l. Variety - your shield against boring meals, nutrient deprivation, illusionary short-term weight loss, and the yo-yo syndrome.

2. Moderation - Your servings may be smaller but very adequate and satisfying.

3. Balance - A sensible combination of fats (20-25%), proteins (15-20%), and carbohydrates (55-65%).

4. Gradual change - The transition from high-fat to healthier low-fat meals is easiest when it is slow and gradual. A radical change will not be permanent. Simply adjust the way you prepare and serve food, the amounts and frequency.

Like your Nutri-plan, the selection of an appropriate physical fitness exercise program must consider your lifestyle and health needs.

The major problem with many weight control programs is that rewards are expressed only in terms of weight loss. Losing weight does not automatically bestow the skill of maintaining it. Proper eating habits as well as other lifestyle changes, once installed must be automatically maintained.

Passwater: Is there an ideal reducing diet that works for everyone?

Conte: Absolutely NO!

Passwater: Is there any hope for the "genetically" gross obese--those who must lose 100 pounds just to be considered fat?

Conte: In weight control, as in everything we do in life, success if based on 85% attitude and 15 percent ability. Success is there for all of those who want it, plan for it, and take action to achieve it.

In my own Bariatric practice, I have several patients who have lost 100 pounds or more--My star patient is a young man who went from 448 pounds to 254 pounds in exactly one year. I am sure my fellow Bariatricians have similar successful cases. Surgical intervention has helped many grossly obese patients. Studies in Charlotte, NC, show that a combination of phentermine and fenfluramine is helping many morbidly obese patients. The FDA has granted a license to MIT to market Dexfenfluramine in the USA (more effective, fewer side effects). But, let me repeat once again: don't treat the scale, don't treat the disease who has the patient but the patient who has the disease. Examples of good medical care and what can be done to give hope to these genetically obese people are many.

I am looking at the Pittsburgh Post Gazette April 16, 1995, at pictures and story of participants in eating disorders group therapy sessions at St. Francis Medical Center in Pittsburgh--very, very encouraging to say the least.

Passwater: What do you recommend for taking off excess body fat?

Conte: Obesity is a chronic genetic, metabolic neural, hormonal disease. It is influenced by emotional, social economic factors interacting with each other and finally becomes a learned disorder. In other words, obesity is a heterogeneous disorder with multiple etiologies or causes, and hence multiple risk factors must be identified by history, laboratory data, and physical examination prior to establishing an individualized treatment.

An intelligent weight-loss program involves: Attitude - Nutri-Plan - Exercise and medications as necessary. These are the four magic keys to successful weight control. Understanding from the very beginning the difference between weight loss and fat loss, between diet and nutrition, and between being thin and being healthy. This understanding is a logical and important step in developing and maintaining a positive mental attitude for the long haul.

Because losing excess body fat is a gradual process, it favors a calm, collected approach rather than a frenetic "lose it now" mentality. You have to develop a less rigid lifestyle, one that reduces the need to consciously control what you eat.

Passwater: Are there supplements that help?

Conte: Yes. It is ludicrous to assume that every case of obesity can and must be treated without the judicious use of medications. I am referring not only to appetite depressants and diuretics. There are many obese individuals who need digestive enzymes, lipolytic agents (choline, inositol), metabolic correctors and nutritional supplements.

I am always emphasizing the difference between therapeutic doses and supplemental doses to my patients. All of them receive a one-a-day multiple vitamin/mineral (total formula). I believe that vitamins act as co-enzymes and are the catalytic agents or activators of all body activities and make them happen quickly and accurately. However, I am not a vitamaniac!

I am also a firm believer in the new age of alternative medicine, which is rapidly catching on because the public is fed up with surgery, drugs, and quick fixes.

Specifically, I am talking about the use of (-) Hydroxycitric acid, [HCA], the extract from Garcinia cambogia that grows in Asia, primarily in Southern India, and chromium picolinate.

Passwater: Have you tested these in a clinical trial? Are there any adverse effects or any conditions that preclude their use?

Conte: Yes, I have conducted three clinical studies on obese subjects using these non-drug, all natural weight-loss enhancers as well as using them in my private bariatric practice.

In an eight-week double blind study in 1991, the active ingredients group lost an average of 11.1 pounds per person while the placebo group lost an average of 4.2 pounds per person. The article describing this study was published in The Bariatrician in 1991. [7] The Bariatrician is the official medical journal of the American Society of Bariatric Physicians -- an international organization of physicians that seeks to encourage excellence in the practice of bariatrics through research, continuing education and exchange of information. This study was the first study done anywhere on humans (utilizing available pre-clinical research data developed with the aid of animal studies) on (-)HCA (extract of Garcinia cambogia) and chromium picolinate.

The 1993 study, a consumer study with no placebos and no exclusions because of associated medical conditions and therapies, but otherwise identical to the 1991 study, confirmed the effectiveness and safety of the original study: subjects lost an average of 11.4 pounds per person in eight weeks. In 1994, we did another consumer study identical to the 1993 study except for an additional laboratory procedure: detection of plasma chromium levels before and after the eight-week duration. The latter two studies were published in part in abstract form at the 35th Annual Meeting of the American College of Nutrition in 1994 and also in the booklet "Citrin: A revolutionary, herbal approach to weight management. [8-10]

The average weight loss was almost 11 pounds per person in eight weeks.

Passwater: How much should they take? Any side reactions? What rate of weight loss should people expect by using this approach?

Conte: The synergistic effects of (-) HCA and chromium picolinate, namely reduction in appetite and cravings for sweets while reducing fat formation and storage, and keeping insulin levels in check, have helped my patients lose excessive body fat and improve their health. HCA and chromium picolinate when taken as directed, that is, one capsule of 500 milligrams of Garcinia Cambogia [standardized to 250 mg of the calcium salt of (-) hydroxycitrate] and 100 micrograms of chromium three times a day, approximately one half-hour before meals is safe and effective. I have seen no side reactions to discontinue the treatment and they do not interfere with other medications.

Keep in mind the smart choice eating: a low-fat, low-sugar, low-sodium version of three meals per day, and a sensible daily exercise program.

Patients should drink a minimum of 64 ounces of water per day, which is essential to kidney and liver metabolic functions. Water intake overcomes the problems of water retention, helps to maintain normal body temperature and proper muscle tone; helps to rid the body of waste, relieves constipation and is a key to fat metabolism and storage.

A weight loss of l-2 pounds per week is achievable with this regimen.

Passwater: How should they measure their progress? Daily or weekly weigh ins? Tape measure? Calipers? Pinch test? Bioelectrical Impedance Analysis? Ultrasonic? Infrared?

Conte: Different strokes for different folks. My personal preferences:

l. Body Mass Index (BMI) - A chart that identifies the overall presence of fat in the body from all sources. 20 to 25 is associated with the lowest occurrence of disease and death.

2. Bioelectrical Impedance Analysis (BIA) - simple, non-invasive, accurate procedure.

3. Waist Hip Ratio (WHR) - shows the distribution of fat in the body. The acceptable WHR is l.0 for men and 0.8 for women.

4. Weekly weight - appears to be more productive during active phase of any weight control program; once every two to four weeks during maintenance and stabilization phase. If you're 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.

l. I want the patient to feel good.

2. To feel good about themselves -- after all, they are the ones who play the leading role -- myself, my staff, their family and true friends -- we all play the supporting role.

3. They must feel good about the program -- otherwise it won't work because it won't last. Smaller goals are easier to reach. "Success by the yard is hard, by the inch is a cinch!"