Excerpt of Epilogue from Chronic Disease of Obesity

This is an excerpt from The Chronic Disease of Obesity

Easier reading can be found on my google document

Epilogue

The main message of this book is that The Sponge Syndrome will cause
weight regain despite Atkins diet and exercise because
the low leptin levels tell your brain you are starving.
Subsequently multiple compensatory hormonal pathways are utilized
to make a reduced obese patient re-gain weight
even at relatively low calorie intakes.

I believe by my personal experience of having Chronic Obesity,
the only way to maintain weight loss for greater than 10 years with satiety is 
with the addition of multiple diet medications.  

Satiety on a restricted caloric diet is crucial to maintain that diet
for the long term.

Major challenges to treatment of chronic obesity:

1- Diet Medication high cost

2- Must stay on diet medication for rest of life.

3- Must stay on restrictive diet for rest of life.

People are offered bariatric surgery rather than trying a LCHF diet
with nutritional ketosis.  

Physicians must learn about diet medications and use them as a first drug.
If on Insulin with Diabetes Type 2 for example switch to
Metformin, Victoza or Invokana.

Don’t ever tell a reduced obese patient,
they regained weight because they didn’t exercise enough
(60 to 90 minutes/day) or stick to a starvation diet (1500 cal/day).
This may be in the guidelines but
it did not work over 10 years in the LOOK AHEAD trial
despite the best institutional support in the treatment group.

Ask your Doctor if he had read Gina Kolata NYT article on
The Biggest Loser.  
They regained even though they did everything right.

It is all about never losing your fat cells.  When adipocytes

are shrunken in the reduced obese,
they are low in Leptin and tell your brain you are starving.
MiRNA from the numerous fat cells then send same message
(starvation) to most of the body
in the form of episomes in the blood stream.  

Remember 70% of your resting metabolism is from the
liver, brain and kidney.
When these organs are tuned down in metabolism
no amount of exercise can overcome it.
More exercise makes a patient more hungry.

The only way to fight the Sponge Syndrome is with
multiple diet medications.

Finally, find a physician certified in the American Board of Obesity Medicine
who has a good bioelectric impedance weight scale so you can follow your muscle mass.
 It will be discouraging to see the 5-10% loss of muscle mass
as you lose weight.

First Body Composition Report before starting Qysmia 
at Stormont Obesity Clinic
6-23-15 244.8 lbs 46.1 lbs muscle mass

12-11-15 222.1 lbs 41.8 lbs muscle mass

4-11-18  204.3 lbs Muscle Mass 38.4 lbs.

5-11-18 vs 5-3-18 at 210 lbs after wt lifting

I think it is more important to lose as much weight as possible in the first 6 to 9 month window.  Then at the plateau, start the low weight high repetition (24 reps, 3 sets, 4 times a week) exercises on very high protein diet (2.4 mg/d protein per kg of lean body weight).

With more exercise is more hunger.  This is why you will need the diet medications more than ever.