Enrique G Saguil, MD

1. Enrique G Saguil, MD • University of the East • Northwestern University Hospital • Presbyterian Medical Center/U of P • West Suburban Hospital/Rush • Center for Athletic Medicine/St Joseph’s • UCLA • Integrative Sports and Wellness

2. Family Medicine • Danada Family Medicine-Wheaton • Total Family Health Care-Clermont FL • Rush Copley Emergency Department

3. Favorite Topics • Hypertension • High Cholesterol • Stress • Depression • Sleep disorders • Knee pain • Shoulder pain • Ulcers and Reflux

4. “Challenging Topics” • Tobacco use • Addictions • Pain control • Irritable bowel syndrome • Fibromyalgia • Weight control

5. “In the Philippines, people are dying from not being able to eat… …in America, people are dying from eating too much!”

6. Weight Control Cafe

7. Appetizer • How things happen • How medicines make it happen • How medical problems can make it happen • CDC statistics • What happens in the body • The Saguil Approach to weight control • Q & A Main Dish Dessert

8. Weight Problems in the US- The “HOW’s” Your Appetizer

9. How it starts diseases Multifactorial: • Medical diseases • Prescription meds • Emotional states • “Mom and dad” habits environment genetics

10. Genetic predisposition -Due to alterations in genes controling appetite and metabolism ……. “res ipsa loquitur” ..we fall under the “Thrifty gene hypothesis” But dad, we’re not Pima Indian descent Oh, I get it!

11. Medical diseases • Renal failure • Heart failure • Liver failure • Premenstrual syndrome • Hypothyroidism • Cushings syndrome • Poly Cystic Ovarian syndrome • Diabetes water fat

12. Prescription drugs • Antihypertensives (calcium channel, ace’s ) • Oral contraceptives (“the pill”, depo, iud) • HRT (estrogen) • Diabetes medicines • Antidepressants (tricyclics) • Antianxiety (SSRI) • Corticosteroids (Prednisone) • Bipolar meds (lithium)

13. Emotion states • Post partum • Depression/Anxiety • Nervous eating\Stress related • Childhood behavior • Injury/chronic pain

14. Other reasons: environment • Poor diet • Sedentary lifestyle • Socioeconomic status • Neurobiological issues (ghrelin and leptin)

15. Popular diets to treat • Vegan/vegitarian/lacto • Pritkin • Low fat • Atkins diet –low carb • Seattle Sutton (delivery) • Weight watchers (meetings) • Nutrisystem • Raw veganism

16. Popular “Drugs” to treat • Ephedra/ma huang/xenadrine • Hoodia p 57 • Leptopril • “Thermogenics” –ECA stack • Dexedrine • Rx- phentermine

17. Statistics and What Happens in the Body Your Main Course

18. BMI • Mass/length • Kg/m2

19. Weight Gain Obesity • BMI Classification by WHO • <18.5 underweight • 18.5–24.9 normal weight • 25.0–29.9 overweight • 30.0–34.9 class I obesity • 35.0–39.9 class II obesity • Over 40.0   class III obesity -A BMI of 35.0 or higher in the presence of at least one other significant comorbidity is also classified by some bodies as class III obesity. -For Asians, overweight is a BMI between 23 and 29.9 kg/m2 and obesity a BMI >30 kg/m2. -The surgical literature breaks down "class III" obesity into further categories. [12] -Any BMI > 40 is severe obesity -A BMI of 40.0–49.9 is morbid obesity -A BMI of >50 is super obese

20. CDC

21. No one is safe -age, sex, race, ethnicity, socioeconomic status, education level, or geographic region

22. What is ideal weight? 100 lbs + 7 lbs/inch above 5 feet

23. The consequences: • Coronary heart disease • Type 2 diabetes • Cancer (endometrial, breast, and colon) • Hypertension (high blood pressure) • Dyslipidemia (high total cholesterol or high levels of triglycerides) • Stroke • Liver and gallbladder disease • Sleep apnea and respiratory problems • Osteoarthritis (degeneration of cartilage and underlying bone within a joint) • Gynecological problems (abnormal menses, infertility)

24. Diet-cholesterol-heart disease Hello bypass surgeon-good bye life savings

25. No one is safe!

26. Sub-cutaneous Fat is “everywhere”

27. Snoring can lead to Apnea!

28. Hello sinusitis!

29. Nasal CPAP every night forever! …..(Hello heart disease)

30. Obesity and HTN

31. > Weight = More Stress to Joints Hello hip replacement!

32. Surgeon General’s call to action to prevent and decrease overweight and obesity 2001 “Overweight and obesity result from an energy imbalance. This involves eating too many calories and not getting enough physical activity.”

33. Social gatherings Stress! Food “outlets” work exercise Kids meals Medical issues

34. Your dessert! • Standard medical practice approach: • Note initial weight • Diagnose medical associated problems • Send to dietician (if covered) • Treat individual problems • Customize suggestions for intervention • Repeat, then bariatric team when ready

35. Irony • The medical problems we wait for, are easily treated individually…..usually with medicine

36. Medical diseases • Renal failure • Heart failure • Liver failure • Premenstrual syndrome • Hypothyroidism • Cushings syndrome • Poly Cystic Ovarian syndrome • Diabetes water fat

37. Prescription drugs • Antihypertensives (calcium channel, ace’s ) • Oral contraceptives (“the pill”, depo, iud) • HRT (estrogen) • Diabetes medicines • Antidepressants (tricyclics) • Antianxiety (SSRI) • Corticosteroids (Prednisone) • Bipolar meds (lithium)

38. Standard Treatment = Perpetuating Cycle “Life style change” “Life coach” “Bariatric Center” “Weight loss center”

39. The Saguil Approach • “Band Aid” Medicine (know an endpoint) • Exercise prescription • Dietary evaluation (ADA, nutritionist) • Supplements (Herbalist, MD, DO, DC,ND) • Spiritual Grounding • Surgery Consult

40. Good doctor • Family practice/internal medicine • Integrative medicine • Chiropractic group • Naturopath • Acupuncturist • Herbalist

41. Move to lose • Planet fitness/cardinal fitness/park district • Running group [ask doc first] • Local hospital groups • Yoga/tai chi • Church • Dvd/ vhs/ library/ netflix

42. PULSE • 20 minutes a day • Anything you want • See your doctor for exercise prescription 220-age=_____(take 60-80% as target)

43. Don’t try this at home

44. Diets • Vegan/vegitarian/lacto • Pritkin • Low fat • Atkins diet –low carb • Seatle sutton (delivery) • Weight watchers (meetings) • Nutrisystem • Raw food/ Juice • Whole food/whole grain/old food glycemic index

45. Glycemic index • A ranking of carbohydrates based on their effect on blood glucose levels within 2 to 3 hours after a meal

46. Timing is everything! • Small and frequent (don’t graze) • Nothing after dinner • Prepare for the weekend/function (no crashing ) • Fight the urge, wait 10 min, meditate • Enjoy what you eat (journal it!) • Ritual

47. Size matters • Portion control (kids size, lunch size, appetizer size, junior size) • Pre-meal salad, fiber or “filler” (water) • 5 fruits and veggies a day • 0-10 scale of fullness

48. Know your enemy • Prevention.com Health Tracker • Gourmetsleuth How to read nutrition lab http://www.gourmetsleuth.com/howtoreadnutritionlabels.htm

49. Read the labels • Fortified, enriched, added, extra, and plus. This means nutrients such as minerals and fiber have been removed and vitamins added in processing. Look for 100% whole-wheat bread, and high-fiber, low-sugar cereals. • Fruit drink. This means there's probably little or no real fruit and a lot of sugar. Instead look for products that say "100% Fruit Juice." • Made with wheat, rye, or multigrains. These products have very little whole grain. Look for the word "whole" before the grain to ensure that you're getting a 100% whole-grain product. • Natural. The manufacturer started with a natural source, but once it's processed the food may not resemble anything natural. Look for "100% All Natural" and "No Preservatives." • Organically grown, pesticide-free, or no artificial ingredients. Trust only labels that say "Certified Organically Grown." • Sugar-free or fat-free. Don't assume the product is low-calorie. The manufacturer compensated with unhealthy ingredients that don't taste very good and, here's the kicker, have no fewer calories than the real thing.

50. “The Box”