Question: How can I navigate through the claims presented by pills and powders that promise to burn fat, boost metabolism or melt pounds without the sweaty hard work of exercise or deprivation of diet?

Answer:

Weight-loss is not as simple as reading a book by a physician. First and foremost, consult a doctor before starting any weight-loss program. Have a blood test and electrocardiogram done to check for anything "silently" wrong, such as high blood pressure or underlying heart-related conditions.

Over-the-counter weight-loss products are problematic in two areas: Ineffectiveness and dangerous.

Here are some specifics:

-- With these supplements, only 5 to 10 percent of patients are successful in reaching their goal. Medical direction is particularly important if you have contributing factors, such as low back pain syndrome. Just because it’s not a prescription doesn’t mean its safe. Too many people equate "natural" with safe. A few years ago, herbal ephedra elevated the heart rate and blood pressure. It was banned.

-- Products with high doses of amino acids, such as protein drink supplements, are dangerous to the liver or kidneys. Take these products to a physician before using them.

-- Specific prescription drugs, such as Xenical by GlaxoSmithKline can be effective and safe if used appropriately. Studies have shown people who use appetite suppressants lose 1.5 to two times more weight than those on placebos. However, in my experience, physicians at times don’t use prescription drugs in a judicious manner, sometimes prescribing too high of a dose, causing side effects.

-- Find a physician who knows what he or she is doing. Obstetricians/gynecologists, family physicians, endocrinologists and internists can be the initial front for a specialist/referral. The bariatrician is a weight-loss specialist who focuses on health and diet vs. a surgical treatment for overweight patients. Visit the physician locater service at www.asbp.org site (American Society of Bariatric Physicians, the professional membership association of clinical physicians).

The Federal Trade Commission recently launched a "Red Flag" campaign which specifically targets certain weight-loss advertisements and the "reality" behind them. For more information on bogus weight loss claims, visit www.ftc.gov/redflag.

Question: I would rather follow my own plan for weight loss, not a physician’s. Besides, my doctor doesn’t seem concerned about my weight, nor my smoking.

Answer:

A few weeks ago, the Associated Press cited a study funded by a drug company, (ITAL) "Survey finds 1 in 3 Americans who try to lose weight take unproven pills." (UNITAL) The article published in (ITAL) The Oklahoman (UNITAL) and various other media outlets around town.

The survey offered a realistic glimpse at some unrealistic dieting practices and highlighted missed opportunities for doctors to help. It was an informative news report, even though survey-sponsor GlaxoSmithKline PLC has an obvious interest in steering people away from dietary supplements.

Obesity is a national health issue, second only to smoking in the number of preventable deaths. Why don’t people turn to a physician for help?’

The survey found most doctors are not helping dieters navigate the maze of claims. In many cases, doctors never got the chance. Of the 1,679 respondents who said they were overweight, only 30 percent said they would see a doctor to help them shed the excess pounds.

But there were missed opportunities, the article states. Forty percent of obese respondents and 72 percent of overweight ones said their doctors had never advised them to lose weight.

There are several reasons for this:

-- General practitioners are not as comfortable in addressing the issue with their patient because of the time and follow-up required and they don’t have a staff trained in weight loss and its variables. As with the physician, the patient wants a quick and simple solution. That isn’t the case with an obese patient. It can take weeks, months or years to lose the weight with a program. Physicians are trained to treat problems, not to teach prevention.

-- Medical schools are lax in training physicians about nutritional matters, such as herbal or nutritional treatments.

-- General physicians are not up-to-date on unregulated, over-the-counter supplements.

-- Physicians tend to be biased about the obese population, such as "this is not a medical issue worthy of my effort, but a character flaw."

Question: How do you know if you are obese?

Answer:

Calculating the Body Mass Index formula is not in a general physician’s clinic regimen. But if the BMI is greater than 30, then you are obese or are a highly trained athlete with high muscle mass. Be an advocate for yourself and make this BMI check a part of your annual appointment.

There is no safe way to lose more than a pound or two a week. For most people, this is the safest way to lose. But for those who are really obese – those who need to lose 50 to 100 pounds -- you can have more rapid loss and suffer less discouragement under medical supervision with guidance and structure.

(Michael Steelman, M.D., is the national Bariatrician of the Year, as selected by his peers in the 1,200-member American Society of Bariatric Physicians. He was recently named medical editor of the peer review journal and is serving his second stint as the organization’s chairman of the board, after serving as president twice as well. Steelman is an Edmond-area resident and certified not only in bariatric medicine but also as a family practitioner. To submit a question for Dr. Steelman’s column, please email him at info@thesteelmanclinic.com.)