l. Variety - your shield against boring meals, nutrient deprivation,
illusionary short-term weight loss, and the yo-yo syndrome.
2. Moderation - Your servings may be smaller but very adequate and
3. Balance - A sensible combination of fats (20-25%), proteins (15-20%),
and carbohydrates (55-65%).
4. Gradual change - The transition from high-fat to healthier low-fat
meals is easiest when it is slow and gradual. A radical change will not
be permanent. Simply adjust the way you prepare and serve food, the amounts
Like your Nutri-plan, the selection of an appropriate physical fitness exercise
program must consider your lifestyle and health needs.
The major problem with many weight control programs is that rewards are
expressed only in terms of weight loss. Losing weight does not automatically
bestow the skill of maintaining it. Proper eating habits as well as other
lifestyle changes, once installed must be automatically maintained.
Passwater: Is there an ideal reducing diet that works for everyone?
Conte: Absolutely NO!
Passwater: Is there any hope for the "genetically" gross
obese--those who must lose 100 pounds just to be considered fat?
Conte: In weight control, as in everything we do in life, success
if based on 85% attitude and 15 percent ability. Success
is there for all of those who want it, plan for it, and take action to achieve
In my own Bariatric practice, I have several patients who have lost 100
pounds or more--My star patient is a young man who went from 448 pounds
to 254 pounds in exactly one year. I am sure my fellow Bariatricians have
similar successful cases. Surgical intervention has helped many grossly
obese patients. Studies in Charlotte, NC, show that a combination of phentermine
and fenfluramine is helping many morbidly obese patients. The FDA has granted
a license to MIT to market Dexfenfluramine in the USA (more effective, fewer
side effects). But, let me repeat once again: don't treat the scale, don't
treat the disease who has the patient but the patient who has the disease.
Examples of good medical care and what can be done to give hope to these
genetically obese people are many.
I am looking at the Pittsburgh Post Gazette April 16, 1995, at pictures
and story of participants in eating disorders group therapy sessions at
St. Francis Medical Center in Pittsburgh--very, very encouraging to say
Passwater: What do you recommend for taking off excess body fat?
Conte: Obesity is a chronic genetic, metabolic neural, hormonal disease.
It is influenced by emotional, social economic factors interacting with
each other and finally becomes a learned disorder. In other words,
obesity is a heterogeneous disorder with multiple etiologies or causes,
and hence multiple risk factors must be identified by history, laboratory
data, and physical examination prior to establishing an individualized treatment.
An intelligent weight-loss program involves: Attitude - Nutri-Plan - Exercise
and medications as necessary. These are the four magic keys to successful
weight control. Understanding from the very beginning the difference
between weight loss and fat loss, between diet and
nutrition, and between being thin and being healthy.
This understanding is a logical and important step in developing and maintaining
a positive mental attitude for the long haul.
Because losing excess body fat is a gradual process, it favors a
calm, collected approach rather than a frenetic "lose it now"
mentality. You have to develop a less rigid lifestyle, one that reduces
the need to consciously control what you eat.
Passwater: Are there supplements that help?
Conte: Yes. It is ludicrous to assume that every case of obesity
can and must be treated without the judicious use of medications. I am referring
not only to appetite depressants and diuretics. There are many obese individuals
who need digestive enzymes, lipolytic agents (choline, inositol), metabolic
correctors and nutritional supplements.
I am always emphasizing the difference between therapeutic doses and supplemental
doses to my patients. All of them receive a one-a-day multiple vitamin/mineral
(total formula). I believe that vitamins act as co-enzymes and are the catalytic
agents or activators of all body activities and make them happen quickly
and accurately. However, I am not a vitamaniac!
I am also a firm believer in the new age of alternative medicine, which
is rapidly catching on because the public is fed up with surgery, drugs,
and quick fixes.
Specifically, I am talking about the use of (-) Hydroxycitric acid, [HCA],
the extract from Garcinia cambogia that grows in Asia, primarily in Southern
India, and chromium picolinate.
Passwater: Have you tested these in a clinical trial? Are there any
adverse effects or any conditions that preclude their use?
Conte: Yes, I have conducted three clinical studies on obese subjects
using these non-drug, all natural weight-loss enhancers as well as using
them in my private bariatric practice.
In an eight-week double blind study in 1991, the active ingredients group
lost an average of 11.1 pounds per person while the placebo group lost an
average of 4.2 pounds per person. The article describing this study was
published in The Bariatrician in 1991.  The Bariatrician
is the official medical journal of the American Society of Bariatric Physicians
-- an international organization of physicians that seeks to encourage excellence
in the practice of bariatrics through research, continuing education and
exchange of information. This study was the first study done anywhere on
humans (utilizing available pre-clinical research data developed with the
aid of animal studies) on (-)HCA (extract of Garcinia cambogia) and chromium
The 1993 study, a consumer study with no placebos and no exclusions because
of associated medical conditions and therapies, but otherwise identical
to the 1991 study, confirmed the effectiveness and safety of the original
study: subjects lost an average of 11.4 pounds per person in eight weeks.
In 1994, we did another consumer study identical to the 1993 study except
for an additional laboratory procedure: detection of plasma chromium levels
before and after the eight-week duration. The latter two studies were published
in part in abstract form at the 35th Annual Meeting of the American College
of Nutrition in 1994 and also in the booklet "Citrin: A revolutionary,
herbal approach to weight management. [8-10]
The average weight loss was almost 11 pounds per person in eight weeks.
Passwater: How much should they take? Any side reactions? What rate
of weight loss should people expect by using this approach?
Conte: The synergistic effects of (-) HCA and chromium picolinate,
namely reduction in appetite and cravings for sweets while reducing fat
formation and storage, and keeping insulin levels in check, have helped
my patients lose excessive body fat and improve their health. HCA and chromium
picolinate when taken as directed, that is, one capsule of 500 milligrams
of Garcinia Cambogia [standardized to 250 mg of the calcium salt of (-)
hydroxycitrate] and 100 micrograms of chromium three times a day, approximately
one half-hour before meals is safe and effective. I have seen no side reactions
to discontinue the treatment and they do not interfere with other medications.
Keep in mind the smart choice eating: a low-fat, low-sugar, low-sodium
version of three meals per day, and a sensible daily exercise program.
Patients should drink a minimum of 64 ounces of water per day, which is
essential to kidney and liver metabolic functions. Water intake overcomes
the problems of water retention, helps to maintain normal body temperature
and proper muscle tone; helps to rid the body of waste, relieves constipation
and is a key to fat metabolism and storage.
A weight loss of l-2 pounds per week is achievable with this regimen.
Passwater: How should they measure their progress? Daily or weekly
weigh ins? Tape measure? Calipers? Pinch test? Bioelectrical Impedance Analysis?
Conte: Different strokes for different folks. My personal preferences:
l. Body Mass Index (BMI) - A chart that identifies the overall presence
of fat in the body from all sources. 20 to 25 is associated with the lowest
occurrence of disease and death.
2. Bioelectrical Impedance Analysis (BIA) - simple, non-invasive, accurate
3. Waist Hip Ratio (WHR) - shows the distribution of fat in the body. The
acceptable WHR is l.0 for men and 0.8 for women.
4. Weekly weight - appears to be more productive during active phase of
any weight control program; once every two to four weeks during maintenance
and stabilization phase. If you're losing inches like crazy, but the scale
isn't budging, don't worry about it. It means a loss of fat and a gain of
Passwater Should dieters set goals?
Conte: Of course. We set materialistic and idealistic goals for everything
we do in our life day in day out
My Weight Loss/Time Management System clearly identifies the total weight
loss desired, the immediate goal (weight loss/week), the intermediate goal
(50% of desired weight loss and size, and estimated date) and finally the
long-range goal (Fit for Life--Reach and Maintain-Final Weight-Final Size-Estimated
date). Asking patients to set goals without setting goals for myself is
counterproductive and stupid. Therefore, I use these unifying principles
as the physician in charge:
l. I want the patient to feel good.
2. To feel good about themselves -- after all, they are the ones who play
the leading role -- myself, my staff, their family and true friends -- we
all play the supporting role.
3. They must feel good about the program -- otherwise it won't work because
it won't last. Smaller goals are easier to reach. "Success by the yard
is hard, by the inch is a cinch!"
Passwater: How does one know their ideal weight?
Conte: I don't believe there is such a thing as ideal weight or ideal
blood pressure, pulse, blood sugar, etc. etc.
I rather think desirable weight according to age, sex, and frame
is more appropriate--But, again, even this weight must be considered in
the panorama of good health, lifestyle, achievability, and reasonable ability
to maintain it.
Passwater: How does the dieter stabilize and maintain the desired
Conte: Self monitoring is the key to success. This includes a self-designed
nutritional plan of three meals a day, drinking at least 64 ounces of water
daily and a sensible exercise program. Many causes or risks have been identified
for the 3 stages or phases of "dieting:" Lapse - Relapse -
Collapse - and they are enjoyment of food, food exposure, lack of interest,
negative feelings, such as depression, stress, major life changes, job problems,
conflicts, illness, socializing, traveling, and "testing oneself."
But, the basic underlying causes: No structural eating plan or exercise;
No self monitoring or record keeping.
Therefore, to avoid what I call the three Dreadful D's: Disappointment,
Discouragement, and Disillusionment -- a dieter must automatically maintain
the once installed proper eating habits and exercise as well as other lifestyle
Passwater: When should dieters be under the direction of a physician?
When should dieters be under the care of a bariatric physician?
Conte: "Going to a physician-supervised program, where the physician
doesn't know what he or she is doing is perhaps a great misrepresentation
because you think you are getting safe monitoring, when in essence you are
not." This is a direct quote from Dr. C. Wayne Callaway, an Associate
Clinical Professor at George Washington University, at a recent hearing
on investigation of the diet industry in Washington, D.C., and chaired by
Representative Ron Wyden of Oregon.
Strategies for losing weight may or may not work, but before individuals
adopt any of the programs for the purpose of losing weight and maintain
their weight loss over extended periods, they should be aware of the pitfalls
of managing his or her own diet. Navigating through your diet sets an uneven
course; only an experienced Bariatric Physician can be your "trusted
pilot" and help you steer clear of rough waters.
Medical guidance is especially needed in Diagnosis-Related Obesity, including
that associated with arthritis, hypertension, diabetes, cardiovascular diseases,
and pregnancy. Short-term weight loss is just an illusion.
Passwater: Any words of encouragement or advice you wish to leave
our readers with?