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Do you think I am fat? - (3/20/2018)

By Dr. Ron Gasbarro

Working in a supermarket gives this pharmacist a chance to people watch. It also gives him the opportunity to eat all day at work. If it wasn’t the sample lady coming by to offer the pharmacist whatever sausages, chicken nuggets, or desserts she was introducing that day, it was being so close to the deli and taking advantage of the subs and side dishes on display there. In fact, the pharmacist knew he was 5 pounds over his ideal weight.

But the parade of customers pushing their shopping carts past the pharmacy was even more revealing. Cookies, soda, candy, chips – none of this was healthy eating. In fact, when Father Tim came by the pharmacy to get his diabetes medication, his cart was packed with all sorts of junk food. “Hey, doc,” Father Tim said, “How do you stay in shape?” “Well, I am 5 pounds over,” replied the pharmacist. “Are you kidding me?” asked Father Tim. ”I am easily 40 pounds over. I suppose you think I am fat.” Is there a nice way to tell someone that he or she is fat, especially when they ask you directly if they are? “You carry it well!” “But you are big-boned!” “That’s just happy fat.” Chubby? Portly? Beefy? Chunky?

Medications for obesity are available but they are expensive, insurance will fight you over reimbursement, and they come with a suitcase full of side effects. For example, Qsymia® (phentermine and topiramate extended-release), a relatively new anti-obesity product, commonly produces adverse reactions such as constipation, insomnia, sinus inflammation, nerve damage, mood disorder, sleep disorder, and dry mouth. Another recent approval is Belviq®, which has side effects such as back pain, constipation, cough, dry mouth, nausea, and fatigue. These medications are prescribed for certain overweight people, such as those who are obese or have weight-related medical problems. Losing weight and keeping it off can lessen the many health risks that come with obesity, including heart disease, diabetes, high blood pressure, certain types of cancer, and a shorter life.

However, these are not magic pills whereby you take them and the pounds just melt away. You have work to do! These drugs are to be used with a doctor-approved exercise, behavior change, and reduced-calorie diet program to help you lose weight. So, put down your Hostess® Ding Dong™ and have a plan. Anyone trying to lose weight wants to lose it very quickly. But evidence shows that people who lose weight gradually and steadily – about 1 to 2 pounds per week – are more successful at keeping weight off. Healthy weight loss is not just about a “diet” or “program”. It is about an ongoing lifestyle that includes long-term changes in daily eating and exercise habits.

Once you’ve achieved a healthy weight by relying on healthful eating and physical activity most days of the week (about 60—90 minutes, moderate intensity), you are more likely to be successful at keeping the weight off over the long term. Even a modest weight loss, such as 5% to 10% of your total body weight, is likely to produce health benefits, such as improvements in blood pressure, blood cholesterol, and blood sugars. For example, if you weigh 200 pounds, a 5% weight loss equals 10 pounds, bringing your weight down to 190 pounds. While this weight may still be in the “overweight” or “obese” range, this modest weight loss can decrease your risk factors for chronic diseases related to obesity.

Father Tim listened to the pharmacist when he suddenly had to leave. “Sorry, Doc, but the potato chips I like are ‘buy one, get one free’. I don’t want to miss out!” And off he rolled to the snack aisle. 

Ron Gasbarro, PharmD, is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com 


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