House Calls / Dr. Michael Schwartz

Obesity is an epidemic. More than 60 million Americans are considered overweight or obese. Weight-associated illnesses costs the American health-care system approximately $30 billion a year. Hundreds of thousands of people die each year from obesity-related disorders.

Weight issues are frequently discussed during patient visits. Patients who are overweight may suffer from fatigue, joint pains, shortness of breath or depression. Severe obesity has been linked to diabetes, heart disease and stroke.

Many think that gaining or losing weight is simple -- if calories in are greater than calories out, a person will gain weight. If calories out are more than calories in, you will lose weight. However, there are many other factors that contribute to weight gain or loss and they vary from person to person.

Not all calories are created equal

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Fact box

Studies have shown that certain food classes require more calories to be digested by the body. For example, eating 100 calories of carbohydrates (cookies, candy, bread, etc.) or fats (creams, butter, etc.) requires only five calories to digest, yielding an excess of 95 calories. Proteins (meat, fish, chicken, vegetables, etc.) require 20-30 calories to burn 100 calories, resulting in an excess of 70 calories. Changing the foods you eat can affect your weight.


Why one person can eat 2,000 calories a day and lose weight while another can eat 1,500 and gain weight is a function of genetics. Studies have identified specific genes which play a role in hunger and metabolism. These same studies have suggested that genetics can be modified by exercise. New medications are being developed to offset the influence of these genes as well.


Any exercise helps increase metabolism, burn calories and promote cardiovascular health. Thirty minutes of moderate exercise will burn about 250 calories; slow walking will burn 125 calories.


Eating sugars stimulates the body to produce insulin. Insulin is a growth hormone which helps store the sugar for need at a later time. Insulin stores sugar as fat and promotes weight gain. Alternatively, by decreasing sugar intake, the body will run low on sugar and will need to produce it. Glucagon (another hormone produced by the body) increases sugar production by breaking down protein and fat cells (ketosis) resulting in weight loss.


Currently, there are only a few approved medications for weight loss and most have had disappointing results. Basically, these medicines either increase metabolism or interfere with absorption of food. Side effects include high blood pressure, heart palpitations, stomach pain and diarrhea.

Herbal Medications

Most of these medications claim they work by increasing metabolism. For the most part, these claims are unsubstantiated.


Surgery for weight loss involves altering absorption and curbing appetite. Gastric bypass, banding or a gastric sleeve are the most common procedures. This type of surgery is generally reserved for the most severe cases of obesity in patients with life-threatening health issues.

Tips and Tricks:

Taking the stairs instead of the elevator when you have the chance can burn an extra 100 calories per week;

Eat smaller more frequent meals in order to better control your appetite;

Bring 5 pound dumbbells to work and use them during breaks;

Drink a glass of cold water when you get hungry. Cold water will help alleviate hunger and will force your body to use calories to warm the water up to body temperature;

Have plenty of healthy, low calorie snacks readily available when you need a quick bite;

Write down everything you eat for a week. Upon review, you might be surprised that you underestimated your calorie intake by 30 percent or more.

There are 3,500 calories in a pound. As such, eliminating only 250 calories a day from your diet will result in a ½ pound weight loss per week, or 26 pounds in a year! Those calories can come from reducing food intake, shifting foods you eat to include more protein or by increasing exercise. Although, everyone would like to lose all that extra weight right away, most patients would happily settle for these results. Consider weight loss a marathon and not a sprint. In the end you will be happy with the results.

Dr. Michael Schwartz is Board Certified in internal medicine with a private practice in Darien. Contact Dr. Schwartz at