Enrique G Saguil MD University of

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

Family Medicine • Danada Family Medicine-Wheaton • Total Family Health Care-Clermont FL • Rush Copley Emergency Department

Favorite Topics • • Hypertension High Cholesterol Stress Depression Sleep disorders Knee pain Shoulder pain Ulcers and Reflux

“Challenging Topics” • • • Tobacco use Addictions Pain control Irritable bowel syndrome Fibromyalgia Weight control

“In the Philippines, people are dying from not being able to eat… …in America, people are dying from eating too much!”

Weight Control Cafe

Appetizer • How things happen • How medicines make it happen • How medical problems can make it happen Main Dish • CDC statistics • What happens in the body Dessert • The Saguil Approach to weight control • Q & A

Your Appetizer Weight Problems in the US- The “HOW’s”

How it starts Multifactorial: • Medical diseases • Prescription meds • Emotional states • “Mom and dad” habits diseases environment genetics

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!

Medical diseases • • Renal failure water Heart failure Liver failure Premenstrual syndrome Hypothyroidism Cushings syndrome Poly Cystic Ovarian syndrome Diabetes fat

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)

Emotion states • • • Post partum Depression/Anxiety Nervous eatingStress related Childhood behavior Injury/chronic pain

Other reasons: environment • Poor diet • Sedentary lifestyle • Socioeconomic status • Neurobiological issues (ghrelin and leptin)

Popular diets to treat • • Vegan/vegitarian/lacto Pritkin Low fat Atkins diet –low carb Seattle Sutton (delivery) Weight watchers (meetings) Nutrisystem Raw veganism

Popular “Drugs” to treat • • • Ephedra/ma huang/xenadrine Hoodia p 57 Leptopril “Thermogenics” –ECA stack Dexedrine Rx- phentermine

Your Main Course Statistics and What Happens in the Body

BMI n Mass/length n Kg/m 2

Weight Gain 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/m 2 and obesity a BMI >30 kg/m 2. n n n n -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

CDC

No one is safe -age, sex, race, ethnicity, socioeconomic status, education level, or geographic region

What is ideal weight? 100 lbs + 7 lbs/inch above 5 feet

The consequences: n n n n n 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)

Diet-cholesterol-heart disease Hello bypass surgeon-good bye life savings

No one is safe!

Sub-cutaneous Fat is “everywhere”

Snoring can lead to Apnea!

Hello sinusitis!

Nasal CPAP every night forever! …. . (Hello heart disease)

Obesity and HTN

> Weight = More Stress to Joints Hello hip replacement!

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. ”

Social. Stress! gatherings Food “outlets” work exercise Kids meals Medical issues

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

Irony • The medical problems we wait for, are easily treated individually…. . usually with medicine

Medical diseases • • Renal failure water Heart failure Liver failure Premenstrual syndrome Hypothyroidism Cushings syndrome Poly Cystic Ovarian syndrome Diabetes fat

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)

Standard Treatment = Perpetuating Cycle “Life style change” “Life coach” “Bariatric Center” “Weight loss center”

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

Good doctor • • • Family practice/internal medicine Integrative medicine Chiropractic group Naturopath Acupuncturist Herbalist

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

PULSE • 20 minutes a day • Anything you want • See your doctor for exercise prescription 220 -age=_____(take 60 -80% as target)

Don’t try this at home

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

All-Bran • A ranking of carbohydrates based on their effect on blood glucose levels within 2 to 3 hours after a meal 42 Porridge, non instant Low 49 Oat bran Glycemic index Low Medium 55 Muesli Medium 56 Mini Wheats Medium (wholem eal) 57 Shredded Wheat Medium 69 Golden Graham s High 71 Puffed wheat High 74 Weetabix High 77 Rice Krispies High 82

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

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

Know your enemy • Prevention. com Health Tracker • Gourmetsleuth How to read nutrition lab http: //www. gourmetsleuth. com/howtoreadnutritionlabels. htm

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.

“The Box”

Supplements • • • Suppressants (5 htp, vanadium, garcinia cambogia, homeopath) Gut builders (probiotics, omega 3, enzymes, fiber, slippery elm) Glycemic regulator (acai, hoodia, leptin) Multivitamin (mvi, d 3, calcium, antioxidant, phytosupp) Disease specific supplement Emotional stability supplement (custom) To be continued….

Spirituality • • Easy now! Church/Synagogue/Temple Yoga center Tai chi center (Qi Gong, Martial Arts) Ymca Breathing 10 min/day/month + 4/8/8 Nature/Arts/Ritual

Money • • Savings (HSA) Care Credit Beg, borrow, sell Buy what works ( 1 vit/3 months) Work at a gym? COD, Wheaton College, BU, NCC Share experiences (others are hurting)

Employer Incentive/Occ Med • • • Work contests Fitness rewards Group discounts HR representation Injury sharing

Q & A time! • Know a safe word!