Victoriya Brener, M.D.
   
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Dr. Frenkel Obstetrician-Gynecologist  
What causes obesity?
Simply put, obesity in caused by chronic ingestion of more calories than you burn. However, type of food that people eat can significantly affect the way in which they burn calories. Insulin is a storage hormone that stimulates storage of protein, fat and sugar. Because sugar is toxic in high concentrations, the body changes sugar into glycogen and then into lipids. In addition, insulin allows sugar into muscle cells, where it is used for energy instead of lipids. Glucose stimulates insulin release. People who eat meals with high concentrations of simple carbohydrates change to the storage mode. In developed countries, most foods are highly processed. Most of the vitamins, fiber, and minerals are removed from white flour, leaving only simple starches that are quickly reduced to sugar by amylase. Table sugar has been processed into its purest form. Because people eat a large amount of those and other low nutritional sources of carbohydrates, their bodies tend to stay in the levels, endogenous steroids (from chronic stress), high density foods (high in fat), and constant availability of food, obesity results. As much as 70% of obesity may be due to this process. Many obese people also develop insulin resistance.
What is insulin resistance?
Insulin resistance develops when people chronically ingest low nutritional carbohydrates and decrease activity levels. If stores of chromium, vanadium, and possibly other nutrients are developed, the ability of striated muscles to respond to insulin is decreased. Chronic high glucose exposure can down regulate the muscle insulin receptors. Exposure to saturated fats can inflame the endothelium and cause endothelial dysfunction. People then require higher levels of insulin, which stimulate the production and storage of more lipids. This process is called insulin resistance. To add insult to injury, the increased amount of body fat makes people more resistant to insulin, and a vicious cycle results.
Why is it so hard to lose weight?
In reality it is not hard to lose weight. Many patients have lost 100 or more pounds before asking for help. Unfortunately, many people lose the same 10 pounds over and over. The real problem is not to regain the weight. The body has several homeostatic mechanisms to return it to its previous high weight. For example, leptin is released from fat cells when cell membranes are stretched (when fat cells are full). As people lose weight, the cell membranes are less tense and less leptin is released. When the serum leptin level decreases, appetite increases and metabolism slows. This process results in an overwhelming desire to eat carbohydrates and calorie-dense foods (high in fat). People lose about 10 pounds, their appetite increases, and they simply cannot pass a fast food restaurant without ordering a cheeseburger, cola, and French fires (supersized, of course). They then regain the lost 10 pounds plus a few more.
How can people lose weight naturally?
The most natural way to lose weight is by eating a healthy diet and increasing activity and basal metabolic rate. Because of homeostatic mechanisms that try to return the body to its previous high weight, a great deal of will power and dedication is required to keep the weight off. Almost any diet program that decreases intake of calories, wastes calories in stool or urine, or increases burning of calories will work for while. The real question is how to lose weight and keep it off in a healthy, effective, natural way. The most natural way to lose weight depends on healthy lifestyle changes, such as eating healthy foods, building muscle, and exercising regularly. Many people may require natural and/or allopathic therapies to lose weight and keep it off in a healthy manner.
What is the best diet to use?
Several healthy diets work very well. All have a few common denominators: high fiber intake, low intake of simple carbohydrates, high-quality protein, 20-30% of calories from healthy fats, and high nutrient content. These diets can be used during the weight loss phase and during maintenance phase by simply increasing the number of calories. Each patient has different dietary requirements. The ratios of carbohydrates and proteins may change from diet to diet, but the percent of fat should always be around 20-30% for lifelong healthy eating program. Whitaker has an excellent healthy eating plan. Other good diets include Weight Watchers, Garden of Eden diet, the 40-30-30 plan, the Mediterranean diet, and the newer version of the American Diabetes Association’s (ADA) high-fiber diet.
What type of exercise program should I use for weight loss?
Any exercise is better than none. Each patient should be evaluated and prescribed an increased activity program. For some patient, the program may consist simply of turning off the television and walking around the house. Others may start a vigorous weight-lifting program. Whatever the exercise or increased activity level, it should be consistent and progressive. Thirty minutes of moderately vigorous exercise before breakfast each morning help promote weight loss and good health. Exercising on an empty stomach turns body’s mechanisms to burn stored energy and stimulates the basal metabolic rate for the rest of the day. Increased levels of activities of daily living, such as taking the stairs, walking the dog, or parking further from the door, can burn additional calories and stimulates the metabolism.  
Whether you work out regularly or haven’t been active in a long time, we’ve got a balanced body conditioning program, customized to your ability level that will help you lose weight & become stronger and fit. Over the years we developed a number of our signature slimming & detoxifying treatments that will help you to achieve long-term results.
  Dr. Brener is a physiatrist. She has been affiliated with Beth Israel Medical Center.
She earned her M.D. from Vinnitsa Medical Institute of N.I. Pirogova and completed her residency in physical medicine & rehabilitation at Downstate & Kings County Hospital Center.
Dr. Frenkel is an obstetrician-gynecologist at Bay OB/GYN, P.C. in Brooklyn. He has been affiliated with New York Methodist Hospital and Lenox Hill Hospital.  
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