Are you unable to lose weight despite rigorous dieting?

I know you've tried everything to lose weight ; the greatest diet or fat melting plan- to no avail. In fact, you're heavier now than ever. Right? The difference with my service is that in addition to my 25 years of weight loss expertise, nutritional degree, psychology degree in eating disorders and medical background, you also get Dr. Richard Koeffler, a board certified physician who specializes in integrative medicine.

Together, the Dr and I identify the underlying causes of your inability to lose weight, including a possible hormonal deficiency, thyroid imbalance, leptin resistance, insulin resistance, mitochondrial dysfunction, metabolic insufficiency, set-point abnormality and vitamin deficiency. In fact, we have a wide-range of methods to treat these conditions, ultimately leading to permanent weight loss success. The fact is, diet and exercise is rarely successful for long-term weight loss if such metabolic disturbances are left untreated.

Hence,, whoever you interview and ultimately choose to guide you should have mentioned how critical it is to ascertain whether you have metabolic and / or endocrinological factors that lead to your weight gain/ weight problem in the first place. (rather than assume it's a matter of you're not having will-power to eat less.) Please, Please be wary!! of a "nutritionist"who promises weight loss by simply following their "diet". It's so much more complex than that!

My program is so specifically customized AFTER I examine your lab tests to find out every single value on the report. For example, I will test for "LEPTIN" (a hormone that has been found to be a major regulator of body weight and me­tabolism.) Scientists discovered that dysfunctional leptin signaling results in one of many viscous-cycles that literally prevents individuals from losing weight. With increased weight, leptin is secreted as a signal to the body to stop storing fat. Leptin stimulates metabolism, reduces appetite and signals the body to burn fat. Studies have proven, however, that the ma­jority of overweight individuals that are having difficulty losing weight have varying degrees of leptin resistance. The leptin is un­able to produce its normal effects of weight loss, with the severity correlating with the degree of obesity and difficulty losing weight.

This leptin resis­tance results in a leptin deficiency in the hypothalamus, which is sensed as starva­tion, so multiple mechanisms are activated to increase fat stores, as the body perceives a state of starvation. Baseline leptin levels and the degree of leptin resistance has shown to be an uncanny predictor of a person’s likelihood of achieving successful weight loss with dieting. So, when I see a lab result and my patients Leptin level is above 12 ng/dl , I know with certainty, that there is a leptin resistance problem and, as with insulin, the higher the leptin number, the more resistance is present.

Leptin resistance also results in cellular hypothyroidism that is not detected by standard thyroid function tests, including the TSH, free T4 and free T3 levels. The metabolic effects of leptin resistance include a diminished TSH secretion, a sup­pressed T4 to T3 conversion, an increase in reverse T3, an increase in appetite, an in­crease in insulin resistance and an inhibi­tion of lipolysis (fat breakdown). Thus, with leptin resistance, significant hypothyroidism very likely exists despite the fact that standard thyroid tests that your Dr took look “normal”.

If a patient of mine tells me during our initial consult that they have been unable to lose weight despite rigorous dieting, I am 99% confident that leptin resistance is an issue that needs to be confirmed (on their lab test) and treated. The Dr and I diagnose and correct this condition regularly which always results in dramatic weight loss. We also treat pre-diabetes and diabetes. and have seen incredible weight loss results simply by switching our patients (who are on the older meds) to the newer class of pre- diabetes /diabetes drugs. Not only do these new meds better control blood sugar, but they also offer the bonus of weight loss in both diabetic and non-diabetic patients, per FDA's recent "off label" approval. These specific drugs are often prescribed (quite successfully) just to combat leptin and insulin resistance.

Have you wrecked your metabolism with too much dieting or exercise?

You never eat fast food, to the contrary, you are constantly depriving yourself and doing regular strenuous exercise, but you can’t seem to lose weight or keep it off. You starve yourself and even run extra miles per week–and find you're maybe a whole quarter pound lighter! soon as you go back to your normal diet routine, the weight comes back. You swear you have no metabolism but your doctor says everything is normal. Your friends recommend yet another fat burning diet but nothing seems to work. Sound familiar?

Could you be doing too much exercise or eating too little? Such a thought is often met with skepticism and eye rolling, as it is assumed you are eating big macs in the closet at midnight. But it may be that too much exercise or dieting may be to blame. All that work for nothing?

Studies continually show that if you chronically diet or “over exercise” your body may turn on you and reduce your metabolism by suppressing thyroid levels. The body normally produces an inactive thyroid hormone called T4, which is then converted to T3. The T3 is the active substance that is responsible for your body’s metabolism. When it is low or suboptimal, your metabolism is low. When it is high, your metabolism is high.

The fact is, chronic dieting dramatically lowers metabolism that stays depressed even after resuming normal food intake. This dramatic reduction in tissue T3 levels (and increased reverse T3) that results in hypometabolism is not detected by the "standard" blood tests used by 99% of physicians and endocrinologists. (They don't order the additional tests because they don't have the time to sit with you to go over the results, remember time = lost $$$)

In particular, those "dieter's that do intense yo-yo dieting and have lost and gained significant weight in the past or only eat one meal a day are at particular risk for hypometabolism.. It is important to determine the extent that a suppressed metabolism is contributing to their inability to lose weight. This is done through metabolic and hormonal laboratory testing and the measurement of tissue thyroid level.

After our first consult, I'll send you to Quest lab (Don't worry they accept every single insurance plan) to determine the physiologic basis of your inability to lose weight. I usually get results in a few days at which time the Dr and I will go over your results, review your extensive medical history and customize a plan based on the safest, yet most aggressive (fast) course of treatment for YOU. It's the antithesis of a one size fits all plan !

Finally, there are numerous medications that can result in an increase in the body’s weight set point and stimulate weight gain. These medications include antidepressants such as Zoloft, Paxil, Celexa and Lexapro; SNRI’s, such as Effexor, Cymbalta and Sevella; mood modulators such as Serequel and Abilify; anti-seizure/pain medication such as Lyrica and Neurontin; birth control pills; synthetic hormone replacement; diabetic medications that stimulate insulin such as glyburide and Amaryll; many blood pressure medications; and many more. There are, however, medications that have the opposite effect and lower the body’s weight set.

Thus, in addition to the diabetes meds I previously mentioned,, these other's can be used to aid in significant weight loss. We also prescribe appetite suppressants if you need /want as well as anti-depressants and meds for BED (binge eating disorder) Ultimately, the difference with coming to me is that I approach weight loss from every angle. What good is going to a nutritionist who designs a plan for you without knowing who you are from the inside out?

In addition to weight loss, we specialize in: Adrenal Fatigue Bioidentical Hormones for Women Bioidentical Hormones for Men Bone Building Density Cancer Prevention Depression Digestive Problems Fatigue/ Chronic Fatigue Syndrome/ Fibromyalgia Hashimoto’s Thyroiditis Disease Heart Disease Prevention Hypertension Hyperthyroidism Hypothyroidism Low Libido Lyme Disease Migraines Multiple Sclerosis PCOS (Polycystic Ovary Syndrome) Perimenopause/Menopause PMS Type 2 Diabetes

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