— Lori, Pennsylvania There are many reasons that one could feel tired all the time besides thyroid disease and not eating enough. Most people need at least eight hours of sleep per night to be at their energetic best, and most Americans do not get this amount of sleep regularly. Sleep deprivation can cause fatigue, anxiety, and weight gain. Another reason why you might be tired is dehydration, especially if you lost four pounds in the first week of your diet. Make sure you are drinking enough non-caloric beverages per day. Depression can also cause fatigue, as can overtraining, but the most common reasons for fatigue are the ones mentioned above. Also, remember that although you are taking some good supplements, a multivitamin and other supplements can never take the place of the actual food that contains these substances. There are other things in the food itself that seem to promote health — not just the vitamin. Therefore, never substitute a multivitamin for good healthy eating of whole grains, fruits and vegetables, lean protein and low-fat dairy. Taking fish oil is a good idea, but you should also be taking in fish twice per week and olive and canola oils as well. If you are not eating healthfully, you cannot be healthy no matter how many vitamin supplements you take. And remember, taking too many vitamins can cause toxicity if you are taking more than the recommended dose of fat-soluble vitamins. Q2. I’m a diabetic who, until recently, was very good about watching what I ate and exercising. In the last several months, however, I have had three surgeries. Needless to say, I have gotten off my routine, and I’m really having trouble getting myself back on a regular exercise and healthy eating regimen. I have been contemplating the use of nicotine gum to help suppress my appetite. Will this work? If not, what else could I try? — Katie, Florida I certainly understand how difficult it can be when medical issues disrupt your routine. It can be very hard to get back on track, and people frequently look for that extra boost. Nicotine gum, however, is for smoking cessation and not for weight control. The good news is that there are some FDA-approved appetite suppressants that have been shown to be effective in controlling appetite and assisting with short-term weight loss. They’re only available by prescription, so you should discuss the options with your doctor. In addition, certain diabetes medications may be less likely to lead to weight gain than others. You might discuss with your doctor whether a change in medication could help you in your weight-loss efforts. Keep in mind that appetite-suppressant medication is not a magic bullet. While it can help you more closely follow your healthy eating plan by controlling the urge to eat, most studies show that weight-loss medications provide only a modest benefit over diet and exercise alone. Another good appetite-control strategy is to design meals with an appropriate balance of nutrients and plenty of low-calorie foods (fruit, vegetables, and other foods that fill you up on fewer calories) to help curb those cravings. Exercise is another tool that can help you control your appetite. If you are getting enough calories and eating balanced meals, chances are that a regular exercise routine will help you stay on track with your eating, too. Finally, don’t set the bar too high. Some common behavioral principles — like setting reasonable goals, using problem solving to overcome the barriers that interfere with your goals, finding a buddy for support, and taking matters one small step at a time — can have you back on track in no time! Q3. I’m trying to lose weight by eating more healthfully, and it’s started to work. I’ve heard that hypnosis, however, might be a good thing to try in addition to a healthy diet. Does it work? Should I try it? Hypnosis, if done by a trained professional, can be a very useful tool for weight loss. It should be part of a comprehensive approach that includes a healthy diet, regular physical activity, and self-care strategies such as setting aside time for yourself, getting enough rest, and making time for recreation. Research has not been conclusive regarding the benefits of hypnosis, but some patients find that it can be a useful part of their program. There are many theories as to how hypnosis can be of benefit, but in our work with patients, we find that they can often use hypnosis to help “turn down the noise” in their thinking and focus their attention more clearly on their goals. Patients often report that hypnosis helps them discover new insights about themselves or their barriers to weight loss. It can also allow them to focus their efforts or take a fresh look at some of their triggers. Another common use of hypnosis is to help individuals better understand and manage difficult emotions. It is not uncommon for people to use self-hypnosis to enter into a highly relaxed state. This helps them to clear the thoughts and feelings that may be causing them distress. In addition to hypnosis, there are many other, similar techniques, such as mindful self-awareness, relaxation breathing, progressive muscle relaxation, and guided imagery, that when practiced with some regularity can really help you to move forward with your health and weight-loss plan. (For home use, you may be interested in the guided self-awareness audio CD available from the Duke Diet and Fitness Center.) So, yes, go ahead and give hypnosis a try — you may get good results! Q4. I was recently prescribed the weight-loss drug phentermine to help me lose the 50 pounds I gained after becoming ill with fibromyalgia. It’s been wonderful in boosting my energy level and helping me stay on my diet (I’ve lost 22 pounds since November). However, it is no longer as effective as it was when I first started. Should I ask for a higher dosage? Is this drug safe for long-term use? Phentermine is the most frequently prescribed weight-loss drug in the United States. It comes in various doses, but the maximum daily dose is 37.5 mg. It is useful for short-term weight-loss treatment but typically loses some of its effectiveness after several months. The problem is, if you stop taking the drug, the weight usually comes back. Phentermine was approved by the FDA in 1972 for three months of use, simply because drugs that were approved for obesity at that time were only approved for short-term use. Many weight specialists now use phentermine for longer periods of time, but they usually require the patient to sign an informed-consent form. Thus far, no long-term side effects are associated with phentermine. To keep the weight you lost off, you can try another medication, like sibutramine, for a while and then switch back to phentermine. Consider phentermine now as a preventive drug — it is preventing you from gaining back the weight you lost. Q5. I have a desk job that requires little physical activity, so four to five times a week I do the Curves workout for 30 minutes. In order to lose 2 pounds a week, how many calories should I be eating? While I’d need your height, weight, and age to calculate this number specifically for you, most people generally need to eat approximately 10 calories per pound of weight to maintain that weight without strenuous activity. To lose 2 pounds of weight per week, you need to decrease the number of calories you take in per day by 1,000, or expend that extra energy in working out, — which is hard to do! Try cutting 500 calories from your diet and burning 500 calories with vigorous exercise every day. The average woman will lose weight on a 1,500-calorie-per-day diet, while men can lose weight on about 1,800 calories per day. I would not go below 1,200 calories per day, however, especially since you are exercising. Q6. I suffer from arthritis. Will losing weight ease the great pain and stiffness in my knees and body? — Teresa, Michigan Losing weight will most certainly ease the pain and stiffness in your knees and body, especially the lower part of your body. This is because weight gain tends to stress the lower joints such as the hips, knees, and ankles more than the other joints. Losing fat mass is a good thing, too — but make sure that you try to gain muscle mass as you attempt to lose weight, as this will also help strengthen the joints. You can gain muscle mass by lifting weights in addition to doing aerobic exercise like swimming, biking, running, or walking. If you are unsure of weight training, a physical therapist or personal trainer might be a good addition to your weight-management routine. Further, extra fat — especially around the middle — contributes to inflammation throughout the body. Of course, inflammation is a part of arthritis, so anything that helps cool those flames throughout your body will help control your arthritis. Q7. Is the Lap-Band surgery that is being offered now safer and more cost-effective than the other weight-loss surgeries? The answer is yes — and no. In general, Lap-Band surgery has a lower complication rate than the more aggressive gastric bypass operation. However, the weight loss on average is less. And while Lap-Band surgery is becoming more common in this country, the Roux-en-Y gastric bypass is still the preferred procedure, both because of better weight-loss results and because of the subsequent decrease in the risk of developing diseases such as type 2 diabetes and hypertension. Here’s some background: In the United States two procedures are typically used, the laparoscopic Roux-en-Y gastric bypass, and the laparoscopic adjustable gastric band (Lap-Band). Laparoscopic surgery, also called minimally invasive surgery (MIS), is a technique that allows surgeons to “see” into the abdomen using a pencil-thin optical telescope whose picture is projected on a TV monitor at the head of the operating table. Laparoscopic surgery is intended to minimize blood loss and postoperative pain and to speed recovery. Gastric bypass surgery is combination of restrictive and malabsorptive procedures. The stomach is divided and a small pouch is created that acts as the new stomach (restrictive part); a portion of the small intestine is then bypassed, and the pouch is attached to a lower segment of the intestine (malabsorptive part). Lap-Band surgery is purely restrictive. An adjustable ring, or “belt,” is placed around the stomach and attached to a “port” connected to the outside of the body via tubing. The belt is tightened or loosened by injecting saline into the port or withdrawing it. By creating a smaller gastric pouch, the Lap-Band limits the amount of food that the stomach will hold at any time. The belt controls the flow of food from this smaller pouch to the rest of the digestive tract so you feel full with a smaller amount of food. Both of these procedures can also be done by means of an open technique (a long incision made in the abdomen), but a laparoscopic approach is less invasive. My advice is to have a comprehensive conversation either with a surgeon or an obesity expert about which surgery, if any, might be best for you. Q8. I’ve been following a 1,200-calorie diet for four months, and have been walking six miles (at 3.5 mph) every day. I recently started riding a stationary bike for 60 minutes (at 16 mph) per day, too. I’ve lost 37 pounds and cannot seem to lose that last 10 pounds. — Sandy, Missouri Great job losing 37 pounds! You are not alone about those last 10 pounds — many people find it the hardest to lose because this when your body fights you the most. You are on a weight-loss plateau, where your body has decreased resting energy expenditure and decreased thyroid hormone secretion to try and stop the weight loss, and your leptin levels are low so you are probably hungry. However, this is the time to keep doing what you are doing and you will win out. Don’t despair, as your body cannot hold out much longer. Continue the 1,200-calorie diet and all that exercise and those last 10 pounds will come off as well. Remember that once you are at your goal weight, in order to keep it off forever you will likely have to work out 60 to 90 minutes most days of the week. Not so bad, though — it should make you feel good to work out, as long as you are doing something you enjoy, like walking or biking. And the 60 to 90 minutes does not have to be done all at once or even at a gym or on a machine. The activities can be raking, dancing, cleaning, and other fun activities. Keep up the strong work! Q9. I had Lap-Band surgery three years ago, but I haven’t had any weight loss! I have been counting calories and fall within the total range from 750 to 1,200 daily. I am in my fifties and had a total hysterectomy in my thirties. The only reason I can come up with is my lack of activity/exercise. I have been limited in that area because of some current health problems. How can I get this weight off? — Kathy, Texas Usually, Lap-Band weight-loss surgery is done in connection with a Bariatric Surgery Center of Excellence. These centers require that patients be seen frequently in follow-up visits by a doctor or dietitian to ensure weight loss. The first thing you should do is go back where you had the surgery and schedule a follow-up appointment with the surgeon or the dietitian. Perhaps the Lap-Band is not really doing its job. The band must be filled periodically with saline to ensure that the opening to your stomach is small enough that you feel full with less food. Usually the saline “fills” have to be adjusted every few months after surgery to allow for weight loss. This is a simple procedure in which the surgeon injects some saline into the port just underneath the skin on your abdomen so that the band fills up and constricts the opening to your stomach. Also, it’s possible that the Lap-Band has slipped and is no longer in the correct position. If that’s the case, your surgeon can put it back in the proper place. You do need to exercise as well. Again, talk with your doctor if you need help finding specific exercises and activities that are compatible with your current health problems. Q10. What do you think about taking injections of human growth hormone to reduce weight and look youthful? What are the pros and cons of HGH? I am 66 years young. — Casilda, Puerto Rico Growth hormone has not yet been shown to be a safe and effective weight-loss medication. The same is true for using growth hormone for looking youthful. Until more studies are done, you shouldn’t try it because of its potential danger to your body. Growth hormone can cause a number of serious side effects — including swelling, headaches, and muscle pain — as well as diabetes, hardening of the arteries, high blood pressure, and cancer. We simply do not know whether the benefits outweigh the risks yet. If a doctor recommends that you take medication for weight loss, you should stick to FDA-approved drugs. These can be prescribed by a reputable obesity expert who is a medical doctor, who should also help you with a diet and exercise program. Q11. I’m 62 years old, and I had breast cancer eight years ago. I used to weigh 125 pounds, but now I weigh 146. Three days a week, I walk between one and four miles, and I work out at the gym a few days a week. I eat fish, chicken, vegetables, and very little sugar. I’m 5 feet 4 and would love to lose 10 pounds, but I can’t seem to lose any weight! — Alice, Virginia Studies show that losing weight, eating less fat, and minimizing alcohol intake can help stave off recurrent breast cancer. So you’re doing the right thing by eating healthfully and increasing your physical activity. If you are eating only protein and vegetables and exercising a lot, perhaps you should have your thyroid function checked. Sometimes hypothyroidism can slow down your metabolic rate and make it tough to lose weight no matter what you do. If your thyroid is normal, then try to write down everything you eat and calculate your caloric intake per day. You can subtract the calories you’ve burned with daily exercise. Perhaps you are consuming more calories than you think. You can also track the number of miles you walk per day with a pedometer. If you walk 10,000 steps per day, that is roughly four miles, which is a good goal for someone like yourself. If all else fails, you should go to a reputable weight-loss clinic run by a physician or a nutrition specialist. Such a clinic would offer many strategies to help you lose weight — including strict diets and medications. Learn more in the Everyday Health Diet and Nutrition Center.
