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Patient OneĀ® discusses natural solutions to healthy weight management with Natural Practitioner Magazine

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What do more than 162 million American adults have in common? They all weigh too much. This is no idle assertion; it's backed up by copious research showing not only the extent of the problem, but also its consequences in terms of health and well-being.

Citing statistics from the National Health and Nutrition Examination Survey (NHANES), a product of the federal government's Centers for Disease Control (CDC), board-certified internist Sue Decotiis said that more than two-thirds of the U.S. adult population—68.8 percent— are classified as overweight with a body mass index (BMI) over 25. Anything below 24.9 is considered normal.

Moreover, according to Dr. Decotiis, whose office is in New York, NY and who markets her own line of private-label supplements, about 85 million American adults— more than half of the overweight segment and over a third of all American adults—are designated as obese, meaning they have a BMI (body mass index) higher than 30.

Additional findings come from the Food Research and Action Center (FRAC). Located in Washington, D.C., this nonprofit organization works to improve public policies and public-private partnerships to eradicate hunger and under-nutrition in the United States.

Leah Sendrowitz, a product specialist with New York-based Patient One MediNutritionals, cited a FRAC report showing that rates of overweight and obesity are higher for African-American and Hispanic women than Caucasian women, higher for Hispanic men than Caucasian and African-American men, higher in the South and Midwest, and tend to increase with age.

Sendrowitz also called attention to the following statement from Womenshealth.gov, the "Office on Women's Health at the U.S.

Department of Health and Human Services: "Over 60 percent of U.S. adult women are overweight, according to 2007 estimates from the CDC's (Centers for Disease Control and Prevention) National Center for Health Statistics. Just over one-third of overweight adult women are obese." As related by Sendrowitz, there is also the following 2009-2010 information from the American Heart Association (AHA): the percentage of adolescents aged 12-19 years who were obese was 18.4 percent; the percentage of children aged 6-11 years who were obese was 18.0 percent; and the percentage of children aged 2-5 years who were obese was 12.1 percent.

If weight were just a number, maybe none of this would matter. Unfortunately, however, excess pounds often are accompanied by illness, infirmity and inability to carry on daily activities.

Jayashree Mani, MS, CCN, nutrition specialist and clinical coordinator for Perque Integrative Health LLC, Virginia-based supplement marketer affiliated with ELISA/ACT Biotechnologies, an allergy test laboratory in Sterling, VA, said, "Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death." And worse, said Mani, taking her data from CDC research, "During the past 20 years, there has been a dramatic increase in obesity in the United States and rates remain high. In 2010, there were 12 states with an obesity prevalence of 30 percent. In 2000, no state had had an obesity prevalence of 30 percent or more." Also sad is the realization, expressed by Sendrowitz, that 50 million people go on "diets" each year, but only 2.5 million are able to keep the weight off.

Exploring the Causes

Why are so many struggling with weight? The quick answer is that they eat too much … and they are insufficiently active.

Accurate as far as this goes, it may not tell the whole story.

"Americans eat too many processed foods and do not consume enough highquality fruits, vegetables, proteins or essential fatty acids," said Dana Yarn, a holistic dietitian and fitness professional for nine years and now co-owner of Lifemoves Studio in Barre, TX. "Our guts have become compromised, and our metabolism has become disrupted by all of the preservatives, dyes, and genetically modified (GM) ingredients making our bodies more toxic, resulting in a reduced ability to manage weight." But, wait, there's more. "The stress levels of Americans are also at an all-time high, and we are not getting adequate sleep, resulting in hormone imbalances, inflammation, poor immune function and weight gain," Yarn added.

Dr. Keith Kantor, an Alpharetta, GAbased naturopath and co-author with Yarn and two other health professionals of a children's book called The Green Box League of Nutritious Justice, said, "Americans are moving less.

Even regular exercise may not be sufficient, if during the other 23 hours of the day they are sedentary." Along with the overconsumption of processed foods, this inactivity is a recipe for poor insulin control and excess weight gain, Dr. Kantor noted.

What's needed, he continued, is a "nutrient-rich diet free of preservatives" and the addition of movement to our daily lifestyle. The book is an effort to give kids an early start on the road to health.

Based in Florida, Dr. Kira Schmid, scientific director of Life Extension, also pointed an accusatory finger at poor diet, lack of exercise and uncontrolled insulin sensitivity as being major causes for the buildup of adipose. To these, she added, "a decline in brain serotonin levels, which contributes to overeating, and age-related hormone levels." Altogether, Life Extension believes there are "nine pillars of successful weight loss," explained Dr. Schmid.

These include: 1) restore insulin sensitivity; 2) restore youthful hormone balance; 3) control rate of carbohydrate absorption; 4) increase physical activity; 5) suppress hunger signals; 6) restore resting energy expenditure rates; 7) restore healthy adipocyte (fat cell) signaling; 8) inhibit the lipase enzyme; and 9) eat to live a long and healthy life.

Dr. Decotiis also cited genetic factors and cultural factors, the latter including huge "supersized" portions served in restaurants, fewer meals prepared at home and eaten as a family, a growing preponderance of junk food, along with the previously mentioned decline in physical exercise and more sedentary time spent watching TV or playing computer games.

But Dr. Decotiis saved her sharpest criticism for environmental factors that contribute to making Americans fat. "We have many strikes against us, including poorly fertilized soil leading to mineral and vitamin deficiencies, which disable metabolic pathways," she said.

Beyond this, she noted the presence of chemicals, heavy metals, antibiotics and hormones ingested in our food, water or by prescription.

"Some chemicals such as bisphenol A (BPA) are estrogen imitators," she said, explaining that body fat holds on to these substances as if they belonged there. Recently, she said, biopsies of children's fat revealed the presence of BPA. Decotiis believes the usage of chemicals parallels the sharp rise of obesity in the 1970s.

Mani summed it up by saying we live in an "obesogneic" environment—eating too much, moving too little, getting less sleep than we need, and being bombarded with more stress than we can healthfully endure.

Seeking Solutions

Rather than be depressed by this litany, sources suggest that consumers feel empowered to fight the good fight against fat. For this struggle, of course, they need all the ammunition practitioners and practitioners' vendors can provide.

Promoting "a family-friendly nutrition plan," Dr. Kantor and his Green Box team begin with the basics—a diet of whole, allnatural foods composed of vegetables, some fruits, high-quality fats and proteins. Highquality supplements are also recommended in addition to, not in place of, high-quality food plans. "We do not promote medications of any kind," Kantor added.

All things being equal—which is not always the case—Dr. Adam Sandford, a naturopath who serves as a product specialist for Patient One, also advocates easing into weight-loss treatments. Unfortunately, he acknowledged that the "calories in, calories out" model—keep intake low and exercise a lot—isn't always successful.

If the endocrine system goes awry, levels of the stress level cortisol may become elevated, triggering increased cravings for carbs and sweets, Dr. Sandford said. "The two things that I ask all people to do, to start managing cortisol and stress, is to sleep at least seven hours per night (going to bed before midnight) and to have breakfast with at least 20 grams of protein within 30 minutes of waking. Just these two actions can reset how the body responds to stress and the amount of cortisol that it makes."

Dr. Decotiis recommends a thorough assessment of each patient before taking any action. "My approach to helping people get to a healthy weight is to attack the underlying problem. I determine if there are any correctable or treatable causes, such as prescription drugs like selective serotonin reuptake inhibitors (SSRIs), particularly paroxetine (Paxil) and other antidepressants such as Depakote or Zyprexa. Steroids are another category of obesity-contributing medications, especially after long-term use," she said. "Even simple over-the-counter (OTC) medications such as antihistamines may contribute to weight gain. Not overlooking the obvious is important." Common hormonal imbalances like low testosterone and low estrogen also must be corrected, she said, especially in patients who don't respond to calorie restriction and exercise.

In addition, she noted, "Women who are in perimenopause can have progesterone imbalance and experience significant hunger and weight gain, as well as anxiety and depression." "Think thyroid" is another Dr. Decotiis mantra. "Thyroid disorders are much more common than realized, and many times those who struggle with their weight may have subclinical hypothyroidism," she warned. "T3 is the active thyroid hormone that works on the level of tissues and metabolism. Many people cannot convert circulating T4 to T3, and blood tests can be confusing. Some thyroid-related questions to ask the patient include, ‘Are you always cold?', ‘Do you feel fatigued?', ‘Have you been experiencing hair loss?' Many times, a patient with hypothyroidism can present with scant hair growth along the lateral third of the eyebrow." In addition, Dr. Decotiis urges the use of "well-produced natural supplements," including: alpha lipoic acid, a "great antioxidant" that works to sensitize insulin to improve the transfer of glucose into cells and muscles; green tea, which, if it contains enough Epigallocatechin gallate (EGCG), is a "highly effective" fat and calorie burner; Garcinia cambogia, which, in a dosage of 500 mg, taken 30-60 minutes before each meal, helps to "inhibit appetite as well as decrease the conversion of carbs to fat (Dr. Decotiis recommends that Garcinia cambogia be taken along with Slim Plex, the green tea supplement in her line of proprietary products); phenyalanine, which is a precursor to serotonin and works to elevate mood; and prebiotics and probiotics, which are needed to help neutralize unhealthy inflammatory bacteria in the intestines.

Prescription drugs also may be useful, although, "Many patients prefer to start with the non-prescription route, and that often is best," Dr. Decotiis said.

Noting that the earliest generations of prescription meds for weight loss were approved by the Food and Drug Administration (FDA) in the 1950s and were limited to stimulant appetite suppressants, Dr. Decotiis said they are "largely well tolerated, safe and have a low addiction potential.

These include phentermine usually dosed once a day, phendimetrazine and diethylproprion.

These drugs vary in their efficacy but all suppress hunger by increasing catecholamine release in the brain to suppress appetite centers in the hypothalamus." Fast forwarding six decades or more, "New FDAapproved meds include: Qsymia, a combination of phentermine and topiramate (Topamax); Topiramate, initially approved as a seizure medication, and which was serendipitously found to suppress appetite; and Belviq (lorcaserin), a serotonin receptor modulator that inhibits appetite without the stimulant effects of the older group of medications," Dr. Decotiis said. "In clinical trials, these new drugs caused modest weight loss, between three and five percent after one year, and were well tolerated." If type 2 diabetes is present, Dr. Decotiis noted that it may be necessary to use such medications as metformin (Glucophage), which helps increase insulin sensitivity, or GLP-1 agonists like liraglutide and exenatide.

GLP (glucagon-like phosphate) is an intestinal hormone that promotes satiety by delaying gastric emptying. "These products also increase sensitivity of pancreatic insulin cells," she said, but the bad news is that they are "associated with an increase in thyroid and pancreatic tumors."

Natural Goals

Given concerns about the side effects of pharmaceuticals, it's not surprising that virtually all sources for this article favor natural alternatives.

One such product is Detox Weight Manager from Integrative Therapeutics, headquartered in Wisconsin. Company literature describes the product as a "dual-function drink mix that enhances detoxification, while also supporting healthy weight management." According to the manufacturer, "The hypoallergenic formula includes soluble fiber and chromium to enhance satiety and reduce caloric intake, combined with such ingredients as N-acetylcysteine (NAC), calcium D-glucarate, and selenium, which have been shown to support healthy liver function and detoxification pathways." According to Dr. Schmid, at Life Extension, leading weight management products include: Comprehensive Weight Management formula; Advanced Natural Appetite Suppress; and Super Citrimax, clinical strength Garcinia HCA (hydroxycitric acid).

Dr. Schmid noted five key ingredients contribute to the effectiveness of Comprehensive Weight Management: 1) LuraLean propolmannan, which slows the rapid emptying of ingested food into the small intestine, reducing the surge of glucose entering the bloodstream; 2) white kidney bean extract (Phaseolus vulgaris), which inhibits amylase, the digestive enzyme that breaks down carbohydrates, allowing them to be absorbed into the bloodstream as glucose; 3) African mango extract (Irvingia gabonensis), which has amylase digestive enzyme-inhibiting properties and also favorably regulates leptin to decrease appetite and facilitate triglyceride removal from adipocytes (fat cells); 4) a proprietary green tea phytosome that enhances the metabolic effects of green tea through better absorption of green tea polyphenols, including EGCG; and 5) coffee extract (according to Schmid, "Chlorogenic acid found in green coffee bean extract has been clinically shown to limit dangerous after-meal glucose surges.")

The flagship weight management product at Patient One is SlimOne. Sendrowitz said the formula unites four synergistic ingredients— CLA (conjugated linoleic acid), 7-Keto (see sidebar), Razberi-K (raspberry ketones), and green coffee bean extract.

SlimOne's benefits are said to include: inhibition of the "hunger hormone" leptin; promotion of lipolysis (breakdown of fat); improvement of insulin sensitivity and promotion of blood sugar stability; optimization of resting metabolic rate; improvement of calorie burning; stimulation of the release of adiponectin, a hormone that regulates fat storage; promotion of a youthful hormonal state; and promotion of lean body mass and healthy body composition.

Sendrowitz said that her company's other entries in the weight-management category are C-Cleanse, which promotes bowel regularity and aids in detoxification, and DHEA, which, she said, helps regulate fat metabolism, helps reduce abdominal fat and improves insulin action.

Perque's weight-management offerings include the following: Glucose Regulation Guard Forte, Whey Guard and Whey Guard Repair, Metabolipid Dtox Plus (MDP) Guard, and Adreno Distress Guard.

According to Mani, Glucose Regulation Guard Forte features herbs like corosolic acid, huckleberry, French lilac, momordica and Agnus castus, coupled with glucose regulating minerals like chromium and vanadium.

Whey and Whey Repair Guard, she said, provide a low-calorie, whole food meal replacement, while MDP Guard is intended to facilitate healthier carnitine levels for efficient fat metabolism and for regulating healthier cellular health and detox.

Finally, Mani said, Adreno Distress Guard contains rhodiola, magnolia and phellodendron aimed at improving cortisol and DHEA resilience and balance. The goal, she says, is to "improve weight management, restorative sleep, memory and fatigue."