Ask the Doctor: Achieve Effective, Lasting Weight Loss

Overweight and obesity increase the risks of developing heart disease, diabetes, and many other chronic diseases.¹ But most people who try to lose weight either fail or wind up gaining it back.

Dr. Florencia Ziemke, founder, and medical director of Evexia Medical, a nutrition and weight management practice in Palm Beach County, Florida, is trying to change that. In this interview, Dr. Ziemke, who has nearly two decades of experience in obesity and nutrition medicine, tells Life Extension why it's vital to focus on safe weight loss and how she helps her patients get results.

LE: Many people consider weight to be a cosmetic issue. What are some of the serious risks of carrying excess weight?

Dr. Ziemke: Overweight and obesity affect one in three of the U.S. adult population. This is one of the leading causes of preventable death in the U.S. after smoking and it is associated with over 200 medical complications including diabetes, heart disease, stroke, sleep apnea, and 13 types of cancer.²

Increased body fat promotes tissue dysfunction, a chronic state of low-grade inflammation, and abnormal physical forces that result in adverse health consequences. Fat in the belly, close to the organs, increases risk for heart disease and diabetes. Fat in the heart wall can cause abnormal heart rhythms. Fat in the arteries causes heart attacks and strokes. Fatty liver disease is the leading cause of liver transplants in our country.³

Furthermore, many adults are on medications to treat complications of the diseases of obesity: high blood pressure, high cholesterol, etc. But nobody is talking about or treating obesity.

LE: Why is it so hard for people to lose weight?

Dr. Ziemke: Excess weight is not a result of flawed willpower. It's important to understand that body weight is regulated. Think of it like a thermostat with a pre-set temperature. Similarly, our body has a pre-set weight it always goes back to. The minute you try to lose weight, the body fights back to compensate. It increases hormone signaling to make us feel hungry, decreases fullness signaling letting the brain know it's time to stop eating, and lowers the rate of metabolism.

Another problem is that we live in an environment that promotes weight gain. Portion sizes have quadrupled over the past decades, and we live sedentary, sleep-deprived, movement-less lives. Most food is not even food; it's highly processed, addictive, and lacks nutritional properties to nourish our bodies.

LE: How can people overcome such enormous obstacles?

Dr. Ziemke: The good news is that long-term and sustainable body weight reduction is possible, under guidance of a trained specialist who can individualize treatment. At Evexia Medical, it's not just about quickly pushing that number on the scale down. Evexia means wellness in Greek. Wellness is the integration of physical, mental, emotional, environmental, social, and spiritual well-being. This is really important to understand. We cannot just talk about a physical body. Instead, we focus on optimal health and well-being.

To do that, we integrate pillars of treatment success including evidence-based medicine, nutrition, lifestyle and behavior, and technology. This is not a quick fix or fad diet. Our specialists work closely with each individual to design long-term health and wellness plans. Importantly, slow and steady really wins the race. Clinically we aim for 5%-10% weight reduction over a three-month period.

LE: You mentioned using technology. How does that help?

Dr. Ziemke: It's important for people to feel supported throughout their health journey. We use an app, telehealth, and remote monitoring technology to help them stay on track and allow us to adjust their program in real-time. Texting and video calling are also available so patients can stay in touch with their healthcare team. A smart scale included in our membership sends information straight to the doctor and healthcare team. It measures weight, body fat, lean body mass, and hydration. It's like your doctor is with you!

LE: What kind of results does your practice see?

Dr. Ziemke: The average weight reduction at our practice is 14% of total body weight at six months and 21% or 46 pounds at 12 months. The average waist circumference reduction is 5.5 inches. Also, 87% of our patients maintain reduced weight, meaning weight that comes off is kept off.

Some other changes we see over 12 months: improved eating behaviors and food habits, control of food triggers and cravings, reduction in prescription medication use, increased movement, improved quality of sleep, and less fatigue. In bloodwork we see improvements in cholesterol, diabetes markers, and liver function tests, just to name a few.

LE: That's impressive! Are there weight-loss tips you have that work for everyone?

Dr. Ziemke: Here's the truth: There isn't a single intervention that will work for all people. It's important to recognize that individualization of treatment is the biggest marker of success. Different people have different needs.

But regardless of the plan we develop at an individual level, all of us need to focus on dietary changes, lifestyle, and behavior. A Mediterranean diet is a good model, though we adapt it to each person. The closest I can come to a blanket statement on diet is: Opt for whole, lean, and clean. And stay away from that addictive, processed junk food!

LE: There is a lot of interest in new diabetes and obesity medications that are being used for weight loss. Do you find them to be safe and effective?

Dr. Ziemke: Medications like Ozempic®, Wegovy®, Mounjaro®, and Zepbound® have been game-changers for certain patient populations. Ozempic® and Mounjaro® are FDA approved for Type II diabetes, whereas Wegovy® and Zepbound® are FDA approved for the treatment of obesity. These medications are potent and carry risks and side effects that require monitoring. They need to be used in the appropriate setting, in the appropriate patient, and with the appropriate supervision. They are certainly not a weekend weight-loss gimmick, as Hollywood has led many to believe. 

Yes, I prescribe them, but not for everyone. Also, when these medications are prescribed, they don't eliminate the need to focus on dietary changes, such as avoiding fast foods and sugary drinks, or the importance of movement and stress reduction.  

If you have any questions on the scientific content of this article, please call a Life Extension Wellness Specialist at 1-866-864-3027.

Dr. Florencia Ziemke has worked at hospitals including Boston Medical Center and Beth Israel Deaconess Medical Center, with affiliations at Boston University, Tufts Medical School, and Harvard Medical School. She is board certified in Internal Medicine and a diplomate of the American Board of Obesity Medicine.

 For more information about Dr. Ziemeke's medical nutrition practice, Evexia Medical, visit evexiamed.com.

References

1. https://www.niddk.nih.gov/health-information/weight-management/adult-overweight-obesity/health-risks. Accessed March 4, 2024.
2. Available at: https://www.ama-assn.org/topics/obesity. Accessed March 4, 2024.
3. Khanna D, Khanna S, Khanna P, et al. Obesity: A Chronic Low-Grade Inflammation and Its Markers. Cureus.2 022 Feb;14(2):e22711.