Dr. Kent Sasse,
Author, Doctor’s Orders: 101 Medically Proven Tips For Losing Weight

Most Americans are overweight or obese today, and all those extra pounds take a tremendous toll on our health. It seems it is more difficult than ever to lose weight these days. Foods are more delicious, higher in calories, and more tempting than ever before. Our lives are also busier than ever, and finding time to exercise seems a nearly impossible task most days. But did you know that one of the best things you can do to successfully lose weight is get a good night’s sleep?
Research has shown that the lack of a good night of sleep leads to more weight gain. The mechanism is thought to be related to an increase in hunger and a decrease in some of our internal impulse control mechanisms. After a night of little sleep, we are tired, hungrier, less mindful of our food and snack consumption, and more apt to give in to temptation around food.
As a physician, I have definitely seen this phenomenon in my own life. After a night on call when I have had very little sleep, I tend to do a lousy job of eating well the next day. Somewhere in my subconscious I may seek to reward myself, or find comfort in things like doughnuts in the doctor’s lounge that I would usually avoid. I also find that if I have not slept enough hours that it is much harder for me to find the energy and motivation to go for a run or do other exercise. Bad combination: eating more treats and exercising less! No wonder lack of sleep is associated with weight gain and obesity.
So what can you do about it? Here are seven important practices you can undertake today that will maximize better sleeping and therefore help you in your journey to a healthier weight.
• For starters, don’t consume caffeine or other stimulants in the afternoon or evening.
• Establish a routine in which you sleep in a safe and comfortable environment that is controlled to your liking, paying attention to the temperature and darkness.
• Avoid alcohol beyond two or three ounces of wine. Alcohol makes us drowsy at first but causes a rebound effect that often wakes a person up in the wee hours and impairs rest.
• Avoid eating a large late night meal. This means a light dinner and no food after 8 PM.
• Find 30 minutes for a brisk walk or other exercise in your day or evening and you will sleep much better.
• Establish your bedtime and stick to it every night. Try to minimize emotionally charged events that occur close to bedtime.
• Set a goal of six to eight hours every night and stick to it. Once a week allow yourself to sleep longer and erase that sleep debt.
Importantly, many of us have unrecognized sleep disturbances that can only be diagnosed by a formal sleep study that is ordered by your doctor. The most common among these is called obstructive sleep apnea (OSA), a common condition that usually occurs as a result of weight gain. OSA afflicts over ten million Americans and is on the rise. It results from airway obstruction by the soft tissues of the neck and throat. If you snore, cease breathing for ten seconds or more during sleep, sleep restlessly, wake up often in the night, experience morning headaches, or simply feel tired all the time, you may need a sleep study. And you may want to talk to your doctor about things like depression and alcohol use that impair sleeping.
Often, lack of sleep just seems like a necessity with all the other responsibilities in life that take up time. If you need to lose weight, then sleeping more hours needs to become a priority. So, consider it a good day when the doctor tells you that the first item on your To-Do list toward losing weight is to sleep more hours. Enjoy those extra Z’s and you will feel better and more energetic, and you will be far better positioned to succeed in achieving your weight loss goal.
So sleep more; it’s Doctor’s Orders.

Don’t wait for the actual New Year to make your resolution. Make it now! Take a few minutes to think about what your health and fitness goals for are for 2011.

* Where do you see yourself going?

* What fun physical activities would you do if you were pounds lighter?

* What would it be like to feel more energy and be more active?

Make no mistake! Losing weight takes effort and hard work, and, yes, taking the time to plan.

While you are sipping your warm chocolate whey protein shake by the fire, we recommend taking time to let your mind wonder through some potential New Year’s resolutions.

Make it a resolution that you can stick to and a resolution with a special meaning to you and a resolution that is specific.

Do not resolve to “lose some weight.” Be specific with your goals: twenty pounds by April 1st and do so with a medically based program regular weigh-ins and support groups.

Post your goals on our Facebook page – let us know what you are working on.

Cholesterol and triglyceride levels are also strongly associated with weight gain and obesity. They represent an important way to measure the circulating lipids that play a role in the development of heart disease, strokes, kidney failure and other arterial disease.

Cholesterol

A normal cholesterol level is generally under 200 mg/dL, although there is increasing evidence that we should probably all be striving for a cholesterol level that is under 175. For people who are seriously overweight, with body mass index (BMI) over 35, weight loss surgery is very effective in reducing lipid levels.

Cholesterol Classification for Adults >= 20 years old

Because hyperlipidemia is so important in these diseases, it has been studied a great deal in the last several decades. There are now even more specific detailed breakdowns of the different types of cholesterol and triglycerides that circulate in the blood stream. More sophisticated testing can be done to separate the “good” cholesterol from the “bad” cholesterol. Our blood stream carries these lipids on certain carrier molecules or particles.

The size of the particles appears to be important in determining whether or not the lipids will in fact lead to strokes and heart attacks. For example, it is now known that HDL cholesterol (high density lipoprotein cholesterol) exerts a favorable effect on our bodies generally, whereas LDL (low density lipoprotein cholesterol) exerts a negative effect on our bodies and increases the risks of heart disease and stroke.

Triglycerides

A normal level of triglycerides is less than 150 mg/dL. Triglycerides are a type of circulating lipid that consists of high energy fatty acids. Triglycerides provide energy for cells to function and serve as a way to store excess energy in fat cells. By eating more calories than your body burns, you increase the likelihood of high levels of triglycerides in the bloodstream.

Triglyceride Classification for Adults >= 20 years old

Conditions that may cause high triglycerides

• Obesity
• Hypothyroidism
• Kidney disease
• Eating more calories than you burn
• Drinking alcohol

Medicines that may raise triglycerides

• Tamoxifen
• Steroids
• Beta-blockers
• Diuretics
• Estrogen
• Birth control pills

Lower Cholesterol and Triglycerides

Lowering cholesterol and triglycerides is an important way to reduce the chances you may suffer from a heart attack, stroke, or other form of atherosclerotic disease.

So what can you do? Well, for starters you can lose weight. It is very clear that weight loss in and of itself results in breakdown of body fats and lipids and decreases the circulating cholesterol and triglycerides. It is very common for people to see lipid levels fall strikingly as they embark upon medically supervised weight loss.

The best ways to treat hyperlipidemia are:

• Reduce calories
• Exercise regularly
• Medically-supervised weight loss
• Reduce alcohol consumption
• Medication to lower lipid levels
• Weight Loss Surgery if BMI over 35

Dr. Kent Sasse is a nationally recognized weight loss expert and the author of the Sasse Guide to Outpatient Weight Loss Surgery. He is the founder of the iMetabolic Institute, and the Medical Director of the Western Bariatric Institute.

Most diabetes is type 2 diabetes that is also sometimes known as adult-onset diabetes. It is chiefly related to weight gain and obesity. It used to be that type 2 diabetes became prevalent later in life after people had reached their 50s, 60s and 70s, and had not only aged, but also gained weight.

Today, type 2 diabetes is increasingly seen among young adults and even children and adolescents who are severely overweight. The health consequences of diabetes are severe.

Diabetes is often associated with elevated circulating blood glucose levels, but the disease is somewhat more complex than that. In type I diabetes, known as juvenile diabetes, the cells of the pancreas fail to produce the enzyme insulin that allows our bodies to process and metabolize nutrients, including sugars. The result is a sharp rise in the blood sugar level, or the circulating blood glucose level.

In type 2, or adult-onset diabetes, the picture is a little different. In this second and far more common form of the disease, which is usually associated with weight gain, the fat cells and other cells become resistant to the effects of insulin and other hormones that are important in processing nutrients, including sugars. The result is the same: circulating blood sugar levels rise. Over time both forms of this disease lead to severe damage of the blood vessels and nerves in the body. Blindness, heart disease, impaired circulation, amputations, and shortened life expectancy are the results of the progression of the disease.

To make matters worse, many of the medications used to treat diabetes also lead to further weight gain! For a more thorough discussion of the medications and weight gain, please see SasseGuide.com.

Weight loss is strongly associated with improvement in type 2 diabetes. Often, even modest weight loss such as 10% reduction of body weight, results in significant improvement or even resolution of diabetes. The more severe or longstanding the diabetes, the more difficult it may be to resolve. But nonetheless, just as weight gain and adding pounds adds to the prevalence and severity of diabetes, so too can weight loss reverse the disease.

Medically supervised weight loss is a tremendous tool in the battle against diabetes. The lower carbohydrates usually emphasized in medically supervised weight loss programs are especially helpful in reducing the circulating blood glucose and reducing the requirement on medications that promote weight gain. So, for most people with type 2 diabetes, the place to start is with a medically guided weight loss program that emphasizes exercise, reduced carbohydrate intake and a long-term plan toward behavior change and use of appropriate protein and vitamin-based supplements.

Weight loss surgery has also proven to be highly effective as a treatment for type 2 diabetes. In fact, studies demonstrate that 80-90% of type 2 diabetics experience resolution of their diabetes after Roux-en-Y gastric bypass surgery. For a larger discussion on this topic see The Emerging Role of Surgery in the Treatment of Diabetes

Weight loss surgery is felt to result in a cure of diabetes in two ways. First, it is usually highly successful in inducing significant weight loss, and this alone results in improvement or resolution of the diabetes. Second, gastric bypass surgery in particular, results in some hormonal changes that appear to be uniquely effective in boosting the cure rate of the diabetes.

One of the more intriguing findings that has resulted from studies in recent years, is that roux-en-Y gastric bypass surgery, and possibly other weight loss procedures, can result in the resolution of diabetes, even in people who are not overweight. This has lead to some re-thinking of the standard treatments for diabetes mellitus. In the near future, we may find that the treatment recommendations have changed toward the emphasis on weight loss, as the number one treatment, followed by medication therapy, followed by recommendation for surgical intervention, even in normal weight individuals. But for today, and for the vast majority of people with type 2 diabetes, the first and best step is usually to apply yourself with every resource at your disposal, to the objective of losing weight. This will be the best thing you can do for your health.

Of course, as with any serious health condition, it is important to discuss it with your doctor and proceed with treatments that your doctor supports.

Dr. Kent Sasse is a nationally recognized weight loss expert and the author of the Sasse Guide to Outpatient Weight Loss Surgery. He is the founder of the iMetabolic Institute, and the Medical Director of the Western Bariatric Institute.

Weight gain leads to an increase in the adipose tissue of all of the body, including soft tissues around the neck and oropharynx. In addition, weight gain leads to larger mass of the trunk and abdomen which must move during ventilation, or breathing. Together, these changes that occur with weight gain lead to a progressively worsening condition known as obstructive sleep apnea (OSA).

In obstructive sleep apnea many people snore and make loud noise during their breathing. But worse, people with sleep apnea will intermittently stop breathing altogether, and these pauses or periods of time in which no breathing is occurring are called “apnea” episodes.

Obstructive sleep apnea and other sleep disturbances are on the rise. An increasing number of people who have experienced even moderate weight gain, now often have a component of obstructive sleep apnea that they must also add to the other aspects of life which can disturb sleep: Namely, stress at work, family responsibilities, anxiety, depression, and many other life, health, psychological and social conditions.

Sleep disturbances are a serious problem because they interfere with the restfulness a person experiences. It is common for people to feel “tired all the time” because they are sleeping poorly. It makes life less enjoyable and it makes a person less effective in their work, and less successful in their social relationships.

Worse, these sleep disturbances are a serious health problem. Obstructive sleep apnea is associated with sudden death, arising from periods of apnea with fall in blood oxygen level and cardiac arrhythmias. It is also associated with severe fatigue and automobile accidents that occur as a result of falling asleep at the wheel.

So sleep disturbances and obstructive sleep apnea are not conditions to be taken lightly. They are one of the most serious adverse effects of weight gain and obesity.

But there are excellent solutions. They begin with effective medically supervised weight loss. In addition, a medically supervised program such as the state-of-the-art program at iMetabolic, can screen you for signs and symptoms of serious sleep disturbances such as obstructive sleep apnea. And formal testing is recommended to diagnose obstructive sleep apnea and begin treatment.

Treatments often consist of adjustments of lifestyle and medications as well as the potential for psychological counseling. With obstructive sleep apnea it may be necessary to use a type of positive airway pressure device, a nasal mask or a face mask that provides air and oxygen supplementation with positive forced pressure. It takes some getting used to, but this type of treatment is very effective at successfully treating obstructive sleep apnea, especially in combination with weight loss.

There are many studies demonstrating the effectiveness of weight loss in achieving improvement in sleep disturbances and especially in obstructive sleep apnea. Medically-guided weight loss programs can play a critical role in treating these important problems. In some cases, weight loss surgery is warranted to treat sleep disturbances and obstructive sleep apnea.

Dr. Kent Sasse is a nationally recognized weight loss expert and the author of the Sasse Guide to Outpatient Weight Loss Surgery. He is the founder of the iMetabolic Institute, and the Medical Director of the Western Bariatric Institute.