5th Post

Karina’s Post

– Binge eating disorder treatment options.

Of course, patients identify the ultimate treatment goal as weight loss. However, reduction or alleviation of frequency of eating-related cognitions, mood regulation, and improvement of overall metabolic health are all also top goals of treatment. Therefore, approaches and interventions include medical/psychopharmacological, as well as psychological/behavioral venues.

The most common pharmacological treatments for obesity include antidepressants, anticonvulsants, anti-obesity agents, and central nervous system stimulants. Antidepressants are directly involved in regulating mood and appetite by increasing one’s level of certain neurotransmitters in central nervous system. Common examples include bupropion, citalopram, fluoxetine, sertraline, and others. They are directly indicated to treat patients with depression, but may assist with weight loss. Anticonvulsants are indicated for patients with epilepsy, bipolar, major depression, and migraines. Weight loss is an off-label use for these medications. Of course, anti-obesity agents are used directly to treat obesity. For example, they may decrease fat absorption in the gut, thereby promoting weight loss. Central nervous system stimulants, used to enhance or accelerate mental and physical processes, are specifically used to treat attention deficit hyperactivity disorder and certain sleep problems. Lisdexamphetamine is the only medication in this class approved by FDA for binge eating disorder.

Although these medications may be and often are effective to assist patients with binge eating disorder, it is important to remember that one of the main components psychological, not physiological. Therefore, it must also be addressed.

Most commonly used psycho-behavioral treatments for obesity include cognitive behavioral therapy, dialectical behavior therapy, interpersonal psychotherapy, and behavioral weight loss. Volumes are written about each, arguing for its effectiveness. In summary, cognitive behavioral therapy focuses on causal relationships between thoughts, feelings, and behaviors. Its focus is to change negative thoughts, thereby reducing negative emotions and unwanted behavior patterns. Dialectical behavior therapy focuses on mindfulness and developing skills to improve emotional regulation, coping skills, and responding to stress more effectively. Interpersonal psychotherapy, as its name suggests, addresses disordered interpersonal relationships that promote emotional problems and unhealthy behaviors. Behavioral weight loss incorporates various behavioral strategies, including those discussed above, to promote weight loss, including restricting food and increasing exercise.

Anecdotally, each and every one intervention described above can be highly effective by itself or in conjunction with other interventions. However, what does research say? As I mentioned in my previous post, research is inconsistent and relies heavily on single case studies. However, recent review article in Annals of Internal Medicine concluded that cognitive behavioral therapy, psychostimulants, anticonvulsants, antipsychotic medications, and cognitive behavioral therapy reduce binge eating and related psychopathology. However, psychostimulants and anticonvulsants actually reduced weight.

Take-home message – be an educated consumer of your own health, insist on collaboration between various physicians that treat you, and talk to your prescriber and mental health professional.

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Marat’s Post:

Last post we talked about medications that cause weight gain. Not surprisingly, there are medications that cause weight loss, weather buy Direct design or as a side effect comma when taking for another condition. Unfortunately, most medications designed to promote weight loss or not covered by insurance and are very costly. For example, diabetes medication Victoza is not only one of the most effective medications directly prescribed for weight loss, but it’s also effective for diabetes and pre-diabetic conditions. In contrast, most other diabetes medications cause weight gain. Therefore, it makes sense to ask your prescribing physician weather Victoza can be replaced for you can replace these medications, as it also has this very wanted side effect of weight loss. For example, search medications as Actos, Glipizide, and Insulin, can cause significant weight gain. Replacing these medications with Victoza, is possible, may make significant difference. Another common medication prescribed for weight loss is Phentermine. And is usually not costly. However, it is considered to be a controlled substance and requires special consistent monitoring, such as frequent physician follow-up appointments. It is also prescribed in a six months on six months off pattern. Interesting Lee, although most depression about antidepressants cause weight gain, Wellbutrin promotes weight loss. Once again, inquire discuss with your prescribing physician if the switch would be appropriate. Weight loss to and now they’re mood stabilizer, like Topamax, also promotes weight loss. However, women of childbearing age should be extra cautious, because it causes birth defects. another new medication, called Qsymia, can be prescribed for weight loss.
Overall, to Summarize last two posts, careful review and optimization of medication regimen, can assist with significant weight loss

Ben’s Post:

Hello this is Ben,

So, for any kid that would want a device to track their eating, health, or how much they walk, pay attention, this is the topic of today’s blog. But this is not just for kids. Adults too can find something that will help them in reaching their health goals. I did some research and these are the gadgets that I thought might be most helpful.

The Misfit Shine

The Misfit Shine is an app that can

  • Store information about your activity and sleep.
  • Tracks steps, distance, calories, weight, food intake, and sleep quality and duration
  • Presents your fitness and sleep trends over time in form of daily, weekly, and monthly stats

HAPIfork

  • Eating too fast leads to poor digestion and poor weight control. The HAPIfork, powered by Slow Control, is an electronic fork that helps you monitor and track your eating habits. It also alerts you with the help of indicator lights and gentle vibrations when you are eating too fast. Every time you bring food from your plate to your mouth with your fork, this action is called: a “fork serving“. The HAPIfork also measures:
  • How long it took to eat your meal.
  • The amount of “fork servings” taken per minute.
  • Intervals between “fork servings”.
  • This information can then be uploaded on a USB drive.

Sensoria Smart Sock

  • Each smart sock is infused with three proprietary textile sensors under the bottom of the foot to detect foot pressure.
  • The conductive fibers relay data collected by the sensors to the anklet. The sock has been designed to function as a textile circuit board.
  • Each sock features magnetic contact points below the cuff so you can easily connect your ankle to activate the textile sensors

If you want a gadget go grab it

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4th post:

Karina’s post:

Treatment for binge eating disorder in adults, Part 1

So what if you identified what the problem is? So what if you have a diagnosis? For many people, at least initially, there is a temporary feeling of relief, as if knowing what’s going on is the first step to addressing the problem. That is true. However, how does one make a decision as to the best course of action to treat a complicated issue/condition, when even medical/psychiatric/psychological community oftentimes cannot agree on what that course should be for each individual patient?

Despite the fact that binge eating disorder is the most common eating disorder, affecting approximately 3% of US adults in their lifetime, research on how to treat it effectively has been scarce. Yes, you can find a wealth of information, both peer-reviewed and anecdotal, on the underlying causes of obesity and binge eating disorder in particular, as well as how to identify it. However, when it comes to effective treatment, researchers, physicians, and patients themselves are stumbled. Annals of Internal Medicine recently published a review article, attempting to systematically look at treatment options for adults suffering from binge eating disorder. Authors conducted a meta-analysis, state of the art statistical analysis, including all treatment-related studies in multiple English-language populations between 2015 and 2016. Interestingly, most studies only included white women ages to 20 through 40 years old. (Not so helpful for other genders, ages, races…) Furthermore, many studies were only single-patient case studies. (What? Draw life-important conclusions on an example of just one person?) Furthermore, many studies had different goals, many inconsistencies, and did not look beyond the end of treatment. So, how are patients to make an informed decision, if the decision-making process is based on limited, inconclusive, and inconsistent information? At the outset of one’s search, the most important piece is to promote collaboration between your multiple physicians and mental health providers, to collect as much information and opinions as possible. More on specific treatment options next time.

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Marat’s post:

Now I’d like to talk about medications. There are some medications that help lose weight and are even prescribed for that purpose. But there are also some medications that cause weight gain. One of the medications that cause weight gain is Depo for birth control. Another class of medications causing weight gain are beta blockers for blood pressure. There are also various classes of psychiatric medications that have this unwanted side effect. Moreover, medications that are used for sedation, such as Benadryl, may cause weight gain. It is important to know, that not all medications within a particular class are not created equal. Some may cause more weight gain, others – less. Yet, others can be weight neutral. Undoubtedly, many of these medications must be prescribed and taken to prevent other life-threatening issues, including beta-blockers or psychiatric meds. However, it is worth to ask your physician whether this particular medication is absolutely necessary and if there is another one within its class that can be prescribed instead to avoid unwanted weight gain.

For example, let’s discuss beta blockers in greater detail. These medications are for blood pressure and heart rate control. They are very important for patients suffering from arrhythmia and coronary disease, in addition to blood pressure control. If this is not the case, there are times when these medications can be replaced by others from a different class. However, if these medications are absolutely necessary, Metoprolol and Atenolol cause the most weight gain, while Carvedilol – minimal. Another commonly used class of medications that cause weight gain is birth control. Depo and other progesterone-only-based medications cause the most gain. When replaced with oral contraceptives, weight gain is minimal to none. Psychiatric medications, such as antidepressants and mood stabilizers, have the potential for significant weight gain. However, there are some within this class that can be prescribed for weight loss. Others – are weight neutral. Therefore, it is very important for your prescribing physician to collaborate with your weight loss specialist in this case.

 

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Ben’s post

In my other entries, I talked about healthy lifestyle. However, it is one thing to talk about it, but another – to do it. This weekend my family went on a hiking vacation. Once in a while, we go on hikes around the United States. Just weekend we visited New Hampshire. We went on a White Dot Trail on Monadnock Mountain. There were definitely some ups and downs. The hike is rated “hard” on Google. The mountain elevation is 3770ft. At first, it was muddy, because the trail is surrounded by little creaks and it was raining the day before. The trail is all covered in big, steep, and flat rocks. They were hard to climb. Oftentimes I had to use my hands to climb up. It was slippery because our shoes got dirty from the mud. We saw all these crooked dwarf trees towards the top and the moss was soft and fuzzy to the touch. Can you imagine the top of the mountain was all rock, with no trees or plants!!! On the way down, I was kind of disappointed – I thought I was seeing the end of the trail, but I kept being mistaken. I was tired. We were hiking for 6.5 hours! I must have been seeing things ☹. But I kept going!  I was so happy to see children of all ages hiking this difficult trail. Even a little 3-year-old! I think It is so important for children to get used to hiking as early as possible, so they grow to love hiking and exercising!

Go for a hike as young as you can! You’ll finish as a real man! (or a woman)

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Third post

Karina’s post:

EATING DISORDERS – BINGE-EATING DISORDER

imagine a situation. I could bet you encounter something like this frequently enough. You are out and about in the community, walking your dog, doing shopping, or simply sunbathing on a bench at a park and you see an overweight person walking by. Truth is, most of us don’t care and we have too much in our minds to pay attention, so we just walk by without a thought. However, prejudice embedded in us by culture is so strong that it is more likely than not a certain thought flutters in. A thought that has to do with evaluation and assessment of that overweight person. Even those of us who are overweight ourselves can’t help it and end up looking at a person carrying extra weight differently than other people. Yes, even those of us who are overweight ourselves. You deny it? Don’t want to admit it? Fine, but be mindful when you have this frequent encounter; pay attention to your thoughts or feelings. Most people with average or slender physique will have a likely immediate reaction of “how could she let herself go?” Most people who struggle with weight problems themselves will have a likely emotional response of “poor baby, I can relate.” This is because people rarely realize or believe that weight problems have underlying medical and psychological disorders that have direct causal link to our behavior and consequently how we look. In other words, weight problems are recognized medical disorders.

Medical and mental health communities have long discussed various eating disorders on both sides of the weight spectrum (over- and underweight) each one has a clear set of diagnostic criteria and can be reliably and validly evaluated, diagnosed, and treated. Each one has physiological and psychological underpinnings. These include binge eating disorder (most common), anorexia nervosa, and bulimia nervosa. I will be talking about each in turn.

It is important to be very clear as to the definition of the word “disorder.” All people at one time or another in their lives may overeat, under-eat, or otherwise, engage in unhealthy eating practices. However, it is only a problem if it’s a problem and causes severe functional limitations and long-lasting consequences in all major areas of one’s life. A disorder is when something out of order. Eating disorder specifically is marked by severe disturbances in eating behavior and extreme over or under eating. Note the qualifiers “severe” or “extreme.” As in many other mental health disorders, a person may have started an unhealthy practice of over-eating without any behavioral, emotional, or medical consequences. This is not a disorder. However, at some point, due to both emotional and physiological reasons this pattern of behavior has spiralled out of control, resulting in a disorder.

Feeding and eating disorders are so unique, with their own underlying aetiology and treatment strategies, that they are in a class of their own in Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. Not surprisingly, binge eating disorder is the most common eating disorder, affecting men and women equally, and prevalent in children. Over 2% of adults (and by some accounts over 5%) are affected by this disorder with complicated aetiology and presentation. Although children and adolescents may not meet full diagnostic criteria for binge eating disorder, they frequently demonstrate multiple symptoms.

Of course, the main diagnostic criterion of binge eating disorder is recurrent episodes of binge eating. Simply put, an episode of binge eating is where one eats a quantity of food significantly larger than would be expected for most people in a particular time or under particular circumstances. However, an important qualifier is also given: people engaging in these episodes of binge eating lose control and it appears as though they cannot stop eating or control how much or what they are eating during that time. More than that, eating is much quicker than normal, leading to feelings of being uncomfortably full, eating when not hungry, eating alone because of feelings of embarrassment, and feeling disgusted with oneself, depressed, or guilty. This roller coaster happens at least once a week.

Consider taking a screen online, put forth by National Eating Disorder Association. Learn more about your eating patterns and if you suffer from this condition. https://www.nationaleatingdisorders.org/screening-tool

Check out Binge Eating Disorder – 7, that is frequently used by physicians to determine a diagnosis.

http://www.vyvansepro.com/documents/Adult-Binge-Eating-Disorder-Patient-Screener.pdf

 

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Marat’s post:

Everybody has their own Set Point. This is how much weight the brain thinks the body needs to stay at and strive for. Just like a thermostat.  Even if the temperature goes above or below the set temperature, the temperature that was originally programmed. This was helpful for our ancestors. The set point was helping them survive through famine. This is because the set point provided for storage of fat. This was the source of power and health for our ancestors. However, today, this is our Kryptonite. The body is preparing for starvation, but starvation never comes. I guess we are so much more skilled in shopping today than our ancestors were at hunting. Go us!

There are ways to get energy in. Most of us are very familiar with this – it’s eating. There are sources of expending energy. Like sports… I think I know somebody who has heard about it. So, our body has a way of commanding us how much to eat and regulating how much energy we expend during exercise. All this is driven by the friendly-evil set point.

Thanks to our lifestyle, we keep increasing our set point. However, it takes tremendous effort and a long time to push the set point down.

More detail on energy expenditure. We expand energy when we exercise and do routine daily activities. Additionally, when we eat, it takes some energy to digest the food. More than that, we have a bonus from our set point, the energy that we expand just for living. However, what the set point giveth the set point taketh away. This is the energy expenditure that mighty brain reduces if it thinks that we lost too much weight and strayed away from our set point. This is one of the reasons why when we lose weight we tend to gain it all back. Another reason is that through special signalling molecules, the brain makes us hungrier. More on this next time…

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Ben’s post:

Hey guys,

it’s Ben. Today I want to talk about genes and how they can interact with your weight. Have you ever checked your family tree? You probably know that your family’s genes can make you look or be a certain way and weight. Genes don’t just cause weight gain, they can also cause different physical appearance. Our genes are part of DNA and can you imagine that it is chosen how we are going to look when we grow up? Genes are part of the body that give the brain instructions on how to create the body.

There is a way to fight your genes. If you eat healthily, don’t play video games, and hike a lot, BOOM!, you have a better chance of not gaining weight (even if your genes contain those instructions to your brain).

For many generations my family has been suffering from obesity. I am the first in the family who started to really fight it (No offense mom). It has been pretty hard to fight my genes, but I try my hardest. When your parents count on you to exercise and to eat healthy all the time, in can get pretty frustrating. Genes can interact with other things, too not just your weight. Even if you’re overweight and you can’t fight your genes, keep exercising! This can keep you from getting depressed and keep you from having heart disease and diabetes, but my dad is going to talk more about it.

The only chance to stop your genes is before you get into your teens

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I hope my post made a difference, Vote for me!!!

It is clear from the title that we are here to discuss lifestyle and challenges associated with weight gain. But first, let us introduce ourselves.

My name is Karina Gitman. I am a neuropsychologist; I also have a doctorate degree in psychology. One of my professional interests is treatment of obesity.

My name is Marat Gitman. I am a physician.  I am also a diplomat of the American Board of Obesity Medicine.

My name is Benjamin Gitman. I am a pre-teen with the concentration in arguing with my parents.

Excessive weight is not only a part of our professional interest, it is also close to our heart (and stomach) both literally and “figure”atively.  All three of us, as well as our parents and grandparents, have been “enjoying” excessive weight.  So, we were destined to live with this problem even before we were born.  With the knowledge and training in the weight medicine, we were able to change our lifestyle to work with what we have been living with.  Even with that, some members of our family are more successful than others.  In this blog we will try to share our knowledge with you, as well as discuss our pitfalls.

As you probably have realized, we are a family.  Discussions about work-related and personal experiences associated with weight loss and lifestyle are frequent in our house.  We have different approaches to this problem.  This is partially due to our personal differences and life experiences, and partially due to the difference in our academic and professional background.  So, we argue.  To resolve this argument, we would like to open up for discussion and to your opinion.   All three of us will post a weekly discussion on a particular topic related to obesity and lifestyle.  We would like to ask for your vote as to whose presentation made more difference for you and sounded more available and approachable.  At the end of the year we will compare our achievements.  Additionally, we hope you will be able to guess who among us is more successful in weight management.  To give you a heads up, three members of our family have achieved normal BMI (weight) and the remaining one is still obese. I understand that the math doesn’t appear to be top notch here (2+ 1 doesn’t always add up to 4) , but one member of our family is not participating in the blog.

Karina will post notes about behavioral approach to weight loss, Marat will post medical aspects, and Ben will post discussion of weight challenges affecting children and his approach to that.

 

First blog post

Karina’s entry:

When my daughter Hannah was in first grade she had a wonderful loving teacher, Ms. Becky. Ms. Becky was a good educator, providing grade appropriate teaching to little children, getting them ready for second grade. She had a special connection with her class. So special, in fact, that she expressed her love by feeding them. She had all class parents on a rotation schedule, buying snacks and sweets, requested by the kids. But that was not enough. Ms. Becky baked. She also loved ice cream parties as a way to reward children for good behavior, completion of scheduled projects, cooperative work in groups, good grades, or just for their beautiful eyes and smiles. And so, these six and seven-year-olds had a nice consistent stream of delicious carbohydrates, fats, and salts in the form of chips, chocolate, and such. What a wonderful year! Kids loved it! By February, Hannah grew two sizes. At seven, she was becoming conscious of her weight and started noticing that it was more difficult to run around. She also noticed that there were other children in her class who were not at all affected by Ms. Becky’s diet, keeping their slender physique while running around with little difficulty. What a wake-up call for a mother, trying to explain to her little girl, why she should avoid extra dessert or have a vegetable instead of sandwich for snack. I gave her a lecture on the basics of genetics, but Hannah was inconsolable, “Stupid genes!!!” She used to say. She still says it at 15 years of age.

Volumes are written about the causes of weight gain and inability or transience of losing it. “Stupid genes” is just the beginning. What about mental health as contributing factors to obesity? Anxiety and depression – at the forefront. What about neurodevelopmental delays, such as autism, intellectual disability, ADHD, or executive dysfunction? The list goes on. What about eating disorders on both sides of the spectrum – binge eating disorder, bulimia, versus anorexia? What about stress? What about boredom? How about simply – this is the way a person is raised and these are the foods s/he is used to eating? Paraphrasing the words of George Orwell, when it comes to obesity, “Everyone is created equal, but some are more equal than others.”

Causes of obesity are plenty, and consequences are unlimited. What about epi-genetics, such as passing on these deep-rooted eating patterns to your children and future generations? What about anxiety and depression – again, at the forefront of consequences of weight gain? What about increased stress? What about poor body image and self-esteem? What about disrupted sleep and severe fatigue?

Identifying the causes and dealing with consequences of one’s weight gain is not helpful. We need to treat it. I will focus on all of these issues and more, as I strongly believe that psychological, social-emotional, and behavioral issues are the biggest contributing factors to the obesity epidemic in the world.

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Marat’s entry:

There are many causes of unwanted weight gain. These range from genetic predisposition (familial predisposition) to lifestyle choices and life changing events and plenty in between. There are, of course, the usual suspects. Dietary habits or certain medications that cause weight gain. There are even medications in the same class that can cause more or weight gain. Quality and quantity of sleep are both very important to consider. Circadian rhythms (stable day and stable night regimen) are also important contributors. Of course, the amount of food consumed and the type of the food will make a difference. Gut microbiota (friendly bacteria that lives in intestines) is important. Level of activity, level of stress, compounding psychiatric and medical conditions throughout lifetime contribute to this problem. It is of paramount importance to identify the causes and develop a plan as to how to eliminate them. In my blog I will be addressing these and many other causes and consequences of obesity one by one, paying close attention to strategies and interventions one can use in and outside of doctor’s office to tackle these.

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Ben’s entry:

Hello,

My name is Ben and I am a 10-year-old kid. I have been struggling to stay thin my whole life. For many generations my family has genes with obesity. I am the first in my family to get rid of extra weight and continue to work on it. There are some downsides and upsides of thought, though. The downsides are that my parents always tell me “Come for a walk or hike with us” or “Eat healthy” and it’s annoying. My parents don’t even let me watch TV, play video games, or play on my phone during the day. The upsides are just that: I go for walks, eat healthy, and don’t play video games. Even though this can get very annoying, I know that I would become unhealthy and overweight if I didn’t do that. If my parents let me stay home instead of coming for a walk with them I would be overweight. If my parents let me eat too much junk food I would be overweight. If my parent let me be a couch potato and play video games all day I would be overweight. Hiking is an amazing experience that keeps you from being overweight and depressed. In my blog I am going to talk about a child’s perspective on food and exercise. I will also try to help parents, who need ideas to keep their children healthy.

Hope this made a difference for you. Vote for me.