Hi, KT.

I can't tell how many other elements of the program you have adopted or are considering. But I think if you make a flow sheet about these two issues they will resolve themselves. Since you are working with the diet doctor lets start there: Calories in should be less than calories out to lose weight and 3,500 calories equals a pound. Obviously, this is basic information and you are already aware of it. But how much alcohol do you drink a day? Is the alcohol the calorie problem? Are you depressed or are you taking the Wellbutrin to see if it can control food cravings? If you are not depressed and a significant number of calories come from alcohol, I would suggest you address the real problem of alcohol overuse.

I would also consider no longer taking the Adipex (anamphetamine-like medication) and just trying the My Way Out program. I wouldn't necessarily focus on trying to lose the weight, but rather take this time to learn more about good nutrition, exercise and the role stress plays in an individual's ability to lose weight.

I think with the titration of Topamax suggested in the My Way Program you may find the craving for alcohol goes away and you fill up fast when you eat. Adipex, like the amphetamine group from which it comes, shuts off all desire to eat. Topamax, on the other hand, lets you get hungry and eat but feel full quickly.

I recommend the nutrition book by Sally Fallon "Nourishing Traditions". Or visit the Weston A Price Foundation Website to get a start on healthy eating. It is at www.westonaprice.org.

Exercising at an aerobic range to burn fat also helps brain receptors release the good dopamine which gives you that sense of well being. I think I covered pulse training earlier to get the best effect. Try to avoid getting hungry, angry, lonely or tired when you are giving up alcohol.

Trust your body to be able to heal itself and take the least amount of medication as possible. Hope this helps!

(Also, I would find a primary provider to coordinate this.)

--Dr. Garcia