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Enrique G Saguil, MD
• University of the East
• Northwestern University Hospital
• Presbyterian Medical Center/U of P
• West Suburban Hospital/Rush
• Center for Athletic Medicine/St Joseph’s
• UCLA
• Integrative Sports and Wellness
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Family Medicine
• Danada Family Medicine-Wheaton
• Total Family Health Care-Clermont FL
• Rush Copley Emergency Department
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Favorite Topics• Hypertension• High Cholesterol• Stress• Depression• Sleep disorders• Knee pain• Shoulder pain• Ulcers and Reflux
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“Challenging Topics”
• Tobacco use
• Addictions
• Pain control
• Irritable bowel syndrome
• Fibromyalgia
• Weight control
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“In the Philippines, people are dying from not being able to eat…
…in America, people are dying from eating too much!”
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Weight Control Cafe
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• How things happen• How medicines make it happen• How medical problems can make it happen
• CDC statistics• What happens in the body
• The Saguil Approach to weight control• Q & A
Dessert
Main Dish
Appetizer
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Weight Problems in the US- The “HOW’s”
Your Appetizer
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How it starts
Multifactorial:
• Medical diseases
• Prescription meds
• Emotional states
• “Mom and dad” habits
genetics
environment
diseases
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Genetic predisposition
-Due to alterations in genes controling appetite and metabolism ……. “res ipsa loquitur”
..we fall under the “Thrifty gene hypothesis”
But dad, we’re not Pima
Indian descent
Oh, I get it!
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Medical diseases
• Renal failure• Heart failure• Liver failure• Premenstrual syndrome• Hypothyroidism• Cushings syndrome• Poly Cystic Ovarian syndrome• Diabetes
water
fat
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Prescription drugs
• Antihypertensives (calcium channel, ace’s )• Oral contraceptives (“the pill”, depo, iud)• HRT (estrogen)• Diabetes medicines• Antidepressants (tricyclics)• Antianxiety (SSRI)• Corticosteroids (Prednisone)• Bipolar meds (lithium)
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Emotion states
• Post partum
• Depression/Anxiety
• Nervous eating\Stress related
• Childhood behavior
• Injury/chronic pain
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Other reasons: environment
• Poor diet• Sedentary lifestyle• Socioeconomic status
• Neurobiological issues
(ghrelin and leptin)
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Popular diets to treat
• Vegan/vegitarian/lacto• Pritkin • Low fat• Atkins diet –low carb• Seattle Sutton (delivery)• Weight watchers (meetings)• Nutrisystem• Raw veganism
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Popular “Drugs” to treat
• Ephedra/ma huang/xenadrine
• Hoodia p 57
• Leptopril
• “Thermogenics” –ECA stack
• Dexedrine
• Rx- phentermine
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Statistics and What Happens in the Body
Your Main Course
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BMI
Mass/length Kg/m2
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Obesity BMI Classification by WHO <18.5 underweight 18.5–24.9 normal weight 25.0–29.9 overweight 30.0–34.9 class I obesity 35.0–39.9 class II obesity Over 40.0 class III obesity -A BMI of 35.0 or higher in the presence of at least one other significant comorbidity is
also classified by some bodies as class III obesity. -For Asians, overweight is a BMI between 23 and 29.9 kg/m2 and obesity a BMI >30
kg/m2.
-The surgical literature breaks down "class III" obesity into further categories. [12] -Any BMI > 40 is severe obesity -A BMI of 40.0–49.9 is morbid obesity -A BMI of >50 is super obese
Weight Gain
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CDC
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No one is safe
-age, sex, race, ethnicity, socioeconomic status, education level, or geographic region
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What is ideal weight?
100 lbs + 7 lbs/inch above 5 feet 100 lbs + 7 lbs/inch above 5 feet
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The consequences: Coronary heart disease Type 2 diabetes Cancer (endometrial, breast, and colon) Hypertension (high blood pressure) Dyslipidemia (high total cholesterol or high levels of
triglycerides) Stroke Liver and gallbladder disease Sleep apnea and respiratory problems Osteoarthritis (degeneration of cartilage and underlying bone
within a joint) Gynecological problems (abnormal menses, infertility)
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Diet-cholesterol-heart disease
Hello bypass surgeon-good bye life savings
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No one is safe!
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Sub-cutaneous Fat is “everywhere”
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Snoring can lead to Apnea!
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Hello sinusitis!
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Nasal CPAP every night forever!…..(Hello heart disease)
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Obesity and HTN
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> Weight = More Stress to Joints
Hello hip replacement!
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Surgeon General’s call to action to prevent and decrease overweight and obesity 2001
“Overweight and obesity result from an energy imbalance. This involves eating too many calories and not getting enough physical activity.”
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work exerciseKids mealsFood “outlets”
Stress!Social gatherings
Medical issues
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Your dessert!
• Standard medical practice approach:
• Note initial weight• Diagnose medical associated problems• Send to dietician (if covered)• Treat individual problems• Customize suggestions for intervention• Repeat, then bariatric team when ready
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Irony
• The medical problems we wait for, are easily treated individually…..usually with medicine
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Medical diseases
• Renal failure• Heart failure• Liver failure• Premenstrual syndrome• Hypothyroidism• Cushings syndrome• Poly Cystic Ovarian syndrome• Diabetes
water
fat
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Prescription drugs
• Antihypertensives (calcium channel, ace’s )• Oral contraceptives (“the pill”, depo, iud)• HRT (estrogen)• Diabetes medicines• Antidepressants (tricyclics)• Antianxiety (SSRI)• Corticosteroids (Prednisone)• Bipolar meds (lithium)
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Standard Treatment = Perpetuating Cycle
“Life style change”
“Life coach”
“Bariatric Center”
“Weight loss center”
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The Saguil Approach
• “Band Aid” Medicine (know an endpoint)
• Exercise prescription
• Dietary evaluation (ADA, nutritionist)
• Supplements (Herbalist, MD, DO, DC,ND)
• Spiritual Grounding
• Surgery Consult
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Good doctor
• Family practice/internal medicine
• Integrative medicine
• Chiropractic group
• Naturopath
• Acupuncturist
• Herbalist
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Move to lose
• Planet fitness/cardinal fitness/park district• Running group [ask doc first]• Local hospital groups• Yoga/tai chi• Church• Dvd/ vhs/ library/ netflix
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PULSE
• 20 minutes a day
• Anything you want
• See your doctor for exercise prescription
220-age=_____(take 60-80% as target)
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Don’t try this at home
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Diets
• Vegan/vegitarian/lacto • Pritkin • Low fat• Atkins diet –low carb• Seatle sutton (delivery)• Weight watchers (meetings)• Nutrisystem• Raw food/ Juice • Whole food/whole grain/old food
glycemic index
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Glycemic index
• A ranking of carbohydrates based on their effect on blood glucose levels within 2 to 3 hours after a meal
All-Bran Low 42
Porridge, non instant
Low 49
Oat bran Medium 55
Muesli Medium 56
Mini Wheats (wholemeal)
Medium 57
Shredded Wheat
Medium 69
Golden Grahams
High 71
Puffed wheat
High 74
Weetabix High 77
Rice Krispies
High 82
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Timing is everything!
• Small and frequent (don’t graze)
• Nothing after dinner
• Prepare for the weekend/function (no crashing )
• Fight the urge, wait 10 min, meditate
• Enjoy what you eat (journal it!)
• Ritual
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Size matters
• Portion control (kids size, lunch size, appetizer size, junior size)
• Pre-meal salad, fiber or “filler” (water)
• 5 fruits and veggies a day
• 0-10 scale of fullness
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Know your enemy
• Prevention.com Health Tracker
• Gourmetsleuth How to read nutrition lab
http://www.gourmetsleuth.com/howtoreadnutritionlabels.htm
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Read the labels• Fortified, enriched, added, extra, and plus. This means nutrients
such as minerals and fiber have been removed and vitamins added in processing. Look for 100% whole-wheat bread, and high-fiber, low-sugar cereals.
• Fruit drink. This means there's probably little or no real fruit and a lot of sugar. Instead look for products that say "100% Fruit Juice."
• Made with wheat, rye, or multigrains. These products have very little whole grain. Look for the word "whole" before the grain to ensure that you're getting a 100% whole-grain product.
• Natural. The manufacturer started with a natural source, but once it's processed the food may not resemble anything natural. Look for "100% All Natural" and "No Preservatives."
• Organically grown, pesticide-free, or no artificial ingredients. Trust only labels that say "Certified Organically Grown."
• Sugar-free or fat-free. Don't assume the product is low-calorie. The manufacturer compensated with unhealthy ingredients that don't taste very good and, here's the kicker, have no fewer calories than the real thing.
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“The Box”
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Supplements
• Suppressants (5htp, vanadium, garcinia cambogia, homeopath)
• Gut builders (probiotics, omega 3, enzymes, fiber, slippery elm)
• Glycemic regulator (acai, hoodia, leptin)
• Multivitamin (mvi, d3, calcium, antioxidant, phytosupp)
• Disease specific supplement
• Emotional stability supplement (custom)
To be continued….
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Spirituality
• Easy now!
• Church/Synagogue/Temple
• Yoga center
• Tai chi center (Qi Gong, Martial Arts)
• Ymca
• Breathing 10min/day/month + 4/8/8
• Nature/Arts/Ritual
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Money
• Savings (HSA)
• Care Credit
• Beg, borrow, sell
• Buy what works ( 1 vit/3months)
• Work at a gym?
• COD, Wheaton College, BU, NCC
• Share experiences (others are hurting)
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Employer Incentive/Occ Med
• Work contests
• Fitness rewards
• Group discounts
• HR representation
• Injury sharing
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Q & A time!
•Know a safe word!