Weight Loss Success: Make New Habits or Break the Old?

Which works better for weight loss: creating new healthy habits or getting rid of bad ones? 

A small but clinically significant study was recently published in the International Journal of Obesity that addressed this question. The good news is that BOTH interventions produced sustained weight loss at one year, with the 21 adults who created new habits having a 6.2% weight loss (roughly 12.5 lbs) and the 22 adults who worked on breaking unhealthy habits having a 4.8% (10.1 lbs) weight loss. 


The intervention group that tried new habits followed the researcher's "Top Ten Tips" which included fairly predictable weight loss strategies such as walking 10,000 steps/day; reading labels, watching portion size and reducing fat content; packing snacks and sticking to a meal routine; choose water over other drinks; slow down and be mindful while eating; and of course, my standard preach of at LEAST 5 servings of fruits and veggies per day.

Interestingly, the bad habit breaking group was called "Do Something Different" (DSD). The concept was to "increase behavioral flexibility" by being assigned a different task to perform each day during the 9 week initial intervention. Tasks could include choosing a different route to work or wearing a new outfit, or even writing a short story.

I love the focus on all-around behavioral flexibility that includes new healthy habits. Consider challenging yourself (or better yet, share a challenge with a friend or family member to increase your accountability) to "Do Something Different" each day on your path to a healthier you. My challenge today? Substitute water for my recently "snuck back in" habit of having a soda with my lunch. 

What About the HCG Diet?

If I had a penny- okay, maybe a dollar- for everyone who asked me about the HCG diet, I'd be ready for retirement! Locally here in Austin, we had a couple people within our medical community do the HCG diet and lose a dramatic amount of weight, which fueled the fire. In my practice, I have had multiple patients try (outside my advice) different versions of the diet- some shots, some sublingual, some pills- and though all lost weight quickly, virtually all regained it in the same time span. Reading the medical literature to find some evidence-basis for the diet, here is what I found:

1. First of all,  HCG is NOT FDA APPROVED for  weight loss, and in fact, the FDA ordered the removal of all homeopathic OTC HCG products from the market back in December 2011 (because not only do they not work, but they promote a dangerous diet.)

2. HCG diets "work" because along with the supplement, patients are restricted to a dangerously low 500 kcal/day diet. Most people consume around 2500 calories per day, so a deficit of 2000 calories per day would mean a 1/2 pound or more of weight loss per day. So YES, anyone who managed to limit themselves to 500 calories a day will lose weight, but at what risk? This amount of caloric restriction can lead to heart arrhythmias, gall stone formation and electrolyte imbalance.

3. The idea behind the HCG is that it will suppress your appetite so that you can stand the severely restricted diet. HCG is the "pregnancy hormone"- if you had morning sickness (which I can first-hand attest does not simply last in the morning) you can certainly believe HCG would make you not hungry. Interestingly enough, however, in the majority of controlled studies, HCG injections showed no benefit over placebo injections- the test subjects lost no more weight on HCG than placebo, and there was no magical "redistribution of fat" (that is often touted as a potential result.)

BOTTOM LINE: HCG diets "work" because of the severely restricted calories in the diet, not from HCG "magic". Talk with your doctor or  registered dietician to find the optimal weight loss plan for you. 

PS. Happy new month- change those AIR FILTERS!

Is it a New or Old Weight Loss Drug?

This month I am talking about obesity & weight loss. By our human (and American) nature, we would all like a quick fix to solve our weight issues. This summer, the FDA approved not one, but TWO new weight loss drugs.  My last blog addressed lorcaserin (Belviq), and today's focus is really something old in a new package.

Qsymia was FDA approved in July 2012, and it is a combination of two older drugs that have been used independently to help with weight loss: phentermine and topiramate. Phentermine is an appetite suppressant, and was half of the infamous fen-fen (a diet pill combo that was removed from the market once its use was associated with the development of pulmonary hypertension (a damaging condition in the lungs) and heart valve issues. Phentermine by itself is still approved for "short term" use- a few weeks- as an appetite suppressant, but there is limited efficacy and safety data available. Topiramate was originally classified as an anti-seizure medication, but indications now also include migraine prevention. Physicians and patients were generally pleased to see that a side effect of topiramate is weight loss (to the point where I have had patients without frequent migraines ask if I will prescribe this drug "just in case"!)

Qsymia combines these two drugs, and showed significant weight loss at one year- an average of 8.9%.
Both drug components are  at much lower doses than the individual drugs are typically prescribed, which hopefully will limit side effects. Indications for this new drug are for patients who have a BMI>30 (defined as obese) OR if they are overweight (BMI>27) AND have high blood pressure, diabetes, or high cholesterol.

If you meet those qualifications and are interested in trying this new drug, don't rush to your doctor quite yet! Qsymia is not yet in pharmacies, though it is anticipated to be in "certified pharmacies" next month (September 2012).

BOTTOM LINE: The newly approved weight loss medication, Qsymia, combines two older medications and may prove to be significantly effective in helping treat obesity, but it is not available quite yet.