Renee Young, ND
Weight management is a multibillion-dollar industry in the United States. It is estimated by the Food and Drug Administration that Americans are consistently spending close to $60 billion per year on weight loss programs and products. In 1992, the Food and Drug Administration reported that Americans were spending approximately $30 billion on weight loss. In 18 years, we have doubled both our waists and the money we spend trying to reduce them! According to the Centers for Disease Control and Prevention, in 2010 every state in the country was reporting that more than 20% of their population were overweight. This means it is likely that 2 of every 10 patients are overweight.
As NDs, we tend to care more about our patients’ nutrition, hormone levels, and risk for complicated disease, while they are more likely to care more about their waistlines. Our training tells us to think about the big picture, but a big patient is a big picture. Good weight management is great health management. Generally speaking, human beings are their healthiest when they are maintaining their optimal weight. People are quirky in that they may have an intellectual interest in their hormone levels and in the possibility of developing some unknown disease at some future date, but our patients are more inclined to follow our advice and enjoy a program if it will result in a slimmer more fabulous version of what they currently see in the mirror. To help my patients achieve optimal weight, health, and wellness, I follow a simple 3-step plan.
Step 1, Figuring It Out
Testing based on individual needs is where our medicine works best and shines. To be able to figure out the real problem that may be bothering your patient, you need to think about that big picture already mentioned. Figuring out what the problem might be and how you and the patient may be able to solve it depends on your knowing as a physician all that you can know. Literally, make a list of every test you perform in your office, then categorize them, and figure out which category or categories your patient might have an issue with. Here are my categories:
- Food allergies and digestive issues
- Sex, stress (including sleep issues), and hormones regulating metabolism and blood glucose level
- Brain chemistry and depression
- Environmental toxic effects and poor detoxification pathways
- The strange, the rare, and the unusual
Step 2, Burning the Fat
Now that you know more precisely what may be wrong with your patient, begin to address those issues that need to be addressed. At the same time, work the nutritional and hormonal magic that will really make it work. Elements to consider include the following:
- Herbs (eg, yerba maté, green tea, and Caraluma fimbrata)
- Individualized nutrition (consider genetic testing)
- Exercise (as much as each individual patient can reasonably do)
- Medications (eg, human chorionic gonadotropin and betahistine hydrochloride)
Step 3, Managing and Maintaining Weight
Key to managing and maintaining weight are lifestyle changes and follow-up care. Lifestyle alterations take root through your good counsel and advice to help your patient implement changes that will help him or her maintain the level of health and wellness that has been achieved. But it is not the end of the road. It is important that your patient should receive follow-up care, checking in twice a year.
Report of a Case
As a clear example of this kind of weight loss program, following is a case study of a patient who followed my program very successfully. She is a 31-year-old single professional woman. She is 67-in tall, weighs 193 lb, and has a body mass index (calculated as weight in kilograms divided by height in meters squared) of 30.0. Her chief complaints are weight gain, anxiety, and fatigue. She works 55 to 70 hours per week in a high-stress job. She had noticed her weight increasing over a 2-year period. She reported that she experienced worse fatigue in the morning. Her anxiety was intermittent and was made neither better nor worse by anything noteworthy. Here is her case:
Step 1, Figuring It Out
The initial intake indicated no remarkable history, no surgical history, and no allergies or current medication use. Physical examination findings were unremarkable.
Conditions to rule out included anemia, hypothyroidism, adrenal fatigue, food intolerance, vitamin deficiency, and depression. Tests ordered were complete blood cell count, comprehensive metabolic profile, thyroid panel, adrenal rhythm panel, micronutrient testing by SpectraCell Laboratories (Houston, Texas), and IgG food intolerance testing.
Results showed a low thyrotropin level, no elevated antibodies, low morning cortisol level, vitamin B12 deficiency, and intolerance to egg and dairy. Assessment indicated hyperthyroidism, food intolerance, adrenal fatigue, and vitamin B12 deficiency.
Step 2, Burning the Fat (Round 1, the First 10 Months)
To correct the hyperthyroidism, the patient was instructed to take the following 1 hour away from food: lemon balm (930 mg), bugleweed (600 mg), rosemary extract (300 mg), blue flag (30 mg), and black pepper extract (15 mg).
To increase the morning cortisol level, she was instructed to take the following 1 hour after the thyroid medication between 7 and 9 am with food: thiamine hydrochloride (100 mg), riboflavin (100 mg), pyridoxine hydrochloride (100 mg), cyanocobalmin (500 mg), ascorbic acid and rose hips (500 mg), niacinamide (100 mg), pantothenic acid (500 mg), folic acid (400 µg), chromium picolinate (200 µg), zinc picolinate (80 mg), and a proprietary blend of adrenal concentrate, biotin, choline bitartrate, para-aminobenzoic acid, inositol, lemon, bioflavonoids, licorice root, and ginseng root (Korean Panax) (1740 mg).
She was prescribed intramuscular vitamin B12. Delivery was 5 mg/mL every 3 weeks for a total of 3 doses, then every 6 to 8 weeks or as needed.
The patient was advised of food intolerances. Primarily, she was to avoid dairy and egg.
Recommended lifestyle changes included the following: Exercise 4 to 5 times per week; join a 5- to 6-week intensive exercise program, such as a boot camp. Eat regular meals. Schedule brain breaks at work.
Her weight loss after 1 year was 27 lb. Her thyroid level corrected in 3 months, her vitamin B12 level is within the normal range, and her adrenal fatigue reversed in 9 months.
Step 2, Burning the Fat (Round 2, Months 11 and 12)
In this case, good old-fashioned diet and exercise along with balancing the hormones was not getting us there as quickly as we would have liked. The best course of action to remove the excess fat and increase muscle was a 6-week round of human chorionic gonadotropin, resulting in a subsequent additional loss of 30 lb.
During 1 year, the patient’s total weight loss was 57 lb. Her current weight is 136 lb, and her BMI is 21.5.
Step 3, Managing and Maintaining Weight
The patient is to follow up every 6 months for weight, body fat analysis, and a vitamin panel. She was required to get a workout buddy.
Finally, she was instructed to adhere to the following basic weight loss rules:
- Know your food. If you can’t tell what your food was when it was picked or killed, don’t eat it. As an example, there is no such thing as a “pasta tree” or a “chip tree.” Everything that you put into your mouth should appear in its natural state. If you follow this rule 80% of the time, you are doing great.
- Treat yourself once on weekends and on Wednesdays. Eat whatever you want once (1 portion) on weekends and on Wednesdays. That way, you know you have only had a treat twice per week.
- If you’re not hungry, don’t clean your plate. This rule is self-explanatory.
- Use smaller dishes. Buy smaller plates, or use your salad plate for meals. Plates have gotten larger and larger. You might think that you’re taking a normal portion, when in fact you are taking double what you should normally eat.
- Change your habits with friends. If you have friends who like to go out to eat ice cream regularly and who complain about life, don’t join them in either habit! Invite those friends to go for a walk with you or to do something other than eat with you. Drug addicts and overeaters have been known to regularly do the same thing—indulge with friends because of peer pressure even when they weren’t planning on practicing their indulgence.
As physicians, we owe it to our patients to have a plan that can be adapted easily to suit their individual set of needs. Figure out a system for your office that will fit your personality and your patients’ requirements. Patients like to know what to expect. Even more important, you should know what your next move will be, especially if your current plan is not achieving the necessary results. Create your own system and follow it to success for you and for your patients.
Renee Young, ND graduated from the University of Bridgeport College of Naturopathic Medicine, Bridgeport, Connecticut, in 2002. She went on to practice for 1 year as a primary care physician at the Weight Loss & Natural Medicine Clinic in Cheshire, Connecticut. During that time, she focused on weight loss and endocrinology. Dr Young was among the first group of NDs to be licensed to practice in the state of California. She is the founder and owner of Young Naturopathic Center for Wellness in Los Gatos, California. She has actively served on several committees for the California Naturopathic Doctors Association. In addition to public educational speaking, she often delivers presentations to other professionals on the subjects of micronutrient testing, cardiac health, and nutrition, specifically relative to weight and hormonal problems. More information is available at www.youngwellnesscenter.com.
