About The Injections Given With The Diet Program
A number of you have asked me why I give injections along with your weight program.  The answer is simple; they improve your chances of losing weight rapidly and they tend to decrease dropouts.  For some reason unknown to me, the B12 and probably the B Complex in the injection, tend to reduce or eliminate the usual feeling of decreased energy and tiredness that often accompany a diet.  These unpleasant feelings can often trigger  eating binges and can usually destroy a diet before it really begins.  The decrease in size of the patches of "ugly fat" that usually goes along with the shots and the exercise and diet program are also partly a result of these injections, or at least they appear to be.  I have no scientific explanation and have to rely on the empirical data gathered in the 40 years that these medications have been used.  I leave it up to you as to whether you take them, but I highly recommend them, particularly if you are a problem dieter with a long history of previous failures when you have tried to reduce.  I have a fact sheet, To Whom it May Concern, that has scientific journal articles and medical textbook references to the ingredients in the injections.  It is available to you.  Copyright © 2004 by J.T. Cooper, M.D..  All rights

An Open Letter to the Spouse (or Parent, or Friend) of My Patient
You may think that this is a rather unconventional thing to do, appealing to someone who is close to a dieter for help, but certain things need to be said to you, or all the dieter's efforts could possibly be for nothing, and the dieter might fail.  For this reason, please carefully read everything that follows.  All the things mentioned in this letter do not apply in every case, but they are used as examples of things that could go wrong. It is obvious that no one holds an overweight person down and makes him or her overeat.  In 99 percent of the cases, the person who is overweight is that way because he or she  eats more food than is burned.  What is not so obvious is the effect that the home and work environment has on the overweight  individual.  Numerous scientific experiments have pointed out, time and time again, that the surroundings and external influences on an overweight person have more to do with his or her  problem eating behavior than the internal cues of hunger have ever had. A large majority of overweight persons never experience a true feeling of hunger or of satiety (lack of hunger) in the way that an individual of normal weight does.  Certain experiments have shown that cues, such as elapsed time from the most recent meal, odors, sight of food (watching TV and eating), being in a certain location, and being emotionally upset will trigger massive food intake at times.  These cues can make even the most compliant dieter vulnerable to problem eating impulses. You may be asking yourself, "What does all this have to do with me?  It is not my problem.  He (or she) should be able to diet by will power alone!  Why involve me at all?  If she (or he) does not do well, the overeating is not my fault." Nothing could be further from the truth.  You are important, in fact, more important than most of the people in this dieter's life, or you would not be reading this now.  If you are truly interested in helping the dieter, please take what is said here on faith for a while and see for yourself whether or not it is true.  It may mean changing your own lifestyle a bit, but the results will be worthwhile.  You are welcome to come with the patient and talk with me at any time. To begin with, never criticize the dieter for not dieting properly, or for his or her eating habits.  Ridicule, teasing, taunting, or other verbal abuse does not stop an undesirable behavior.  It most likely will only make him or her want to eat more than before.  You may have to bite your tongue to do so, but only comment on desirable eating behavior.  If the patient is not breaking the diet, then comment on how good that behavior is.  If a lapse does occur, and this will happen, the less said, the better.  In the long run, positive reinforcement techniques work better for compliance to a diet plan.  To repeat, even if you see something done incorrectly, please say nothing. Since seeing or smelling food can be important in producing undesirable eating behavior, the dieter needs to "fat-proof" his or her dwelling.  This means that all junk food that might be tempting must be cleaned out.  For the rest of your family or social group, it might mean going out to get ice cream and refusing to eat it, or something equally tempting, in front of the dieter.  To eat such goodies in front of someone on a diet is an act of cruelty. Many families are used to eating together, but the dieter may decide not to eat with you if distress is caused by sitting and watching others eat.  He or she may simply eat quickly and then get right up from the table after finishing, even if others have not yet stopped eating.  Many dieters are pickers, and if such a person remains at the table, it will be difficult not to nibble at one thing or another.  Please be understanding, and at a later date, when dieting efforts have been successful, normal table behavior may be resumed. A dieter may have to stay away from problem places, such as pizza parlors, taco stands, spaghetti houses, hamburger stands, take-out fried chicken stores, doughnut parlors, and other equally tempting dens of obese iniquity.  Please do not bring this type of food home or order by phone and tempt the dieter.  The result is usually disastrous and  is equivalent to tempting an alcoholic to go into a bar, or to bringing him or her a bottle of whiskey.  No thinking and caring person would do that to an alcoholic, but lots of people will try to "feed" a dieter. What this message boils down to is that the dieter is weak and does have some bad habits, but he or she is worth any and all efforts to help save him or her from the life-shortening effects of obesity.  You and others may be inconvenienced a little, but surely you can tolerate these minor annoyances for a while. About one of every hundred dieters is faced with open or hidden sadism, or mental illness, on the part of his or her spouse or a relative.    A certain type of person seems to feed on the misery of others, particularly of those who are overweight.  One example is the husband who keeps his wife fat, usually because of insecurity or other related reasons.  He feels secure because she is so obese that no one else would have her.  When his wife tries to lose weight, such a man becomes anxious and tries to get her to go off the diet by tempting her, annoying her, or by otherwise sabotaging her efforts.  As she gets closer to her lower weight goal, he becomes more and more anxious and insecure,  and will resort to physical abuse, verbal assaults, and as a last desperate effort, may cut off her funds so that she cannot continue her weight program.  For those who stick it out and continue the diet program, there is sometimes divorce, usually coming on the heels of an increasing amount of verbal and physical abuse. Not all victims are wives.  Many are husbands of insecure wives, or children of insecure parents.  Some men are victims of a bullying, feeding wife.  These women try to get and keep what they want, a husband so fat and unattractive that no one else would want him. In summary, you and others who have close contact with the dieter have more influence on him or her than you could ever realize.  Without your total assistance and support, the dieter will more than likely fail.  The attitude that "food is love" is widespread.  The idea is still strong in many people, that by giving food you accept love, and by rejecting that food you also reject that love.  You can, however, show love in ways not related to food.  Try flowers and small, inedible (not made of chocolate) gifts to show affection and love.  They work just as well and last a lot longer!  Please let me know if I, as this person's therapist, can help you in your efforts to be supportive to my

Caffeine In Beverages
A lot of my patients wonder why I am so opposed to EXCESS caffeine in their diets.  There are several reasons for this. Certain women who drink even a small amount of caffeine each week may develop or worsen a condition known as fibrocystic disease of the breast.  There is some evidence that chronic or severe degrees of this problem may develop into something far worse, breast cancer. In a few susceptible persons, the intake of any significant amount of caffeine will cause a temporary rise in the blood sugar, followed by a later deep drop.  During this drop in blood sugar the person may experience hunger, jitteriness, sweating, anxiety, and feel bad in general.  These types of feelings can often lead to overeating, thus spoiling the diet. For these reasons, it is generally better to restrict one's intake of all caffeinated beverages to two or less every day.  All of the major companies have sugar-free and caffeine-free beverages.  Even the cola drinks are fine, PROVIDED THERE IS NO SUGAR AND NO CAFFEINE.  Some of these drinks are free of caffeine, but they are loaded, with sugar, so read the labels! There is also a large variety of teas and coffees that have little or no caffeine.  Koolaid and CrystalLite have a lot of good fruit drinks without sugar, but sweetened with Nutrasweet (aspartame) or Splenda.   These drinks are legal in any amount you want each day.  Do a little shopping around and label reading and I think you will be well pleased with the tasty and enjoyable drinks you will find that have little or not calories or caffeine! Gatorade is loaded with sugar and should not ever be drunk by one of my patients.  It doesn't help you any more than the sugar-free drinks mentioned here.  Also, AVOID CRANBERRY JUICE AND CRANBERRY SAUCE!  The cranberry is very bitter and can't be tolerated unless it is loaded with sugar.  Studies by kidney specialists have shown NO VALUE to someone with kidney or bladder problems.  Plain water works just as well and doesn't have the extra sugar that cranberry drinks contain to feed the bladder germs.  Also avoid any form of SlimFast drinks or "diet" foods with the same name, as well as any other milkshake formula that is supposed to help you lose weight.  If you must use cranberries, use CrystalLite Cranberry flavored drink or capsules filled with cranberry powder that are available at health food stores. Blueberries contain tannins, a chemical that duplicates what cranberries contain if we are to believe the theory that these tannins help bladder problems, and they are sweet without the need for extra sweeteners.  If in doubt, use unsweetened blueberries with artificial sweeteners to

Almost everyone with a weight problem has a chocolate problem too. 
I have always had a hard time resisting any form of chocolate, except for chocolate-covered cherries and mints with a chocolate coating.  These two forms of candy made me ill one Christmas about forty years ago, resulting in an instant revulsion for both kinds ever since that time.  Since I have a hard time resisting chocolate, I decided to see if there was anything about it that would turn me off.  I struck paydirt in the first reference book I consulted and in a Food and Drug Administration policy guideline reference publication. It seems that candy bars don't grow on trees after all!  Over half of the chocolate we consume comes from Cacao trees in West Africa. The Cacao tree grows in a lush tropical environment and has a number of fungus and insect enemies.  It is necessary to spray the trees with a number of chemicals, including toxic fungicides, that could still remain in small amounts in the harvested cacao beans. The cacao trees produce a certain number of seed pods each year.  These pods are harvested, and the cacao beans are removed manually by natives.  They are then spread out on the jungle floor and allowed to ferment (a nice way to say rot) for about a week in the jungle heat and humidity.  There is nothing to keep insects and small animals from nesting and feeding among the beans while they are exposed to the elements.  It is common to find animal droppings,  hairs, and dead insects, in this fermenting collection of cacao beans. After they have been left like this for a week, they are packed in bags and stored in warehouses until they are loaded into the holds of ships for transportation to this country.  In the warehouses and in the ship holds they are subjected to the ravages of  rodents and insects.  The cacao bean is a rich source of fats and carbohydrates and is relished by both kinds of pests. The resulting mixture of cacao beans, insect fragments, rodent droppings, leaves, and rat hairs is unloaded in this country and is taken to one or another of the various chocolate  factories.  An effort is made to remove as many of these contaminants as possible, but the thousands of tons of raw material processed each month make this a virtual impossibility. To quote the FDA manual:  "The action levels are set because it is not now possible, and never has been possible, to grow in open fields, harvest, and process crops that are totally free of natural defects."  Translate natural defects into hairs, insect fragments, and animal waste.  There is a level at which the FDA will seize a product and not let it be sold. If 100 grams (about three ounces) of chocolate exceeds an average content of 60 microscopic insect fragments or one rodent hair when six similar samples are analyzed, or if any one sample contains more than 90 insect fragments or three rodent hairs, then this sample will be rejected by the FDA.  I suppose this means that if there are only 59 insect parts, or only one rodent hair per 100 grams, then we're fine! Animal waste is normally the color of chocolate and cannot be tested for with any great accuracy.  The cooking process destroys almost all the germs, so I guess this means that it is reasonably healthy.  Nobody is hurt by this contamination, since the hairs and insect parts are mostly protein, but the  thought of chocolate with all this possible filth mixed with it has made me less likely to eat it.  I am afraid that when I bite into a candy bar, the crunch may not necessarily come from peanuts! The cookies, milkshakes and bars we use are made with a higher grade of chocolate that is more carefully processed and are much cleaner and rodent hair or insect parts are not tolerated by the company that makes them. Sources of information are Foods and Food Encyclopedia, by Considine and Considine, 1982, Van Nostrand Reinhold Co., New York, plus the FDA's Compliance Policy Guides Manual, Food Defect Action Levels

Dealing With Pests and Feeder Saboteurs  
Many of my patients report that relatives and so-called "friends" will attempt to get them to eat by trying to talk them into it.  Below are a couple of simulated conversations with these pests in certain situations.  It would pay you to practice these conversational defenses when alone, so that when they actually happen, you are primed and ready to defend yourself. 1) The Who, Me approach.  When told that you should stop losing weight and get off that diet before it kills you (this is when you are still 50 pounds overweight) and that you should eat more, say the following, or something similar (say it with the most innocent tone you can manage without laughing in his or her face:) "Who, me?  Do you really think I'm thinner?  Honestly I haven't really thought about it.  Why are you concerned?  I'm not on a diet (It's an eating program, not a diet, so you're not lying)." "Gee! I guess I am a little smaller, but I wouldn't let it worry you.  By the way, what is your purpose in bringing up something like this?  I always consider what I weigh and what I eat as a highly personal thing, like my sex life.  Incidentally, how is your's?" "It's interesting that you should bring up my weight.  I had been a little worried about you!  You're looking a little pale and peaked.  Is everything alright with you?  Have you seen your doctor lately?"  (This last comes under the rule that the best defense is a good offense.) Use all or part of the above, or something similar. 2) The Broken Record approach.   When offered food that you don't want, continue to repeat the same phrase, while still agreeing with the pest. Pest:  "Have some of this cake, I made it just for you!" You:  "I'm sure you went to a lot of trouble, but if you had asked me first I would have been able to tell you that I don't care for cake." Pest:  "But you always did like cake." You:  "You're right, but now I just don't care for it." Pest:  "It's not that many calories and it won't really mess you up on your diet." You:  "I suppose you're correct, but I just don't care for it." Pest:  "I wish you'd get off that diet." You:  "You could be right, if I were on a diet, but I just don't care for it." Pest:  "You're not being very friendly by not eating my cake after I made it just for you." You:  "I suppose you could assume that, but I don't care for any." At this point the pest leaves to find another victim.  Remember, don't admit you're on a diet and don't use the fact you're on a diet as justification.  You don't NEED to justify your actions to anyone.  If you use the diet as a reason, the pest will want to know all about it and will argue that in her professional (unofficial doctor) opinion, the cake is no problem.  It isn't a problem for them, but will be for you if you give in.  I have used cake, but it could be anything or group of things to tempt you. 3) The very best way when faced with a pest is to say: "I know you mean well, but my weight and diet are very personal things to me and I don't discuss them with anybody.  They are off-limits to you." The saboteur will then just claim to "only want to help."  You can let this person know that you realize he or she was just doing their "Christian duty," but that the subject is still off limits and what part of "NO!" was not understood.  Repeat these statements if you are still annoyed by this same person later

Fast Foods and Cleanliness
The next time you go by one of those places in the mall or shopping center that sells candy, frozen yogurt, ice cream, cookies, hamburgers, hot dogs, fried chicken, gyros, tacos, pizza, burritos, etc., take a minute to look at the person serving you or preparing the food behind the counter.  I did and it has cured most of my cravings for these foods, at least bought from one of these places.  I managed to stop these cravings through aversion, just like I cured most of my desire for chocolate earlier.  (See Chocolate Anyone? in this booklet.) It is not my intention to disgust you or turn your stomach,  In fact, I may be doing you a favor in making you aware of just how dirty some of these places are.  The counters are clean and the cooking areas are inspected by health department personnel, but they can't do anything about the people. In a recent inspection of local establishments that served food at a counter, I noticed how often the person cooking or serving touched some "forbidden" areas of their body and then served food without washing their hands.  These areas included the mouth, the nose (finger inside nostrils or wiping under the nostrils with fingers), the ear canal, the front or back of the head to adjust hair or hairdo, the rump, the eyes (in one case to remove dried pus from the corner of the eye), or the abdomen. It was appalling!  I rarely had to wait more than  30 to 60 seconds in most places to see the above.  In most cases the person involved didn't even realize he or she was doing it.  I have three choices when I see poor personal hygiene habits.  I can ignore them and eat contaminated food, or I can complain to the management, or I can congratulate myself on finding a way to keep myself from eating these fast foods.  I usually choose the last alternative and find my problematic eating of these goodies has decreased to almost nothing. I apologize to some of you who may feel that this section of the newsletter is in poor taste, but you'll have to admit that using the information above will probably  help keep you from impulse eating.  It also pays to use inside service, since the drive through route doesn't let you observe these people as closely.  Let  me know what you observe. It is alleged that law suits have been filed over finding a deep-fried rat in a bucket of fried chicken and rat droppings in the food served by a certain taco restaurant and dogs or cats being served in Chinese restaurants.  I easily could believe the reports, but I leave it to you to draw your own conclusions. It is not my intention to downgrade or hurt those persons who are dedicated to serving good, clean, wholesome foods at their restaurants.  There are some in the area who won't tolerate any sloppiness of their employees.  By taking a little time to observe, you can tell for yourself which ones do a commendable job and which ones are

Guilt Versus Realism in Weight Reduction  
You are learning a skill when you try to change your way of dealing with food and problem eating habits.  Like any learning, there are often mistakes associated with the process.  Too many patients are destroyed by their mistakes and binge because of shame and guilt.  If you were learning math, you wouldn't let a few mistakes make you quit the course?   So why let an episode of problem eating ruin your diet program? This is a form of Self-Defeating Behavior (SDB) and is quite common in my patient population.  SDB occurs when the patient doesn't have the proper insight into what makes him or her behave in a certain way.  Going off a diet program, even a little bit, sets off an orgy of guilt, self-accusation, and self-punishment.  The punishment is usually in the form of quitting slimming efforts altogether, or binging.  The self-abuse with food is followed by even more guilt,  feelings of helplessness, and more eating.  The only time that we can break the cycle is when the patient becomes aware of what is happening to her. Rule number one is to be realistic about what you are trying to do.  Your primary goal isn't to lose weight, it is to change your eating habits.  An extra few pounds of temporary water retention on the scale can almost destroy many of you.   I have seen patients who were losing fat rapidly, but who were also temporarily accumulating extra  water weight, go into hysterics and cry over what a scale told them instead of what their minds and their loose clothing should have told them. If you find yourself deviating from the diet program you are on, don't let it get to you.  Go right back on the program then, and don't binge.  If you have problems, talk to my staff or me.  That's what we're for and we don't mind at all.  There is a new drug out that may help binge eating.  Ask me about it. Another form of SDB is refusal to use a diary.  A lot of my patients make excuses for not keeping a diary.  "I don't have time to fool with that diary."  "I don't think you trust me."  "I wouldn't dare bring you in a  diary with what I eat every day." None of these excuses really makes sense.  We know that if everything else is equal, patients who bring the diary in monthly are twice as likely to be successful as those who don't.  In spite of this, half of my patients either refuse to bring it in, or conveniently "forget" it month after month.  Get a small spiral notebook to make notes on, or use one of our diary forms, then write everything down, including problems.  This helps you! My rule of letting realism be my goal with you makes me gently try to get these "lost sheep" to bring in their diaries at the risk of making them mad.   Why would I continue to insist on having another pair of eyes and ears through the diary, particularly when I know it generates anger in some of you?  The reason is obvious, I feel it would help you to do better.  Talk to me if you have problems with controlling your food intake.  There is hope for the most difficult dieter.  I know because I used to be one

How to Fail at The Weight Loss Game!
A lot of my patients want to know how to fail at losing weight. Believe me, it's easy! Just do all the things I list below, or even part of them, and you should have no problems keeping all of your fat deposits. Also, in the event you want to SUCCEED, do just the OPPOSITE of what we say below. Listen to all your friends when they tell you that you don't need to lose any more weight. After all they are experts and many of them have medical degrees, don't they? They have no reasons, such as jealousy or envy that would make them say something like this. Even if you're 5 feet tall and weigh 180 pounds, it pays to listen to people who would sabotage your efforts to improve your health and well-being. Rely on your "appetite suppressants" to do all the work for you. Ignore the massive amount of medical research that has shown that these medications are only useful as a temporary measure in controlling hunger and have no long-term effect. Be sure and not build up a bunch of good habits to replace those bad ones that helped make you overweight in the first place. When you go to a party or social function, be sure and starve yourself before going, so that you are ravenous enough and vulnerable enough to "pig out" after you get there. In order to fail properly, be sure not to eat enough to keep you out of trouble BEFORE you leave home or work to go there. If you use them, be sure and take your diuretics (water pills) more often than the directions say. Use them to take off "weight" rather than excess edema fluid. Don't worry about the potentially dangerous side-effects that can occur if they are taken too often. Also, be sure to load up on forbidden foods that are high in sodium (salt), so that you can bloat up again tomorrow. Don't tell Dr. Cooper about your other medicines, including diuretics and heart drugs that you are taking, it would only confuse him and keep him from prescribing some of the ones he uses. If you make a mistake, be sure and heap a lot of guilt on yourself. A little guilt will go a long way. Once you have made that one mistake, tell yourself that since you have already blown it, you might as well stay off the program the rest of the month. Be sure and deny any problems on your next visit and not share your problems with Dr. Cooper and his staff. Become a "COUCH POTATO" and never exercise, it could become habit-forming. Do as little moving around as possible and never take the stairs or park more than a few feet away from a store. Be sure and park in the handicapped spaces and run into the store wearing your tennis outfit or jogging suit. Let your problems, anxieties, anger, or depression make you eat. It is better to crush bad feelings underneath a load of food than to deal with them like an adult. Get inside your shell or closet and EAT! Be sure and not take your vitamins and minerals. They might make you hungry! Ignore the evidence that vitamins don't increase appetite if they are formulated the way Dr. Cooper specifies. Don't take a chance. All these vitamins and minerals do is stimulate the chemical machinery that helps your fat burning system work better. Don't read the information sheets and diets that are given to you in this office. It's just too much trouble to keep up with all that knowledge. Instead, look in the Enquirer for the latest miracle diet and eat what it says eat, plus whatever else you want. Look only at the scales and don't look at how your body is getting smaller every week. Quit at the first sign that your "weight" is up on the scales. Don't read "Why Didn't I Lose Any Weight?" in this Helpful Hints booklet. It might keep you from quitting your diet program. There are other "helpful hints" that I could list, but it should be obvious to all my patients that these keys to failure are not things you really should be doing. They were listed in this way to get your attention and to make you

Is It Really Hunger?  
Many of my patients report to me that they have strong feelings of "hunger" that are not helped by appetite suppressants.  On careful questioning most report that the "hunger" they feel is a growling stomach, a burning in the stomach, or an empty feeling.  True hunger doesn't EVER show itself in this way. A growling stomach is just a sound, not an indication that you need to eat.  As for the other symptoms, what they really are experiencing, in most instances, is PAIN from excess stomach acid or an irritable stomach that has spasms.  Feeding the person with these symptoms will relieve the distress for a short time, but antacids or antispasmodic medicines will do the same thing without adding excess calories to the daily intake. The next time you experience this type of symptom, don't give in and eat.  Take a healthy dose of Mylanta II, Maalox Plus, Gaviscon, Gelusil, or other antacid liquids.  If this fails to help, let me know and I will prescribe an antispasmodic medicine or Pepcid, Zantac, Prilosec or similar medicines for you.  You are not really hungry after all, but are uncomfortable! Another alternative is to use the Super Soup as a filling agent for your stomach in this situation.  There are very few calories and a lot of satisfaction in using this type of low density foodstuff.  Any of the above are preferred to overeating or to using excessive amounts of appetite suppressant over and above what is really needed.  All any medication can do in dieting is to take the edge off your hunger.  None of them will keep a person from impulse eating or habit eating or nervous nibbling. If you are on aspirin or an anti-inflammatory drug like Motrin, Advil, or others like these, you might want to have your doctor prescribe Carafate, a protective coating agent for the stomach that is often better than antacids.  Talk this over with me if there is a problem and we will try to resolve it for you.  The biggest weapon you have is your own knowledge about your body and how it

More About Water Pills, Fluid Retention and Sodium  
It is a rare day that passes without at least one person coming in and requesting a "water pill" to relieve one or more problems. both perceived and actual.  These diuretics are NOT just for removing water from your body.  This isn't their true function.  The actual action of any of them is to induce the kidney tubules to remove SODIUM (found in salt and other substances) from the blood that flows through the kidneys and to cause the body to excrete it through the urine collecting tubules in the kidneys, down into the bladder, and finally outside. Water tends to follow sodium, therefore we have a great deal of water passed out through the bladder along with the salt.  I shall write "salt" in this article, but I am really referring to sodium.  For many people, diuretics are a life-saver.   The buildup of fluids in the lungs, the abdomen, and the lower legs is enough to cause serious breathing and functional changes in the body, often enough to cause death. Diuretics are also useful for the person with hypertension (high blood pressure) and tend to lower the amount of excess fluid in the circulation, causing a lower pressure.  In cases of overuse,  the loss of too much fluid and salt causes weakness.  This is similar to the symptoms of heat exhaustion from losing too much fluid and salt through sweating.  The person who abuses these diuretics finds herself with weakness, muscle spasms and cramping, and a shortage of two vital minerals, potassium and magnesium. Dieters also tend to collect unwanted salt and water.  The discomfort of fluid retention can be relieved by intelligent use of these.   For dieters, if you must use them, the ideal way to take these medications is every two to four nights.  Since there is a 48 to 72 hour interval between doses, the body has a chance to recoup the losses of minerals other than sodium.  Night is the best time to take the diuretics, since the body is lying flat and fluid pooled in the lower part of the body has a chance, through gravity, to equalize and make more sodium available to the kidneys to be filtered out. It is estimated that almost twice as much salt and water can be gotten rid of if diuretics are given at night.  It is true that getting up at night is a problem for some people, but the increased efficiency of action is worth it! Drinking large amount of water during the day and just before retiring is an excellent way  to "prime the pump" and increase the sodium loss.  The extra water makes the sodium loss much greater and helps carry out other waste products  that accumulate whenever a large amount of fat is lost.  If drinking plain water is objectionable to you, try Koolaid sweetened with Nutrasweet (lemon and other flavors), weak teas, herb teas, water with lemon juice added, and the sugar-free, caffeine-free, sodium-free Dr. Pepper and DietRite Cola, which are available.  The main thing is to get plenty of fluid flow through the body. One last warning.  Please don't take these medications just to lose "weight" on the scales.  Use them ONLY if you have genuine fluid retention and bloating.  Also, don't use another doctor's prescription, plus mine, to make your scale weight look better.  Taking too many of these has been FATAL to a few patients.  Swollen hands are NOT indications for diuretics unless they are swollen the first thing in the morning.  Swelling of hands during the day is caused by another mechanism and should be ignored when deciding to use diuretics.  If you have swelling of the ankles or feet or the lower leg at night, use a diuretic.  If the swelling occurs more than 12 inches above your ankle, ignore it and don't use diuretics.  Ask me for a prescription for a MILD diuretic if you feel you need one and I will give you one to take to your pharmacy.  I no longer dispense or prescribe the stronger ones in my practice.  They caused too many

Motivational Roadblocks  
Most people who are overweight are very unhappy about their obesity.  So why do they have so much trouble starting a diet program or sticking to it?  We believe that would-be dieters give in to a variety of motivational roadblocks.  Let's consider several of these, and suggest how you can avoid them. Let's start with the almost universal feeling among dieters that their being on a diet is somehow (cost-wise, etc.) unfair to their families.  The truth is that what's really unfair to their loved ones is remaining overweight.  This is because overweight individuals are at considerable risk of developing any number of very serious, life-threatening diseases.  If you feel guilty about spending money to lose weight, ask yourself: "What do my children need more, new designer jeans, or a healthy me who will be alive and well to love and nurture them?"  Really at issue is not whether you can afford to lose weight, but whether you can afford not to. Another reason why many people have difficulty starting a diet or sticking to it relates to their history of previous diet failures.  Individuals who have tried unsuccessfully to diet many times in the past may be convinced that to try again would only mean having to face failure one more time.  They may also feel that they will receive ridicule from their family and friends if they even suggest that they are going on a diet "one more time."  These individuals have convinced themselves (or have been convinced by others) that they will always be fat because they have no willpower or self-control.  However, these same people often display considerable willpower and self-control in other areas of their lives. For example, in their role as parent, they are able to get up in the middle of the night to care for a sick child, even when they themselves are feeling ill.  Doesn't such behavior require willpower and self-control?     The dieter should recognize that failure to diet successfully in the past was not a matter of  lacking willpower or self-control.  The real "culprit" was a lack of knowledge about how to avoid or lessen the impact of such dieting pitfalls as weight loss plateaus, binges, and the feelings of deprivation, fatigue, and boredom.  We can help you there. In the absence of such knowledge, dieting can be a frustrating and highly stressful experience.  This is why dieters should seek help, rather than continually trying to diet on their own.  This is why Dr. Cooper has given you access to the knowledge needed to cope with the stress of dieting. It isn't only people who have unsuccessfully dieted in the past who encounter motivational roadblocks.  Individuals whose histories are ones of successful dieting, but unsuccessful maintenance are also frequently reluctant to start a new diet program.  They tend to feel that even if they once again take the weight off, they will put it right back on.  Their concern is justified!  But, they need to understand that the main reason dieters put weight back on is that dieting alone does nothing to change the habits and patterns which were responsible for the excess weight in the first place. Thus, if you have repeatedly lost and regained excess poundage, there is cause for hope as well as concern.  You can learn how to change your habits and patterns and make your next diet a lasting success. You may be one of those personalities who is an "all or none" dieter.  At the first sign of a problem, you quit.  Please try and resist this impulse.  If you make a mistake, it isn't the end of the World.  It is only part of a learning process, in which you are EXPECTED to make mistakes.  When a problem occurs in your dieting pattern, don't quit, learn from it.  You will make yourself stronger if you accept your weaknesses and problems and work with them, turning them into strengths. If we have helped you see how you might now be able to steer around the motivational roadblocks we've described, why not make a new start?  Are you thinking to yourself, "I will, but right now I'm too busy?"  If you are thinking that, you've just run into another roadblock!    There will always be stressful and busy times in life, and these are probably the very times when you most likely overeat and gain weight.  Now is the time to learn techniques for coping with stress in non-food

Stop Problem Eating At The Source  
Problem eating starts as a chain of events that ends when the wrong food or drink is consumed.  We might think of this chain of events as a group of events or situations that are separate, but yet connected.  At any point in the chain it should be possible to stop the progression, but it is very difficult after the first link or so is passed.  If things can be stopped at the first link, we can abort the entire sequence and prevent a lapse in the diet program.  A few examples should illustrate what I mean. You are at a birthday party and are watching everyone else eat ice cream and cake.  The first link would be your attendance at the party and possibly you could plead a previous obligation and not attend.  This would mean you would not be exposed at all to the sweets.  In the event that you can't excuse yourself because the birthday person is a relative, the next link in the chain must be attacked.  Politely refuse to take a plate or dish that contains the sweets from anyone.  Use the same techniques that I mention in "Dealing With Pests" and say you don't care for it.  Don't let it be placed in front of you or handed to you.  Remain standing with your hands behind your back.  Where can they put the plate of sweets then? If you ever put your hands on the forbidden sweets it is almost impossible not to eat some or all of it, so stop everything at this point.  It means being assertive, but not unpleasant to the person offering it to you. Another situation places you at home in the evenings or on the weekends in a bored state.  You feel the desire, but not the hunger, for something.  Hopefully, you have fat-proofed your home and there is nothing there to eat that is a problem food or beverage.  This would be breaking the chain at the first link.  If you don't have it near you, you can't eat or drink it. In spite of not having something near at hand, you still may want it bad enough to go out and buy it.  (Pizza, candy, ice cream, etc.)  At this point make yourself a promise that perhaps you might get it, but you will wait 30 minutes before going out.  Occupy your time with some non-food activity and wait the half hour.  Pat yourself on the back!  You have delayed for a significant period of time.  Eat or drink something permitted during this time and often that's enough to satisfy your cravings. Now promise yourself another 30 minutes of delay before going for the problem food.  Repeat the process for several more times if possible.  It is hoped that eventually the desire will go away and you will be safe.  Plan your delay tactics ahead of time in your mind.  Then, when the situation actually comes up, you will have already practiced your actions mentally and should be less likely to give in to temptation. These two situations are only a sample of mental exercises you can do.  Write down situations from your own experience and plan how you will handle them when they occur.  Not only that, but when the problems arise, write them down as well and practice how you will make sure they don't happen again to you in the future.   Your use of these techniques is limited only by your imagination and

The Importance of a Proper Maintenance Program  
There are two points in a diet where you can fail easily.  The first is during the first two months when a patient is adjusting to a new weight reduction program and the next critical time is during maintenance.  Some patients seem to fall victim to the "Aha phenomenon" and rapidly stop their efforts toward maintaining a normal weight at this point or shortly thereafter.  It takes a long  time to stabilize a new, lower weight level and to build a new set point.  This means that if a patient lets down her guard, the weight will creep back on again and all the  effort, expense, and time will be lost.  Time after time I have seen patients successfully lose 50 to  75 pounds and then just fail to return for scheduled visits.   I will see them years later when they have regained all their weight and have to start all over again. Ask to see my maintenance plan for further

The Possible Dangers of Laxative Abuse  
I am NOT saying that long-term use of laxatives will cause cancer, but am merely discussing some theories of my own and how they might relate to your continued well-being.  In order to analyze what sort of problems a person needing a laxative might have, we must first look at someone who NEVER has to take anything for irregularity. Some patients are lucky, and I find myself in this group, because they are regular and have no problems with their bowels.  These patients are usually faithful about drinking lots of liquids  every day.  Their intestinal tracts are not full of dry, hard, caked material because they have a high intake of fluids to prevent this type of problem.  They not only drink  water, but they take in lots of fruits and high-fiber vegetables from the leaves, stems, and pods of the plants.  (Broccoli, cauliflower, prunes, apples, fresh greens, squash, cabbage, Brussels sprouts, Figs, etc.) In addition to the high fluid and fiber intake that occurs every day in these people, they WALK a lot every day.   It is rare to see a person who walks daily who also has a complaint of constipation..  On the other hand, the irregular patient rarely moves around that much and gets a false sense of security from so-called "aerobics" classes. So much for the three F's (fiber, fluids, footwork) and their role in preventing irregularity.  Now let's look at what patients use and how each one could be a problem. Avoid laxatives that expose the intestine to  powerful irritants day after day, sometimes for years?  Could we be changing these cells to malignant cells with the irritants? The laxatives with docusate and/or dantron are usually harmless and rely on a gentle stimulation of bowel activity along with a detergent or wetting action in the bowel contents.  Laxatives like Surfak, Colace, or Doxidan have one or both of these.  Dolcolax tablets and suppositories have another gentle  bowel stimulant that doesn't appear to be  irritant laxative.  These can be purchased at any pharmacy.  Sugar-free Metamucil and Sugar-free Citrucel are allowed. Regular Metamucil and regular Citrucel are forbidden, but you can use Metamucil capsules.  Avoid mineral oil or castor oil..   You can get mineral oil pneumonia as a result of frequent use.  Milk of magnesia is permitted occasionally in liquid or tablet form.  You may also use PerDiem granules as another source of a fiber-containing laxative.  As with all laxatives of this type (with Psyllium seed fiber), you must be SURE to take in lots of water when you use it.  Uncle Sam cereal is a laxative in cereal form, usually only available at WinnDixie stores, but your grocer could carry it if you asked him. An excellent fruit dish can be made by stewing six pitted prunes and 4 dried apricot halves until soft.  Use a fork to mash and mix the fruit compote produced.  Use half of the mixture every day to help regularity.  It goes well with bran cereal. In summary, try the three F's and try to avoid a laxative unless absolutely necessary.  As with any laxative, observe the precautions that common sense dictates, including omitting them when abdominal pain, nausea, or a skin rash develops. YOUR PILL DOESN'T GIVE ME ANY ENERGY! Many patients have complained to me that the appetite suppressants we use in this office don't give them any energy.  THEY ARE NOT SUPPOSED TO!  Some of you have been used to taking some of the now-outlawed "speed" pills.  These pills had a powerful stimulant effect and gave "energy" to a patient taking them.  The only problem is that this type of energy is the result of the body being unable to detect fatigue.  Fatigue is nature's way of telling you to stop before you overdo it.  These pills can no longer legally be prescribed or dispensed in Georgia. The suppressants that we now prescribe have a gentle effect on the body usually, and take the edge off of your hunger.  THE BEST APPETITE SUPPRESSANT IS GOOD FOOD!  By using these mild medications, you can go though the day and suppress part of your hunger, while eating the proper mix of protein, fruits, vegetables, roughage, and milk products. None of the suppressants really control the true problem in overeating.  Most overweight persons don't eat because they are hungry, they eat in response to habits and previous conditioning.  If hunger is not the cause of overeating, then why suppress hunger with medication and ignore the basic problems?  Only five or ten per cent of your problem eating is caused by true hunger.  The rest of your problem eating can't be touched at all by these drugs, but they do help you some.  You also have to change your habit patterns and lifestyle routines. IF YOU WANT TO HAVE ENERGY, YOU ARE GOING TO HAVE TO USE ENERGY!  This means at least 20 to 30 minutes of aerobic exercise a day in order to build up your supply of stamina and vitality.  Along with this new feeling of invigoration, you will also burn up a substantial amount of extra fat in the process. In many of my books I mention exercise as an important part of your treatment.  Don't expect to do well if you don't at least walk some each day.  Rolling around on the floor or on a machine, doing calisthenics, weight lifting and tennis are poor substitutes for a daily walk.  Don't try to jog or run unless you have been cleared medically to do so. If you have a lack of energy and have questions about yourself, let's talk about it on your next monthly visit.  There are many causes for lack of energy, some mental, some physical.  We can cover them with you then.   I should mention that sugar and sugary drinks actually ROB you of energy by reflex

The Role of "Appetite Suppressants" in Treating Obesity  
There is an old saying: "there ain't no free lunches."  What this means is that for anything "given" to you, there is a price.   In medicine, we balance the good a medication does with the side-effects and lack of expected problems.  Appetite suppressants are really hunger suppressants that take the edge off your desire for food.  They work inside the brain in the hunger center and tend to dull or eliminate the drive to eat that is generated by perceived hunger.  This means that the natural forces that make you eat are affected, but it usually does nothing for cravings, or compulsive eating.  Problem eating is about 5% real hunger and 95% non-hunger triggers of undesirable eating patterns.  If you forget or ignore this fact you are doomed to fail. When a person sits down to eat after having not eaten for five or six hours, the drive that makes her eat is HUNGER!  When that same person has a full stomach and still wants a piece of pie, that is APPETITE!  Many of us use eating to relieve other things besides hunger.  We may be conditioned to eat when we are angry, tense, unhappy, sleepy, or tired.  We may also eat when food cues, such as being offered food, are encountered.  This type of eating has nothing to do with hunger, and is NOT usually helped by hunger suppressants. The literature that I gave you is full of examples of how you can eliminate these false food cues and fight them.  Your own retraining of your mind and habit patterns will do more for you to stop these undesirable eating habits than all the medications in a drug store.  When a patient expects to have the medication "do it all," he or she will almost always be disappointed.  You are going to have to do 90 per cent of the work if you want lasting slimness.  I will help you all I can, but there is just so much that medications can do! Hunger suppressants can occasionally cause you to be jittery, dry-mouthed, irritable, and can interfere with your sleep.  In case this happens to you, take the medication earlier or break the tablet in half and try  a lesser dose.  If the medicine comes in a capsule, open the capsule up and pour out about half of it to cut the total strength down.  You may then take what is left.  By all means, let me know on your next visit that it gave you problems so I can adjust the dosage.  In many cases, the true cause of the symptoms listed above was NOT the medication, but hunger caused by skipping NEEDED meals.  The hunger suppressant will dull your hunger, but it will not stop your body from objecting to you if you haven't fed it properly.  Patients who starve themselves wind up sick, uncomfortable, and usually with no real fat loss. The low blood sugar levels caused by starvation or too little food will cause you to have the above symptoms.  These symptoms are caused by your body's effort to raise your blood sugar by putting out epinephrine (adrenaline) into  the blood stream.   This is what causes the rapid pulse, sweating, weakness, and general discomfort that follow a low blood sugar episode..  If you eat properly this should not happen. You will occasionally note side-effects with these hunger suppressants.  Dry mouth is seen at times, but this is helped somewhat by drinking more water and adjusting the dose.  Bladder irritation is rarely seen, but is an occasional problem.  Jitteriness is common, but is usually not long-lasting.  We occasionally see temporary male impotence, but this is relatively rare. Surprisingly, blood pressure elevation is not the problem  that the textbooks say it is.  With the low doses of hunger suppressant that are used in this office  we have rarely had problems.  These drugs dilate the blood vessels (dropping  the pressure somewhat) while they cause the heart to pump more forcefully (increasing the pressure a little).  The result is usually no real change in blood pressure, but a significant fat loss that in itself helps decrease blood pressure. The long-term effects are usually beneficial to patients and most patients wind up better off, with reduced need for blood pressure drugs, or the ability to get off them entirely when ideal weight is reached. A bonus effect of hunger suppressants is their ability to help us break through the SET POINT that often causes us to stop losing fat at a certain weight.  This is an attempt by the body to conserve fat, but it can be overcome by a combination of aerobic exercise and use of certain hunger suppressants.  This was recently mentioned in several  medical journal articles by Drs. Stunkard, Weintraub and Atkinson, some of America's foremost experts on obesity.  They used phentermine and other drugs in their studies, but Meridia and the other suppressants have the same effect. If you wish to use hunger suppressants, or if you have questions about them, please tell me.  Properly used, they are of great value, just like anything else.  Improperly used, they could cause harm, particularly at an excessive dosage.  Ask me about using hunger suppressants in a safe

The Set Point in Weight Control  
Your body tends to hold on to it's fat, particularly when your caloric intake is less than what your body needs.  This process is called the SET POINT.  If we don't get enough food, the body simply cuts down on what it burns, unless we force it to  go ahead and use calories by increasing our exercise.  Then the body loses fat in spite of it's defense mechanisms.  Appetite suppressants also help overcome the set point, so you should take them daily if we prescribe them, but if you don't do some type of exercise daily it is doubtful that you will be successful.   Walking is the best exercise of all.  Talk to me about possible exercise prescriptions for you if walking is not always possible.  Sugar and alcohol produce disasters and should be avoided TOTALLY while you are dieting.  One drink of alcohol can ruin an entire month of dieting.  One regular soft drink can wreck as much as a week's worth of dieting.  This can get very

Thin Thinking Versus Fat Thinking  
I used to weigh 240 pounds.  I don't any more, but  I still think like a fat man.  Below is a description of how thin people think.  Thin people: Avoid eating movie popcorn because it is greasy. Split a large pizza with three friends. Think Oreo cookies are for kids. Nibble cashews one at a time. Think that doughnuts are indigestible. Read books they have to hold with both hands. Become so absorbed in a weekend project they forget  lunch. Fill their desk candy dish with paper clips. Counteract the afternoon slump with a walk instead of a Danish. Exchange a gift deep-fryer for a radio. Lose their appetites when they're depressed.. Only use leftovers too skimpy for another meal to make soups. Prefer The Joy of Sex to The Joy of Cooking. Throw out stale potato chips. Only eat Swiss or Dutch chocolate, found in special stores. Think it's tacky  to stop at a special store just to buy chocolate. Don't celebrate with a hot-fudge sundae when they lose weight. Warm up after skiing with coffee instead of hot chocolate. Try all the salads at the buffet, and have only one dessert. Find iced tea more refreshing than an ice-cream soda. Get into interesting conversations at cocktail parties and never quite work their way over to the hors-d'oeuvre table. Have no compulsion to keep the candy dish symmetrical by reducing the jelly beans to an equal number of each color. Think that topping brownies with ice cream makes too rich a dessert. Bring four diet cookies into the TV room instead of a

Water and Fat Loss: A Vital Connection
How eight glasses of water (or more) keep fat away! Water is possibly the single most important helper in losing weight and keeping it off.  We take it for granted, but water is the only true magic potion for permanent weight loss. Water suppresses the appetite naturally and helps the body to metabolize stored fat.  Studies have shown that a decrease in water intake will cause fat deposits to increase, while an increase in water intake can actually reduce fat deposits. Here's why:  The kidneys can't function properly without enough water.  When the kidneys don't work to capacity, some of their load is dumped on the liver.  One of the liver's primary functions is to metabolize stored fat into  energy for the body.  But, if the liver has to  do some of the kidney's work, it can't operate efficiently.  As a result, it metabolizes less fat, more fat remains stored in the body and weight loss stops. Drinking enough water is the best treatment for fluid retention.  When the body gets less water, it perceives this as a threat to survival and begins to hold on to every drop.  Water is stored in extracellular spaces (outside the cells). showing up as swollen feet, ankles, legs, and hands. Diuretics offer a temporary solution at best.  They force out stored water along with some essential nutrients.  The body perceives a threat and replaces the lost water at the first opportunity.  Thus the  edema, or bloating, quickly returns.  The best way to overcome water retention is to give your body plenty of water. Then  the stored water is released naturally. If you have a constant problem with water retention, excess salt may be to blame.  Your body will tolerate sodium only so much.  The more salt you eat, the more water your system retains to dilute it.  But getting rid of unneeded salt is easy--just drink more water and eliminate sodium through the kidneys.  A heavy person needs more water than a thin person  since larger people have larger metabolic loads. Water maintains proper muscle tone by giving muscles their natural ability to contract and by preventing dehydration.  It also helps to prevent the sagging skin that usually follows weight loss.  Shrinking cells are buoyed by water, which pumps the skin and leaves it clear, healthy, and resilient. Water helps rid the body of waste.  During weight loss, the body has a lot more waste to get rid of.  All that metabolized fat is changed to water and must be "flushed out."  Drinks  that contain sugar, such as Gatorade are cruel jokes on dieters and should be avoided.  Read the labels and if there are no calories or ingredients listed, or there are more than 3 calories per eight ounce glass of a drink, avoid it like the plague.  Ask me if there are any questions.  Be a label-reader and nobody can fool you with some fake "diet drink" that is loaded with

Weight Loss Versus Fat Loss  
What is it that you hope to lose when you go on a diet?  The answer, of course, is weight, but the weight of what?  Each person's overall weight is actually comprised of two components.  One of these components consists of the individual's muscles, bones, and vital organ tissues, and is called lean body mass (LBM).  The other component is fat.  Although most people talk about wanting to lose weight, are you really interested in losing muscles and other vital tissues, or are you interested in losing unwanted fat? Unless you have a weight clause in your work contract, like some airline employees have, you really shouldn't be concerned about whether or not you have excess protein and muscle deposits on your body.  After all, it is excess fat that jeopardizes our health and detracts from our appearance.  If you think about it, have you heard anybody complain lately that their muscles were too heavy? It is known that if we diet without exercising, we lose too high a proportion of LBM along with the fat lost.  Since it isn't healthy to lose vital tissues over a period of time, this loss of mostly muscle protein must be minimized.  If we aren't careful this muscle loss can be substantial.  Charles Kuntzelman, author of the book, Diet Free, contends that for every pound of fat we lose, we could lose as much as two pounds of LBM.  The fat loss is desirable, but the muscle loss is not.  That's because the more muscle tissue we have, the higher our metabolic rate is. While dieting without exercise can result in the loss of substantial amounts of muscle as well as fat, I'm happy to report that if you exercise properly while dieting, about 90% or more of the weight you lose will be fat.  I want you to think more in terms of body composition than body weight.  If you don't exercise, your loss of body weight may actually be indicative of a dangerous change in body composition. How many days have been ruined for you because the scale showed that you gained an ounce or two?  If you have understood what I have been discussing up to this point, you should be able to free yourself from enslavement by the scale.  Begin by repeatedly reminding yourself that your concern is with losing fat, rather than weight.  Then develop the habit of gauging your dieting progress in terms of changes that reflect loss of FAT, such as a shrinkage in your body measurements and a need for smaller sizes of clothing. It's also important that you realize that a slower than expected loss, or actual gain of body weight, may indicate a beneficial change in body composition.  What I'm referring to is the fact that when they diet and exercise, some patients actually GAIN lean body mass.  If you are losing inches like crazy, but the scale isn't budging, don't worry about it.  It means a loss of fat and a gain of valuable LBM.  Your friends will all assume that you have lost "weight" because of your slimmer look.  If they ask you how much you've lost, simply say, "I've gone from a size ____ to a size____". In closing, let me emphasize that to lose fat and not LBM, you MUST do some daily exercise.  Ask me about 

What is a Thief?  
There are many varieties of thieves in the world, but the most vicious of all are those who steal something of great personal value from another person.  The thing stolen doesn't need to have resale value in order to make the crime a serious one.  Sometimes, the item that is stolen away from the owner is health, happiness, and self-respect. The person who is trying to diet and lose unwanted fat moves through a jungle of food cues and temptation every day.  In a large percentage of cases this person must lose the weight in order to prevent significant health problems, or to lessen the seriousness of an illness already existing.  Fat loss will make the person feel better and healthier, both mentally and physically.  Fat gain, or lack of fat loss, will perpetuate the problems that already exist in the patient's health situation. With all of these pressing needs you would think that nobody in her right mind would attempt to get a dieter to go off a weight losing program.  It is both disappointing and a source of anger to me that some people would, indeed, try to sabotage another's plan of fat loss and self-improvement.  Almost daily I am told by some luckless patient that he or she was literally bullied by someone into eating or drinking something that was forbidden.  At the time the dieter did not have the ability or the strength to resist, but later was overcome by guilt and remorse while the culprit went happily off to seek another victim. The purpose of this note to you is to make you aware of this problem and to suggest some possible remedies.  In the process it is hoped you will launder your mind of guilty thoughts and look closely at this saboteur.  In other writings I have called them Feeders, but they have another name, Thieves and Scoundrels. Each month you put out a substantial amount of time and money to pursue your goal of thinness and a healthier body.  This time and money have a certain value.  Anyone who would try to wreck your diet with "just a little bite of this" and with the admonition, "come on and try it, it won't hurt your diet," is stealing something of great value from you and should be treated like a Thief and Scoundrel! Even if you dismiss their tempting words as the mouthings of fools, you still are being put at risk and are in danger of going off your diet because of these sabotage efforts.  Since only a fool or malicious busybody would try and wreck your diet, you owe this person no courtesy or consideration.  Treat her (or him) with the contempt she deserves and try to remove her from your life if possible.  If you can't totally avoid her, try to minimize your contacts and live your life and diet as you see fit.  Books on assertiveness and self-improvement are available in any library.  If assertiveness doesn't work, try avoidance.  If avoidance doesn't work, try showing her this sheet or talk to me about it for

Who Should Not Diet  
We have known for a long time that there is a connection between dieting in the early stages of pregnancy and birth defects, low birth weight babies, stillbirths, and generally poor survival of the infant.  The main difficulty is the low caloric intake, not the medications.  Particularly during the first three months of pregnancy, there are problems if the caloric intake drops down much below 1,800 calories daily. Be sure that you are not pregnant before starting on any weight program, plus don't get pregnant during the entire time you are on the weight-losing stages of your diet.  Once you start the program of weight loss, keep using birth control until you reach maintenance.  It is better to be safe than

Why Didn't I Lose Any Weight  
The most common cause of discouragement in our program is lack of weight loss on the scales.  I have had women lose two dress sizes in a month, but because they failed to lose weight on the scales, they quit the diet.  If you will think about it, THIS JUST DOESN'T MAKE SENSE! A person who is successfully losing fat every day will begin to shrink in size.  As fat is burned, the body must get rid of the waste products (mostly water) through the kidneys.  Sometimes, this waste water is retained for some time and it artificially raises the weight of the person on the scales.  Unless you are aware of what is happening, you can lose your motivation and quit the program.  Again, THIS DOESN'T MAKE SENSE! Think of your body as a living warehouse, one we can weigh on the scales every day.  Inside the "building" you have stored fat, protein, water, salt, bone, brain tissue, and waste products.  During every day of your life you put in a certain amount of water and get rid of a certain amount of fluid.  When you burn fat, this fat is changed to water and waste products and these byproducts are then eliminated.  If you exercise, healthy muscle tissue is built up into what I call "good weight." All of these items in your "building" affect what you weigh, depending on how much of each is present at the moment you step on a scale.  Water retention from medications, excess salt intake, hormones, or menstrual cycle changes can force the net weight upward, EVEN THOUGH YOU ARE LOSING FAT DURING THIS TIME.  Bowel Irregularity can produce a temporary increase in net weight of as much as two or three pounds.  A full bladder (vs. an empty one) can add an extra pound or so.  The "good weight" from muscle tissue growth can add poundage too. What does this mean to you then, when you step on the scale?  You basically have a number given to you by a hunk of metal.  If the number is less than before, you have lost "weight" on the scale.  You can usually believe this indicator of progress, but you CAN'T believe it if you have been exactly on your program and the scale doesn't show it. Please don't fall into the scale-watcher trap.  If you only look at the weight on the scale, you are doomed to failure.  Think more about body composition changes than about scale weight.  Look at the way your clothes fit you.  Are they looser on you than they were?  Are you able to get into things that had gotten too small for you before you started your fat loss program?  If so, you have lost FAT, and this is the name of the game, FAT LOSS INSTEAD OF WEIGHT LOSS!  The scales typically will lag from one to four weeks behind the changes in size, so don't give up and stop your diet for the wrong reasons. Don't forget to keep doing your daily exercises, in order to keep yourself as trim as possible.  The toning effects of the exercises are an additional bonus that adds to their ability to raise your metabolism, both directly and indirectly.  If you exercise properly and faithfully, almost 90% of your solid weight loss will be FAT loss.  In summary, quit being a slave to the scales.  Take the time to really observe what is going on in your body.  As the fat is burned off, your healthy protein stores are increased, and your size shrinks, and you get slimmer and slimmer. Don't let your friends get you discouraged because they have lost more "weight" than you have.  Everyone is different, and besides, they may be stretching the truth when they tell you how much they have lost.  Talk to me if there are still

You Can Come With Us And Have A Salad!  
There are many traps for dieters, but one of the most common that I hear about is the SALAD TRAP.  A lot of people on a diet are talked into going to a restaurant or fast food place with this big lie.  I don't know about my patients, but I find it very hard to simply eat a salad while my "friends" are sitting across from me and smacking their lips over pizza, pasta, Mexican food, Chinese food, or some dessert. This is about as cruel as someone can be to you.  The situation often comes up when you are out with other people and are a relative captive to their wishes.  Only let yourself be trapped like this once, and from then on avoid being anywhere with them where problem eating might occur.  I always have something else to do when approached by this type of feeder, and you should too. Another example of this occurs usually with a woman who goes shopping with other women.  I have found that food or dessert is almost always involved with any excursion to stores or shopping malls.  It is a good idea not to trust most people, particularly if you have been trapped by this same person or persons before.  Avoid people who attach themselves to you and always want you to go around problem foods.  Make any excuse necessary to keep away from these nuisances.  Also, never  go to problem eating places with your family.  Being a parent doesn't entitle you to be abused by excess temptation with pizza, fried foods and other things that are even worse. Remember! Never go shopping or to lunch with another woman, and very few