PHILADELPHIA WEIGHT MANAGEMENT PROGRAMS

(Overview)

A variety of weight reduction programs are available in this office. It is important that you be in a weight reduction program in which you feel comfortable. If you do not feel comfortable on a diet, you will not do well.

The weight reduction diets that we have found to be most successful and therefore, are most often recommended are high in protein, low in carbohydrates, and low in fat. A high protein diet will maintain your lean body mass (muscle, bone, organs). Preservation of lean body mass will result in a higher metabolic rate, which in turns enables you to burn fat more rapidly. Carbohydrates provide energy, help to maintain lean body mass, and help to prevent demineralization of bone. Some fat is required to meet your nutritional needs.

SELECTION OF FOOD

On all of the above programs foods are selected from a list provided to you. If you do not see the food on the list, you cannot have it.

You will not have to count calories. You will be shown how to estimate portion size without using a scale.

Each item should only be eaten once each day with the following exceptions:

1. You must have at least one protein portion daily (fish, fowl, or beef). This will help prevent you from burning up protein or lean body mass. You should only burn up fat when you are on a diet.

2. Raw and steamed vegetables (less than 5 minutes) may be eaten in unlimited amounts (enjoy your salad).

3. High fiber cereals are permitted on the all of the diets. Nutrisweet or saccharin along with skimmed milk may be used.

4. High protein, low fat puddings/shakes and bars, which can be used for snacks or meal replacements, can be purchased at our office. These products are useful in controlling both hunger and cravings.

PREPARATION OF FOOD

The food may be baked, broiled, boiled or grilled. No cooking oils should be used except for PAM. Chicken and Turkey may be cooked with the skin on. However, do not eat the skin. All fat should be trimmed off beef. Use only LEAN ground beef or ground turkey.

NO SALT!!!!!! Use condiments such as garlic powder, pepper, onion powder, etc. No Salt Substitutes!

FLUIDS

You will notice that you will be urinating more as you lose fluid during the diet. You must replace this fluid in order to burn up your fat.

YOU MUST DRINK 64 OUNCES OF WATER EACH DAY!!!!!!

Do not drink more than two 8-ounce glasses of sugar-free, caffeine free sodas per day due to their salt content. Carbonated beverages that have no salt, calories, or caffeine may be taken in unlimited amounts. (Ex. club soda, certain flavored seltzers, seltzer, Perrier.) Decaffeinated black coffee or tea may be taken in unlimited amounts but cannot be counted toward the 64 ounces required. Decaffeinated beverages are preferred. There appears to be a higher incidence of cystic breasts in women who consume large amounts of caffeine. There also appears to be an increased incidence of elevated blood pressure and palpitations in both men and women who consume large amounts of caffeine. There appears to be increased hunger in patients who consume large amounts of caffeinated beverage daily.

Drinks such as Crystal Lite or Diet Cool Aide will often lead to increased sweet cravings. Avoid them.

AVOID ALCOHOL!!!!!!

EXERCISE

Aerobic type exercise (brisk walking, running, jogging, treadmill, swimming, stairs, etc. should be done 20 to 30 minutes 4 to 5 times a week. (However, start slowly, 5 to 10 minutes, and work your way up.)

Exercise tapes are also good when the weather is poor.

DIARY

A daily food diary must be kept. You will be given a diary sheet to complete each visit.

APPOINTMENTS:

Appointments are not required after the initial visit. The schedule of office hours is included in your brochure. If you know that you are going to be unable to keep a weekly appointment get an extra week of medication or supplement.

Make an effort to keep your weekly visits even if you have not done well. Remember, everyone has bad meals, bad days, or even bad weeks. The cheating is not what ruins your diet; it is the failure to get back on your diet. Everyone occasionally gets off track. Try not to get off track too often, do not get too far off track, and most importantly, get right back on track.

You will receive a call from the office after starting your program to make sure that you are not having any problems. If you miss a weekly visit you will receive a phonecall. If you do not respond to the phonecall you will receive a personal letter from us. We know that dieting can be difficult but we cannot help you unless you come back into the office.

EATING OUT:

Only order what is on your food list.

Tell the waiter that you are on a low salt diet.

If you order something broiled or grilled have them do it dry or else it may be cooked in butter or margarine. Order salad with dressings on the side. Ask for steamed vegetables instead of sautéed.

FAT PROOF YOUR HOME:

1. Get rid of all the fattening foods.

2. Buy the right foods (or you will not have the proper foods to eat).

PLATEAUING OR STANDING STILL:

You will not lose the same amount of weight each week. On some weeks you will not lose any weight. This is called plateauing.

The two main reasons for this are:

1. Fluid retention (Drink more if this happens)

2. Decreased metabolism during the diet (Do more aerobic exercise)

MAINTENANCE:

If you do not stay in a maintenance program you will regain your weight. A comprehensive maintenance program is offered and will be discussed with you as you approach your goal weight.

LABORATORY TESTING:

1. All patients will have appropriate blood laboratory screening studies ordered.

2. Electrocardiograms are recommended for patients over the age of 35 and will be done as indicated on other patients.

3. Body Composition Profiles (measurement of body fat) will be done on all patients on weight reduction programs.

4. Other test will be ordered as indicated.

USE OF APPETITE SUPPRESSANTS AND OTHER MEDICATIONS DURING THE WEIGHT REDUCTION PHASE

MEDICATION:

The use and dosage of medication will be discussed individually since this will vary depending upon your program and medical condition.

The purpose of appetite suppressants is to reduce your hunger drive. This reduction in hunger can help you resist the many physiological and psychological pressures to eat. These drugs thus assist you in following your weight reduction program. This will in turn lead to weight loss with a consequent improvement in health.

We would like to tell you a little about appetite suppressants. All appetite suppressants have the potential to show both amphetamine like side effects such as irritability, rapid heart beat, inability to sleep, or feeling hot, and antihistamine like side effects such as dryness of the mouth and drowsiness. The proper selection of the appetite suppressants to be used, as well as the effort to have patients take the lowest dose possible that will give good appetite suppression, keeps these side effects at a minimum. If you do develop any bothersome side effects, another method of appetite control will be considered.

This office has extensive experience with the use of appetite suppressants. The latest and most successful medications are used, both individually and in combination. All patients who are taking appetite suppressants are monitored closely.

PATIENT REMINDERS

1. You must only choose foods for your diet from the list given to you!

2. You must drink 6-8 glasses of non-caloric beverages each day!

3. Try not to cross your legs for extended periods of time. The peroneal nerve at the back of the knee is particularly sensitive to pressure as weight decreases!

4. Avoid prolonged standing in one position and avoid rapid changes in position!

5. Avoid very hot baths, hot whirlpools, and saunas!

6. Avoid hazardous activities such as scuba diving, swimming alone, diving, motorcycle driving, piloting a plane, etc.!

7. Refer to the INTERCURRENT ILLNESSES for recommendations regarding illnesses that might occur during the course of the program!

8. KEEP WEEKLY APPOINTMENTS.

INTERCURRENT ILLNESSES

The conditions described below may occur during the course of your program. They may not be related to the program. The measures listed may be taken if necessary. Although most illnesses can be managed in this office, referral to your family physician or a medical specialist may be necessary at times.

COLDS:

Rest and increase your fluid intake. Notify the physician if fever persists.

Congestion: nasal spray or drops, oral decongestants with or without antihistamines.

Cough: sugar free and alcohol free medication.

HEADACHES OR OTHER MILD PAIN:

Tylenol preferred. If Motrin, Alleve, Nupren, Etc. are taken, they should be administered with food.

CONSTIPATION:

Drink at least 6-8 glasses of water daily

Milk of Magnesia, Sugar free metamucil, stool softeners such as colace

INDIGESTION:

Maalox, Mylanta, Pepcid, Tagament

HEMORRHOIDS:

Sitz bath, Preparation H, Anusol suppositories, Cortaid cream

VOMITING:

Usually viral in nature.

Notify physician if this persists more than 24 hours.

Clear liquids and rest

LIGHT HEADEDNESS or DIZZYNESS:

Increase sodium intake

Bouillon 2-3 times daily

DIARRHEA:

Usually viral in nature. Rarely due to allergy to minerals in

supplement. Possible lactase deficiency. Although this is rare,

Lactaid may be prescribed.

Kaopectate, rest, clear liquids

Lomotil, Imodium may be prescribed.

Notify the physician if symptoms persist beyond 24 hours.

Avoid any hazardous activity.

DO NOT TAKE UNLESS PHYSICIANS SUPERVISING YOUR WEIGHT REDUCTION PROGRAM ARE NOTIFIED

Tranquilizers Alcohol

Sleeping pills Caffeinated coffee or tea

Aspirin Cocaine

Diuretics Marijuana

Emetics Digitalis

Enemas Butazolidin

Cortisone, Prednisone Indocin

General Anesthesia Feldine

NOTIFY THE PHYSICIAN OF ALL MEDICATIONS THAT YOU ARE CURRENTLY TAKING, BOTH THOSE PRESCRIBED BY YOUR FAMILY PHYSICIAN OR MEDICAL SPECIALIST AND THOSE PURCHASED OVER THE COUNTER.

OUR ATTITUDE TOWARD PATEINTS WHO ARE ON A WEIGHT REDUCTION PROGRAM

1. We do not yell at or humiliate patients.

2. We feel that since you are paying good money and are taking time to come into the office you are motivated.

3. However, since we are busy because these programs are successful, if you do not do well we will constructively sit on you (but always in a constructive manner).

4. As long as you are honest with us about your program, we will be happy to work with you as long as it takes for you to reach your goal.

THINGS THAT WILL UPSET US

1. If you do not eat the minimal amount of calories that you have been told to eat. 2. If you do not eat at least one protein portion each day.

3. If you do not take the vitamins and minerals that are important to your program.

4 KEYS TO SUCCESS:

1. KEEP AN ACCURATE FOOD DIARY.

2. DRINK PLENTY OF FLUIDS.

3. START AN EXERCISE PROGRAM.

4. KEEP WEEKLY APPOINTMENTS.