Brief Answer:
Thank you for reaching out to us at HCM

Detailed Answer:
My dear, The answer to your question is not simple. First, your situation is very complex and there is no one answer to just losing the 40 pounds. First, we need to plan your diet around all the medications you take for your chronic conditions as so many of them cause metabolic changes that cause you to either crave sweets, increase your appetite beyond fullness and make you feel lethargic.

You live in the United States, so depending on your insurance most pay for a diabetes education program. I highly suggest you enroll in one and also the support group that goes with it.

Your environment and lifestyle factors interact with the metabolic changes caused by medications. Exercise will reverse some of these effects. I completely understand the pain with the arthritis. Do you have access to pool therapy? Low impact movement of some kind is of utmost necessity as approved by your primary physician.

It is necessary to get adequate sleep as that will affect weight gain by afflicting your circadian rhythms and melatonin. Set a specific time each night to go to bed with the tv off; learn to practice some sort of progressive relaxation to deal with stress.

Now, are you asking for further fat loss or is the problem specific to the hanging skin? If the hanging skin is from losing weight and you don't plan on losing anymore, it is usually surgically removed in the US if you can show the excess fat is causing you rashes under the folds and the excess skin is now creating a chronic medical condition.You said you are allergic to yeast - if you are getting candida infections under the fold have your doctor document this and discuss his opinion on surgical removal.

No matter how much you hurt now, if we don't get you up and going you may hurt worse. We need to get you on a total lifestyle plan. I will be back later this after noon. Please write back for clarifications or specific questions and welcome to my virtual clinic. Kathy Shattler, MS,RDN

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Brief Answer:
Oh, hon, I am not done with helping you yet.

Detailed Answer:
XXXXXX,
I need to get you on your meds correctly so they aren't working against your weight problem.

First thing in am have a 6 oz. cup of hot green tea. You have hyper or hypo thyroidism as it is important as to how to take meds for low thyroid. Nevertheless, continue to drink green tea up to 3x per day to help boost metabolism.

Since abdominal weight is metabolically active, it is important to be concerned. I can relate to the arthritis pain and the difficulty walking. Again, swimming (many low cost classes at the YMCA), low impact exercise, arm exercises or try one of the numerous "Sit Fit" programs. Exercise will turn off some of the genes your problems have turned on. VERY important. Please try.

To lose weight it takes a deficit of 500 calories per day to lose one pound per week. Every calorie counts, especially since your body is working against you unless you exercise, eat right and assure adequate vitamins/nutrients. I suggest looking up the DASH diet and following a controlled calorie diet.

Please refer to high glycemic carbohydrates in a google search. Some individuals respond well to avoiding these foods to help control sugar and body weight. Eat scheduled meals (important to help regulate hunger hormones) and a small snack.

You may choose to count carbohydrates and eat about 150 g carbohydrate per day focusing on eating up to 75 g lean protein sources and limiting saturated fat and eliminate all fried foods. Replace cooking oil with virgin olive oil and make your own sauces and salad dressings.

Eat only fresh fruit, fruit canned in its own juice; no juice only 8 - 10 glasses of water per day.

Take care with Clonidine as you will gain water weight. Another reason (aside from hypertension) to cut back on the salt (2,300 mg. sodium).

Take your simvastin at night.

So, please google Dash Diet, high glycemic foods, try the green tea, possibly a chewable multivitamin in am with breakfast and more than likely you need calcium due to depletion effect of omeprazole and almost everyone is vitamin D deficient, but since funds are limited and the test is expensive I will not ask you to get it tested.

I have thrown so much at you. You need to start somewhere. Does any of this help? You sounded so discouraged. You can DO something about these issues! Oh and capsaicin cream rubbed on your knees will relieve pain enough to move around less painfully and although I am not prescribing, just alerting you. Feel free to look up some of the things I advised and feel free to write me back if you think you can make a commitment to the rest of your life! I will clarify and further advise. XXXXXXX Shattler, MS,RDN If no further questions please close out, but I am here should you need me.

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