Sunday, April 6, 2014

Obesity and weight loss

It's that time of the year again. You know what time of the year I'm talking about. The weather is getting warmer, flowers are blooming and your friends and family start flocking to the water for some fun in the sun. Your children and friends beg you to go to the beach but you are hesitant. You start trying on bathing suits you’ve worn in the past and you wish you could go back to January when you made that resolution to lose a few pounds and actually stick with it. You start to think “what happened to my pre-children body”. Well, you’re not alone as this is the feeling of many adult women across the U.S. The good news is that it’s not too late to change things.

Although this blog is to provide insight into accomplishing your weight loss goals, I would be remiss if I didn’t give some background on the impact of being overweight/obese on both the health of the individual and our community. Obesity is more than just a cosmetic concern. According to the CDC, more than one-third of adults in the U.S. are obese. The estimated cost of obesity in the U.S. in 2008 was $147 billion. Obesity occurs over time when you eat more calories than you use. Factors that may affect your weight include your genetics, over-eating, eating the wrong types of foods and physical inactivity. Being obese increases your risk of diabetes, heart disease, stroke, arthritis and some types of cancer. There can also a profound effect on your children as the rate of obesity in children is much higher in families whose parents are obese. Now that everyone is feeling good about themselves, let’s look the two steps needed to not only improve our health but to also look and feel better this summer.

Step one is to develop a proper diet. I’m sure you’ve heard the phrase “abs are made in the kitchen”. While this sounds so simple and difficult at the same time, there is a lot of truth to this statement. You can do hundreds of crunches or a daily ab ripper routine, but unless you are eating healthy no one will ever notice that six pack. There are a thousand and one diets currently available and while they each tout that they’re the most effective, but there are some easier ways to diet that aren’t so restrictive. I like to call this process eating clean. Here are some of the major highlights of the eating plan I recommend to patients:

1.      Buy groceries from the outside aisles of the store. By doing this you will avoid the majority of processed foods and eat more fresh fruits and veggies

2.      Eat lean meats such as chicken or turkey breast, lean beef or steak, fish and lean pork

3.      Do not skip meals (especially breakfast)

4.      Try eating 5-6 small meals a day at a frequency of every 2.5 to 3 hours

5.      Limit simple carbs and salt intake

6.      Track the amount of calories you eat (there are many phone apps for this) and depending on what your goals and activity level are, limit your intake between 1,500 to 1,800 calories a day

Step two is to begin an exercise program. I know what you’re thinking, “I don’t have time for exercise. I have children in all sorts of activities. My job is too demanding. It’s too hot or too cold. I didn’t sleep well last night.” I could keep going but you get the point. You HAVE to make time for exercise. A regular exercise program will increase your energy and actually make you more productive at the excuses listed above. Once again, there are no right or wrong choices when deciding on a program as long as doing nothing isn’t one of your programs to choose from. Here are some highpoints on exercise I recommend to patients:

1.      Exercise at least 30 minutes most days of the week ( a minimum of 5 days)

2.      Try to incorporate both weight bearing exercise and cardio into your program

3.      If you are just starting to exercise start by walking for 30 minutes at a stroll. Start off at a pace that you are able to carry on a conversation with someone and then increase your intensity over time

4.      Exercise with a friend as this will increase your chances of sticking with a program and make the experience more enjoyable

Although these two steps are recommended for most adults, it is still important to discuss your diet/exercise plans with your physician and allow them to help assist you in your weight loss and physical fitness goals. For severe cases there may be medication therapy that can assist you in achieving your goals. Call your physician today and erase the doubt that weight loss can’t be achieved.

Monday, January 20, 2014

Long term birth control

No hassle birth control

Although there are several contraceptive methods currently available to women, most are unaware that there are long-term birth control options which are: extremely effective, convenient and well tolerated. Oral contraceptive pills can be an effective form of birth control but it can be a hassle to remember to take a pill each day. Patches and rings are effective as well, but there are many women in whom this method is not desirable. The three month progesterone injection (Depo Provera) is effective in preventing pregnancy, but there can be several significant side-effects related to this method. So, where do women turn to find a methdod of contraception that can offer higher effectiveness as well as convenience? The answer is that it may be time to try a LARC.

LARCs (long-acting reversible contraceptives) are either contraceptive implants or intrauterine devices that are effective from 3 to 10 years. As the name implies, LARCs are reversible, but what you may not know is that they are equal or more effective than a sterilization procedure. I will spend a little time briefly explaning each method but you can discuss these methods with your doctor in more depth.

Implanon, and the newer implant called Nexplanon (original I know), are both implants that are inserted under the skin in the upper, inner portion of the arm. They are both good for 3 years. The implant is inserted under local anesthestic (lidocaine, etc.) and is done in the office. Insertion is quick and easy however the removal can be a little more difficult depending on depth of insertion and scar tissue.

There a three intrauterine devices currently available in the US. Mirena (effective for 5 years) and Skyla (effective for 3 years) are the two IUDs that have a hormonal effect to your monthly cycle and both contain progesterone. Although Skyla is a newer product, Mirena has been used for years. In addition to being highly effective in preventing pregnancy, the progesterone containing IUDs can decrease the amount bleeding during your cycle (80% by 3 months and 90% by 6 months). There is a small chance (about 20%) that women using a progesterone containing IUD may not have a period at all! Just as the implant, the IUD is inserted in the office.

Paraguard is a non-hormonal IUD. Some women wish to have a hormone-free form of birth control and this presents an excellent, and effective, method for contraception. For women with heavy periods the Paraguard is probably not the best option as it does not reduce the amount of bleeding.

As you can see, there are 3 basic forms of LARCs available. Each one has it's pros and cons, but if a long-term, reversible option for birth control interests you, talk with your OB-GYN about your choices.

Thursday, January 9, 2014

Understanding hot flashes

Hot flushes (aka "hot flashes") are one of the most commonly reported symptom from women who are "going through menopause". The word menopause means "the end of monthly cycles" and typically begins in the middle ages of a woman's life (late 40's to early 50's). While there are other symptoms associated with menopause such as insomnia, irritability, irregular periods, painful intercourse, etc. hot flashes are probably the most common complaint from women in this age group. According to the American College of Obstetrics and Gynecology up to 75% of menopausal women in the US will experience hot flashes.

So, what are hot flashes? To answer this I have to first explain what causes menopause in the first place. As menopause nears, the ovaries start to produce less estrogen. The lack of estrogen causes a spike in a several other hormones which, in turn, cause the symptoms of a hot flash (sudden feeling of heat that rushes to the upper body and face lasting a few seconds to several minutes). Hot flashes occur when blood vessels in the skin of the head and neck open more widely than usual, allowing more blood to shift into the area, creating heat and redness. Researchers believe that this vascular shift is due to changes in neurotransmitter activity that are not fully understood, occurring in response to rapidly changing hormone levels.
The good news, there are several options for the treatement of hot flashes! Hormonal therapy includes etrogen plus or minus progesterone (depending on whether you still have a uterus). In addition to treatment of hot flashes, estrogen therapy is also beneficial for vaginal dryness, urinary tract problems, prevention of bone loss and reducing the risk of colon cancer. There are potential risks associated with hormone therapy and should be discussed before starting these medications. Specific to hot flashes and mood changes associated with menopause, there was speculation that that a class of medications called SSRI's may help. These medications theoretically stabalize the thermo-regulatory centers of the brain. There is a new medication in this class marketed and approved specifically for menopausal women. There are also certain blood pressure medicines that can relieve symptoms of hot flashes.

Ask your doctor for more information on treatment options available for menopausal symptoms.