Sibutramine (Meridia) is a norepinephrine and serotonin reuptake inhibitor. Weight loss is dose dependent: It affects the appetite center of the brain, where it increases satiety so you feel full faster and with a smaller quantity of food. The drug has been extremely well studied. Clinical studies have shown that sibutramine is effective and safe, if properly prescribed. Blood pressure and heart rate must be monitored, however, as sibutramine can cause a dangerous rise in blood pressure. Sibutramine should never be used in patients with a history of coronary artery disease, congestive heart failure, cardiac arrhythmia, or stroke. Because its action affects the brain, it is not safe to take with most antidepressant drugs. The side effects of sibutramine include dry mouth, constipation, and insomnia.

Orlistat (Xenical) is unique in that it does not enter the circulation but rather works in the digestive system to block the absorption of fat, which is then eliminated from the body through the stool. If you eat too much fat, diarrhea is the unhappy result. Orlistat works well because its action is entirely within the digestive tract; it doesn't interact with other medications, and does not raise blood pressure or the heart rate. However, because it blocks absorption of fat, it blocks the absorption of the fat-soluble vitamins, and these should be taken separately.

The truth is that there is no ideal weight-loss pill. Medications are suitable for some people, and can assist in raising the metabolism forward, but they are useless if exercise and an optimal diet are not in place. You won't need drugs with my plan.

Nonprescription Weight-Loss Drugs

Drugs that are sold over the counter and over the Internet promise weight loss but deliver little in the way of results. Weight-loss supplements fall into two basic categories: those that claim to suppress appetite and those that block the absorption of food. The appetite suppressors contain caffeine like substances (such as ephedra or ma huang, which is now banned). Studies in animals have indicated a small appetite-suppressant effect, but the human studies have been too brief to support the claims.

Appetite suppressants have the side effects of increasing blood pressure, headache, insomnia, and heart palpitations. You will feel jittery, as is the case with too much coffee. The absorption-blockers seem to have a small effect, but cause side effects of bloating and gastrointestinal complaints.

The bottom line is: Over-the-counter and Internet-sold drugs do not work, and are usually not safe. Save your money. You have to change your diet and exercise routine to see a meaningful change in your weight.

The Park Avenue Mystique

According to the New York City Department of Parks and Recreation, what is now Park Avenue was originally laid out in the 1811 Commissioners' Plan as Fourth Avenue. In 1832, the long, narrow strip down the middle of the island was granted to the New York and Harlem Railroad, which ran horse-drawn cars along its path, starting with a run between Union Square and Twenty-third Street. By 1834, the service operated from Prince Street to the Upper East Side. Though given its present name in 1888, it was the 1903 conversion from steam to electric train power and the 1913 completion of the present Grand Central Terminal that paved the way for Park Avenue's future. The previously open rail yards and tracks north of the terminal were covered over between 1921 and 1924, and the avenue's wide, landscaped center medians gave credibility to its name. Subsequently, the wide malls were narrowed to their present configuration, to accommodate wider traffic lanes.

Today Park Avenue consists of rows of apartment buildings on the east and west sides of the street, separated in the center of the avenue by wide, planted islands. As the seasons change, so do the lovely gardens. In summer, the plantings consist of begonias; spring, tulips and flowering apple blossoms; fall, chrysanthemums; and the end of the year brings festive and beautifully lighted Christmas trees. The apartment buildings lining Park Avenue embody conservative elegance. Some of the grandest residences were constructed between 1920 and 1930 by Rosario Candela, with only one apartment per floor. Candela's apartments created the "off the foyer" layout, in which the foyer was an additional room that set the tone for the entry into the formal living space. Candela's well-constructed apartments had thick walls, large rooms with elegant double moldings, and very high ceilings. Born in Palermo, Italy, Rosario Candela's father was a plasterer. The architect Candela's own story represents fulfillment of the American dream, because today his elegant buildings are landmark structures and epitomize New York City living at the highest level. Our office is located in one of the beautiful buildings built by Rosario Candela.

Do You Have the Park Avenue Mind-Set?

1. Do you have a sense of time urgency? Are you always in a rush?

2. Do you inhale your food -- are you always the first one at the table to finish a meal?

3. Do you talk so fast that people tell you to slow down?

4. Will you sacrifice a health-promoting behavior, such as a yoga class, for an extra hour at the office or to take on one more after-school activity for your children?

5. Do you reach for a cookie or candy bar to power yourself through the afternoon?

6. Do you speed up at the yellow light?

7. Would you rather spend time working than working out?

8. Do you find yourself falling into bed at night and saying, "Not tonight, dear," because you have no energy left for sex?

9. Do you talk on your cell phone or eat meals while driving?

10. Do you eat on the run; i.e., in the car, at the airport?

11. Do you frequently order in or order room service?

12. Do you hit the mini-bar the minute you check into your hotel room?

13. Are your thumbs sore from using your Blackberry all day long?

14. Are you a multi-tasker?

15. Are you addicted to caffeine?

If you answered yes to two or more of these questions, you need my plan. And the more affirmative answers you gave, then the more likely the plan will be successful for you, because of your drive. The positive aspects of these traits focus you on your work; the negative aspects cause you to neglect your health.

Since knowledge is power, I suggest that you use this behavior pattern to improve your health and to identify what you are doing wrong. Your strong determination can actually be an asset in correcting the negative health patterns. When these people see that something is broken, they fix it!

How the Park Avenue Mind-Set Could Work for You

Sandra is a forty-five-year-old single woman who is a senior portfolio manager at an investment bank. Since becoming a senior executive, Sandra had allowed her weight to gradually creep upward, due to long hours at the office, little or no time for exercise, and eating out frequently, choosing rich foods. Sandra camouflaged her extra weight with expensive couture suits. While her overall health was good, her total cholesterol was just over 250 mg/dl. Her waistline had increased to 37 inches. Both of these are independent risk factors for disease. Sandra was accustomed to being "in charge" and informed me that she "knew all about eating and how to lose weight," but clearly she needed help with this. Sandra's work required her to entertain clients for dinner five nights of the week. Her business dinners were usually at four-star restaurants and always included fine wines. Sandra had an active social life that also included alcohol. If an average drink accounts for 200 kcal, then Sandra was consuming about 4,000 kcal per week just in the form of alcohol! One pound is equivalent to 3,500 kcal, so theoretically just by eliminating alcohol it would be possible for her to lose approximately one pound per week.

These are the changes I suggested for Sandra:

1. Eliminate alcohol. Drink only mineral water at business dinners. Initially, like all of my patients, she resisted this idea but, once she agreed to it, she was amazed at how easy it was. She ordered a large bottle of San Pellegrino and lime slices for the table. Her clients did not seem to mind her abstinence, and she also became more efficient at these meetings.

2. Stay away from the bread basket and order a crudités platter to be served prior to dinner. Sandra saved calories by eliminating simple carbohydrates and was a big hit with her clients. They loved the elegantly presented, chilled vegetables and thought this was a gracious gesture by their hostess. (After all, they were trying to control their weight, too!)

3. Order two appetizers as your dinner or cut the main course in half. Restaurant portions are just too big.

4. Make daily aerobic exercise a priority. No more excuses!

Because Sandra enjoyed being in control and saw the program was working for her, she focused her energy on this. After six months, Sandra had lost 35 pounds and normalized her cholesterol. She realized that simply being in a fancy restaurant is not a green light for passively overeating but rather another opportunity to control a situation. I was able to make her Park Avenue mind-set work to her advantage!

Jackie is one of my favorite success stories, and her story was actually published in Modern Bride because it was so inspiring to other women. Exactly one year before she was due to wed her high school sweetheart, Jackie resolved to lose 25 pounds. At five foot six, the bride-to-be was concerned about the weight she had put on in her twenties, a decade she spent drinking and partying. She needed a jumpstart to get her going. When I first inquired about her eating habits, Jackie told me that she only had coffee in the morning. As I probed the nature of this beverage, I learned that she was starting her day with a Starbucks Caffè Mocha Grande with whipped cream. We looked this up and she was astounded to find that the calorie content was a whopping 660 calories! Jackie switched to Skim Cappuccino Grande. As she waited in line at the local Starbucks, she warned her fellow caffeine lovers about the calorie content of her former favorite "coffee" beverage. I put Jackie on a regimen of running, weight training, and a healthier diet. She restructured her eating habits by reading nutritional labels; eating half portions when dining out; and substituting fruits, vegetables, proteins, and whole grains for sweets and fast foods. She cut down on her alcohol intake by switching to occasional low-calorie wine spritzers. As a result, the newly trim bride had her wedding dress taken in from a size 10 to a 6, and marched down the aisle like a diva!

Here is another typical patient of mine -- John, a fifty-six-year-old attorney who heads a law firm representing the music industry. His demanding schedule calls for almost weekly trips to the West Coast. His long workdays and extensive travel resulted in his becoming 75 pounds overweight -- and exhausted. When he finally saw his internist, John was diagnosed with high cholesterol, high blood pressure, and type 2 diabetes mellitus. John's lifestyle had made him wealthy in a material sense but had bankrupted his health! Luckily, his internist referred John to me. John, a highly motivated individual, was resolved to change his life for the better. He readily implemented the diet and exercise recommendations that I made. Travel was a particular concern. Although John always flew first class, he realized that the food served by the airline was not what he should eat while trying to lose weight. He followed my suggestion and took an 8-ounce container of plain low-fat yogurt, cut-up vegetables, and low-fat string cheese with him on flights. He drank only water while on board the plane. While in Los Angeles, he always stayed at the Peninsula in Beverly Hills. He asked his hotel to pack a lunch of smoked salmon and vegetables for the return flight. John made a point of walking two miles daily on his home treadmill and on business trips. As his weight came down, John was able to jog comfortably.

Over time, as his cholesterol, blood pressure, and diabetes resolved, I was able to reduce and subsequently discontinue all of John's medications. He made his health a priority and did not come up with excuses to avoid living a health-promoting lifestyle. He simply followed the Klauer Plan one day at a time. While continuing to manage the responsibilities and pressures of a demanding career, he chose to also reverse the illness within his body. He changed his life. He was still under the same time pressure but now made time for his health.

I tell Sandra's, Jackie's, and John's stories because: (a) If they were able to make these changes, then so can you; and (b) by committing to my diet and exercise plan, you can improve your health. When you consider each change that these very different people made, you realize that these are things that anyone can do. Their strong will and determination to persist are what enabled these people to change their lives. They did not give up and they did not give in! Day after day, they followed the plan that they saw was working until they reached their targets.

The key is to keep your goal in sight. It is your health and well-being that are at stake, and these are high stakes, indeed. Treat a weight-loss plan like a business plan -- have a goal and take the necessary steps to get there. As another successful patient stated, you must "plan the work and work the plan!" It will not happen overnight but if you persist, you will get there. The wonderful news is that when you follow this plan you can expect to look and feel better than you have in years.

Copyright © 2005 by Jana Klauer

BUY THE BOOK How the Rich Get Thin $20.42