weight loss and cholesterol

I am a 25 year old male. I've gained 100 pounds in the past two years, 90 of the pounds basically being gained in the first of the two years. In September 2001 I weighed 200 pounds and was looking and feeling great. That was after "yo-yo-ing" a lot  before that. Specifically, I was a heavy child from over eating, I lost it in puberty w/o trying to lose it, gained it back in high school from over eating, lost it senior year of high school through diet and exercise, and continued to "yo-yo" (up to about 45 pounds) all the way through to the summer of 2001, when I was down to a good 200 and feeling food. Again, since the summer of 2001 I have gained more weight than ever before (100 lbs, putting me now at about 300, I am 6 ft tall and fairly muscular, underneath).
     It's like I've totally given up. I feel horrible. I have no energy. I'm not active, no out door activities, both because it's so strenuous and also because of the social reasons. My question is, do you ever treat patients like me? Do you recommend I start with psychotherapy and/or counseling sessions or something? Why am I sabotoging myself when I know how much damage it's doing to me and my potential lifespan? Do you know how horrible it feels to wake up in the morning with such high expectations on yourself for that day and go to bed every night with such guilt and depression? (That's a rhetorical question.)
     Another question is, is there ANY real, FDA approved, proven-to-work, medication to reduce appetite and aid in weight loss?
     My other issue is that a year ago my cholesterol check was horrible, which one would THINK would make we want to change from that point. I had like 262 cholesterol, with a low "good" cholesterol count. Doctor said I was in 2nd highest risk category and that if diet and exercise doesn't work after a month to bring it down, I should go on cholesterol lowering meds. I don't have high blood pressue (at that point) and I don't have diabetes (at that point). Well, I didn't diet and exercise for that month, and I didn't get my cholesterol
re-checked. But a year has gone by and I want to check it now. Last question, do you recommend I go on cholesterol medication no matter what at this point, seeing is that thus far my weight loss atttempts are so shotty?
      I understand the concept of low fat and low calorie food, going to bed on an empty stomach, getting exercise, etc. That's how I lost weight in the past. But this time I just feels so overwhelmed. When I try to exercise, it feels so hopeless. Last question: If I can afford it, could I benefit a great deal from a personal trainer? Not just to have someone motivating me, but also because: medically speaking, do these folks (personal trainers) have a lot to offer in terms of true techniques for eating and exercising for maximum weight loss efficiency, including for optimal energy levels?
       Last thing: I have frequent heart burn and occasional chest pain. Should this be looked into?

[Kevin Pho, MD]

First off, although you are young, obesity and an elevated cholesterol puts you at increased risk for heart disease.  Any chest pain should be evaluated and discussed with your personal physician.

Regarding the cholesterol, the decision of medication is made based on the LDL (i.e. "bad" cholesterol level) - a fasting lipid panel should be done to determine this value.  If the level is above 160, then medication should certainly be considered.

As for weight loss - a referral to a dietician should be considered.  In terms of medication, Orlistat and Meridia have been approved as medications for obesity - these options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
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