weight and more. Participants are encouraged to make small changes. During the first week, they’re encouraged to walk five minutes per day; the second week, they’re encouraged to increase it to 10 minutes per day, and so on.
Small changes can add up to a big difference. If you’re curious, try cutting back or eliminating soda from your diet. “A soda every day can cause you to gain 10 pounds in a year,” says Lopez. What about diet soda? “Diet soda is a false sugar and it’s worse for you, because your body doesn’t know how to react to it, and it contains chemicals.”
If you’re feeling nutritionally virtuous about the orange juice you drink, think again. “Orange juice and other juices are loaded with sugar. The sugar in juice and soda is almost the same. If you like drinking juice, water it down and make sure you’re not consuming more than an eight-ounce portion per day,” advises Lopez.
Healthy for Life is a hospital-sponsored, school-based program that supplements existing physical and nutrition education. Currently, the program is targeted at seven Sonoma County schools as well as the Boys & Girls Club of Santa Rosa and Petaluma.
“We want people to be healthy and exercise, so we provide programs for people who don’t know how to do that,” says Lopez. “Memorial is committed to helping people make life changes, and our two programs are free to anyone who walks through our doors.”

Raising awareness

The American Medical Association (AMA) declared obesity a disease in June of this year. It's a move that defines 78 million American adults and 12 million children as having a medical condition that requires treatment. “The AMA is trying to ramp up awareness, hoping to prod physicians into making the diagnosis and treatment of obesity a priority,” says R. Logan Faust, M.D., a gastroenterologist with Sutter Health. The AMA’s decision essentially makes the diagnosis and treatment of obesity a physician’s professional obligation.
Since 1980, the prevalence of obesity has increased 134 percent, says Dr. Faust, yet physicians tend to focus on the problems that can result from obesity (high blood pressure and diabetes, for example), rather than the weight itself. A Body Max Index (BMI) that exceeds 30 is considered obese, and a BMI that falls within the range of 25 to 29.9 is considered overweight.
What’s the key to getting the pounds off and keeping them off?
“It’s about getting motivated and taking responsibility,” says Dr. Faust. “The bottom line for all treatments is to eat fewer calories than you burn. Conceptually, it’s that simple, although it’s quite a bit harder to put into practice. The trend of therapy at the moment is to implement behavioral modification. What’s shown is that if you begin an organized program that provides regular feedback and encouragement, you’re more likely to lose weight.
“Studies comparing the most popular diet plans—Weight Watchers, Jenny Craig and the like—show they’re equally successful in getting the weight off,” he adds. “The problem is if you stop the program, you can regain the weight because you lack the intensive, ongoing encouragement.”
Sutter patients (as well as those using other health plans) are able to take a variety of classes through the Northern California Center for Well Being to learn how to manage their weight. All of these classes focus on what steps to take and encourage participants to check in 12 to 15 times to reinforce their progress and help achieve their final weight-loss goal. Additionally, an active weight-loss program using a calorie-restricted diet and nutritional supplement is available through the Sutter-affiliated program, Healthy Steps.
For patients with a BMI of 40 or higher, bariatric surgery may be the best way to lose weight. Bariatric surgery involves a variety of procedures that help patients achieve weight loss by reducing the size of their stomach.
“It’s hard to lose weight, but it can be done,” says Dr. Faust. “Behavioral therapy and reinforcement can make all the difference. So many diseases can be prevented without any medication or surgery just by encouraging exercise, healthy eating and weight loss.”

An integrative approach

Queen of the Valley Medical Center in Napa takes an integrative approach to working with patients interested in losing weight. “We have dietitians, personal trainers and stress coaches available,” says Tawnya Dorn, a registered dietitian and certified diabetes educator working inside Queen of the Valley Wellness Center. According to Dorn, sometimes losing weight is more complex than simply counting calories.
“When I meet with clients, I encourage them to look at their behaviors. What are they doing that causes them to eat more food than they need? Or, to eat the foods that aren’t best for them?”
One trend Dorn has discovered is that a lot of clients are watching TV while they’re eating and that they continue to eat throughout the night. “It’s important to disassociate screen time from eating time,” she says.
According to Dorn, how you manage stress can also influence eating and weight gain, which is why the Wellness Center encourages patients to meet with stress coaches and personal trainers at Synergy Medical Fitness Center, also part of Queen of the Valley. “Weight management needs to be a complete approach for people,” says Dorn.
The Wellness Center also offers a variety of classes, including one-on-one counseling with a dietitian, grocery store tours to teach people how to shop as well as classes such as Eating for a Healthy Heart.
Is there a key to managing your weight? “Find a way that you can eat for the rest of your life and make small changes to get there,” she advises.

Alternative procedures

Sometimes, despite all your efforts to eat right and exercise, you may not be able to lose the love handles or the muffin top, but there are alternative procedures that can help.
Liposuction offers a targeted attack, says Sina Bari, M.D., a Stanford-trained plastic surgeon and partner at Dr. Stanley Jacobs Cosmetic Surgery, located in San Francisco and Healdsburg. According to Dr. Bari, liposuction is the oldest and most well-proven strategy for removing fat. “Though there are newer techniques, [liposuction] is still the gold standard for achieving results,” he says. The procedure is done on an outpatient basis and it takes about seven to 10 days to recover.
While he uses BMI to evaluate patients, it’s not a perfect tool. “A marathon runner or a professional football player may score outside the range of normal despite being perfectly healthy,” he explains. Nevertheless, it provides a base to start from. “If a patient’s BMI is above 30, plastic surgery may work well with other treatments to get people toward their goal.”
The best candidates for liposuction are people who are living a healthy lifestyle but still have some pounds they want to get off, or women who’ve experienced changes in their bodies after pregnancy, says Dr. Bari. Liposuction can be a good way to kick-start a healthier lifestyle and get motivated. “Sometimes people get discouraged and give up; liposuction can reinvigorate patients and the results are often lifelong.”
CoolSculpting is another alternative procedure that can eliminate excess fat that’s resistant to diet and exercise. “CoolSculpting entails a medical device that attaches to a fatty deposit, such as in the abdominal area or inner thighs,” says Cristina Cortese, director of patient services and a licensed aesthetician at Artemedica, the office of Victor Lacombe, M.D., a board-certified facial plastic surgeon in Santa Rosa. The device draws in the tissue and freezes it for one hour. “Twenty-five to 30 percent of fat cells will be destroyed forever in one treatment,” says Cortese.
The Food and Drug Administration has approved CoolSculpting for the abdominal area, back, inner thighs and arms. It takes four to five months for the body to eliminate the fat cells and for patients to see results. However, some patients see changes beginning about two months after treatment. “It’s not invasive, there’s no down time and no restrictions. You can go to the gym afterward, if you want,” says Cortese.
The ideal candidates for CoolSculpting are healthy, active and within 15 to 20 pounds of their ideal weight, but can’t get rid of the muffin top, pooch or love handles,” adds Cortese.
The procedure helps patients lose inches and sculpts the body to create a leaner look. “Once you destroy the fat cells, they don’t regenerate. If you gain a tremendous amount of weight, the fat will come back, but not in the treated area,” she says.
Patients are encouraged to make an appointment four to five months following treatment for a checkup and to decide whether to retreat the area. “Most patients choose to revisit the same area because they were so pleased with the results,” says Cortese.

Staying fit for life

If you follow the headlines, then you’ve known for years that it’s important to eat right and exercise. But honestly, some of us are still looking for that magic pill that will melt the pounds away.
“It’s hard to change bad eating habits, and we’re still looking for that pill,” says Dr. Faust. “We may find the medication someday, but you still have to eat fewer calories. The best approach, in the words of Michael Pollan [author of In Defense of Food], is to eat whole foods, mostly plants, and not too much.”
“Learn how to exercise and eat healthy. Go back to cooking at home with fresh fruits and vegetables. And remember, everything in moderation,” says Lopez. “It’s OK to slip on occasions. Life happens. But when you slip, go forward and continue to make healthy choices.”
Managing your weight may also be your best defense for preventing serious illness and disease. According to Mortensen, finding the right balance of food and exercise is a key factor in preventing chronic health issues and disease.
“About 70 percent of cardiovascular issues such as high cholesterol, high blood pressure, heart attacks and strokes could be prevented if we could make sensible food choices and make exercise part of the weekly routine,” she says. “And a healthy diet could take a big bite out of breast and colon cancer. People need to move more, cook more and eat less processed food. That’s really all there is to it.”



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