Open Letter to Legislators on Obesity

Dear Senators McCain, Senator Flake and Congressman Franks,
I am a Family Physician, Obesity Specialist and Health Policy Fellow.  I had the opportunity to meet with your staff a few months ago and would like you to consider co-sponsoring S-1184 and/or HR-2415 the "Treat and Reduce Obesity Act." Obesity affects 34% of the population and 33% of the population in the US is overweight. Obesity is affecting military readiness and our economy using 21% of all healthcare costs.
One of the challenges I find as a physician who treats obesity daily, is that medications and therapy that is effective in treatment is not covered by Medicare services.  S-1184 will allow me as a physician to use effective medications for obesity that patient's current cannot afford.
I would love to talk with you or your staff about this bill and its effect on our treatment ability.
Please consider co-sponsorship of this bill and feel free to contact me regarding this issue at any time.
Sincerely,
Adam S. Nally, D.O.
Board Certified Family Physician & Bariatrician
Health Policy Fellow

Honesty is the Best Policy . . .

Andreas Eenfeldt, MD, a trusted low-carb colleague posted this today. Couldn't help but repost it here. Thanks Andreas!

The Real ....

A Fat Attack Can Kill You

What is a "Fat Attack?"  A "Fat Attack" is defined as a gain of more than 5% of your total body weight.  A gain of this much weight can be notably detrimental to your health.  Gaining just 5% of your total body weight increases your risk for diabetes, heart disease, hypertension, stroke, osteoarthritis, polycysitic ovarian disease, allergies, and the list goes on . . .  Most importantly, your weight gain significantly affects your life and increases your risk of death by 20-40% according to recent study in the New England Journal of Medicine.
Between 300,000-400,000 deaths occur every year due to obesity.  435,000 deaths occurred due to smoking in 2008 according to the CDC.  Obesity is just as dangerous as smoking
"Overweight and obesity are now so common that they are replacing the more traditional public health concerns such as under-nutrition and infectious disease as some of the most significant contributors to ill health." (World Health Organization 1997 statement on obesity.)
So what should you do if you're having a "Fat Attack?" You should follow up with a your physician or a weight management specialist, a physician that is specialty trained in the treatment of obesity and its related disorders.
You can find a physician that has this special training through the American Society of Bariatric Physicians. These physicians have significant specialty training in identifying and successfully treating overweight and obesity conditions.
You can be successful in loosing weight and your "Fat Attack" shouldn't lead you to a heart attack. Look up your nearby bariatrician and start your treatment today.

Waist Size in Childhood Predicts Risk for Adult Metabolic Syndrome

A recent study published in the Journal of Obesity begun in 1985 shows that your waist size as a child is a very strong and independent risk factor in your forming metabolic syndrome later in life.  Metabolic syndrome is a precursor stage to type II diabetes mellitus that puts you at significant risk for heart disease and stroke. The study was conducted in 2188 boys and these boys were followed and evaluated at age seven, fifteen, and twenty-seven years old (twenty years later).
Results show that as your waist circumference increases as a child, your risk for metabolic syndrome notably increases and is unrelated to waist changes between childhood and adulthood.  This means that emphasis on childhood weight is significant and must be a factor in evaluation of the child's overall health and risk for disease later in life.

HCG & Weight Loss Fads

A number of patient have heard and asked me about Human Chorionic Gonadotropin (HCG). It is a hormone normally secreted by the trophoblastic cells of the placenta during pregnancy. It was first described as a treatment for obesity in conjunction with a very low calorie diet by Dr. A. Simeons in 1954.  Dr. Simeons reported weight loss success combining HCG with a very low calorie diet.  Multiple subsequent studies revealed that this method has been ineffective and that there has been no significant effect of HCG over placebo.  It appears that the weight loss occuring in these patients was due to the very low calorie diet used at the time and not the HCG; however, it has also since been shown that the diet used by Dr. Simeons was deficient in protein content based on current standards accepted in the bariatric (weight and metabolism specialist) community. 

The American Society of Bariatric Physicians released a position statement on HCG including the following summary and conclusions:
"Numerous clinical trials have shown HCG to be ineffectual in producing weight loss. HCG injections can induce a slight increase in muscle mass in androgen-deficient males. The diet used in the Simeons method provides a lower protein intake than is advisable in view of current knowledge and practice. There are few medical literature reports favorable to the Simeons method; the overwhelming majority of medical reports are critical of it. . .
Conclusions:
It is the position of the American Society of Bariatric Physicians that:
1. The Simeons method for weight loss is not recommended.
2. The Simeons diet is not recommended.
3. The use of HCG for weight loss is not recommended."
(http://www.asbp.org/resources/uploads/files/HCG%20Position%20Statement.pdf)

It is important that you consult your doctor before you begin any weight loss program and that you are aware of the recent data on current fads like the use of injectible and subligual HCG.

Dr. Nally is a member of the American Society of Bariatric Physicans and adheres to the metabolic and weight managment guidelines set forth by this medical society.

The Obesity Epidemic

I find it interesting that last year there were 435,000 deaths from cigarette smoking. Last year, there were also 400,000 deaths from obesity related illness. Obesity is second only to smoking as a cause of death. That is significant.
I have spent the last year reading and researching everything available on weight control. For the last 10 years of my clinical practice, two things have been elusive. First, almost two-thirds of the patient's in my practice are overweight or obese. That correlates with the current figures in the united states. However, most of these patients are very closely watching their diets and are exercising. However, the average patient is only able to loose 5-10 lbs and then the weight seems to return. Despite the depth and certainty of our faith that saturated fat is the nutritional bane of our lives and that sedentary behavior and over-indulgence or over-eating are the cause of our nations obesity, there is, and always has been, significant and plenteous evidence that the above assumptions are wrong . . . dead wrong.
I have patient after patient that comes to my office limiting their intake of fat and limiting their calories (sometimes to less than 1000 per day) and exercising more than most triathletes and they are still gaining weight.
Second, these same patients continue to have a climb in their cholesterol levels. It seems that I just continue to raise their doses of cholesterol lowering medicine to chase the numbers as they increase in adiposity.
To quote H.L Mencken, "There is always and easy solution to every human problem, neat, plausible, and wrong." After, a year of reviewing study after study and reading every legitimate source of research I can get my hands on I have come to the conclusion, as have many others, that fat doesn't make you fat.

Case in point, obesity rates remained fairly constant in the United States from 1960-1980 and then around the time the surgeon general released his "Report on Nutrition and Health" recommending that we all cut the fat out of our diets, our weight has increased to almost 33% being overweight in 2009.

This surge in obesity seems to correlate extremely closely with the constant message that obesity, diabetes and heart disease are caused by fat. We have been told for the last 30 years that we should eat less fat and eat more carbohydrates. Our society has been bombarded by this message and for the most part, we have believed it and followed suite. And the proof is in the statistics. We are getting fatter and fatter.

However, seeing what I have seen in the last 10 years of my practice, a large number of people have turned to the message of Dr. William Banting published in his "Letter on Corpulence" published in 1863 after he lost over 50 lbs. This message has been republished and repackaged in a number of ways, but the physiologic message is the same: Eat Fat and Grow Slim(1958), Calories Don't Count (1961), The Doctor's Quick Weight Loss Diet (1968), Dr. Atkin's Diet Revolution (1972), The Complete Scarsdale Medical Diet (1978), The Zone (1995), Protein Power (1996), Sugar Busters! (1998), and The South Beach Diet (2003). All of these advocate that it is the carbohydrates that are the problem and not the fat. It is fascinating to me that these have all been dismissed by the American Heart Association, The American Medical Association, and multiple nutritional authorities as misdirected fads. I, myself, told patients for years that these were just "fad diets." However, we were wrong.

Claude Bernard explained it this way, "In medicine, we are often confronted with poorly observed and indefinite facts which form actual obstacles to science, in that men always bring them up, saying: it is a fact, it must be accepted." (An Introduction to the Study of Experimental Medicine, 1865) The fact of the matter is that body weight is set by a complex interaction of hormones regulated by the body to maintain a homeostatic balance. The urge to simplify this complex situation so that physicians and apply it and patients can embrace it seems to have taken precedence over the obligation of science to present the evidence with relentless honesty. Unfortunately, this is an area of science where an enormous amount of data has been theorized and instead of rigorously proving those theories, there has become a dedicated practice of convincing the public that those theories have already been tested and the answers are already known. This is an area of medicine that, in the words of Gary Taubes, "purports itself to be science and yet function like a religion."

We have understood the actual science of fatty acid metabolism since the 1930's when Rudolf Schoenheimer & David Rittenberg identified the stages of cholesterol in the metabolism.

In 1965, we had a clear understanding of which hormones stimulate fat mobilization and which hormones promote fat accumulation. Forty years ago, there was no controversy to this. And the facts have not change, in fact we know more about hunger and the hormonal balance of fat mobilization and fat storage than we ever did before. And in 1976, Stephen Woods and Dan Porte described the evidence that insulin is the primary factor in the drive to store fat as "overwhelming."

So what is the bottom line? It is this. When your body sees carbohydrates or sugars of any type, it produces insulin. Insulin is the driving force to store fat. Whenever insulin is present, the body is told to store fat. When insulin is not present the body will use is previously stored fats for fuel. The key then to weight management is management of carbohydrates. The fewer carbohydrates you eat, the less insulin you make and the less fat you will store.

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