- The Washington Times - Thursday, September 20, 2007

Dr. Denise Bruner has maintained a 50-pound weight loss for 25 years. Now she is giving her patients tips on how to control their appetite in a healthy way.

She says she was inspired to lose weight because she was having too much fun in life to face a premature death.

“I had a family history of diabetes and heart disease,” says Dr. Bruner, who has a private practice in Arlington and is certified by the American Board of Bariatric Medicine to practice weight-loss medicine. “I tried to implement a healthier lifestyle. I want to reach age 100 in a good way.”

On the basic level, people experience hunger as a method of self-preservation. However, controlling a person’s appetite in this day and age is another story.

“Hunger is if you take a box of frozen brussels sprouts from the freezer and eat it. Then you’re hungry,” Dr. Bruner says. “Appetite has to do with stress, emotional issues and the chemicals we’re exposed to in the environment.”

Many foods are genetically modified or contain hormones, causing an increase in appetite, she says. High-sugar foods trigger insulin secretion, she says. When insulin is released in the bloodstream, the blood sugar drops and the eater wants to eat sugary foods again in response.

“I try to encourage people to start the morning with a diet of protein,” Dr. Bruner says. “Rather than having a bagel with orange juice, have a piece of whole fruit or whole-grain bread with low-fat peanut butter or an egg or a slice of turkey. Don’t get the insulin going, so you’re not hungry throughout the day.”

The body is designed to know when it no longer needs more food, says Dr. Mahsin Habib, who has a private practice in Ashburn, Va., and Bethesda. He runs a weight loss and health clinic.

When the stomach is stretched from being full, it stimulates the vagus nerve and tells the hypothalamus in the brain that the person should stop eating, Dr. Habib says.

“The magic question is: How do we all end up overeating?” Dr. Habib says. “It’s more complicated than that. Your brain can override the common-sense response that your body is telling you.”

A person’s willpower and the influence of the social environment contribute to whether a person overeats, Dr. Habib says. Nutrient deficiencies also can cause someone to be hungry or have a slow metabolism.

More often than not, when people eat, they are not responding to hunger, says Dr. Lawrence Cheskin, director of the Johns Hopkins Weight Management Center and associate professor of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“Hunger is a natural physiological control mechanism to ensure that we don’t lose weight,” Dr. Cheskin says. “It’s far more important that living things not lose weight than they don’t become obese.”

For this reason, appetite-suppressing drugs usually don’t help most people, he says. They may help initially, but it doesn’t last.

“We choose to ignore them because we’re not eating because we’re hungry anyway,” Dr. Cheskin says. “The medicines tend to cause modest effects on weight and wear off over time.”

Right now, there are appetite-reducing medicines on the market that cause a person to feel full, such as Meridia. There also are medications that block the absorption of some of the fat a person eats, such as Xenical.

“Medicines have a place, but they are not the first line of defense against obesity,” Dr. Cheskin says. “The first line of defense is changing what you eat and your exercise habits. The very first line of defense is prevention.”

While some people undergo weight loss surgery, they need to adopt a healthy diet to keep the pounds from coming back, says Dr. Amir H. Moazzez, a bariatric surgeon at Inova Fair Oaks Hospital in Fairfax. He performs laparoscopic gastric banding and laparoscopic gastric bypass weight-loss procedures. He also has a private practice in Fairfax.

More than 10 million of the 90 million obese people in the United States are considered morbidly obese, at least 80 to 100 pounds overweight, he says. While sometimes weight-loss surgery is the only effective option, people need to adopt long-term weight-management strategies.

If a person loses less than one-fourth of the excess body weight after a laparoscopic gastric banding procedure, it is considered a failed surgery, Dr. Moazzez says. The failure rate is about 20 percent. Laparoscopic gastric bypass surgery is considered a failure if the patient loses less than half of the excess body weight after surgery. The failure rate for this surgery is about 10 percent.

“The lifestyle has to be changed for them to be successful,” Dr. Moazzez says. “The surgery will give them a tool.”

Many people eat out of boredom, says Karen Heagney, registered dietitian and clinical nutrition manager at Inova Fair Oaks Hospital. She suggests that her patients write down what they eat and the surrounding circumstances.

Sometimes, people reach for food when they should be reaching for water, she says. Also, there has been research to indicate that lack of sleep contributes to obesity, Ms. Heagney says.

Further, there is a lot of evidence that fiber makes a person feel full. Therefore, people should eat a diet based on fruits, vegetables, beans and whole grains.

She also suggests starting meals with a bowl of broth-based soup. Because it’s hot, it makes a person eat slowly.

Also, statistically speaking, when a meal is started with a large low-calorie salad, diners end up eating 12 percent fewer calories at that meal than if they had not started with a salad, she says.

The most common characteristic of people who are able to maintain their weight loss is that they exercise most days of the week, she says. Trading sitcom-watching for exercising is always beneficial.

“It’s not really about changing your appetite,” Ms. Heagney says. “You are making a lifestyle change. It takes about 90 days to make a lifestyle change stick.”

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