Weight Loss Notes From Dr. Kalman’s Notebook


By Douglas Kalman PhD, RD, FISSN

Nutrition Editor

A few items from the note pad to pass along this week…

6 out of 10 are Overweight!

Weight loss and weight control is not easy for the majority of society. This is evident by the fact that an alarming ~60% of the American population is either overweight or obese!  6 out of every 10 people have a weight issue. Being overweight or obese affects so many aspects of life that it is staggering. We know that those with obesity issues suffer from discrimination, lower salaries, less social life, psychological stress and more. However we also know that by just reducing one’s body weight by 5 to 10% of total body weight that the innards improve (meaning, the risks of various diseases are reduced) coupled with improvements in body image, self-confidence and more. Many people who compete in weight-based sports have to lose weight or cut weight to make their class. This is also true for bodybuilding and other fitness related sports. This column covers various issues surrounding the process of making weight and potential implications.

Binge Eating

In one recent study, it was discovered that just about 1 out of every 5 people who were seeking weight loss counseling were found to have clinically validated binge eating disorder (1). That is, 22% of all people seeking weight loss counseling when tested and evaluated by psychological gold standard tests were found to have issues with binge eating. This on one level is surprising and yet on another is not. Within weight based sports (again, fitness and figure are weight based as these activities evaluate how your body looks) it is often said that some people will develop eating disorders or disordered eating (they are not one and the same). Thus with this in mind, let’s examine some of the interventions that are useful – reason being, if you or someone you know does binge, there is help out there.

First off, the definition of binge eating is roughly someone who eats an unusually large amount of food at one time — more than a normal person would eat in the same amount of time. Now with a definition in hand, what can one do?

Often, people who have “BED” hide it, or are ashamed, while others seek to compensate by over-exercising (trying to burn their binges or demons off) yet while others seek nutritional or psychological counseling. Until recently, some psychiatrists have also prescribed medicines that are typically used for obsessive-compulsive disorder (OCD). In reality, since OCD is often thought of as a form of depression, anti-depressants are used. There are six drugs that have shown to be useful in good double-blind placebo controlled studies. The six drugs shown to be effective in such studies include: fluvoxamine (Luvox), fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), and clomipramine (Anafranil). Anafranil also has the interesting side effect that in some women who take it, whenever they yawn, they experience an orgasm. No joke. Interestingly enough, some physicians also prescribe venlafaxine (Effexor), for BED. Some in the health field view BED as a form of obsessive compulsive disorder (OCD).

Well now, there seems to be a new breakthrough for “BED”. The medicine that is gaining wide use and excitement is an unexpected one, Lamactil (lamotrigine). Unexpected because this is a drug primarily used for epilepsy and bipolar disorder! However, due to the way that it works in the body, it is also showing promise to reduce binge eating while stabilizing mood. If you think you binge and are concerned about the implications, talking to a counselor, psychologist or psychiatrist about medical and behavioral intervention would be worthwhile. Research also does show that when people combine talking therapy with medical intervention, the success rate of the intervention is quite amplified.

A New means for weight control?

We all know that to lose weight one essentially has to have a negative caloric balance. That is not so simple for many, making pharmaceutical, nutritional and other interventions (surgical) commonplace. Typical dietary supplements that are popular include such brand names as Lipo-6, Hydroxycut, GutBeGone and others. In addition, a few medicines are also prescribed by physicians to help with appetite suppression, metabolic elevation/stimulation or caloric “blocking”. These range from Meridia (sibutramine), Xenical/Alli (orlistat) and various versions of phentermine. Three newer drugs have also achieved FDA approval for weight loss, Empatic™, Contrave™, Belviq™ and Qnexa™ to be heavily promoted through news media outlets and of course DTC advertising.

Now, researchers have realized that two existing drugs already on the market may be more effective for aiding in body fat loss, blood sugar stabilization, mood elevation, appetite control and metabolic enhancement (the holy-grail if you will for a weight loss drug). This combination can be prescribed right now by any physician under the off label use guidance.

Want to know what this exciting, useful, relevant drug duo and the typical prescribed (or efficacious) dose is? Phentermine at 15 mg and Metformin at 500 to 850 mg dose given together once per day. This dosage and dosing routine is not standard for either of these two independent drugs and that is why the combination is so interesting (synergy anyone?). Typically phentermine is prescribed at various doses (15 or 30mg) and given twice per day (appetite suppression with slight metabolic enhancement) while metformin can be dosed anywhere from 500 mg or higher from once to three times per day. Again, this new combination of phentermine 15mg with metformin 850 mg taken once per day is showing great promise in clinical trials as well as in real world use. Thus, this is a combination for those looking for weight control (and more) that can be discussed with your physician.

Growth for Loss?

It has been reported that overweight/obese people have substantially less circulating growth hormone (GH). This is often termed “GH deficiency” or “GH insufficiency” (GHD/GHIS). When one has lower or less circulating GH the result is increased body fat levels, coupled with loss of muscle mass. This makes insulin resistance more of an issue – which begets an ugly cycle (2).

So what is one to do if they are looking to lose weight, have some belly fat and are unsure if the cause is in part from low GH levels or reduced sensitivity to circulating GH? Interestingly enough before the GH aspect is discussed further, it should be noted that DHEA-S (the sulfated version of DHEA) becomes typically elevated with weight loss while correlating with enhanced or protected muscle mass. Therefore, if having your GH levels tested (your physician will know how to do a GH challenge test), one might as well have their circulating DHEA-S levels evaluated. If both are low, than intervention might be indicated. Interventions with GH administration are typically dosed at 0.15 to 0.30 mg per day. Dose escalation (after the initial dose of 0.15 mg/day) is typical until the physician finds the right dose for you – this is done by looking at your GH and IGF-1 levels (called the GH/IGF-1 axis). The reason that IGF-1 levels are included in the evaluation is that low levels of IGF-1 are also an indicator of insufficiency/deficiency as a result (or cause) of the overweight/obesity. If this means of weight control/loss is of interest to you, ask to have your levels of GH, IGF-1 and DHEA-S evaluated and be sure to explain that the testing needs the right challenge (the doctor will know what this means or one can view the testing methods at www.questdiagnostics.com and the answers will be apparent.

Winning isn’t everything, however winning is also achieving the goals that you personally are seeking – and that being said, I can think of no better resource for aiding and supporting your goals than this site.

More articles and insight from Dr. Kalman

For nearly two decades Dan has produced countless hours of media, earning a reputation as a leader in the world of fitness & bodybuilding publishing. Dan has conducted numerous A-List interviews, serving as host and lead commentator for the Mr. Olympia contest, the Arnold Schwarzenegger Classic, while also appearing as host & moderator at the Olympia Press Conference. In 2005 Dan developed the Pro Bodybuilding Weekly radio show for which he was awarded the IFBB’s Lifetime Achievement Medal. Prior to creating Digital Muscle, Dan was the Senior Features Editor at Muscular Development Magazine. His favorite thing to talk about? Baseball.