How My Patients Lose Weight

I’ve been helping my clinic patients lose weight about 5 years now. I usually see them once a month for about 6 months, then space it out after that. If they stick to the plan, most folks lose 10-15lbs per month for 3 months, then 5-10lbs per month for another 3 months.

Here’s how they usually do it:

  1. Intermittent Fasting
  • Intermittent fasting just means going for longer periods without eating food.
    • Most people already “fast” between bedtime until breakfast – about 8-9 hours every night.
    • When fasting, the body burns FAT instead of FOOD.
  • For most people with a 9-5 work schedule & wants to have dinner w/ family: 
    • Fasting Option 1: 4 hour eating window – usually 5-9PM
    • Fasting Option 2: One-meal a day (aka OMAD) – usually dinner. 
    • There are more advanced fasts (24 hours, 36 hours, 5-7 days even), but I don’t typically recommend those to start.
  • During your fasting period…  
    • Black coffee or unsweetened tea is ok. Green tea is a great option throughout the day.
    • Seltzer water is ~probably~ ok. 
    • Make sure to sip water / tea throughout the day to stay hydrated. 
    • DO NOT SNACK – it will break your fast. 
    • If you feel “hungry” at lunch – it’s really because your mouth is bored! Create a routine for lunchtime – go for a walk, you’ll realize how easy it is to forget about lunch after that.
  • Take a cheat-day (eat it all!) one day a week.

2. Low-Carb Meals.

  • What to eat during meals? Stick to low carb / low sugar foods. 
    • Vegetables that grow above the ground : broccoli, spinach, greens, zucchini, yellow squash, mushrooms, green beans, cabbage, brussel sprouts 
    • Protein: pork, chicken (dark or white meat is ok), tofu (I prefer extra-firm – easiest to cook with), and plenty of eggs. 
    • Carbs: try to avoid – the less the better! But if you must have a little bit – beans and brown rice are better (lots of fiber content which slows digestion). 
    • Dairy: avoid, but if you must – try plain greek yogurt, Swiss, cheddar. 
    • Alcohol: avoid, but if you must – champagne, red / white wine has less carbs. Limit to 1 drink per day. Avoid mixed drinks & beer. 
  • How much to eat?
    • Eat until you feel full – listen to your body. If you feel that you tend to eat too much at a sitting – simply go for a 5 min walk after the 1st serving and you’ll probably not feel hungry after that. 
  • *The diet needs to work on all the days, not just when you are motivated. You need it to work when you are exhausted from work and tempted to get take out. I STRONGLY recommend doing some meal-prep every Sunday to cover your weekdays so you can avoid bad decisions.* 

3. What exercises or work-outs should be done? 

  • Unless you are already on a routine that you enjoy, you don’t have to start with any exercises. Can talk about this later.

4. What medications can we use? 

  • 4 common options –
    • Contrave = bupropion / naltrexone 
    • Qsymia = low-dose phentermine / topiramate 
    • Ozempic, Trulicity = semaglutide weekly injections, if there is prediabetes or diabetes.
    • Mounjaro = tirzepatide weekly injections
  • Which one for me?
    • As an old teacher said – “All medications have side-effects. If there’s no side-effects, it means there’s no effect.”
    • Generally, these 4 options are well tolerated and relatively safe to use with close monitoring. My job is to help pick the right one for each patient.

5. Speaking of side-effects – some excellent medications (including diabetes medications) have side-effects of causing weight gain. Part of my job is help evaluate for those and change meds if necessary.

6. FAQ: 

– Will I get dizzy or light-headed if my blood sugar is low? If you are not on diabetes medications, you probably won’t have this problem. Remember that you are training your body to burn fat, instead of waiting for food. Your body will get all the energy it needs from fat stores. If you have these issues, it’s likely due to not having enough fluids and/or electrolytes. 

– What if I get a headache from fasting? Usually this is from not having enough fluids – drink more water (until your urine is very light yellow). You can also try taking a daily multivitamin. 

– Can I work-out while fasting? Yes – athletes have shown a small decline in peak performance for 1-2 weeks after starting fasting, but once the body gets used to burning body fat, the peak performance comes back to normal.   

– Can I use artificial sweeteners or drink diet sodas? Not recommended.

– Can I drink flavored seltzer waters? Probably yes. 

– Should I count calories? No. Realistically, it’s too much hassle for the long run.

* Remember: ultimately, each person’s body is unique. These are the strategies that has worked very well for most people. You’ll need to fine-tune it to suit you – a simple, low effort eating plan / lifestyle that makes your life easier rather than harder. * 

#. More resources online: 

– DietDoctor.com – recipes, foods to eat / avoid, etc. 

– Dr. Jason Fung / “The Obesity Code”. Lots of great talks on youtube.