Aishwarya Rai Weight Loss Diet!

Aishwarya Rai Weight Loss Diet!

Aishwarya Rai Weight Loss Diet and Workout Routine

Aishwarya Rai Weight Loss Diet

Aishwarya has already stunned everyone with her sensuous, bold, seductress avatar in Karan Johar’s directorial venture ‘Ae Dil Hai Mushkil.’ And now at Cannes Film Festival 2017, she has proved once again that she is the queen of Bollywood. From flying kisses to elegant poses, she looked every inch a royal princess. She got a very good response after this amazing body transformation. All thanks to Aishwarya Rai weight loss!

There was a time when Aishwarya Rai’s tremendous post pregnancy weight grabbed many eyeballs. She was criticized for her weight gain post baby but she chose to ignore the haters and prioritized her family and child over her looks.

Aishwarya Rai’s message on Motherhood

The Bachchan bahu spoke vastly about motherhood. She said, “I didn’t over think the fact that I had put on weight. I didn’t do anything as expected of someone who came with all the adages as me. There’s a lot of glamour and a lot of visual that is attached to me. But I stayed committed to my reality. If my body did go through this change, so be it. I didn’t play into the stereotype of what is possible. It’s an individual choice if people decide to go under the knife. I had access to that but I chose not to. I was genuinely comfortable in my skin and I got recognition along the way. Women who met me publicly, thanked me for the fact that I was giving them strength to be comfortable with the natural change. Hormonally anything can happen to a woman, your body can go through change and it’s important to remain comfortable and not let it affect you psychologically. My comfort and my conviction to just say true, in turn, gave strength to so many women. Suddenly, it’s okay to put on weight. It’s okay that your body changes physically from health reasons or otherwise and it’s okay to choose to dress the way you want to. I am happy with my weight and I love my daughter.”

Aishwarya Rai With Her Daughter Aaradhya

Now, Aishwarya Rai is back with a bang. After widespread criticism over her baby fat, she has transformed herself. The celebrity mother has lost all the weight she gained during and after pregnancy and is looking fitter than ever. Take a look at her fairytale appearance at Cannes, 2017.

Aishwarya Rai at Cannes 2017

Aishwarya Rai Weight Loss

Aishwarya Rai Cannes 2017

 

Aishwarya Rai Bachchan Cannes 2017

 

Aishwarya Rai Bachchan Diet

 

Spellbound! Isn’t she mesmerizing?
But how did she manage to flaunt a slim, graceful figure with no remains of the pregnancy baggage? Let’s check out –

Aishwarya Rai’s weight loss DIET

BREAKFAST

Aishwarya Rai’s weight loss secret is that she never skips her breakfast. She starts her day with warm water, with lemon and honey in it. It is a great way to revive your metabolism.

In breakfast, she takes brown bread toast or a steaming bowl of freshly cooked oats. Oatmeal is considered a healthy whole grain and contains high levels of protein and fiber.

LUNCH

Her lunch normally consists of boiled vegetables which are easy to digest, full of nutrients, contains little or no fat and flavorful. Sometimes she also takes a bowl of dal as well as one chapati. Aishwarya says -“I can survive on dal, chawal and vegetables”.

DINNER

She prefers to eat very light for the dinner and eats a cup of brown rice and grilled fish. Brown rice has high fiber content and is more healthier than white rice. Thus helps in burning more fat and decreases the chances of overeating by satisfying the appetite. Grilled fish provides the required protein and omega 3 fatty acids.

Apart from this, Aishwarya keeps her portion in control and prefers smaller meals throughout the day. She strictly avoids any fatty, junk or fried foods. Instead prefers fruits, vegetables, and fresh juices. She keeps herself hydrated by having 8 glasses of water per day. She tries to maintain a fat-free diet which not only accentuates her figure but also brings a glow to her skin.

ALSO READ: Amazing Diet Secrets Of Shilpa Shetty.

Aishwarya Rai weight loss WORKOUT ROUTINE

Aishwarya is not a regular gym going person and doesn’t follow any workout routine. In one of her interviews, she admitted that she was never serious about the workout and never worked hard to achieve a toned and lean figure. Actually, she never wanted a lean figure and feels happy in her curvaceous body. It seems her figure is all because of her good genes.

But if at any time she feels this need for the perfect body she attends gym twice a week. Aishwarya prefers yoga over workouts. She believes in the method of eating right and practicing yoga. According to her, yoga is the best way to keep the body powerful and so as flexible.

Aishwarya Rai's Weight Loss

  • Aishwarya Rai’s weight loss workout routine starts with brisk walking or jogging in the morning.
  • After this, she devotes 45 minutes to yoga which includes power yoga.
  • Sometimes she also does functional training along with full cardio workouts at home.

 

 

Kim Kardashian And Beauty Line

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Kim Kardashian West at the Forbes Women’s Summit in New York earlier this month. On Wednesday, she will introduce her new cosmetics line, KKW Beauty. CreditAngela Weiss/Agence France-Presse — Getty Images

When it comes to beauty influencers, Kim Kardashian West can be credited as a pioneer. With her longtime makeup artist Mario Dedivanovic, she lauded the benefits of contouring (that old-school stage-makeup method of using darker base shades or bronzer to chisel and define features) early on. But unlike her half sister Kylie Jenner, whose Kylie Cosmetics line had its debut two years ago and has enjoyed booming success, Ms. Kardashian held herself apart from the legions of social media tastemakers turned solo makeup entrepreneurs — until now.

On Wednesday, Ms. Kardashian will introduce KKW Beauty with one product: perhaps unsurprisingly, the Crème Contour and Highlight Kit, with a contour stick, a highlighter stick and a brush/sponge, all with dual ends. It will be sold exclusively at KKWBeauty.com in four shades for $48 each.

Though Ms. Kardashian is no stranger to beauty brand extensions — she has her own fragrance line, and she and her sisters licensed their name for Kardashian Beauty and Kardashian Tan — this is the first time she has had full control over all the particulars, including product, packaging and image. Further, she intends the business to become a full-blown line, with several products already in the pipeline.

The rollout has not come off without a hitch, however. Last week, Ms. Kardashian posted a promotional image of herself on Twitter, in a cream-colored bra top and high ponytail, looking very contoured and very, very tan, prompting allegations that she had darkened her skin. Or, to put it more bluntly, that she was essentially wearing blackface.

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Ms. Kardashian will introduce her line with one product, the Crème Contour and Highlight Kit. CreditBen Hasset

But certainly no one is betting against Ms. Kardashian, who has proved adept at capitalizing on controversy in the past. Here, she responds to the blackface Twitter storm and explains how her own beauty evolution is reflected in KKW Beauty.

You’re not the first social media star to start her own line. Why were you slower to the game?

I had a line with my sisters, and we were in a licensing deal and a partnership, and it took time to get out of that. Right after, I said, “Hey guys, I want to do something on my own.” Kylie had just started her lip kits, my mom and Kylie had found a really great business model and found great partners. I learned so much from them.

Does that mean you’re going to work with the same manufacturer as Kylie?

Yes, I’m working with the same manufacturer. I’ve had a relationship with them for a while actually. But the lines, they’re totally separate. We don’t really talk to each other about what we’re doing and what our formulas are.

Mario, your makeup artist, recently signed on with Laura Mercier. With the introduction of your line, will you continue to work together?

Mario and I, we’re like family. We started in this together. We are so close that no matter what, we will always get advice from each other. I literally FaceTimed him at 2 a.m. the other day with a million swatches on my face. I was like, “I can’t decide which swatch and what shade this product should be,” and he told me which was best.

You two have been moving toward a more natural look, with less contour.

Yes, but I’ve always stayed true to contour. I’d say that for the past six months, I haven’t been wearing much makeup, but I try to have a little bit of a bronzy look that’s really beautiful and really creamy-looking. That’s why the sticks are cream. There’s no setting powder. But you can make it a heavier contour by adding a setting powder on top of the cream contour.

Why did you move to a more low-maintenance look?

Having kids really changes it up.

A lot of the social media-driven brands are targeting a younger shopper — more a 20-something millennial — but perhaps the quality of the product isn’t there. Being a mom, and being in your 30s, what’s your focus going to be?

When we get to my concealers, I’ll have anti-aging formulas. That’s really important to me — and, of course, the quality. In the beginning, this line will really be about all the correcting and perfecting tricks I’ve learned. There’s the cream contour. There will also be powder contour and undereye concealer. I’ve always had dark undereye circles from being Armenian. These are the things I feel like I’ve really perfected.

Definitely that’s part of your image. Speaking of image, tell me about your side to the blackface controversy.

I would obviously never want to offend anyone. I used an amazing photographer and a team of people. I was really tan when we shot the images, and it might be that the contrast was off. But I showed the image to many people, to many in the business. No one brought that to our attention. No one mentioned it.

Of course, I have the utmost respect for why people might feel the way they did. But we made the necessary changes to that photo and the rest of the photos. We saw the problem, and we adapted and changed right away. Definitely I have learned from it.

Jennifer Lopez Looking Good At 46

Jennifer Lopez Looking Good At 46

Jennifer Lopez’s 90-Calorie Breakfast & Veggie Diet That Keeps Her Slim At 46

 by Dory Larrabee
Jennifer Lopez Diet

Getty

J-Lo is revealing her exact diet secrets that keep her thin, as well as her workout routine (she has two trainers!), what she avoids (caffeine and alcohol) and how much sleep she gets below!

Jennifer Lopez, 46, looks absolutely flawless. Regardless of her age, the American Idol judge is leading a lean and healthy life thanks to a few important factors. Copy her exact lifestyle, diet and workout tips below.

Workout With J-Lo’s Trainer

Buy J-Lo's Trainer's DVD

Buy J-Lo’s Trainer’s DVD

Jennifer spilled her exact diet to Us Weekly‘s January 18 issue. Her breakfast is a 90-calorie chocolate Body Lab Shake. “I do it with quinoa milk or water.” She also drinks coffee — but it’s decaf. “I haven’t had caffeine in years.”

“By lunchtime, I’m starving,” J-Lo says. She mixes it up but a typical day is salmon and a veggie-packed salad. She loves broccoli, peppers and zucchini with a drizzle of vinaigrette on top. She usually has a protein with quinoa for dinner. “If feels like rice and beans, which I grew up with. And I like pork and chicken — especially Puerto Rican style!” Jennifer tries to have dinner with her family as often as possible. “I try to eat with the kids around 6:30.”

Jennifer Lopez’s Diet & Workout Routine

Of course, diet is not the only thing keeping J-Lo looking young. “I’m rarely in the sun, but if I am, I wear a lot of sunscreen. I’ve never been one to take a lot of sun, which is why my skin has maintained itself. And I don’t drink or smoke or have caffeine. That really wrecks your skin as you get older.”

Beauty sleep is important for Jennifer. “I love a good nine or 10 hours, but I can never get that. So seven or eight is mandatory. [If I don’t get it] I just don’t feel right. I start feeling crazy, I get emotional and I feel tired all the time.”

As far as exercise, she says she prefers to get it over with in the morning. “I don’t like doing it later; it’s harder to get there when I have my day going already. I work out three or four times a week. When I’m in New York, I work out with David Kirsch — he’s an amazing trainer. When I’m in L.A., I work with Tracy Anderson. I like the balance that they both give me. They have two totally different approaches. I like switching it up with my body.”

David says they do “planks, pushups, boxing. A bit of everything.” Get more top tips from David on how to get a body like J-Lo here.

Tracy says: “We just freestyle.” They do 3-pound arm weights with “butt and thigh moves that incorporate the core. We want to keep those famous curves.”

Madonna’s Trainer Keep’s Her In Shape2!

Madonna’s Trainer Keep’s Her In Shape2!

 

Madonna’s Workout Routine Is Not Nearly As Insane As You’d Think

The rock goddess’ trainer opened up about how how he keeps her in shape. Here’s how to work out like Madonna—yes, you can actually do this.
madonna-work-out-feat
2014 WireImage

Madonna’s personal trainer is opening up about how she looks that fit at age 57. And, according to Craig Smith, who has worked with the Material Girl for two years, she doesn’t work out as much as you’d think.

Madonna currently works out for at least 30 minutes, six days a week, Smith tells Daily Mail Australia. “I vary the workouts every single day,” he says. “She does a combination of circuit training, interval training, and resistance training. Dance is obviously a huge part of that.” Those workouts include barre training, yoga, martial arts, and boxing, and Smith says they cover everything from core strength to flexibility.

Madonna also uses light weights of 2.5 to 5 pounds for her barre training, with 20 to 30 reps each.

According to Smith, a “typical” daily workout for his client includes a dance-based warm-up to get her heart rate up. Then, she shifts to upper body work, like 20 reps of push-ups, planking for up to 80 seconds, and core work. She’ll finish by focusing on her thighs and legs with some isolated core training, stretching, and meditation.

Madonna’s workouts seem surprisingly doable, and they are, says Jim Pivarnik, Ph.D., a professor of kinesiology at Michigan State University. Pivarnik tells SELF that Madonna’s tactic of mixing it up is “outstanding,” adding “the more you can mix it up, the more you can prevent overuse injuries.” However, Pivarnik points out that Madonna is still using most of her muscles on any given workout, she’s just emphasizing different muscle groups on one day over another.

Mixing is up is also great for keeping yourself from getting bored of your workout. But you want to still target some of the same muscle groups, he says, because that’s how you work them enough to really make an impact. “Your body doesn’t know the difference, whether you’re punching a bag or using a weight machine.” Doug Sklar, a certified personal trainer and founder of New York City-based fitness training studio PhilanthroFIT, tells SELF, “Some variety is important, but repetition is essential to allow your body to adapt to the training and then make progress.”

In order to strike a balance—mentally and physically—Pivarnik recommends aiming for five days of cardio with two days of resistance training (on cardio days or “off” days).

Want to mix it up, but can’t reach Madonna-like levels of variety? Sklar suggests doing a different workout at least once a week to strike a good balance between condition-building repetition and mental fatigue. And, if you need more variety than that, he suggests doing small daily variations, like running a different route, doing your workout in a different order, or trying out a new dance class.

As for the light weights Madonna uses (which are typical in barre workouts), Pivarnik says they’re good for creating lean muscles without bulking you up. However, feel free to grab a heavier set, too. Lifting heavy (and moving between sets quickly) can count as cardio, too. A good rule of thumb, per Sklar: If you can’t perform eight reps, the weight is too heavy. If you can perform more than 12 reps, the weight is too light.

While Madonna can get her workout done in just 30 minutes, Pivarnik points out that she also gets an additional cardio workout from her onstage performances. “You’ve got to consider the whole day,” he says. Plus, Madge’s trainer himself admits that “80 percent” of her fitness is attributable to her regimented diet. (And that’s not even mentioning what must be rockstar genes.) So, it’s good to keep in mind that while adopting Madonna’s workout routine might make you more toned, it probably won’t make you actually look like Madonna.

Beyonce and Lemonade Diet

Beyonce and Lemonade Diet

The Lemonade Diet or Master Cleanse is a liquid mono-diet, created by Stanley Burroughs in the 1940s and more recently made popular by Peter Glickman through his book “Lose Weight, Have More Energy and Be Happier in 10 Days”.The Master Cleanse is said by Stanley Burroughs and later authors to eliminate toxins and congestion that have accumulated in the body. It should be noted that the Master Cleanse is a fast, not a diet, as it is not a complete source of macro-nutrients. Thus it should be considered as another form of fasting (click here for more info on fasting).

Supporters of the Master Cleanse/ Lemonade Diet credit it with helping them increase their energy levels, alleviate some chronic diseases and with weight loss.

LEMONADE DIET GUIDELINES

Essentially the Master Cleanse consists of consumption of:

  • Fresh lime or lemon juice with maple syrup and cayenne pepper mixed with water and drunk up to 12 times a day.
  • Herbal laxative tea is taken twice a day, morning and night.
  • Internal salt-water baths.
  • No other food is consumed.
  • This regimen can be followed for 10 days, or possibly longer and depends upon a person’s physical condition.

Do not stop any medication you have been prescribed without consulting your doctor first! Any fasting should only be done so with the consent of a healthcare professional.

The Master Cleanse also known as the Maple Syrup Diet, Lemonade Diet, Lemon Detox hit the headlines after it was reported that R&B star Beyoncé Knowles had lost 20 lbs. (9 kg) in 10 days by following the Lemonade Diet under a nutritionist’s supervision. Beyoncé followed what essentially was a version of the Master Cleanse, using the Swiss-made Madal Bal Natural Tree Syrup, which consists of four different South East Asian palm syrups and Canadian grade maple syrup.

How to do the lemonade diet

 

Naomi Campbell does the Master Cleanse three times a year to keep her figure looking stunning. It has also been reported that Howard Stern’s primary co-host on his morning radio show, Robin Quivers, lost 73 lbs (33 kg) on the Master Cleanse. Actor Jared Leto is also reported to have lost the 62 lbs. he gained to play a movie role, using the Master Cleanse.The Lemonade Diet’s main promoter, the late Stanley Burroughs, published a slim volume in 1975 called “The Master Cleanser with Special Needs or Problems”. The book is still available today and the techniques are often adapted. Contrary to popular belief, the Master Cleanse was not designed for weight loss, but originally created to cleanse the body and flush out toxins. Nevertheless, in his book Stanley Burroughs also endorses his diet as “a reducing diet”.

Below you will find an overview and instructions about the Lemonade Diet. Excerpts from the Stanley Burroughs book “The Master Cleanser with Special Needs or Problems”, are highlighted in italics.

Purpose of the Lemonade Diet

  • To dissolve and eliminate toxins and congestion that have formed in any part of the body.
  • To cleanse the kidneys and the digestive system.
  • To purify the glands and cells throughout the entire body.
  • To eliminate all unusable waste and hardened material in the joints and muscles.
  • To relieve pressure and irritation in the nerves, arteries, and blood vessels.
  • To build a healthy blood stream.
  • To keep youth and elasticity regardless of our years.

When to Use the Lemonade Diet

  • When sickness has developed – for all acute and chronic conditions.
  • When the digestive system needs a rest and a cleansing.
  • When overweight has become a problem.
  • When better assimilation and building of body tissue is needed.

How Often Should You Do the Lemonade Diet?

Follow the Master Cleanse diet for a minimum of 10 days or more – up to 40 days and beyond may be safely followed for extremely serious cases. The diet has all the nutrition needed during this time. Three to four times a year will do wonders for keeping the body in a normal healthy conditions. The diet may be undertaken more frequently for serious conditions.

HOW TO MAKE THE LEMONADE

  • 2 Tbsp of lemon or lime juice (approx. ½ lemon)
  • 2 Tbsp genuine maple syrup (not maple flavored sugar syrup)
  • 1/10 Tsp cayenne pepper (red pepper) or to taste
  • Water, medium hot (spring or purified water)

Combine the juice, maple syrup, and cayenne pepper in a 10 oz. glass and fill with medium hot water. (Cold water may be used if preferred). Use fresh lemons or limes only, never canned lemon or lime juice nor frozen lemonade or frozen juice. Use organic lemons when possible. The maple syrup is a balanced form of positive and negative sugars and must be used, not some “substitute”.

Stanley Burroughs goes on to suggest the use of darker grades of maple syrup, which he writes have a greater mineral content. He states, “Maple syrup has a large variety of minerals and vitamins. Naturally the mineral and vitamin content will vary according to the area where the trees grow and the mineral content of the soil. There are the minerals found primarily in the average samples of pure maple syrup: Sodium, Potassium, Calcium, Magnesium, Iron, Copper, Phosphorus, Sulfur, and Silicon. Vitamin A, B1, B2, B6, C and Pantothenic Acid (B5) are also present in the syrup.”

HOW MUCH LEMONADE TO DRINK?

The book suggests that between six and twelve glasses of the lemonade should be drunk daily and that as you get hungry to simply drink another glass of lemonade. For those who are overweight, less maple syrup may be taken. For the underweight, more maple syrup may be taken. However, it is advisable not to vary the amount of lemon juice per glass.

LAXATIVE HERBAL TEA

The Master Cleanser states that you should expect two, tree or more bowel movements per day. Otherwise, the waste tends to stay in the body leading to tiredness and other problems. If this is not the case, a laxative herbal tea last thing at night and first thing in the morning should be taken.

INTERNAL SALT WATER BATHING

Part of the Master Cleanse or Lemonade Diet is the “salt water bath”. Enemas and colonic irrigation are advised against and instead internal salt water baths are recommended.

Directions: Prepare a full quart of luke-warm water and add two level (rounded for the Canadian quart) teaspoons of uniodized sea salt. DO not use ordinary iodinized salt, as it will not work properly. Drink the entire quart of salt and water first thing in the morning. This must be taken on an empty stomach. The salt and water will not separate but will stay intact and quickly and thoroughly wash the entire tract in about one hour. Several eliminations will likely occur. The salt water has the same specific gravity as the blood, hence the kidneys cannot pock up the water and the blood cannot pick up the salt. This may be taken as often as needed for proper washing of the entire digestive system.

If this does not bring about the desired effect the first time used, The Master Cleanser suggests adding a little more or less salt until you find the right balance or taking in extra water with or without salt.

 

Prepare yourself mentally and physically before embarking on the detox. Speak to your health care practitioner. Make sure you have all the required ingredients for the Master Cleanse. Ensure you have emotional support of friends or family to get you through the difficult times.

  • The night before: you start the lemonade detox take herbal laxative tea.
  • First morning of the detox: take the salt water bath or if not possible the herbal laxative tea, do not take both.
  • Lemonade formula.
  • Breaking the Lemonade Diet: do not overeat, eat too soon or to frequently.

Next, lemonade diet variations and how to finish the plan (important to minimize side-effects or weight re-gain!).

Mental Health Awareness Month- ( Medical Doctors Help To Lose Weight)

Mental Health Month- (Mental Health Awareness Month- (Medical Professionals Help To Lose Weight)

How to Help Your Patients Lose Weight

How to Help Your Patients Lose WeightMany pages of The Carlat Report have been devoted to how we cause our patients to become obese with some of the medications we prescribe. In this article, we review ways in which we can atone for our sins.

To begin with, you need to learn what Body Mass Index (BMI) is, because this is the preferred outcome variable in all the obesity research these days. The BMI takes height into account in determining how overweight (or underweight) somebody is. The formula is: weight (in kg) divided by height (in meters) squared. You can use inches and pounds with the NIH table at http://www.nhlbi.nih.gov/guidelines/ obesity/bmi_tbl.htm (go ahead – look yourself up).

Normal weight is classified as a BMI of 18.5-24.9, overweight is 25-29.9, and a BMI of 30 or How to Help Your Patients Lose Weightabove is considered obese The definitive study of the relationship between BMI and mortality (NEJM 1999; 341: 1097-1105) followed more than 1 million men and woman over 14 years, and reported the BMIs of those who died during that period. The lowest death rates were found among women with BMIs from 22.0 to 23.4 and among men with BMIs from 23.5 to 24.9. Of course, as one’s BMI increases, one’s death rate goes up. For example, men with BMIs of 35 or higher had triple the rate of cardiovascular death as the ideal group. People with very low BMIs also incurred a higher death rate, but these increases were quite small.

If you weren’t already motivated to prevent weight gain in your patients, hopefully this data motivates you further. Unfortunately, many psychiatric medications cause weight gain. The table below is helpful as a quick reference of weight gain liabilities of some of the more common agents we prescribe.

How to Help Your Patients Lose Weight
Helping Patients Lose Weight

Assuming that you have calculated your patient’s BMI and that you both agree that his or her weight is a problem, how do you go about facilitating weight loss? Most experts recommend setting a pretty modest weight loss goal initially, on the order of 10% of initial body weight over six months. Setting the bar low helps prevent failure and disappointment.

Most patients have a hard time sticking to a diet on their own, and a recent study comparing self-help dieting with participation in Weight Watchers bears this point out. In this study, about 150 overweight or obese men and women were randomized to Weight Watchers vs. “self help” (two 20 minute nutritionist visits and some pamphlets). After one year, the Weight Watchers group lost 9.5 lbs. vs. 2.9 lbs. for the self-help group. At two years, there was some weight regain, but the Weight Watchers group was still lighter, with a loss of 6.4 lbs, than self-help with 0.4 lb (JAMA 2003; 289:1792- 1798). Not that Weight Watchers is special–all commercial diet programs seem to work about equally well, meaning very modestly. A more recent JAMA article randomized dieters to four popular programs: Atkins, Zone, Weight Watchers, and Ornish. After one year, each program produced modest weight loss, ranging from 4.8 pounds for the Atkins diet to 7.3 pounds for the Ornish diet. Differences among them were not statistically significant (JAMA 2005; 293:43-53).

Exercise is important too, although the oft-cited recommendation of 45 continuous minutes of exercise three times a week can be a tall order for people who are obese and, according to another study, may be no more effective than shorter bursts of exercise spread out throughout the day. In this study, 148 overweight women were randomized to three different types of exercise: 40 minutes/day of walking; 40 minutes/day but divided up into 10 minute sessions; and 40 minutes in short sessions on a home treadmill. The women in the three groups lost weight equally well, and those in the short session/home treadmill group were more likely to actually exercise during the last half-year of the study (JAMA 1999 282: 1554-1560). The moral of this story? Advise your patients to exercise in short sessions throughout the day and tell them to get a treadmill if they can afford one.

Medications for Obesity

Believe me, there are a lot more prescription medications for weight loss than you realize. For example, have you ever heard of diethylpropion, mazindol, phendimetrazine, or phentermine? They’re all FDA-approved for obesity, and each is a basic appetite suppressant, related to amphetamine. There are also a number of non-stimulant medications, which we’ll focus on because they are generally considered safer, although not necessarily more effective, than stimulants.

Xenical (orlistat)

It sounds like a dream-come-true: A pill that simply prevents the absorption of too much fat. Who would need to diet anymore? Despite its promise, orlistat has not become as popular as you might predict. Most patients have bouts of diarrhea and fatty stools over the first four weeks, and beyond that, it’s not miraculously effective, leading to only about 6 more pounds of weight loss than placebo over one year (International Journal of Obesity 2003; 27:1437-1446). It’s dosed at 120 mg TID with meals, and patients should take vitamin supplements to ensure they get their daily A, D, E, and K. Rumors are that is will be sold over-the-counter soon.

Despite its problems, Xenical may be helpful for psychiatric patients, especially those with metabolic complications of atypical antipsychotics. In one study, patients with metabolic syndrome and type 2 diabetes (without mental illness) were randomized to receive either orlistat 360 mg QD plus dieting or dieting alone. After 6 months, those in the orlistat group lost more weight, had improved measures of glucose control and systolic blood pressure, had lower cholesterol levels, and were less likely to meet criteria for metabolic syndrome (Curr Med Res Opin 2004; 20(9):1393- 1401).

Meridia (sibutramine)

Meridia works by inhibiting the reuptake of both norepinephrnie and serotonin, thereby suppressing appetite. Large placebo-controlled studies have shown it to be quite likely the most effective of the weight loss meds, leading to an average weight loss of close to 10 lbs. more than placebo over a year (International Journal of Obesity 2003 27: 1437-1446).

In psychiatry, Meridia (sibutramine) seems quite effective for the treatment of binge eating disorder. According to a recent study, it reduced binge eating and depression, and also led to 16 lbs. of weight loss (vs. small weight gain in the placebo group). (Arch Gen Psychiatry 2003; 60:1109-1116). Patients in this study received Meridia 15 mg QD; only dry mouth and constipation were more common in the Meridia group than placebo. It did not increase blood pressure but did increase heart rate from 80 to 87.

While serotonin syndrome is a theoretical concern, the European Agency for the evaluation of medicinal products concluded in a 2002 safety review that there was little evidence implicating Meridia as a culprit in a few reported cases (http://www.emea.eu.int/ pdfs/human/referral/451402en.pdf).How to Help Your Patients Lose Weight

Prozac and Wellbutrin

It’s nice to be able to offer a “twofer” to patients who want to lose both depression and weight. Both Prozac and Wellbutrin qualify for this unusual status. While Wellbutrin appears to have gotten most of the press about being a weight loss agent lately, it turns out that our old stalwart Prozac has been studied even more intensively for this indication.

According to a recent meta-analysis by Agency for Heath Care Research and Quality (http://www.ahrq.gov/ downloads/pub/evidence/pdf/obespharm/ obespharm.pdf), six decent long term (at least 12 months) placebo-controlled studies of Prozac have been published, and the average extra weight loss achieved over placebo was about 7 lbs. Most of these studies used the relatively high dose of 60 mg QD.

While Wellbutrin can boast only three placebo-controlled studies, these were all larger studies than any of Prozac’s, with study populations ranging from 217 to 423. The average excess weight loss over 6-12 months was about 6 lbs, and the maximum recommended dose was used– 400 mg QD.

Some of these studies excluded patients with major depression, and others didn’t. The weight loss effect seems to occur either way, which may come as a surprise to those of us who suspect that the “weight gain” of patients on SSRIs is an indirect result of improved mood. Apparently, with Prozac and Wellbutrin, you can improve mood and lose weight at once.

What’s Dexatrim?

Many of my patients over the years have either been taking over-the-counter Dexatrim or have asked me whether they should take it. Dexatrim is a weight loss product that used to contain a stimulant called phenylpropanolamine, or PPA. However, in November of 2000, the FDA publicized results of a study showing a higher risk of hemorrhagic stroke in women taking products with PPA, and it asked manufacturers to voluntarily stop using PPA in any product. While this fell short of an actual recall, the weight loss industry for the most part complied, and you’d be hard-pressed to find any PPA in drug stores today. You can still buy “Dexatrim,” but it is a reformulated “natural” product, with no PPA. For more information on this topic, see the FDA’s PPA information page at http://www.fda.gov/cder/ drug/infopage/ppa/default.htm.

TCR VERDICT: Programs and pills: Both work, but weight loss is modest.

 

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