Monday, February 25, 2008

Weight Loss

By Angela Zechmann, MD, MPH

2/25/08 Hello, and welcome to my blog! I am a physician specializing in weight management medicine, which is a relatively new specialty in medicine. My practice is called South Sound Preventive Medicine, located in Olympia, WA. I absolutely love what I do! Considering that obesity is now America’s number one cause of preventable premature loss of life, it is surprising that there are not many more physicians like me who specifically focus on helping people to lose weight and get healthier.

If you suffer from the disease of obesity, take heart. Yes, you heard me right, I said obesity is a DISEASE. It is not a personal failure, a lack of willpower, or laziness. It is a long-term chronic disease, and it causes in its wake many other chronic diseases, like high blood pressure, arthritis, and diabetes, to name just a few.

Obesity is a treatable disease, but it will require life-long vigilance to keep the disease under control. “Diets,” which have a starting point and an ending point, will not help, and will actually worsen the disease, because once you end the “diet” you will most likely regain all of the weight you lost, and then some. If this has happened to you, don’t beat yourself up. It is the natural history of this chronic disease.

So, how is this disease treated? Well, first of all, we must define what it is. Physicians and researchers use the standardized BMI (Body Mass Index) calculation, which is a measure of weight relative to height. The BMI is not perfect, as someone who is very muscular may have a high BMI but a low fat percentage. Click on the BMI table if you would like to measure your own BMI. Here is how to interpret the number you get.

<18.5 Underweight
18.5-24.9.1 Normal weight
25-29.9 Overweight
30-34.9 Mild Obesity
35-39.9 Moderate Obesity
40 and over Severe Obesity

Now that you know where you are at, let’s get to work.

The first thing a bariatric physician will do is to take a careful history. I have my patients fill out a graph which shows me how the weight has come on, what diets the patient has tried, and what sorts of life events have been associated with weight gain or loss. This graph is incredibly helpful. I also ask about current lifestyle: who you live with, who cooks, what sort of job you have, or if there are other stressors in your life (for example, taking care of small children or an ill parent). I ask patients to keep a food diary. I ask what sorts of illnesses they have had or currently have, and what medications they are on. Finally, I ask about the family history of illnesses.

The next step is a physical exam. Vital signs and measurements are important; Blood pressure, pulse, current weight and height, neck, chest, waist and hip measurements, and a body composition analysis, which tells us how much of the weight is fat and how much is fat-free (ie muscle and bone). I like to keep an eye on these measurement to make sure the weight loss is fat loss and not muscle loss, which is common in fad dieting.

The final step is blood testing. In my clinic, I get the bare-bones basics in the beginning. I ask patients to fast overnight, and then we get a blood sugar level, cholesterol profile and a few other labs which help me determine liver, kidney, bone marrow and thyroid function. I do not get expensive tests unless someone is having trouble losing weight.

Once we have an idea of what is going on, we can make an individualized treatment plan. There are many causes of obesity, but in general, they fall into four categories:


The next blog will discuss each of these in turn.

In the meantime, consider finding your nearest bariatric physician to learn more about how to control your disease. A good place to start is the website of the American Society of Bariatric Physicians: Just go to the tab marked “find a physician” and click on your state. A list of society members will pop up so you can find the one closest to you.


Lucy said...

I am a former patient of Idaho Weight Loss, who doesn't visit there any more due to financial (travel) reasons, as I live in the Seattle area. Dr. Rader told me about Dr. Zechman on my last visit, so I decided to check out the website and see if there are others over here in my situation. As I transitioned off of diet meds (phentramine), I gained 20 pounds. I went into denial as to how much I was eating, and ate too much, especially during stressful situations. I've gone back to regularly using Spark People and increased my caloric goal from 1000-1200 calories/ day, to 1200-1400, as this is still below my BMR caloric resting requirement, for my goal weight, of 1460. I've gone back to the pool to get my laps in, and I've found this manageable. I still have "fat-attack" days, but am losing weight again and feeling good about not using my meds.

rainglo said...

I am a newer patient w/Angela Zechmann, my experience so far has been quite positive. I wasn't a YO YO dieter historically, just steadily gained gained gained over the years, top weight was 319. I was somewhat less when starting this program 9/08. Now my home scale says 279. Losing pounds and inches and have learned so much about hidden sugars in foods. Didn't really want to take the meds at first, but now see it as an investment in my future excellent health and so with quite a way to go, feeling quite positive about the changes!

Auntie Wes said...

What sort of meds/supplements do you promote in your practice?

autumnstar said...

I found info about Dr. Zechmann thru a Low Carb doctor list. Is it possibly true there is an LC doctor in lil' ol' Oly? Is it possible there is reason amongst the sea of lipid hypothesists!? If so... is she taking patients!? Sweet sweet fortune!

Angela said...

For Autumnstar and Auntie Wes: Yes, there is a bariatrician in lil 'ole Olympia. I promote controlled carb, not an Atkins-type low carb except in diabetics. I use prescription appetite suppressants in carefully selected patients and other medications when medically indicated. My goal is not to put patients on a bunch of medications but to get the obesity under control and hopefully get patients OFF some of their medications. I am indeed taking new patients. The wait is generally about 2-3 weeks. All the best, Angela

D said...

great blog. I’m on a diet right now, so this really helps


I am celebrating today. I weighed in this morning at 260.6 pounds.
I started on January 19; my wife received a letter from Dr. Zechmann. I weighed a bit more than 310 pounds. I am 57 years old with high blood pressure (not any more!), and bad knees. I had my hip replaced last year and my father passed on. In a former career I was the classic doughnut-eating patrol sergeant. I ate to relieve stress; I ate bad food out of habit. My eating was out of control. When I started this program my knees hurt all the time and I had just about no motivation to exercise.
My younger brother got diagnosed with diabetes.
I started Dr. Zechmann's program not having any idea what would really happen.
I thought a lot about my health and my future. I think I reached one of those "Ah ha" moments. I started thinking: If this goes on...
I have lost 50 pounds as of today on this program. Further, I now do 100 flights of stairs in less than 30 minutes on a Stairmaster every other day. (That's with some brief breaks along the way for water.)
My knee pain is just plain gone. My blood pressure readings are now consistently good to very good. I have quit taking Prilosec and I still love hot peppers. My quality of life is improving instead of rapidly declining.
I get it: from now on I will be in charge of my eating and my health. Going backwards is not an option; I can be healthy or I can eat the junk I used to crave. I can't do both.
My FIRST goal is that on August 1, 2009, I will weigh 250 pounds and I will be strong, vibrant amd healthy.
Thank you sincerely Dr. Zechmann for teaching me what I truly needed to know and putting me on the right road.

Lee said...

What if you are overweight, take blood pressure meds, your doc says you aren't a candidate for weight loss meds? What can you suggest?

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SARAH said...

I heard about Dr. Angela Zechman from 2 different people. I am 45, 4 children, very athletic, and then....I can't lose 5 - 10 lbs. in a week! You know we could all do that in our youth....invincible, then! After many failed attempts to find "ME" again, and at the end of my rope, that is when I heard about Dr. Zechman. I called, made an appointment and that was the beginning of my journey back to "ME". I know that my weight loss is not "typical", 60lbs. in 4 months, but, I can tell you that with Dr. Zechmans intruction I have been able to do it. I have went from a size 18 to a size 10/12....I am feeling sexy again, my husband is so "LOOKING" at me again and I am on cloud 9.

alen mcmilan said...

I just accros from your blog and I thought I would have to leave my first comment after reading your great article on weight loss, I really glad on you.I think Many of the people want to know on this.So ,I think this will help them a lot.

Julie Trinque said...

Okay....So,I have thought about posting something on here for months, but have truly agonized over how to put it all into words. I'm just going to go for it and tell it like it is and let it ride ther. First of all, THANK YOU Dr. Z for saving my life - that is how I feel! I started this journey with you 7/2/10 with the attitude of "Okay, this is it - it's the last thing I'm going to try and if it fails, I will accept being "large and in charge" for the rest of my life!! (That means 5 7 and 208 on your scale... 220 to 210 on any given day on my scale. The reason I had this attitude was... I was 135 when I was in the Army, met my husband and when I got pregnant, w/ our beautiful, amazing daughter (she's 19 going on 20 now). I was so sick during the first 6 mos of pregnancy I was hospitalized etc. from my 7th month to my 9th month I jumped to 220. Although she was 9 7 i never really lost that weight and have flucuated up to 220 for the past 20 years. I paid THOUSANDS to Jenny Craig, Weight Watchers, took Metabolife, tried Slim Fast, even hire a personal trainer and worked out 6 days a week at the gym for FOUR months and lost SIX pounds.. (duh - he was having me eat completely WRONG). I have tried cabbage soup diets, surivor rice diets, trim spa and dexitrim - hell I even tried to put my finger down my throat and make it all come back up... but fortunately... I'm a Texan and I LOVE my food and I just couldn't do it. Anyway - w/ no surgical intervention - Dr. Z taught me how it all comes together - the body - the sugar etc. Trust me - I'm from Texas and my husband is 1/2 frend and 1/2 Italian so we love our food!!!! (my husband is also in his 50's - 10 yrs older than me and in Law Enforcement w/ a fam hx of heart disease - very high risk!|!) He has lost 50 lbs and I have in the 40's I think (I dunno - because the number really doesn't matter to me at this point - I feel soooo Good!) I went from a size 18 to 20 to my athletic daughter (she plays college volleyball on a scholarship)jeans and yes those would be SIZE TEN |!! I am ALIVE|!! I want to LIVE!!|! I took GERD/REFLUX Medication for TWENTY YEARS and NO i do not have to take it anymore! I no longer have to sleep all the time or take naps on the weekends... I no longer have insomia... I get 6 - 8 hours of sleep and feel so amazing, HEALTHY and rested i can go at warp speed all day long! I even recently got a promotion at work!! Trust that I eat.. like I said... I"m from Texas... we LOVE our food... I fix our evening meals from Dr. Z's recipe books she has all over her clinic - we LOVE the chili, beef stew, fajitas and more... and we just monitor and control what we eat daily with the exception of our splurges which ya know .... it's okay to do that... just remember YOU are the one in control and in charge... a size 20 to a size 10 from July to November.. REALLY People... Why have any procedures etc esp. if you don't have the knowledge you need to maintain and feed your body how you are supposed to? We looked at it this way - do you have to pay for office visits? Um.. Duh ... OKAY... is the good and fresh foods better for you.. Um yeah... so pay now..... OR pay later when you are on a fixed income and so unhealthy you pay on average $500.00 per month for presccription drugs for health probs when you are retired on a fixed income... Yeah... NO THANKS... we plan on living life to the FULLEST long after retirement. Thanks again Dr. Z for the education I have needed for the last TWENTY YEARS! Forever indebt ...... Respectfully, Julie Trinque!!

Angela said...

Julie, thanks for your post! Hopefully your testimony will help many others who have struggled with this disease for so many years and feel like failures because DIETS DON'T WORK! This is a long-term disease of the chemical communication between the cells of the body. The weight gain is not the real problem, it's just a sign that something is amiss. Our treatment is all about rebalancing this communication system. It's a lot of fun for us to watch people like you as they get the disease under control and feel so much better! Life is fun again, not a constant struggle. Keep up the good work and thanks for writing!

Angela Z

Dr. P said...

Angela, you were recommended by a local physician here in Olympia for weight loss. However in reading your Blog I noticed that you use phentramine with some of your patients. Years ago I used PhenPhen and suffered heart valve damage in all four of my valves and would never consider taking any weight loss medications. It was my undersdtanding that you used a different approach in your program so I am a bit perplexed. Also I understand that you do not accept insurance and wondered if your lab tests were covered by insurance since you are a MD? Or would I need to request these tests through my primary physician so I could have them covered?

Angela said...

Dr. P -
Yes I do use phentermine and other related drugs because they assist people so much in getting the unbalanced appetite center under control again. Fenfluramine was the medication in Phen/Fen that created heart valve issues. I am so sorry to hear that you were one of those who suffered such serious complications and I certainly understand why you would not feel comfortable taking weight loss medications.
I do use a very different approach because I help people understand the true cause of the weight gain- an imbalanced chemical communication system - and how to correct it. It's a comprehensive program. Initial lab work is included and follow up labwork is done at minimal cost to you.

Hope that helps- Angela

Victrolla said...

Hi Dr Z,
I work at an eye doctor's office. Almost everyone who has had weight issues here has come to see you. The results have been amazing! I am looking forward to scheduling appointments for myself and husband. I'm looking forward to finally losing the weight!

Maria said...

Hi Dr Z
I just saw you today I want to succed on my journey will do what it takes to be one fo your happy patients I compare my self to Julie Trinque hopefully I can share my success too!!!

Katie Vespe said...

I am interested in meeting with you! I am 5'2 and 150ish lbs. I am on a LOW fat diet due to cholesterol.. and I do an hour of semi intense workout every other day. My concern is that my BMI isnt high enough to allow the help of diet pill assistance. My insurance does cover dietary consultation.. but not the pill assistance. Is my BMI too low to get the help of the pills along with the lifestyle change/ education?

SARAH said...

Wow....what can I say other than this is the most surprising journey I have ever been on with myself. I started with Dr. Z. on June 3rd, 2010. In November of 2010, many people I know and family members were shocked at the transformation....they did not even recognize me! I did not recognize myself but on the same token, I did not recognize the photos of myself from the begining.....I just never seen me the way the photos portrayed me....thats probably why I never let people take photos of me and I was the one always taking the photos. It is like the mind of a child, if I close my eyes and I can't see them, they can't see me. I did not want to be seen...barely wanted to exist, but knew that "I" was in that "body" somewhere, it was just a matter of finding the right key to unlock the door. My key was Dr. Zechmann...I can truly say that she was my saving grace....I was done, felt like my marriage was done and I would live a life of being alone for the rest of my life. But I knew I deserved more than that and that, I owed more to myself than that. The appetite suppressants worked great, but without the eduacation I received, the suppressants would have been useless. Just another futile attempt to lose weight. It is so unbelievable what you can find out by reading labels on food. So much hidden sugar, so many wasted calories. I can't thank Dr. Zechmann enough. When you go from a size (tight) 18 to a comfortable size 8 after so many years of diets and programs that never worked, it is pretty clear that the lifestyle change of eating habits and KNOWING what you are putting into your body and what those foods do to you, is pretty darn important. No more prescription Pepcid, no more aching knees, no more lower back aches and very rarely a nap is needed to get you through the day. I don't just cope anymore, I live and I live my life to it's fullest. I don't worry about getting older, I just look forward to what I am going to do with my life and I look forward to all of the things that are there for me to experience. I started tearing up at one of my last appointments with Dr. Zechmann---she did not even recognize me and made me so proud of the accomplishments I have made to this date. Not only do I thank her for the knowledge she has given me, but also for the encouragement and support that she provides. She always takes her time with you, answers any questions you have and gives encouragement and positive feedback. Thank you Dr. Zechmann for making me feel relevant, for giving my self esteem the boost it has needed for many years. My husband thanks you as do my children...they are thankful that I will be around many more years with a much more healthier lifestyle. The path of self destruction that I was on had now hit a major road block. I have reclaimed my LIFE! What a great feeling that is! Thank you to Dr. Zechmann and her staff for what they are doing to eduacate people about food and helping me see what I was doing to myself. Cheers!

Moe said...

Can you recommend some iPhone applications that would assist with diet tracking?

drquinn18 said...

I am 5'9'' 240 pounds 24 yrs old and want to weight around 150! My bad habit is eating chex mix and not exercising like I should. I drink plenty of water and eat small to medium portions of food. My ankles hurt when I walk or run. My weight goes from 240 in the first of the month and then 230 towards the end of the month. Do I need surgery or just a gym membership? also excellent blog!

Wendy said...

I start with Dr Z. In Feb 2011 after a huge struggle with weight gain. I had researched different things I could do such as bypass, hypnosis, (crazy huh? ) taking a million different diet pills that were "guaranteed to work" nothing worked. At my lowest point I was taking cholesterol pills, could barely walk because of a ruptured disk in my lower back and barely able to sleep because of the pain, my self esteem was in the toilet. I went to a family Dr. Who would give me buckets of pain pills that were addicting and tell me to exercise and who wanted to cut open my back but really wouldn't help me. I thought that my life was pretty much useless at 48. Then I thought I would try 1 last time for help I found Dr Z. Website on the internet at first I passed it by then I kept looking at it for some time before I thought why not? Can't be any worse than any other thing I had tried. So I made an appointment arrived skeptical and a big chip on my shoulder listened to what she had to say thinking yah right here we go again, took her pills went home and starte to think about what she said and it made sense. Now 5 months later 35 lbs lighter, better attitude, better back, self esteem climbing I am a die hard fan of this Lady Dr. She has made me feel like I can do this and she won't desert me but always be there to help me if I slip. I have a disease but it doesn't control me with Dr Z's help I control it. Many thanks for all your help and I hope more people find this and it helps them also.

Vicki said...

Dr Z,
Do you consider your practice strictly limited to bariatrics? I feel like your initial education was wonderful but now am seeking more info towards healthy living/eating. Do you offer more education in regards to organic eating, superfoods, not all calories bring equal etc? Is this something I would need to seek from a nutritionist/dietician? I am doing research on my own but need more answers. What do you think? Also I am wanting more info regarding exercise/fitness training. Any guidance on that or do you refer to trainers at the various gyms?

Angela said...

Hi Vicki!

My practice is limited to Bariatric medicine- but of course we teach all about how calories are not calories and the importance of understanding how your body handles the food you put into it. I encourage eating organic foods, not only because they do not have the pesticide residues but because they contain more nutrients than their non-organic counterparts.

Regarding exercise - this is extremely important, as you know! Not to lose weight but to maintain it. Muscle burns calories! We always emphasize keeping as much lean muscle mass as possible, building some up if possible, and my patients do an excellent job of that. I always encourage working with a personal trainer since form is so important in strength training in order to prevent injuries, but I do not recommend anyone in particular.

Congratulations on your success at getting the basics down so that now you can delve deeper into long-term healthy behaviors!

miriam said...

Hello, In November 2010 I weighted 234, I am barely 5 feet tall. In that same year I got my second granddaughter, my wrist hurt I thought I had carpel tunnel, I had back problems, shoulder problems, I didn't have a lap to hold my grand baby I think that was the worst pain of all, when I held her my arms would go to sleep. I went to the Dr. for my elements, they would always says lose weight and you will feel better. Well i tried. I was watching my friend loose weight, she show me the recipes Dr Zechmann has, she lost 30 lbs and was looking great. So finally I got the courage to go see Dr. Zechmann. Now 10 months later I have lost 90 lbs. I can hold my grandbaby all day long, I go on 40 mile bike rides and do spin classes. My new self is so exciting. sugar is a bad drug. Get it under control and you won the battle. thank you so much DR. Zechmann
Sincerely Miriam

cristal said...

Dr. Zechmann,
I am very interested in starting a treatment with you. You were recommended to me by a friend whos partner has had amazing results with you. I just had a baby 2 months ago but before he was born I was already considereed obese. I'd like to be at a healthy weightfor once in my life. HOw soon could you see me.

Angela said...

Cristal, give us a call at (360) 413-1296 and we can probably get you in within a week or two. Look forward to working with you!


Anonymous said...

Does anyone know of a Doctor in the Marysville wa area? who specializes in weight loss

Vicki said...
Interesting article. Thought I'd share.

Bruce said...

To Moe
Best iPhone app for tracking daily intake and progress is a free app called: lose it. Try it. Simple to use and powerful.
Good luck!

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debbee said...

Do you prescribe Qsymia?

Dr. Angela said...

Hi Debbee,
I do not prescribe Qsymia at this point. It is a combination of topirimate and phentermine. I have been using these drugs in their (much less expensive) generic form together for years now and I find that patients differ in their dosage needs for each one and for the combination. It is likely I will not prescribe Qsymia until it becomes available as a generic, and even then, only if it would be a cheaper alternative to what I currently prescribe.

Thanks for the excellent question!

Dr. Angela

Sir David said...

Keep it up; keep posting more n more n more.get more info

Kathy said...

I was seeing a Doc in Oklahoma he put me on phendimetrazine. It was working really well. I had to move to Washington. Do you use this med in your program?

Dr. Angela said...

Yes I do!

Anonymous said...

I have been seeing Dr. Angela for three months now. It's been a long time since I have felt this good! Thank you Dr. Angela - you gave me back my life!

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Torezzian Lady said...

It was really a great blog. And you also attend to the comments and questions of your readers. I was just wondering if there is a medical weight loss suitable for me. I am 55 year old, I don't eat vegetables. I only eat pork.

Mindi Zumwalt said...

I have struggled with my weight all my life. I have tried so many things. I have high blood pressure as well as diabetes which I'm having a hard time controlling. I have state medical and am on low income housing. I have a daughter who is 13 and I'm so worried I won't be around to see grand babies. I am desperate to get this surgery done.

Erin Pehl said...

Well now that I feel like I am part of a family I am so excited to start my journey. I wanted to add for some of the bloggers that I added the FOODUCATE app on the app market for any phone. It tracks everything that Doc wants to see, It also has a bar code scanner so you can scan you item and it will ask you portion size and wool-lah done. I am happy to have the support of my family and friends and can't wait to see the outcome. Thanks DOC

Helen Chapman said...

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Jessamine Stenger said...

I love dr Z! She kept me motivated, in line and knowledgeable about what I needed to do and fix my issues. I was 194lb standing at 5'1 1/2 on 9/15. I know i am now 161 at home. I have an appointment tomorrow 11/2/15 and will see what their measurements and weight is. I love her program so much I am actually posting a review. (I hardly ever do!!) With all that said, I had an appointment in early 10/15. I had gotton lost (gps took me to a housing place?) I called 3x, 2x it went to voicemail and the 3rd time I was put on hold. I ended up being 11 minutes late. I mentioned all the above to the front desk and she said have a seat and ill see if we can squeeze you in, because the person's appointment after you has already went in. I said ok thank you. 5 min later i'm told i need to reschedule due to being late. i could come back later that day or tomorrow. I told the woman at the front desk that i couldn't, not only did i make this appointment over a month ago but also i lived an hour away with 6 children i had and have to make accommodations for. Also, I have a job during the day. I asked why i couldn't take the appointment of the person that took my spot? she said because i was late and they were behind. I reminded her that i was only 11 min late and tried to call. she said i could call later and make another appointment i said no and left. Mainly i said no because i had another appointment for the 2nd of november already booked the same time i had booked the october appointment. I figured i would just give it a month. I can not afford the gas and time from work to be turned away due to being 11 min late.. so YES I LOVE this dr and how much she has helped me but I do suggest to be early, especially if you live far. I will leave an hour and 45 min early instead of just 80 min ahead of my appointment.

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