"How the Rich Get Thin" Excerpt

Chapter One: The Park Avenue Mind-Set

You can never be too rich or too thin.
-- Wallis Simpson, Duchess of Windsor

The Upper East Side of Manhattan is one of the most exciting and dynamic places in the world. It is also one of the areas of highest concentrated wealth in the world. The people who live in the elegant apartments and town houses in our neighborhood have a lifestyle defined by long working hours, hectic schedules, and the pressure of always looking their best. They are under constant time constraint juggling work, deadlines, meetings and social obligations, domestic and international travel, plus personal commitments. Time is a very precious commodity in New York City, and not something to be wasted. Park Avenue people are constantly in a hurry to get to the next appointment, to conquer the next rung on the social ladder, and to achieve another professional success. They work hard, they play hard, and they demand the best of everything.

Men and women who have arrived at the pinnacle of success want to look and feel fabulous once they get there! Their occupations and social circles require that they "look the part." They strive not only to be chic; they want to be fashionably slim. But the excessive hours of working, high-profile entertaining, and abundance of the best foods also contribute to an expanding waistline. They don't plan for the midafternoon hunger by tossing a piece of fruit or a container of yogurt into their briefcase or Hermès bag, so by dinnertime they arrive at a restaurant famished and dive right into the bread basket; they postpone an exercise session until the end of the day instead of scheduling it for the first thing in the morning (a time when the session cannot be interrupted or forgotten); they cut their schedules too tight so that taxis are taken for distances that could easily be walked. In effect, it is an accumulation of time misspent that makes their weight gradually creep up.

For my patients to enjoy what they have worked so hard for, they must change their behavior and realize the truism that life and health are gifts. The magnificent mind and body that provided them with the good life can become old before its time if not treated with respect. By approaching eating and exercise with the same discipline that characterizes the rest of their lives, their excess weight is lost, and a vibrant, youthful appearance is regained.

What Is the Park Avenue Mind-Set?

People who can afford to live on Park Avenue (or in other upscale areas) exhibit certain recognizable character traits. Because residence in this prime area is so valued, these traits are also associated with financial success. They tend to be highly competitive, always in a hurry, impatient, status conscious, and they want to be noticed. They are often preoccupied with work. These traits are true for both males and females.

Women who are not working outside of the home and are married to successful men with the Park Avenue mind-set are often just as driven. These women often belong to charitable groups and raise millions of dollars for worthy causes they are passionate about. In fact, many organizations would not be able to exist without the tireless work of these dedicated women. However, there is an expectation that they have to look perfect at all times. There is an intense competitiveness to looking fabulous at this level.

Since the 1960s reign of such New York socialite icons as Slim Keith, Doris Duke, and Babe Paley, dubbed the "beautiful people" by Diana Vreeland, the beloved editor of Harper's Bazaar and Vogue, the rich have been considered the great influencers of fashion, style, and culture. As Wallis Simpson, the American-born Duchess of Windsor, once said, "You can never be too rich or too thin." The Park Avenue princess lives, dresses, and dies by this motto. And she may unknowingly sacrifice her health to do so. While it may be true that you cannot really be too rich, you most definitely can be too thin. By maintaining a dangerously low weight to fit into sleek designer fashions, a woman may eliminate vital nutrition. The items that I find lacking most commonly in such people are dairy products and sufficient protein. In some cases, such extreme dieters are fighting a never-ending battle with a body type they were born with, instead of eating sensibly to sustain the health of the body they have.

How Your Body Type Affects Weight Gain

Your body type is determined largely by genetics, over which we have no control. William Sheldon, M.D., first developed the concept that everyone is born with a certain body type. Dr. Sheldon outlined three basic body types: ectomorph, mesomorph, and endomorph.

Ectomorph is the type that fashion magazines would have us aspire to: tall with long, thin limbs and little body fat. Most supermodels and basketball players are the ectomorph body type. It is an unrealistic goal for many people not born this type.

Mesomorph body types are characterized by an athletic, strong, and compact body. The world's top figure skaters and tennis players tend to fall into the mesomorph category.

Endomorphs are round and gain weight easily.

The body type that you were born with is the body type that you will have for life. It is one of your physical characteristics, just like your eye color. If your goal is to keep yourself in the best of health, by avoiding excess weight, exercising daily, and maintaining correct posture you will look fabulous whatever body type you possess.

Body Types

Ectomorph -- slim, lithe, long-limbed: Gisele Bundchen, Cindy Crawford, Chris Rock

Mesomorph -- athletic body, muscular: Gabrielle Reece, Katie Couric, Sarah Jessica Parker, Mark Wahlberg, Andre Agassi, Kristi Yamaguchi

Endomorph -- round, voluptuous: Queen Latifah, Danny DeVito, Roseanne, Dr. Ruth, Azzedine Alaia

Do You Need a Medicine Cabinet Makeover?

I have heard some pretty amazing stories from patients about the lengths they have gone to in order to lose weight: fad diets, smoking, laxatives, and even stimulants like amphetamines and cocaine. Losing weight by any of these methods can result in a disruption of the body's chemistry. While people may lose weight by such means, their health declines and they end up looking worse and worse.

Unscrupulous medical professionals, especially via the Internet, give ready access to a variety of dubious medications promising weight loss. Many of my patients have previously tried unsuccessfully to become thinner by taking such "miracle" pills and potions only to find that the drugs were sabotaging their health. Thyroid stimulants, diuretics, nervous system stimulants, and the like can take a strong mind and body and turn it into a medical emergency: Unnecessary thyroid medication will cause bone loss and arrhythmias. Diuretics are dehydrating and put a strain on the heart. Stimulants cause an increase in both blood pressure and heart rate. Yet I have seen many patients who, out of desperation, have resorted to these means.

Don't become lured by an unhealthy solution to excess weight. There is no place in your life for this!

Drugs That Cause Weight Gain

A number of prescription and over-the-counter medications are associated with significant weight gain. Unfortunately, patients are not always told in advance about this unwelcome side effect: A weight gain occurs and the patient doesn't know why.

These medications are frequent causes of weight gain:

Antidepressants: Fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil) are effective antidepressants but can increase weight. A different class of antidepressant also associated with weight gain is mirtazapine (Remeron). For someone who is depressed, these drugs can lift the heavy emotional load; however, they should only be prescribed by a competent psychiatrist -- never purchase them on the Internet. Antidepressants that do not increase weight are bupropion (Wellbutrin) and nefazodone (Serzone).

Antipsychotics.

Antiseizure medications: Just about all of these medications cause some weight gain with the exception of topiramate (Topamax), which may cause weight loss.

Oral contraceptives (Yasmin may cause weight loss).

Corticosteroids (for asthma, autoimmune conditions, and allergies).

Antihistamines (for allergies).

Beta blockers (for high blood pressure).

If you are taking any of the above drugs and have gained weight, do not assume that your doctor knows that you are experiencing weight gain, because it does not occur in all patients. Discuss your weight change with your physician. There are alternative medications that may work just as well for you. For example, decongestants may be substituted for antihistamines; ACE inhibitors or calcium channel blockers may be substituted for beta blockers; antidepressants that do not cause weight gain as a side effect can be substituted for those that promote weight gain; barrier methods can replace oral contraceptives.

Julia is a thirty-eight-year-old mother of twins who experienced a depression after the end of her ten-year marriage. She consulted a psychiatrist, and was treated with psychotherapy and a high dosage of paroxetine (Paxil). After several months, her depression resolved and she stopped seeing her psychiatrist. But four years and thirty pounds later, this young woman was still taking the medication plus an oral contraceptive and an antihistamine. Distressed because her own weight-loss efforts were not working, she sought my help to lose weight.

When I spoke with Julia, she was amazed to hear of the combined effects of her medications, as their potential for weight gain had never been explained to her. First, I suggested that she consult with her psychiatrist, whom she had not seen in over three years, to assess whether she could safely eliminate the antidepressant; she had been obtaining paroxetine (Paxil) prescriptions from her primary care physician. Her psychiatrist agreed that she did not need the medicine anymore. She was able to reduce her antihistamine, which she took for hay fever, to a minimal amount on high-pollen days. Julia lost the excess thirty pounds in about three months. She is now happy, confident, and slimmer.

The drugs were probably appropriate at the time they were prescribed, but she should have been told that weight gain was a possibility. Also, her use of medications had continued for longer than necessary. Additionally, mixing medications had had a cumulative effect with regard to weight gain.

The Myths of Diet Drugs

Baby boomers are known to demand the "instant gratification" factor. This is a real problem with weight management because there are no shortcuts. A magic pill that will cut appetite, raise metabolism, and give you a supermodel body does not exist. There are medications that treat obesity, but they only work when combined with diet and exercise. One of the worst things that a physician can do is to prescribe any of these medications without explaining the limitations of the drug, and not stressing that they won't work without changing the diet. And, like every medicine, they all have side effects.

Drugs That Reduce Food Intake

The drugs listed are prescription medications and should only be taken under a doctor's supervision. The Internet has made these medications available online, which has resulted in serious medical consequences, including death. If you have a significant amount of weight to lose, consult with your doctor about a diet and exercise plan.

Phentermine, which decreases appetite, is the most widely prescribed and oldest prescription weight-loss medication, having been around for thirty years. It stimulates the release of norepinephrine and dopamine from nerve terminals. As such, it increases the heart rate and raises blood pressure. Other side effects are dry mouth, constipation, and insomnia. Because of its effect on blood pressure and the heart rate, usage of phentermine should be carefully monitored, and the suggested treatment period is no longer than six weeks.

Several years ago, the combination of phentermine and fenfluramine (Phen Fen) was thought to be the answer for quick and easy weight loss. People who took the drug experienced dramatic reduction in weight and felt almost no hunger. But soon this "miracle drug" was found to be responsible for damage to the heart valves. Tragically, several deaths resulted from the drug and it has now been removed from the market. The gold standard of weight loss has always been a healthy diet and exercise. Don't risk your life by using this dangerous drug combination.

Continue on page 2