Our weekly webinars provide patients with education, encouragement and empowering ideas that arm them with tools necessary to create lasting change in their mindsets and habits surrounding weight-loss and healthy living. Tonight our discussion centered around the idea that honing and enhancing our problem solving skills is an important and essential piece of staying the course in our weight management efforts. Here are three things to consider: Problem Solving requires vision, creativity, persistence, optimism and resilience. These are all skills we can learn and strengthen over time. Effective problem solving requires us to assess which obstacles are in our control and which are out of our control. Even when obstacles are out of our control, there is ALWAYS something we CAN control. If you'd like to learn more, sign up for our weekly education series by emailing emily@shillmed.com (Our webinars are free for existing patients! Call or text 509-303-4001 for your free consultation!)

Weight Loss Before Surgery Provides Critical Outcome Improvements One reason I chose to focus my primary care career on weight loss is the significant impact I can have on a patient life. I'm happy to help people fix problems with their health, but I want to spend the majority of my time helping people prevent chronic disease so they can enjoy life to the fullest into their final years. Surgical Benefits of Weight Loss One of the strongest modifiable risk factors in a surgical setting is patient weight. Patients with higher weight have a higher risk of co-morbidities, complications, difficulty coming out of anesthesia and poor surgical outcomes. Not to mention, recovery from surgery is typically easier when one does not carry extra fat tissue. Faster Time To Surgery With Weight Loss Orthopedic surgeons know, some of the patients who most need knee replacement surgeries are the very patients who can't have them. Why? Because many surgeons will not take the additional risks associated with higher BMI. Some surgeons require weight loss before surgery to a BMI of less than 40, but lately, there has been a trend for surgeons to require a BMI of 35 or less. This not only improves safety in the operating room, but it improves the durability of the replacement joint and minimizes the risk that the joint will have to be replaced during the patient's lifetime. Improved weight --> Fewer Surgeries --> Improved Quality of Life. At ShillMed, we quickly help patients lose weight to achieve the required surgical weight WHILE maintaining muscle mass and managing related chronic co-morbidities. We coordinate with primary care and specialists as needed and have a strong focus on helping patient make lasting changes. We specialize in helping patients who have tried unsuccessfully, in the past, to lose weight. If your patient has a medical need to lose weight or if they have lost hope, we are ready to help them find enduring success. Losing weight often takes time, but our patients average 10-20 pounds per month (while maintaining muscle mass). So even if you've got 50-100+ pounds to lose before your surgery, we can get you to surgery fast. That makes for a better quality of life sooner! Improved Knee Joint Surgery Outcomes With Weight Loss Weight loss before joint surgery may seem overwhelming, but it can be done, and in many cases, it can be done quickly. Our patients typically lose 10-20 pounds per month while maintaining muscle mass, which is crucial for  safer anesthesia recovery and fewer joint infections . Losing weight prior to surgery also  reduces surgical risks, improves wound healing, and decreases the risk of blood clots,  among many other benefits. Our comprehensive approach is personalized to each patient and may include medical-grade meal replacements, GLP-1 therapy, chronic medication optimization, and personalized nutrition and exercise plans. To ensure safety during rapid weight loss, we monitor body composition (fat/muscle/water) at each visit, monitor labs, adjust medications, and provide nutrition training, all aimed to  improve mobility, enhance rehabilitation, and increase post-operative satisfaction . Our cash-pay plans are flexible and affordable, with custom length plans available to suit individual patient needs. I invite you to reach out with any questions or to discuss how we can collaborate to improve patient care. I am also available to meet one-on-one with any provider interested in learning more about our services. I look forward to working together to get your health back.

Fixing body composition by losing weight can be done safely, effectively, and rapidly with medical-grade meal replacements. The supervision of a board-certified weight loss physician is essential to the safety of this process. How Meal Replacements Help You Lose Weight In short, medical-grade meal replacements give you all the nutrition that your body needs (vitamins, minerals, trace elements, macros, etc) in an ultra-low calorie package. This allows your body to focus on getting energy from your fat stores without going into starvation mode. Meal Replacements Are Easy Many people love using medical-grade meal replacements because they are simple. You stop eating regular food (that's right....no more prep time!) and you use meal replacements instead. For the most part, the only choice you have to make is what flavor at each fueling. Will I Be Hungry? Most people find that meal replacements do a great job of helping them feel satisfied, and teaching them that as a society, we tend to overeat. By the end of a medical-grade meal replacement program, you should find yourself eating less quantity of food because you find yourself satisfied with fewer bites. For the few people who find that they don't get quite enough, we can increase the number of meal replacements OR add supplemental nutrition like protein and greens. Remember, this is a short time sacrifice to retrain the body and brain while improving health. Isn't Processed Food Bad? It Seems Like Meal Replacements Are Processed Food Well...yes... There's now question that a meal replacement is going to be processed food. That's how we make sure all the nutrients are in it. Compared to a whole foods diet, meal replacements are not ideal. However, because you can achieve complete nutrition with so few calories, the speed of weight loss is typically worth the short term trade off. Most patients who use meal replacements aren't eating a whole foods, plant based diet when they decide to lose weight. When you look at it in that light, this is a step in the right direction. Once weight loss has completed, we work on transitioning patients to their lifetime dietary choices with whole foods that come from as close to the farm as possible (plants and meat). Do I Eat Any Real Food? That depends on your goals. For most patients, we recommend a full-time meal replacement program initially. This means 4 meal replacements per day (for most patients) replaces your food entirely. We see rapid weight loss and lots of happy patients here (10-20 pounds lost per month), and the quick progress is rewarding. Most people adapt to using meal replacements rapidly. Some patients have circumstances that don't allow them do completely stop food - or they prefer to continue with some food. In these cases, we use 3 meal replacements per day to ensure complete nutrition and a highly prescriptive diet of meat and specific veggies once per day. The idea is to keep the calorie count low, the nutrition high, but normalize things like date night, client meetings and family dinner. People using this approach normally lose between 7 and 15 pounds per month. How Do I Get Started? Simple. To learn more or get started, you can either call/text us at 509-303-4001 OR BOOK NOW on our website for an initial consultation. The best part is that the first visit is FREE! Many Ways to Lose Weight - A Review Here's another take on the weight loss categories I wrote on a different day with more in depth information. Weight loss methods can be grouped into five main categories: Diet and Exercise - we've all tried this with varying degress of success. Diet and exercise (lifestyle) changes are foundational to any of the other categories of weight loss. This can be on your own or with the help of a trainer, coach or physician. Medical-Grade Meal Replacements - Replace your food with these products to lose 10-20 pounds a month on average (and some people many more!). These work effectively, but require a high level of discipline and physician supervision. Medications - See my other blog posts for more information on specific medications. Suffice it to say you can get rid of medications that cause weight gain, choose medications that tend to be weight neutral or weight negative, AND consider GLP-1, stimulant, or other medical therapy to induce weight loss. Be warned though, medications are NOT a panacea for weight loss. They have side effects and downsides, just like any other treatment modality. Have a good discussion with your doctor before embarking on this journey so you can know what you're up against and take appropriate countermeasures. Procedures - Mechanically filling the belly with something other than food can reduce the calories you consume. Some products allow you to take multiple pills multiple times daily to fill your stomach with the no-calorie products....similar to an Orbe. These are not effective, especially once you stop taking them. A gastroenterologist is able to place a balloon in the stomach to mechanically fill the stomach and reduce caloric consumption. That said, this procedure is expensive, rarely covered by insurance, and requires sedation and a professional. It also must be done in conjunction with a year-long lifestyle education program in order to demonstrate lasting results. Surgery - A variety of bariatric weight loss procedures can help you lose weight rapidly and keep it off for good. Guidelines have been clearly established by The American Society for Metabolic and Bariatric Surgery . If a patient fits the guidelines, they must be carefully selected to ensure effective weight loss and to limit the likelihood of weight regain after surgery. In the properly selected patient, these surgeries can be lifesaving. Know what you're asking for though, there are life-long side effects to these surgeries, including vitamin deficiencies that require ongoing supplementation. Go in with eyes wide open, and remember to really give your all to a lifestyle change program first! Medical-Grade Meal Replacements Can Help You Lose Weight Quickly and Effectively.

Weight Loss is one of the most effective non-pharmacological interventions for managing high blood pressure. I've been working in primary care in various roles for well over a decade. Through all the good and bad, there's one moment that seems more crushing that almost all the rest -- (cancer and end of life discussions aside) -- and that is the moment you tell a patient they have a chronic medical condition that will require medical treatment. There's something about that first pill that is harder to swallow than any that follow. Whether it is pride or the realization that aging is real, most of us will come to this moment. Some in their 30's, others in their 80's. When that moment hits, be ready to discuss this important question with your doctor - WHAT CAN I DO OTHER THAN TAKE PILLS? That's right! The first treatment for high blood pressure is NOT always medication (though in some cases it may need to be). In medical school, we were taught that lifestyle modification is almost always the first treatment. Of course, the problem is that no one really defined lifestyle modification. In other words: "Treat High Blood Pressure With Weight Loss." That's a big statement with a LOT to unwrap...exercise, diet, stress, nutrition, fitness levels, age...(and the list goes on)... That's one thing we teach you at ShillMed - to be the athlete that your mother thinks you are - and to eat the way your body dreams of with healthy, fresh, whole foods. Of course, there's a LOT of nuance here, but that's for another blog post. In many cases, a combination of strength training and cardiovascular exercise can impact your blood pressure enough to keep you off medications. In fact, let's answer the question a little more directly: "By what mechanisms does losing weight improve your blood pressure? You can treat high blood pressure with weight loss because you: 1. Reduce Sympathetic Nervous System (SNS) Activity Your nervous system responds to the state of obesity by ramping up into the "fight or flight" response, resulting in higher heart rates and clamping down on the blood vessels (vasoconstriction). The result? Higher blood pressure. These responses are part of the sympathetic nervous system, and studies show modest weight loss of 5-10% total body weight - especially visceral fat loss - leads to less sympathetic overactivity according to an article in Obesity Research & Clinical Practice . Another study in the Journal of Hypertension showed that your body may reward you with lower blood pressure just for trying to lose weight, even if you're not that successful! 2. Decrease Insulin Resistance The debate rages as to whether insulin resistance causes obesity or obesity causes insulin resistance. I'm not entirely sure whether the chicken came before the egg, but one thing is clear - they feed each other. When you lose weight, your insulin sensitivity generally improves. That means you have less insulin racing around your blood, your pancreas doesn't have to work as hard, and your fat cells are less prone to increasing in size (in fact, they get smaller! That's why we can call it weight loss!) In any case, as the quantity of insulin goes down in your body, you retain less water because high insulin signals the kidneys to hold on to sodium, and consequently, water. This results in a higher blood volume and that...begets higher blood pressure. Some evidence also suggests that the higher leptin levels lead to higher sodium retention by the kidneys as well. Guess where you find higher leptin (fullness or nutritional satisfaction hormone?) levels? In obesity! Check out this article from Gland Surgery for more details. 3. Turn down the Renin-Angiotensin-Aldosterone System That's a lot to unpack - and this article in Gland Surgery does that pretty well. Suffice it to say that the adrenal glands and the kidneys manage blood pressure, and some of our most powerful high blood pressure medications work on this system. Losing weight can have an effect on this system similar to medications like lisinopril, losartan, and others. Further, when you have obesity, your kidneys don't let go of sodium as well, which leaves more blood volume and higher blood pressure (see above if this sounds familiar). This article will help you understand the details a little better. Why Weight Loss Matters & Why It Should Be First My goal is not to disparage medication. It can be highly important. For example, if your blood pressure is higher than 150 systolic (the top number), we should probably do something to get it lower - at least temporarily - in order to keep you safe while you work on lifestyle changes that can last. Also, don't forget that some people are just genetically endowed with higher blood pressure. You may not be able to lose enough weight or exercise consistently or hard enough to get your blood pressure back to normal. In that case, recognize that this is NOT a failure. Instead, know that this is a part of your story you must control with medication, but that doing so will help you keep other parts of your health in check. Health is a game like dominos...once one falls...well, you get the idea. No matter who you are, no matter where you are in your health journey, consider the value of improving your lifestyle. Whether you've picked up 5 pounds or 50, consider choosing to treat rising or high blood pressure with weight loss. What questions do you have about blood pressure? Drop a comment below, and we'll select a few to guide future blog posts. Doctor Otto Shill, DO is a dual Board-Certified Internal Medicine and Obesity medicine doctor practicing in the Spokane Washington area. He is an expert in treating the underlying issues of complex medical conditions and using the treatment of metabolic disease to improve the overall outcomes of his patients. Please note that no doctor-patient relationship is formed by reading this blog and that you should discuss any potential changes to your healthcare plan with your own primary provider before making any modification to your personal plan of care.

Lifestyle changes are the foundation of weight maintenance - regardless of how you lose weight. Available Weight Loss Treatments At ShillMed, we use a variety of techniques  and weight loss treatments to help our patients lose weight. Before recommending a plan, we’ll meet with you to review your medical history and understand your past attempts at weight loss. Then we can tailor a weight loss plan to your lifestyle. Food Selection  We’ve all tried this, and if you’re looking for help, you probably feel like you’ve failed multiple times with nutrition. We’ll help you to find a diet that fits your lifestyle AND supports weight loss. No matter how you choose to lose weight, your food choices remain crucial to your success. Physical Activity & Exercise Movement matters. Weight loss benefits from intentional movement – from walking to weightlifting. While exercise alone won’t normally lead to dramatic weight loss, appropriate physical activity helps you build momentum, protects you from weight regain, and offers a ton of long-term health.  Medical-Grade Meal Replacements At ShillMed, we use the OptiFast program to ensure our patients get COMPLETE nutrition while losing weight. In fact, we are the ONLY OptiFast clinic in the Inland Northwest. Our patients experience rapid weight loss (typically 40-60 pounds in 3 months) while a doctor monitors labs, ECG, blood pressure, and medications in a simple, easy-to-follow program. Don’t worry – we focus on maintaining your muscle mass – so your metabolism stays intact! Even Oprah loves OptiFast! Check out the #1 top moment of her illustrious career on TV! https://www.oprah.com/oprahshow/oprahs-top-20-moments Medications Losing weight does NOT require medication; though, in the properly selected patient, medications can be helpful during the weight loss journey. We use some medications for appetite suppression early in the program, while other medications can be powerful and lifelong. Many patients choose to pursue weight loss without medication – and we support that! For those who choose medication, we support that too! These patients may be offered medication to address weight either directly or indirectly, some medications include: Metformin Phentermine Bupropion Topiramate Saxenda Victoza Contrave Anti-depressants Others   What do we think of compounded GLP-1’s like semaglutide and tirzepatide? At this time, the FDA has stated that compounded GLP-1 medications violate US patent law. Also, this FDA stance causes us to question whether compounded medications will be available to patients long term – and abrupt discontinuation can lead to significant weight regain. For this reason, we don’t use compounded medications; however, we are happy to prescribe brand-name medications such as Jardiance (empagliflozin), Ozempic and Wegovy (semaglutide), Mounjaro, and Zepbound if desired after a consultation with our physicians.  Procedures (Bariatric Surgery, Gastric Bypass, Balloons, Etc) We do our best to help you avoid invasive weight loss procedures, but occasionally, a patient may find this approach beneficial or necessary. If you are considering a balloon procedure or debating weight loss surgery, please book a FREE consultation with our physician to review your case. Even if you decide to go forward with your procedure, research shows that weight loss before a weight-loss procedure or surgery will significantly improve your overall outcome. If you’ve already had a weight loss surgery and find yourself gaining weight, our program could be right for you. We’ll help you get back to your goal weight and back on track! Commit to Your Weight Loss Journey   At the ShillMed Weight Loss & Lifestyle Medicine Center you’ll find an unmatched, personal experience in your weight loss journey and a weight loss treatment that is right for you. Our expert team specializes in helping patients overcome weight-loss challenges and providing the resources you need to lose weight now, and the support to change your lifestyle so you keep it off later! Call the ShillMed Weight Loss & Lifestyle Medicine Center and get started today at 509-303-4001 or schedule online at https://shillmed.hint.com/booking