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Guide for the Perplexed: Calories, Exercise and Successful Weight Management

In the previous piece I outlined what I have found to be useful for our patients as they embark on a weight loss plan and has allowed long term and sustained weight maintenance. The real good news is that everyone who wants to lose weight can do so with some help. Amazing tools are available now in terms of Applications, exercise programs and medically managed diet plans that have a strong track record in both safety and success. In this article I want to address the medical management of obesity. 

The critical element here is calorie restriction. The diet is the most difficult part of weight management. Weight management is essentially a calorie consumed vs. calorie expenditure balance. A strict diet helps tilt the balance towards weight loss. This is the most difficult but given medical tools available it is actually much easier than one may think. In general, any medically managed program should provide an additional 4-5 Lb. of weight loss per month. The pitfall here is not the first 10 Lb. but it is how to sustain the weight management over the next 12 months, and how to avoid a “yo-yo” diet. After the first successful period of weight loss the body reacts in a number of ways and metabolism actually slows down. The body produces a hormone called Ghrelin which increases appetite to negate any weight loss to restore the original (non-desired) weight. After a 20 Lb. loss Ghrelin increases by about 30% creating a ravenous appetite that will quickly force one to regain the weight back, negating any success. This can last up to a year. Patients and physicians struggle with this issue and patients lose momentum and become discouraged when any success is reversed despite their best effort.

The really good news is that the correct use of medications can really enhance the original weight loss, and counter the body’s attempts to reverse the weight loss. There are amazing medications available, all FDA approved with an excellent track record in our medically supervised weight management program. Weight loss medications need to be highly personalized and there are no “cookie-cutter” approaches or shortcuts. 

In the next installment of the series I will explore the types of medications available and how to navigate the terrain of weight loss medications. 


Kavian S. Milani M.D

Virginia Family Medicine

Fairfax, VA

For questions

Kavian S. Milani M.D Kavian Milani, MD, is a board-certified family medicine specialist at Virginia Family Medicine’s two offices in Vienna, Virginia, and their office in Fairfax, Virginia. He has won numerous awards for his outstanding excellence in care, including the Top Doctor award by Northern Virginia Magazine for five years and counting, the Top Doctor award by Washingtonian Magazine, and the Excellence in Teaching Award from George Washington University. Dr. Milani enjoys learning, teaching, and practicing medicine equally. His interest in medicine began while earning his Bachelor of Science in biology at George Mason University, from which he graduated in 1990. He earned his medical degree from the University of Virginia School of Medicine in Charlottesville, Virginia, in 1995 before completing family medicine residency training through the University of Virginia, too.

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