Choosing to Lose…

As Mary White, 48 of Clarkston, begins her cardio warm-up with her personal trainer Peggy Staycoff, the inspiration of what her body is now capable of doing mitigates her profound dislike of the next 12 minutes she will spend running on the treadmill.

In March of 2007, Mary underwent gastric bypass surgery, a form of bariatric or weight loss surgery that alters the anatomy of your digestive system by limiting the amount of food you can eat and digest.

“Even though I’ve been overweight my whole life, I’ve always considered myself a healthy person. I’ve always believed in the power of exercise and a healthy diet,” says White.

At 5 foot two inches tall, White’s heaviest weight was 234 pounds.

“For years, I had tried every diet, exercise routine, and diet pill that came onto the market. Nothing worked for me. I finally realized that I could not achieve my optimal weight goal alone,” says Mary.

The decision to have gastric bypass surgery is a weighty one loaded with many concerns, questions and even dangers. For Mary, her decision took many years of investigative work where she educated herself on what the surgery involves, its risk factor and its long-term prognosis for sustained weight loss.

During gastric bypass surgery or Roux En Y, the kind of surgery Mary had, the stomach is reduced to the size of a walnut and food is allowed to bypass part of the small intestine. Not only is the stomach’s capacity diminished thereby resulting in feeling full more quickly but fewer calories are absorbed as food is bypassed from the small intestine. Generally, individuals with a Body Mass Index (BMI) of 40 or higher or individuals who have a life-threatening disability due to obesity can be considered as candidates for the procedure.

In the spring of 2006, Mary thought she had her decision made and surgery was scheduled for April. But her family, fearful for her safety and survival, sat Mary down and discussed with her their concerns over the operation. During her family’s intervention, she decided against having the procedure and cancelled her surgery date.

That year, she gave herself the freedom to eat whatever she wanted. Much to her surprise, she only gained six pounds.

“But I was constantly tired. At the beginning of 2007, I decided to give the procedure more thought once again, said Mary.”

This time, she teamed up with Dr. Mark Pleatman, a general surgeon specializing in bariatric surgery at St. Joseph Mercy Hospital in Pontiac. Dr. Pleatman provided Mary with not just the scientific and medical answers she was still searching but also the comfort in addressing her and her family’s concerns. After a few consultations with him, she and her family members changed their minds and set a date for Mary’s surgery.

Mary knew that having the surgery was just part of the change that could eventually result in her reaching her weight goal. Once the surgery was complete, the onus was on her to make the additional changes in her lifestyle.

If bariatric surgery is accompanied by sustained behavioral changes such as a healthy and balanced diet, and exercise, it can provide a long-term solution to weight loss, says Dr. Pleatman.

During the next few months, with the procedure always present in her mind, she tried to lose some extra weight in an effort to put less stress on her liver during the time of surgery. And, she spent many sleepless nights terrified over the uncertain outcome of her decision to have this life-changing procedure.

The operation, which took about 4 hours, was a success. For the next six weeks, Mary would have to follow a strict diet: two weeks of liquids, two weeks of pureed foods and two weeks of soft foods. After six weeks, regular food was gradually added back into her diet as her stomach began to heal.

She also worked with a nutrition counselor who advised her on what to eat, how much to eat and how to appropriately balance her foods so that she was meeting her nutritional requirements.

“I realized that for years, I was eating wrong. I wouldn’t eat the whole day and then I would consume way too much because I was so famished. I was eating so fast that my brain could not receive the signal that I was full,” says Mary.

With her current weight at 124 pounds, Mary has lost almost over hundred pounds since her surgery last spring. She also exercises with a personal trainer three days a week.

In addition to her physical appearance, her eating patterns have also changed significantly. Mary eats six small meals every day and she can only eat about one cup of food at a time due to the reduced size of her stomach. If she tries to eat more, her body will reject it and pain and vomiting will consequently and unfortunately follow. She also takes a cocktail of vitamins, which are specifically designed, for bariatric patients and will have to take them for the rest of her life. But for her, these lifestyle changes are worth every ounce of weight that has vanished from her body.

“I can finally walk the talk I’ve been trying to walk. Having this procedure was the best and most difficult decision I have made so far in my life. It has made a life-long dream of mine come true,” Mary says.

Our Get Fit Challenge Winner Shares Her Success

Several months ago we offered the chance for our readers to tell us why they wanted to get in shape. We received many submissions from people across Southeast Michigan. Some had never exercised and wanted to get started, others had once been fit but over the years had let themselves “slip.” Even more were concerned about their health and their abilities to enjoy the every day things in life.

The person we would select would have the opportunity to workout at Bally Total Fitness for three months with a personal trainer.

We selected 28-year old Elizabeth Schmaltz whose story reflected her battles with diets, working out and losing unwanted pounds. Elizabeth was like many people who struggle with obesity, she knew she needed to lose weight, but didn’t know how to go about it. Even though she had a gym membership, she was too intimidated by the equipment to get an effective workout.

As our winner, Elizabeth has spent the last three months working out at the Bally Total Fitness in Troy with certified personal trainer Brian Gambino. Brian put Elizabeth on a workout plan and gave her nutrition guidance, beginning with a food diary to monitor what she was eating. A disciplined workout combining cardio and weight training and Elizabeth was on her way.

We are happy to report that Elizabeth has lost 25 pounds since she started.

So, how does she feel now?

“I feel great, fantastic, to the point where people are starting to notice. I had a co-worker who said, ‘Oh, I can see your collarbones,’” Elizabeth candidly shares with us.

Great attributes to Elizabeth all through this process have been her humor, optimism and motivation. She has never pretended that her weight hasn’t been a struggle, yet she is comfortable with who she is. Her primary goal was to be a thinner, healthier, Elizabeth.

Although getting started was difficult, she is now a natural around Bally Total Fitness.

“I’m pretty familiar with all of the machines in the weight area and I’m increasing my own intensity in cardio,” says Elizabeth. “I’m doing some jogging and that is going really well. I really like it, it’s a challenge; but it’s a good one.”

She has also been able to change her outlook on her past eating habits. By keeping a food diary, she was able to monitor what she was eating, how much, and how many calories she was consuming.

“It was tough doing the food diary. I was trying to justify eating a muffin in the morning every day, I’d say; ‘It’s okay to eat a 400 calorie muffin.’ But now to look back, I ask myself, ‘Why was I doing that?’ It was awful to do at first, but there was no way I was going to write down 12 potato chips,” says Elizabeth. She has since changed that attitude and consistently logs in what she eats throughout every day.

Elizabeth is very positive about her experience and her success at losing weight. “I think I thank you every time I talk to you, but this has been enlightening and has been such a good experience. I’m so glad I took the opportunity to do it,” she says.

She also recommends that others in her situation take the opportunity to get into a gym, and even hire a personal trainer.

“I would say it is a worthy investment even if you do it for two or three sessions, just get an idea on what to do, and what machines to use. There is a ton of information online that is helpful. But, you really just have to try and find a way to stick with it,” she suggests.

Elizabeth credits her personal trainer, Brian Gambino, of Bally Total Fitness for getting her on the right track. “Working out with Brian was fantastic! He increases the intensity of what we do every week and there were a lot of exercises I was doing and I wondered what I was doing to myself? But once I got used to it, I just figured out that this (workout) was how it was going to be and I embraced what was given to me,” says Elizabeth.

She adds that working out with Brian was “fun” and that he continually supported and motivated her throughout their time together.

Elizabeth is well on her way to improving her health as she continues to work out on her own. She still gets to the gym 5-6 times each week, despite working a full-time job and earning her second bachelor’s degree in business at Oakland University.

She has not quite set a final weight loss goal for herself, but is taking things “one day at a time.”

“As a person who has never been thin, I have no idea of what anything less than 200 lbs. looks like, so once I get there, I will decide how far I want to go,” says Elizabeth.

Somehow, I think whatever goals she sets, she will reach.

Editor’s note: Be sure to watch for our January issue when we wrap up this series with Elizabeth’s personal trainer, Brian Gambino, share her workout with you, as well as excerpts from her food diary.

Women & Weight Loss: Why the Difference?

With Ernest Quin of Physician Directed Hy-Tch Weight Loss

So, why do men seem to keep winning on the reality television show, “The Biggest Loser?” Well, it is not simply coincidence. In fact, men generally have an easier time losing weight than women because of their physical makeup and because of some of their dietary preferences.

It is a well-known fact that the more muscle you have, the more fat you will burn. Your metabolism will be higher, and your body will process the calories you consume much more quickly. Men tend to have a physical makeup that contains more muscle tissue than women; however, women can be very successful at losing weight using some of the same approaches as men.

According to Ernest Quin of Physician Directed Hy-Tech Weight Loss, most diets don’t work for men or women because they’re temporary. “After a person loses the weight, providing they stick to the diet, they gain the weight back because they return to their old eating habits. Weight loss programs that use meal replacements have the same problem. Once they stop purchasing the pre-packaged meals (which can get expensive), they gain the weight back,” says Quin.

Successful weight loss is truly about changing your lifestyle. There are many fad diets out there that may help you lose 2-15 pounds quickly, but many people quickly regain that weight once they stop the diet. Why does this happen? It happens because people return to their eating habits (which were generally poor) after they discontinue the diet.

Some points to consider when trying a true weight loss program is to consider how you are going to maintain your new body once you are finished with the program. If you simply have replaced your meals with meals from a program, but didn’t learn what the calorie intake and nutritional value of the meals were, you have not learned the skills to change your lifestyle when you return.

Keep in mind, exercise is important. However, if you are taking in 5000 calories a day, but only burning a fraction of those through exercise, then you are not going to lose or maintain any weight loss.

“A successful program measures a persons metabolism (which can be different from one person to the next) in order to customize a nutritional weight loss program for that individual,” says Quin.

Other considerations in choosing the right weight loss program for you:

• Program should have no meal replacement

• Program should not be a “one size fits all” weight loss program

• Program should strive toward lifestyle change for permanent weight loss

Men tend to carry their weight in different areas than women. For example, men tend to gain weight in the belly area, where women tend to put weight on in their lower body such as legs, buttocks and abdomen. No matter where your problem areas are, the process if very similar: exercise regularly, and eat properly.

A true commitment is necessary to losing and maintaining weight regardless of your program. Too many people begin a program, only to slowly fade off the regimen and never fully completing the lifestyle change necessary. This is where you see the Yo Yo dieter.

So, when you sit down and start looking at your weight loss opportunities, do the research. Take the time to find a program that meets your needs, and has the best possible outcomes for long term maintenance. You will be happy you did so.

Get Fit Challenge Update

It’s 8 a.m. on a Wednesday morning and Elizabeth is already on the treadmill warming up. Her trainer, Brian Gambino, BACSCS, is finishing up with one of his other clients. These days are beginning to work their way into Elizabeth’s routine, a routine that she says she needs to keep herself on the fitness trail.

At 28-years old, Elizabeth had the foresight to notice that she did not like the path her health was taking. Overweight, but recognizing she needed to improve her health, Elizabeth faced the same obstacles many people do… she didn’t know how to get started.

This is now changing with the help of her trainer, Brian, and Bally Total Fitness. Brian has several accredited personal training certifications including: ACSM, Health & Fitness Instruction; NSCA, Certified Strength and Conditioning Specialist, and ACE. He is a past Personal Training Director for Bally Total Fitness and has been involved in personal training for over nine years. Elizabeth has her work cut out for her!

In their initial session, Brian set up a program for Elizabeth that involves cardiovascular workouts 5-6 times per week, accompanied by three days of circuit training. He also provided nutrition information and assigned Elizabeth to keep a food diary that she brings to him for evaluation.

“Our goals are to get her moving again and back into workouts. We want her to lose weight and just get healthier,” says Brian. “What I’ve set up for her is a three times per week total body workout that includes her major muscle groups and helps burn calories. Then she does two different modes of cardiovascular exercise, such as the treadmill and the elliptical.”

By changing up the machines Elizabeth uses as well as the cardiovascular workouts, Brian is trying to reduce the risk of repetitive injuries, as well as keeping her body guessing what is coming next.

Currently, Elizabeth is performing 6-9 different exercises each session at 12-20 repetitions. The circuit training allows for her to maintain an elevated heart rate so that she can continue to burn calories throughout her workout.

In just her first four sessions, Elizabeth has already increased some of her strength, as well as her cardiovascular endurance. She has increased her treadmill time from 20 minutes to 30 minutes, and Brian has noticed an increase in her strength.

Elizabeth’s submission for the Get Fit Challenge noted how she had a gym membership, had tried different workouts, but ultimately was unsuccessful because she was intimidated by the workout machines, as well as the lack of knowledge of what to do. Today, that is changing.

“I am pleasantly surprised (with the progress). I still don’t love the weight section and still find it intimidating, but the program Brian set up for me is super easy to follow. We walked through it 2-3 times the first day,” says Elizabeth. “I am the type of person that needs things neatly mapped out and structured. Brian has really helped.”

With just a few training sessions under her belt, there is no dramatic weight loss. And, as Brian points out, dramatic weight loss right away is not realistic.

“We can expect to lose one to two pounds per week for women somewhere between 4-6 weeks,” says Brian. “After that she will begin to burn more fat. Elizabeth has a great attitude and is fun to train. She makes the job more enjoyable.”

Brian has seen many people succeed in their attempts to improve their health and hopes that Elizabeth will be another one of those success stories.

We’ll continue to follow Elizabeth’s progress in our upcoming issues, including her results at the end of her three-month Challenge. Good luck, Elizabeth!

Weight Loss for Life

With Tom Rifai, MD

Statistics state that over 100 million adult Americans are overweight or obese. This may surprise you. After all, every day we read in the paper, see on television, or hear on the radio how obesity is a major risk factor for heart attacks, diabetes, cancer and more. So why is it that with all of this information so readily available to us through clinical studies and public awareness campaigns we are still seeing a rise in obesity in America?

Well, where do we begin to look for the answer? We hear experts say, “Carbs, no carbs; fats, no fats; count calories, cut portion sizes, eliminate sugars, exercise, do this, do that.” This jumble of information can be overwhelming to anyone just getting started on a weight loss plan.

According to Dr. Tom Rifai, a board certified nutrition specialist, for some people it is simply the lack of knowledge of how to start dieting. “The knowledge of what to eat is lacking for many people,” says Dr. Rifai.

The American lifestyle is set up for obesity to thrive, according to Dr. Rifai. Fast food restaurants, foods high in trans fatty acids, and a sedentary lifestyle has helped cultivate an obese society.

“It’s the environment, the environment, the environment,” repeats Dr Rifai. “It is at school, at work, at home. We can’t change the world, but we can change what foods are in our home.”

Many people try to diet, but still bring unhealthy foods into their home to satisfy other family members’ cravings. Dr. Rifai says this is dangerous for the person trying to lose weight because the temptation of the food is always there.

“Will power can only take you so far, and eventually you are going to give in,” says Dr. Rifai. “The key is to not bring any of the indulgences into the house and don’t use excuses like: ‘I have kids, and the kids like cookies.’ That is ridiculous. There is no rule that says kids MUST have cookies.”

Many times people set themselves up for failure to lose weight right from the start by setting their weight loss goal too high. According to the National Institute of Health’s guidelines on weight loss, as little as a 5% to 15% reduction in body weight for an overweight individual can have a dramatic impact on his/her overall health, lowering their risk of many diseases. For a 200 lb. person, this equals a loss of only 10 to 30 lbs. A person setting a higher weight loss goal may be focusing on an inappropriate and therefore unattainable weight.

“A good weight loss program involves a doctor, dietitian and a support group when necessary,” says Dr. Rifai, referring to those who are obese. Successful weight loss is a commitment. The patient must be committed to changing their eating habits, lifestyle and environment, according to Dr. Rifai.

One such success story is Joe L. of Michigan. At 295 pounds, this senior citizen decided he was tired of being overweight. He made a commitment in July 2006 that it was time to finally shed the pounds that had accumulated over the last 45 years.

Joe’s story may be very familiar to many: “I’ve been on every diet. You name it. I could lose weight for major events such as my daughter’s wedding. I’d lose 25 pounds for pictures and everything, then I would gain 30 pounds back after. I started this program and I’ve lost 90 pounds in about 8 1/2 months. I never realized how bad I felt before I started this diet. I didn’t realize how much my weight impacted me after 45 years of consistently gaining weight.”

In addition to losing the unwanted pounds, Joe discovered that his health improved significantly. He was able to discontinue his blood pressure medication, reduce the dose of his cholesterol medication and begin resuming a more active life.

One of the keys to dieting is to “stay ahead of your hunger,” says Dr. Rifai. This consists of eating small, healthy portions of protein foods every 2-3 hours. This way you never get hungry and overeat.

“People can quit smoking, quit heroin or cocaine, but you can’t quit eating. We need to eat. The key is to not let yourself get hungry,” says Dr. Rifai. “Our bodies are designed to gain weight to survive.”

Exercise is another key element to losing weight, but it does not have to necessarily begin at the same time as the food modifications. However, an exercise regimen is important to maintaining the weight that you do lose, says Dr. Rifai. Unfortunately, our sedentary lifestyle doesn’t always lend itself to exercise.

“We went from building pyramids by hand back in ancient times to riding moving sidewalks from the north side to the south side of Somerset mall! I know it’s very stressful to walk that,” Dr. Rifai states sarcastically.

“Exercise can be as easy as parking farther away in a parking lot, gardening, mowing the lawn, or taking the stairs. It doesn’t have to be 2-3 hours in a gym.”

So many benefits can result from weight loss that most patients of Dr. Rifai’s find themselves with a new lease on life. The motivation that patients feel to continue the program and the benefits they reap from feeling better about themselves translates into more sustained outcomes.

“This is not a war on obesity for people, this is a war on poor lifestyle,” says Dr. Rifai. “Thus, the war requires a plan, and we give people that plan.”

Key mistakes people make is skipping meals to lose weight, says Dr. Rifai. By skipping meals, you are letting your body get hungry. When there is no nutrition in the body to feed from, then it starts feeding from your muscle, which in turn reduces muscle mass. With loss of muscle mass comes a decrease in metabolism, which in turn causes us to burn fewer calories and gain weight.

“Many people skip breakfast. You should never skip breakfast,” says Dr. Rifai. “You should always eat within one hour of waking. Think about it, you’ve gone through 7 to 8 hours without eating, and then you skip breakfast and add another 4 to 5 hours on to that time. You have to stay ahead of the hunger.”

Utilizing a multi-disciplinary approach to weight loss is the cornerstone to successful weight loss, believes Dr. Rifai. By exercising, changing your lifestyle and educating yourself on healthy foods, you are more likely to be successful.

“We teach you how to cook and eat properly. We don’t teach you to drink four shakes a day, because all you learn is how to drink four shakes a day. You don’t learn how to eat properly and nutritiously,” says Dr. Rifai. “There is a place for protein supplements, but as part of the whole program, not the focus of dieting.”

So, the question still remains. If we know being overweight is dangerous to our overall health, why do we continue to see obesity rising in America today? The answer may simply lie in knowledge.

Tom Rifai, MD, BCPNS, is a lipid disorder and bariatric specialist as well as Director of the UnaSource Weight Control Program in Troy, Michigan. He graduated with “Highest Honor” from Michigan State University with his Bachelors of Science in Psychology and Pre-Med in 1992. He received his Medical Degree from Wayne State University in 1999 and completed his Internal Medicine Residency at Beaumont Hospital in Royal Oak, Michigan, in 2003.

Fitness: What Women Want

1. “How do I get rid of the jiggle on the back of my arms/legs/butt/stomach?”

2. “How do I stop my back/neck/knees/hips/etc. from hurting?”

3. “How much time do I need to spend exercising?”

4. “How can I tone my body without getting bulky?”

5. “I eat right/work-out, why can’t I lose weight?”

6. “How can I get more energy?”

As a personal trainer, and physical therapist, these are some of the top fitness questions (or variations) that I get asked by women. The majority of women who participate in an exercise program do it to lose weight, and “get toned.” As they age, women start to have more issues with pain in various parts of their bodies, and decreasing energy levels. As priorities change and responsibilities accumulate with career, family, etc., women (as well as men) often stress about finding time to exercise.

Let’s try to address these issues one at a time (maybe 2 or 3 at a time).

1. Getting rid of “the jiggles”, weight loss, and toning vs. bulking.

To address the big one first: you cannot spot reduce; what was thought to help weight loss years ago is not the same as what we know today; and there is really no such thing as “toning” – that pretty much covers it, right? Just kidding.

But seriously, spot reduction really does not happen. Unfortunately, women accumulate fat first in the areas that come off last: legs, butt, back of arms; add a pregnancy to it and your abs take a beating. This is a generality, but true for most. Weight loss happens (when done correctly) in the order that nature dictates. The important thing is to lose the weight and be patient about where on your body it happens.

Some things to consider about weight loss. For a long time, people were told to do aerobic exercise (I don’t mean step aerobics or classes necessarily) in a supposed “fat burning zone” (FBZ). This zone was usually at a low to moderate intensity, often described in practical terms as the point where you could still talk while exercising as opposed to being completely out of breath. This level was the one where the greatest percentage of calories burned were from fat. More recent research has shown that while the FBZ may in fact have burned the highest percentage of calories from fat, higher intensity/interval training (HIIT) exercise will burn more total calories and total fat.

For example, exercising in the FBZ may burn 300 total calories, with 200 of them from fat (67%). HIIT may burn 500 total calories, with 250 of them from fat (50%). Ask yourself, would you rather have 80% of $100, or 30% of $1000? Furthermore, the traditional aerobic training would generally burn calories only during the exercise, while HIIT can continue to use calories for many hours after exercising, resulting in further weight loss.

So what is HIIT exactly? Simply pick an exercise that you may typically do for “aerobic” exercise (i.e. running, biking, elliptical, etc.), or pick an atypical exercise such as punching a heavy bag or jumping rope. After proper warm-up, go at the highest intensity you can for a period of up to 2 minutes. This means that if you are used to walking on a treadmill, you may actually have to run. If this is painful, pick a different exercise. Then slow down to a low to moderate intensity for a period of up to double your “hard work” intensity. For example, if you ran fast for 1 minute, you can speed walk or jog for up to 2 minutes. Then repeat this cycle for however long you had planned to exercise, or whatever you can accomplish. Realize that even if you cannot last as long as you do with the typical aerobic exercise, if the intensity is high enough, you will still burn more calories.

Don’t take what I am saying wrong, people can and will lose weight with the typical aerobic exercise. The high intensity workout is another option for those who have not benefited or cannot participate in the typical workout program.

The other piece of the weight loss puzzle that many people miss is the resistance training component. Strength training is necessary for many health issues, including weight loss.

Metabolism, or how many calories your body uses for various activities, as well as doing nothing at all, is directly related to how much muscle you have. It takes 50 calories/day to maintain 1 lb. of muscle. This equates to 350 calories per week and 18,200 calories per year. About 3500 calories equal 1 lb., so 18,200 calories burned is a little over 5 lbs. lost by doing absolutely nothing beyond maintaining the muscles you already have. Add 5 lbs. of muscle and your body will burn about 25 lbs. per year just maintaining that muscle.

The other benefit of strength training is to add muscle to those areas that “jiggle.” While you will not necessarily burn the fat by adding muscle there, having muscle in those areas as opposed to not having muscle there is still a better option. Strength training will also help achieve the “toned” look.

Let me break down the whole issue of “toning. A muscle can grow, shrink, or stay the same. To build muscle for tone versus bulk means to grow the muscle less, either way you need resistance training. Unless a woman takes steroids, becomes a crazy gym rat, makes big muscles a priority, or has genetically large muscles, she will not get too bulky, generally speaking.

To build muscle, the exercise needs to be somewhat intense. Many people waste time in the gym doing an exercise with far too light of a weight. If you are doing 3 sets of 10 reps (another story all together) with a weight that you could do 3 sets of 50 reps with, then you should use a heavier weight or do more reps – make each set a challenge. If the weight is too light; do more of them and then go heavier next time. Your body does not know the convenience of the number 10 or 20. If you do 11 or 17 reps, nothing bad will happen, but maybe something good will.

Most people who work out for 1 hour or more could be done in half that time if their workouts were intense enough and they got down to business.

2. Stop the pain.

Pain can happen anywhere, to anyone. As we age, pain often becomes more prevalent due partly to normal changes that occur in our bodies, but also due to the lack of exercise or physical activity that we used to do. According the American Obesity Association, 62% of women, ages 20 to 74, are overweight (Body Mass Index (BMI) of 25 or more) and about half of that population (34 percent) is obese (BMI of 30 or more). As far as back and neck pain, studies have shown that for every 1 lb. of weight carried in front of a person (stomach, chest, etc.) about 10 lbs. of stress is put on the spine; not to mention the hips, knees, and ankles/feet.

How do we stop this? One, either don’t gain weight or take off the weight that you can (see the above section). Two, strength train to help support the extra 10 lbs. (or more) that is on your joints. On an additional note, WebMD examined five medical conditions that are of great concern to women: heart disease, breast cancer, osteoporosis, depression, and autoimmune diseases. The list of risk factors for these conditions included many things that cannot be changed (age, sex, race, etc), but common between the first 3 were high blood pressure, physical inactivity/sedentary lifestyle, and obesity/overweight – all of which can be helped with exercise. Depression and

autoimmune disorders also have plenty of research to show the value of exercise for treatment.

3. How much time?

The most precious commodity for many of us – these days we feel we need 48 hours in one day to get everything done. Our personal needs take a back seat to many other things. This holds especially true for women. Things are different than they used to be. Many women have full time careers and families. Not to say that we men don’t work hard, but as much as I may do, I am amazed at how my wife can balance her career and take two kids to and from day care, come home, make dinner, clean up, pack lunches, etc. – all before I get home from work (I do help out).

For many women they only have maybe 10-20 minutes to work out, or maybe that is all the time they want to devote to it with their other priorities. The good news is, if you only have 10-20 minutes, that is great. As I said before, most people waste a lot of time working out. If you are there to be social, that’s fine too, but don’t mistake that social time as workout time. The high intensity/interval training I spoke of earlier generally does not last longer than 10-20 minutes. Alternate that with strength training days (still 10-20 minutes of intense work) and you can have an awesome workout.

4. Where is my energy?

It’s pretty simple. Your energy probably has gone to the job, children, spouse, home, etc. and as was just stated – not to you. Proper exercise and diet (not the quick fast food dinner that may be common) has to become a priority again. A little activity goes a long way.

One of the best exercises a person can do if they have young children is to do what the kids do and join in on their playing. Rather than trying to have kids calm down because we are too tired, let them go all out (not on the Playstation, I’m talking good old active playtime) and join them. You will find that it can be very intense exercise, and if you can work up to playing the whole time they do, your overall energy levels will get up there as well.

If playing with kids is not an option, take other steps such as parking farther away from the door at work, the mall, etc. and walk. Use the stairs vs. the elevator.

Do some stretching during your lunch break. Find an excuse to be active, and do not forget the importance of eating right and getting enough sleep (about 8 hours for most adults).

Realize that “intense exercise” is very relative. What is intense for one person is easy for the next. Only you know how hard you are working, but actually work when you work-out. Always warm-up, pick some exercises you like (or at least don’t hate for a few minutes) and go for it. You will improve over time if you give it a chance.

Ask an expert if you are unsure of proper technique, use of equipment, etc. Just about anything is better that nothing as long as it does not cause pain or other undesirable effects. Be like Nike – “just do it.”

And in regards to the title of this article, besides the fitness part, I’m still trying to figure it out.

Reshaping You to Fit Your New Body

A growing epidemic in the United States is morbid obesity.

Be it genetic predisposition, poor eating habits, a sedentary lifestyle or post partum weight gain, the US and the world is realizing the medical costs associated with this epidemic. Already, the statistics are staggering. Forty percent of the population is obese and increasing every year.

For the longest time morbid obesity was treated non-surgically. Weight reduction was usually tied to exercise and calorie controlled diets. Medically, physicians were able to help by correcting imbalances in hormone status such as thyroid, estrogen, and cortisol. Anti-obesity

drugs such as phentarmine have also played a role, but their long term side effects are still questionable and cost is a factor. But as obesity skyrocketed, so has diabetes.

About 15 years ago, a surgical option was developed for the very morbidly obese and was reserved for those in life and death situations. Although complications were relatively high, it was the beginning stages to developing the protocols for surgical weight loss procedures that we are accustomed to today.

Weight loss surgeries today consist of either lap bands or gastric bypass. These procedures have proven very successful in extreme weight loss for the morbidly obese and has been maintained over a longer period of time than

most non-surgical entities. In fact, according to the Agency for Healthcare Research and Quality, bariatric surgeries have increased nine-fold between 1998 and 2004 from 13,386 to 121,055. Complication rates have also decreased due to laparascopic techniques.

While significant weight loss may look successful on the outside, it leaves another side that is largely not talked about – excess and sagging skin.

When consulting for bariatric surgery, the potential for body reconstruction should always be addressed. A lot of physicians and patients assume that once the weight loss is done, the patient will go back to their perceived new looks without any corrective surgery. As a plastic surgeon who performs post-bariatric cosmetic surgeries, almost 95% of patients require some reconstructive work approximately one to two years after their surgery.

A lot of patients don’t realize that with morbid obesity the skin, fascia and underlying tissue support system is strained and damaged to the point that it loses its recoil abilities. Very few people will have their skin go back to normal.

Think about pregnancy and how the abdominal skin does not return 100 percent to its pre-pregnancy state. Now, use this same analogy and put it to skin on the entire body for a much longer period of time. You can realize the extent of the damage to the skin and underlying tissue.

Our skin, breasts, and underlying tissues are soft, pliable and somewhat durable. But our bodies were never made strong enough to handle excessive weight over a long period of time.

So where do we start?

In the face, one usually sees the tell tale signs of aging: redundant skin in the face, neck and eyes; fatty deposits in the neck and eyes; early jowling; thinner skin; exaggerated facial lines (nasal labial folds). These are usually taken care of with brow lifts, eyelifts, face and neck lifts and fillers such as fat, Restylane or Radiesse.

Also common after weight loss is hair loss. This can be taken care of medically or sometimes surgically with micro or macro hair graft transplantation.

The chest and breast area usually does not fair well after extreme weight loss. The breast support system is made of skin, connective tissue and ligaments. Unfortunately, these specific tissues don’t hold up well to excess weight over long periods of time. As the weight loss is complete, the breasts tend to lose a lot of their volume, shape and support. They decrease in size and become ptotic (droopy).

Treatment options may include a breast lift, augmentation or oftentimes both. Thanks to newer techniques in minimally invasive surgery (PEBAM, SPAIR) scarring is left to a minimum while the saline or silicone implants can increase the breast’s volume.

The arms also suffer from redundant skin. The skin in the inner aspect of the arm is the thinnest compared to the outer arm. Some of the redundant skin involves the axilla and upper back area. The excessive skin is usually excised and the upper arm reconstructed to give a more natural look. This is known as a brachioplasty.

Liposuction is also used as an adjuvent in certain areas. The scar heals up somewhat well and is located on the inside of the arm extending into the axilla. If the upper back has redundant skin, an upper body lift is considered to get a more cosmetic appearance.

The areas most people complain about is the abdomen and thighs. In the abdominal area, the skin may be loose and overhanging their beltline, there could be some fatty deposits that are not desirable, and the muscles may be weak and need to be tightened. Also, hernias resulting from the gastric bypass may be present. The best way to take care of the abdominal area is either liposuction, abdominoplasty, or both.

In the thighs, the skin becomes redundant and sags both in the inner and outer areas. The buttocks can also lose their volume and sag. An inner and outer thigh lift is usually done in conjunction with a buttock lift. This can involve liposuction to contour the thighs. The abdominoplasty, inner and outer thigh lift, and buttock lifts are collectively known as a lower body lift. The scars are acceptable and usually hidden in creases or the underwear line.

Liposuction alone is not enough to give the body the contouring that is most pleasing. It is an adjunct only. Surgical scars usually take a year to heal and in about 10 percent of patients, revisions may be necessary. Like all surgeries, the risk of complications is greater in the post bariatric population. A thorough medical clearance is advisable, and peri-operative antibiotics and DVT prophylaxis is given.

The big question is how much of this surgery should be performed at a single setting? There is no right answer. However, scientific studies show that the longer in surgery you are, the more at risk you are to suffer afterwards (pneumnia, DVT, Pulmonary emboli, atelactasis, etc.).

The general rule of thumb is usually six hours. My philosophy is to stage the surgeries over a three month period, doing no more then 6-8 hours at a time. Remember, it’s not how fast you get to the finish line. It is getting there in the safest fashion.

In the end, realistic expectations and safe and effective reconstruction by a board certified plastic surgeon can help you get over the stigma and the resultant excess skin left. Leaving behind, a new you!

Ayoub Sayeg, M.D. is a Board Certified Diplomate, American Board of Plastic Surgery, Cosmetic and Breast Fellowship Trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington, D. C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit from 1998 to 2000.

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