W8MD Medical Weight Loss Program is a medical weight loss, metabolic syndrome management and sleep wellness program for people who are serious about losing weight and gaining control of their health. We understand that losing weight and keeping it off is a challenge for many people and a physician trained in the new field of Obesity Medicine can help. That is why we are committed to our proven approach to medical weight loss using evidence based non surgical methods. We want to give you all the tools you need to succeed in losing weight fast and safe in Greater Philadelphia and New York City. Our Group has helped patients achieve their goals by using a proven four-step method for safe weight loss: •a physician-supervised diet and weight loss medication, •a personally structured and administered exercise program, •comprehensive behavior therapy, and •ongoing weight maintenance support. We can help you achieve long-lasting weight loss without feeling constantly hungry and deprived. When you resent your weight loss plan because you feel constantly hungry, it is much more difficult to maintain any significant lifelong changes. When you feel hungry, you are biologically driven to eat, and diet plans that force you to fight that biological impulse can be difficult to maintain. At W8MD Medical Weight Loss Program, we want to help you achieve lasting weight loss results and make changes that will keep you healthy for a lifetime. W8MD Medical Weight Loss Program is dedicated to individualized, affordable treatment and as one of the very physician supervised medical weight loss programs to accept most health insurances for the weight loss physician visits. Our non-surgical medical weight loss program is based on the latest medical research and utilizes proven methods to lose weight rapidly and keep it off for a lifetime. Our Medical Director, Dr. Prab R. Tumpati, is a highly trained and respected physician with training in Obesity Medicine, in addition to being board certified in Internal Medicine and Sleep Medicine, and is well versed in the medical treatment of overweight and obesity. Dr. Tumpati oversees all our patients and helps customize their individual weight loss treatments. We are committed to helping you lose weight as safely and efficiently as possible. We understand that losing weight and keeping it off is a challenge for many people and a physician trained in the new field of Obesity Medicine can help. That is why we are committed to our proven approach to medical weight loss using evidence based non surgical methods. We want to give you all the tools you need to succeed in losing weight fast and safe in New York City. If you are a bit overweight or obese and would like to lose weight safely and effectively using proven and evidence based methods instead of fad and unhealthy diets, W8MD’s unqiue insurance physician weight loss and wellness program might be right for you. Call 1-800-w8md-007 or visit www.w8md

1. How the USDA’s Failed Food Pyramid Contributed to Insulin
Resistance and weight gain, metabolic syndrome and diabetes!
In May 2011, the USDA released a graphic called “My Plate” to help
people choose what foods to eat instead of the “Food Pyramid”. The
useless and misleading food pyramid, which has been confusing
consumers for over 25 years, has advocated a philosophy of eating
more grains and other less “fatty” foods. Food Pyramid failed to
differentiate simple versus complex sugars and placed undue
importance in promoting grain based products. How can the USDA, a
government body set up to promote agriculture and promote sale of
agricultural commodities
be also charged with
health
recommendations?
Unfortunately,
consuming a lot of the
grain based “simple
carbohydrates” such as
breads, potatoes, rice
etc. although low in fat,
are high in glycemic index and can lead to a phenomenon called
“Insulin Resistance”. Affecting up to one in every three Americans,
Insulin Resistance is very common and can lead to difficulty losing
weight, pre-diabetes, or type II diabetes, heart disease and other long
term health problems associated with obesity.
What is Insulin Resistance?

2. Insulin resistance is a condition in which the body produces insulin
but does not use it properly. Insulin, a hormone made by the
pancreas, helps the body use glucose for energy. When people are
insulin resistant, their muscle, fat, and liver cells do not respond
properly to insulin. As a result, their bodies need more insulin to help
glucose enter cells. The pancreas tries to keep up with this increased
demand for insulin by producing more. Eventually, the pancreas fails
to keep up with the body's need for insulin. Excess glucose builds up
in the bloodstream, setting the stage for diabetes. Many people with
insulin resistance have high levels of both glucose and insulin
circulating in their blood at the same time. Learning about insulin
resistance is the first step toward making lifestyle changes that can
help prevent diabetes and other health problems. An Obesity
medicine physician well versed with medical management of Obesity
and
Insulin
Resistan
ce might
be able
to help!
Cause of Insulin Resistance
Scientists have identified specific genes that make people more
likely to develop insulin resistance and diabetes. Excess weight and
lack of physical activity also contribute to insulin resistance.

3. Many people with insulin resistance and high blood glucose have
other conditions that increase the risk of developing type 2 diabetes
and damage to the heart and blood vessels, also called
cardiovascular disease. These conditions include having excess
weight around the waist, high blood pressure, and abnormal levels of
cholesterol and triglycerides in the blood. Having several of these
problems is called metabolic syndrome or insulin resistance
syndrome, formerly called syndrome X.
What Are The Effects Of Insulin Resistance
Insulin resistance can lead to many problems including weight gain,
especially around the tummy due to the anabolic effects of Isulin. It
also leads to metabolic syndrome as defined below, fatty liver,
polycystic ovaries, acanthosis nigricans or dark patch around the
neck, axilla, groin or other areas, skin tags, prediabetes, risk of
elevated blood pressure, cardiovascular disease etc.
What Is Acanthosis Nigricans?

4. Insulin resistance and prediabetes usually have no symptoms.
People may have one or both conditions for several years without
noticing anything. People with a severe form of insulin resistance may
have dark patches of skin, usually on the back of the neck.
Sometimes people have a dark ring around their neck. Other possible
sites for dark patches include elbows, knees, knuckles, and armpits.
This condition is called acanthosis nigricans.
What Is Metabolic Syndrome?
Metabolic syndrome is defined as the presence of any three of the
following conditions:
• waist measurement of 40 inches or more for men and 35 inches
or more for women
• triglyceride levels of 150 milligrams per deciliter (mg/dL) or
above, or taking medication for elevated triglyceride levels
• HDL, or “good,” cholesterol level below 40 mg/dL for men and
below 50 mg/dL for women, or taking medication for low HDL
levels
• blood pressure levels of 130/85 or above, or taking medication
for elevated blood pressure levels
• fasting blood glucose levels of 100 mg/dL or above, or taking
medication for elevated blood glucose levels
What is prediabetes?
Prediabetes is a condition in which blood glucose levels are higher
than normal but not high enough for a diagnosis of diabetes. This
condition is sometimes called impaired fasting glucose (IFG) or
impaired glucose tolerance (IGT), depending on the test used to
diagnose it. The U.S. Department of Health and Human Services
estimates that about one in four U.S. adults aged 20 years or older—
or 57 million people—had prediabetes in 2007.

5. People with prediabetes are at increased risk of developing type 2
diabetes, formerly called adult-onset diabetes or noninsulindependent
diabetes. Type 2 diabetes is sometimes defined as the form of diabe-
tes that develops when the body does not respond properly to insulin,
as opposed to type 1 diabetes, in which the pancreas makes little or
no insulin.
Studies have shown that most people with prediabetes develop type
2 diabetes within 10 years, unless they lose 5 to 7 percent of their
body weight—about 10 to 15 pounds for someone who weighs 200
pounds—by making changes in their diet and level of physical
activity. People with prediabetes also are at increased risk of
developing cardiovascular disease.
How do you diagnose Insulin Resistance?
Health care providers use blood tests to determine whether a person
has prediabetes but do not usually test for insulin resistance. Insulin
resistance can be assessed by measuring the level of insulin in the
blood. However, the test that most accurately measures insulin
resistance, called the euglycemic clamp, is too costly and
complicated to be used in most doctors’ offices. The clamp is a

6. research tool used by scientists to learn more about glucose
metabolism. If tests indicate prediabetes or metabolic syndrome,
insulin resistance most likely is present.
Diabetes and prediabetes can be detected with one of the
following tests:
Fasting glucose test. This test measures blood glucose in
people who have not eaten anything for at least 8 hours. This test is
most reliable when done in the morning. Fasting glucose levels of
100 to 125 mg/dL are above normal but not high enough to be called
diabetes. This condition is called prediabetes or IFG. People with IFG
often have had insulin resistance for some time. They are much more
likely to develop diabetes than people with normal blood glucose
levels.
Glucose tolerance test. This test measures blood glucose
after people fast for at least 8 hours and 2 hours after they drink a
sweet liquid provided by a doctor or laboratory. A blood glucose level
between 140 and 199 mg/dL means glucose tolerance is not normal
but is not high enough for a diagnosis of diabetes. This form of
prediabetes is called IGT and, like IFG, it points toward a history of
insulin resistance and a risk for developing diabetes.
People whose test results indicate they have prediabetes should
have their blood glucose levels checked again in 1 to 2 years.
Why is it important to look at glycemic index of foods?
Glycemic Index of foods is
important because it
determines how much insulin
your body is going to need after
the meal. The higher the
Glycemic Load, the higher the
Insulin Requirements. It is
believed that eating high
glycemic foods such as Bagels,
Doughnuts, white breads, white
rice, sweetened beverages
etc., the body starts to go into Insulin Resistance. The Insulin

7. Resistance, in turn will lead to higher levels of Insulin circulating in
the blood stream at baseline setting the stage for insulin resistance.
Since insulin is an anabolic(body building hormone), this can not only
lead to weight gain, but also lead to central distribution of weight.
Research has shown that central distribution of weight leads to
increased risk of cardiovascular disease, diabetes and other health
problems.
http://youtu.be/TjK8kR6ggbY
Tips for Avoiding Insulin Resistance
According to the American
Diabetes Association, nearly
two million new cases of
diabetes were diagnosed in
people aged 20 years and older
in 2010. Since the grossly
misleading food pyramid was
introduced, the incidence of
type 2 diabetes has gone up as
much as 400 percent in the
United States. Pre-diabetes,
also called insulin resistance
syndrome or metabolic
syndrome, affects about a third
of all Americans. If you have
some extra weight
especially around your waist,
you might be insulin resistant!
An obesity medicine physician
specializing in the medical
management of obesity and
insulin resistance might be able
to help.
W8MD physicians have specialized obesity medicine training
and are well versed with managing insulin resistance and other
metabolic effects of weight. W8MD physicians can help you lose
weight safely, effectively using proven non surgical methods.

8. Call (800)W8MD-007 for more information.
§ Get enough protein. If the body gets carbohydrates without
enough protein, it goes into insulin resistance. Most people need
about 30 grams of protein at each meal. One egg is about 7
grams. As we evolved as hunters and gatherers, we are
designed to eat a non-grain based diet rich in protein, fruits, nuts
and vegetables.
§ Try to work more physical activity into your day. Both exercise
and resistance training can help reduce your risk of diabetes,
and also helps to control it once you have it.
§ Eat more fiber. Fiber helps reduce your risk of diabetes by
improving your blood sugar control. Try more fruits, vegetables,
beans, whole grains, nuts, and seeds.
§ Choose whole grains. When you do eat grains, look for the
word "whole" in the ingredient list. Whole wheat, stone-ground
whole wheat, brown rice, and oats are all whole-grain
ingredients.

9. § Eat fewer simple carbohydrates. These foods, with high
glycemic index, break down quickly in the body, and can lead to
rapid fluctuations in blood sugar levels. Go easy on foods like
white rice, white bread, white pasta, refined flours, candy, fruit
juice, soda pop, and baked goods made with white flour. The key
is to understand glycemic Index of foods and focus on low
glycemic foods.
§ Get enough sleep. When you're sleep deprived, your body
drives you to eat more simple carbohydrates. Get at least 7-8
hours a night.
§ Get help from Obesity Medicine physicians. You probably tried
them all and still cannot lose weight! You might want to get help
from physicians trained in Obesity Medicine that can help deal
with the complex issues leading to weight gain.
W8MD Glycemic Index Guide
In general, you want to limit the high glycemic foods, have
limited medium glycemic foods and have mostly low glycemic
foods with adequate protein, fat, and other nutrients. Protein is
generally low glycemic.
High GI foods = 70-100
Intermediate GI foods = 56-69
Low GI foods = 0-55
Glycemic Index of some common Foods
Food Carbohydrates (gm) Glycemic Index
Glucose has a GI value of 100 HIGH
Baked potato, Russet, baked without fat (
1 small potato, 5 oz.) 85
Waffles, Aunt Jemima (1 piece) 76
Gatorade (1 cup) 78
Grapenuts (approx. 1 cup, Kraft) 75
French Baguette
95
Bread, white (1 slice)
73

10. Bagel, (white, frozen)
72
Stuffing ( approx. 1 cup)
74
Graham wafers (approx. 1 cup) 74
Grape nuts (approx. 1 cup, Kraft) 75
Shredded wheat (1 oz. serving) 75
Total (1 oz. serving, General Mills) 76
Cream of Wheat (1 oz. serving, instant,
Nabisco) 74
INTERMEDIATE
Spaghetti, (plain, cooked, 3/4 cup)
61
Rice (brown, cooked, 3/4 cup)
60
Raisin bran (1 oz. serving, Kellogg's) 61
Oatmeal (1 cup) 66
Bran muffin (large) 60
Green pea soup (1 cup) 66
Ice cream, regular(1/2 cup) 61
Blueberry muffin (1) 59
Raisins (1/4 cup)
56
Power bar, chocolate 56
LOW
Apple
34
Orange
42
Banana
52
Grapes (1 cup)
46
Carrot (raw, 1 medium) 47
Sweet corn (1/2 cup 54
Dried apricots (1/4 cup)
31
Peas (1/2 cup) 48
Bread 100% whole grain (1 slice) 51
Orange juice (3/4 cup, 6 oz.) 52

11. Fruit yogurt (reduced fat, 3/4 cup)
27
Tomato soup (1 cup) 38
*Skim milk (1 cup) 32
While Milk (1 cup) 27
Baked beans (1/2 cup)
48
Lentils (1/2 cup)
29
Kidney beans (1/2 cup)
28
Lima beans (1/2 cup, baby, frozen)
32
Garbanzo beans (1/2 cup)
28
*NB: Please note that whole milk has lower GI compared to
skimmed or 2% milk
(Chart adapted from *The New Glucose Revolution)
Other Resources on Glycemic Index
1. The GI Diet Guide - A very useful and practical list of
foods. A must visit link - www.The-GI-
diet.org/lowgifoods/ - Very useful and practical!
2. University of Sidney's Glycemic Index Website -
http://www.glycemicindex.com/
3. Comprehensive Glycemic index list spread sheet: for
A comprehensive list of Glycemic Index, get the excel
spread sheet here and look up the glycemic Index. Please
note reduced fat milk has higher glycemic index
compared to whole milk!
Summary Of Insulin Resistance
Insulin resistance is a condition in which the body’s cells do not
use insulin properly. Insulin helps cells use blood glucose for energy.
Insulin resistance increases the risk of developing prediabetes,
type 2 diabetes, and cardiovascular disease.
Prediabetes is a condition in which blood glucose levels are
higher than normal but not high enough for a diagnosis of diabetes.

12. Causes of insulin resistance and prediabetes include genetic
factors, excess weight, and lack of physical activity.
Being physically active, making wise food choices, and
reaching and maintaining a healthy weight can help prevent or
reverse insulin resistance and prediabetes.
How can W8MD Medical Weight Loss Centers Program For
Diabetes Prevention And Weight Loss Help?
W8MD Medical Weight Loss Program is a medical weight loss,
metabolic syndrome management and sleep wellness program for
people who are serious about losing weight and gaining control of
their health. We understand that losing weight and keeping it off is a
challenge for many people and a physician trained in the new field of
Obesity Medicine can help. That is why we are committed to our
proven approach to medical weight loss using evidence based non
surgical methods. We want to give you all the tools you need to
succeed in losing weight fast and safe in Greater Philadelphia, New
York City and other places.
Author: Prab R. Tumpati, MD, Sleep and
Obesity Medicine
Medical Director, Sleep Medical Associates
and W8MD Medical Weight Loss Centers
of America located at 2003, Bath Avenue,
Brooklyn, NY 11214. Also have locations in
Philadelphia, Connecticut and other places.
Physicians interested in a low cost weight loss franchise to add a
W8MD Medical Weight Loss Program at their facility are also
welcome to contact us.
http://www.w8md.com