What has made slimming centres or weight-loss centres boom recently in our country ?

A boom of slimming centres in our country in recent times may well be attributed in one way to the ‘heath awareness ‘ created by health magazines, fitness guides, fitness programmes, easily available on video cassettes etc. and on the other hand to the fashion magazines and western outfits creating, a cosmetic ‘thin is in vogue.’

The basic idea of a slimming centre or a weight loss centre is to scientifically help an obese person to trim excess fat off. What should otherwise have place under the banner of medical profession, has now become a multimillion rupee business.

What precaution should I take in joining a slimming centre or a weight-loss centre ?

Any one suffering from a serious weight problem should certainly not joint a slimming centre or a weight loss centre without a proper understanding of the difference between just weight loss on one hand and fat-loss leading to weight loss on the other hand.

The body is made up of four major tissues :

Muscles, Bones, Water and Fat. It is possible to lose weight by reduction in weight of all the four tissues at a time or by reduction in any of them in a cmuscles and water or byombination such as reduction in any one of them singly such as only muscles or only bones or only water or only fat.

A reduction in the weight of body tissues such as muscles, bones and water is dangerous and has nothing to do with the treatment of obesity. A weight loss programme could prove dangerous if it includes "

1. Loss of muscles : could include loss of the muscles of the heart, liver, kidney, brain etc. sometimes irreversibly.
2. Loss of bones : (rate but possible) in the form of their becoming, porous (osteomalacia) or thinning out and is of grave medical concern.
3. Loss of water : if it is medically proved that a person is suffering from retention of water (oedema) in such excess amounts as to cause harm and aggravate certain serious conditions such as high blood pressure, congestive cardiac failure, swelling of the body during pregnancy etc. Then attempts under medical guidance must be made to remove excess water, keeping a close monitoring on levels of vital elements such as potassium, (K+) etc., for fear of possible dehydration. "No attempt is justified in administering diuretics or water loss drugs to a normal obese person to effect weight loss. "

All such weight loss programmes involving especially muscle loss or water loss can be manipulated to give ‘quick’ or miraculous weightless, as the speed of weight loss in this case depends on the ‘eagerness of the obese person and the intensity given by the concerned centre.’

Such quick weight loss programmes obviously end up landing the obese person into serious side effects " loss of hair, face pale, drawn and haggard, weakness, wrinkling of skin, loss of appetite, nausea, irritation, lack of sleep, etc., and dangerous consequences of health: damage to vital organs, kidney, liver, heart, brain, etc.

The various possible ways all discussed in detail in the preceding chapters and discussed in brief here, to induce quick-weight loss in an obese person are :

1. Appetite Suppressing drugs : An increase in their dosage can severely reduce food intake leading to quick weight loss in the form of ‘muscle’ loss.
2. Diuretics : Their over use can lead to severe and rapid ‘water’ loss in the form of urine.
3. Diets : Such as various fad diets, starvation programmes etc. depending on their severity lead to rapid muscle and water losses.

Take the case of L.P., a young man of thirty. When he was first examined by me, he was overweight by twenty kilos. His breathing was laboured, his blood pressure was too high and had an array of digestive complaints.

Not long before being referred to me, he had joined a slimming centre where he was told that nothing was wrong with him except that he ate too much. He was given a high protein diet and told to restrict his fluids. Within one week, he lost seven kilos but shortly thereafter became dizzy and, collapsed. At that point his family doctor brought him to my clinic. A medical examination showed that he suffered from a condition called ketosis - a result of protein breakdown, (muscle loss ) in the body. He was retaining urea in the blood due to a kidney infection. He also proved to be severely dehydrated ( water loss).

His lost fluids were replaced. He was put on proper treatment to correct ketosis and kidney infection. The underlying cause of his obesity was found and properly treated. He was advised, to eat nutritionally balanced meals.

During the following eight months L.P. lost twenty - kilos with a return to normal blood pressure. There is every reason, to believe that he will continue to do well until he reaches his destined weight.

The above case strongly highlights that if a competent doctor, had examined the patient earlier, and diagnosed the kidney infection, the setting in of ketosis could have been recognized, the high-protein diet promptly discontinued, the condition treated and the collapse of the patient avoided, thereby sparing the young man and his family from considerable anxiety.

It is important to be first examined by a qualified doctor. An overweight person, before attempting any weight loss, first must be diagnosed that his excess weight is due to excess fat. Once on a weight loss programme he should be rechecked by the doctor regularly, to confirm that the weight loss is fat loss and nothing else !

Could you give a guideline as to how a well-run slimming centre or a weight loss clinic should function ?

The key to a well-run slimming centre or a weight loss clinic ( centre ) should be ‘proper supervision both medically and nutritionally’.

This is how a slimming centre or a weight loss clinic (centre) should work :

1. All patients desirous of fat and inch loss must be examined by a qualified doctor. The doctor after a detailed conversation with the patient should note his personal and family history. On the basis of history and medical examination, a diagnosis must be made as to the underlying cause of obesity. In cases where the doctor finds it necessary, appropriate blood tests must be carried out.
2. Once accepted, the patient should continue to eat exactly as always for one week. He should keep a detailed diary of food he eats, the amount, the method of cooking and at what time of the day . This applies to any food whatsoever eaten at any time during the one week period. At the end of one week, on the second visit, the doctor and a nutritionist must evaluate the patient’s food noted in his diary, taking into account the amount of food eaten, kind of food and time of eating.
3. Once the evaluation has been made, the patient should meet the doctor who treats him for his underlying cause of obesity and makes corrections in his food habits towards sensible, practical and tailor-made easy to follow nutritionally balanced eating, depending on his individual need and life style. Certain cardinal rules should be laid down :
   1. No meals may be skipped;
   2. No crash diets;
   3. No diet pills;
   4. No strenuous exercises;
   5. No substitution in the diet, unless ordered by his own family physician, or a specialist (salt- free, low cholesterol, etc.) Once the desired weight loss is achieved, the patient should be told to visit the doctor at least once in two to three months, for a follow-up of the weight record.

4. A few simple rules should be followed by each patient. In order to carry out the weight loss programme, he must attend the centre once a week ( or fortnight, as the case may be) for atleast three months. At each weekly session, the patient’s food diary must be checked to ensure his co-operation towards sensible eating. He must be weighed and his body measurements must be noted and his treatment for obesity continued.

The doctor should give a short pep talk, together with a discussion on nutrition, health problems of overweight and obesity, dangers of poor nutrition, crash diets and discussions on various forms of quackery.

The doctor should emphasize that there is no magic formula and that common sense of sensible and good eating habits are the real key to success in losing weight. At no time should a patient be made to feel guilty or a failure when he does not adhere to sensible eating or fails to lose weight during the week. He should not be scolded but rather an attempt should be made to find out what caused the back sliding.

Once the desired weight loss is achieved, the patient should be told to visit the doctor at least once in two to three months, for a follow-up of the weight record.

In essence, the goals of the slimming centre or weight-loss clinic, should be to help the patients to rind the cause of their overweight problems, to show them through diagrams and charts, why people get fat, and how being fat affects the body, the mind and behaviour.

Each patient’s problem should be treated sympathetically and individually.