But Doctor, I don't eat anything!

One of the most prevalent issues I help patients deal with on a daily basis is weight loss.  The foundation of what is now popularized as "Wellness" is healthy eating, exercise, and achieving a healthy weight. 


The title of this post is an oft heard phrase in my clinic.  Although, I do believe that many patients feel that they are not currently eating very much, people would be surprised to learn how few calories it takes to maintain their weight...let alone lose it.

Frequently by the time I see a patient dealing with obesity they've already gained the weight that is making them obese and are now just maintaining.
Under the laws of physics patients don't just magically become obese without, at some point, bringing in more calories than they are burning.  It is true that there are certain medical conditions that slow or speed up your metabolism but the principle is the same, if you are gaining weight, you are taking in more calories than your body "needs."


You can calculate your basal metabolic rate or BMR by visiting http://www.myfitnesspal.com/tools/bmr-calculator.  This is a simple tool that helps to guide you on how many calories you need each day just to maintain your weight.  The nutritionists out there will likely point out the many pitfalls in using such a calculator because each individual's BMR is personal but this serves as a useful starting point. 


I strongly suggest patients who are motivated to lose weight to use an application for their smartphone called MyFitnesPal.  This app communicates with another application called RunKeeper.  Both of these apps are free and easy to use.  They help track your caloric intake, measure your calories expended by exercise, and keep you on track with your caloric goals for the day/week/month. 


A recent study came out reviewing the effectiveness of smartphone applications in helping patients to lose weight.  http://www.ncbi.nlm.nih.gov/pubmed/25402403.  This study found that overall these apps are not any more effective than placebo in helping patients to lose weight.  But there were some interesting findings.  Patients who benefited the most were those who were motivated to lose weight, and these tools did help.  For those who weren't motivated, the app did not help-- because they didn't use it!  They also found that use of the apps decreased significantly after the first month.  Like any other long-term lifestyle interventions, if you only intervene for a month, at the end of a six month study there won't be any positive results.  So, I'm not sure this study is going to change my recommendations.  If a patient is motivated to lose weight AND they are willing to stick with a program of lifestyle change, the tools such as MyFitnessPal can be very useful. 


I've had many patients who have successfully lost weight and maintained their weight loss with these tools.  I have used MyFitnessPal myself to lose 20 lbs. 


Weight loss and maintaining a healthy weight are challenging, long-term issues but the cause is not hopeless.