I am sitting here in my white lab coat with dirty sleeves (from use), thinking that there is no reason for a practicing physician to support the current health reforms before Congress.  Patients are going to have a rude awakening when their new insurance cards don’t give them the kind of access to doctors they are expecting. Doctors are too frustrated and marginalized to play ball with the president. Here are the reasons that every doctor I know is vehemently against Obamacare:

*  No comprehensive tort reform. Most surgeons I know are struggling with a constant fear of malpractice claims. Most have had at least two or three frivolous lawsuits in their careers to contend with. Most have spent hundreds of hours with lawyers going over the fine print of their records only to have the case settled. Most surgeons are now opting out of accepting insurances in order to afford their malpractice premiums which are often close to $100,000 yearly. Caps on pain and suffering are only one part of the problem.  32 states have some kind of tort reform already, but there needs to be a consistant federal mandate or doctors will hop from state to state.  In California, when caps of $250,000 were instituted, doctors’ premiums did not decrease until a second law compelled insurers to transfer savings to physicians. Nuisance suits can be blocked by creating boards of doctors and lawyers to review cases before they are brought (these boards already exist in Tennessee and Michigan). “Loser pays” statutes can be added (doctors win the vast majority of suits) so that liability insurance companies won’t force doctors to prematurely settle claims to avoid large legal fees.
*  The bills before Congress all include large Medicare cuts. The Baucus bill would cut Medicare by $500 billion over a decade. This will lead to cuts to hospitals who will then be compelled to cut patient services and doctor salaries. The moratorium for not cutting doctor reimbursements across the board by 21% as Congress is supposed to do is not likely to last. Medicare cuts to doctors will cause more to quit or game the system. A changeover from fee-for-service to bundled payments, as the Baucus bill envisions, will leave many doctors out in the cold when they are denied payment for a service that is considered unnecessary or redundant.
*  The growing doctor shortage – the Association of American Medical Colleges calculates we will be 125,000 doctors short by 2025 – does not leave us with the manpower to take care of an additional 30 to 40 million patients. Doctors will be more rushed than ever.          
*  The extension of Medicaid to 10 million more people as the Baucus bill proposes will be a disaster for doctors. Consider that Medicaid often pays doctors less than $10 per office visit. 50% of doctors don’t take Medicaid, and states have already been cutting Medicaid payments to hospitals because most states are having trouble funding Medicaid. Medicaid networks of services and service providers within hospitals are being cut, making it impossible for doctors like me to take care of these patients (we have nowhere to send them for services or procedures).

We doctors are being squeezed, marginalized, ignored, and criticized. Of course we aren’t happy. Of course we feel that it will impact our patients’ care.      

If there is a hardworking doctor out there who thinks the current health reforms are good for doctors or America, I don’t know her.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel’s new Ebook: Swine Flu; the New Pandemic, will be published in early October. Dr. Siegel is also the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

Part of my residency training in psychiatry was spent working on the locked unit at the Shattuck State Hospital in Massachusetts.  It was there that I learned strategies to keep people safe when voices or visions or delusions made them threaten others with harm—whether verbally or physically.  The strategies were very important, because some of the folks on the unit had never been violent, while others had been court-ordered to the Shattuck after committing very violent crimes, including murder.  We needed to protect not only the staff, but patients, too.
 
The lessons I learned at the Shattuck are ones that the Administration should keep in mind in dealing with Iran.  After all, Mahmoud Ahmadinejad appears either to be a pathological liar with extremely violent intentions and a willingness to distort history or to actually be delusional.  In either case, he qualifies as an inpatient on a locked psychiatric unit.
 
Here are lessons from the Shattuck:
 
1. It is highly desirable to listen to every patient, even those with delusions, because their truth may be audible, despite the content of their speech being insane.  Someone with grandiose delusions, who believes he is the savior of the planet, may actually be expressing deep feelings of low self-esteem.  Similarly, the desire to obtain nuclear weapons and destroy one’s neighbors may relate to internal feelings of having been annihilated.  So it may be with Iranians, whose self-esteem and willingness to be led by a madman (notice the contracted words mad and man), may reflect their internal feelings of vulnerability.

2. When a delusional or violently ill patient seeks to arm himself, he is to be watched extremely closely and repeatedly searched.  There can be no negotiation on this account, as the violent or delusional man cannot be trusted.

3. When the delusional or violently ill patient is found to have secreted away a weapon, it must be presumed that he fully intended to use it and that he will be very angry that he cannot.  Therefore, he must be rapidly disarmed and then placed in quarantine, lest he either rearm himself or attempt to show his strength using his fists or a discarded needle.  On a psychiatric unit, that means a room search, confiscating any weapon and placing the patient in the locked quiet room.  In Iran, it means destroying Iranian nuclear facilities, then isolating the country, then searching for any other threats.

4. Psychiatric patients at the brink of violence are not comforted by, nor dissuaded from that violence, by quiet speech or bargaining.  They are comforted by a show of force that convinces them that they are better off in the good hands of a healer than left to  the chaos of their own intentions.  Even four-point restraints can be a comfort to a man out of control whose mind knows not the limits of rational thought and action.

5. Time is of the essence.  When a psychiatrist on a locked unit feels a patient is about to become violent, the thought processes inside that patient often have been brewing for a very long time.  At that point, making the unit safe has to precede more elegant attempts at healing.

6. The other patients are watching.  This means that the psychiatrist’s response to a violent patient will either quiet the unit (for which you may read the Middle East) or inflame it.  Permissiveness is always perceived by the unstable as a call to chaos.

7. Always read the clinical history of every patient for any past episodes of severe violence.  The past is a good indicator of the future, even when great progress would seem to have been made.  Witness the recent embracing of terrorists by Muammar el-Qaddafi.

8. Keeping the unit safe is not about hating anyone.  Even the violent patient is a worthy human being at the core.  But that does not mean that the patient is not a grave risk to himself or to others.  There can be no fear of taking action, nor any joy in doing so.

As it was at the Shattuck, so it is in Iran.  I hope Dr. Obama is listening.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be emailed at info@keithablow.com.

President Obama lost something invaluable last week when he weighed in on the arrest of his friend, Harvard professor Henry Louis Gates, Jr., saying the Cambridge police acted stupidly. He lost the presumption that he is colorblind and embraces all races and both genders equally.

This colorblindness was, perhaps, the fondest hope of the American public when we elected President Obama to our highest office.  As the son of a white woman from Kansas and a black man from Kenya we hoped his election marked the ascent of a leader possessed of so much empathy, so much intelligence and such a desire to understand all perspectives and experiences that he could resonate with anyone’s needs and disenfranchise no one.

That hope has withered for many, and it will be difficult to resurrect.  The fact that President Obama remained in a church headed by a pastor (Reverend Wright) who denounced white people, together with the fact that the First Lady says she felt no pride in our country until very recently, together with the fact that President Obama nominated a woman to the Supreme Court who slurred white judges as inferior, together with the President’s recent unwarranted slur of a white police sergeant as stupid seems to reveal deep-seated anger in him and constitutes a psychological pattern of insensitivity to the feelings of Caucasians.  He is a President who now (and hopefully only temporarily) seems the least colorblind of my lifetime, a terrible irony and tragedy I certainly didn’t imagine transpiring when he announced his candidacy.

The emotions some white people are sharing with me seem to parallel the feelings that African Americans may have struggled with in the past.  They tell me that they fear President Obama resents them, but won’t say so plainly, that he considers them “less than” others, maybe even demonic (like Reverend Wright does), but won’t admit it.  This gives them, and it gives me, a sliver of insight into how painful it must have been for disenfranchised minorities for decades in this country.  But the price of that slim window on the feelings of others has been high, indeed.  For the millions of white Americans who now better understand what it feels like to doubt that the President of the United States is their President, too, our heightened empathy comes with deep sadness and not a little anxiety.

President Obama doesn’t seem to understand the full depth of what has transpired.  It can’t be glossed over with the words he shared after the Crowley fiasco: 

“This has been ratcheting up, and I obviously helped to contribute ratcheting it up.  I want to make clear that in my choice of words, I think I unfortunately gave an impression that I was maligning the Cambridge Police Department and Sgt. Crowley specifically.  And I could’ve calibrated those words differently.”

He then invited Crowley over to the White House for a beer with Professor Gates.

What we needed, as white Americans, for all Americans, was a moment less about political caution and false camaraderie and more about self-revelation.  I kept thinking, as I listened to President Obama, of how short his statement fell from the words of another great African American politician, Jesse Jackson.  During the 1984 Presidential campaign, when Jackson sought the Democratic nomination, he referred to New York City as Hymietown, a slur against Jews.  I remember him taking the podium at the Democratic Convention and apologizing.  It was 25 years ago, and I was just 22-years-old, so forgive me if I have forgotten some of the words.  Most of them are seared into my memory—these two-and-a-half decades later:

“If I have offended anyone, or renewed old fears, I am deeply sorry.  Charge it to my head and not my heart.  I am an imperfect servant.  God is not yet finished with me.”

That was plenty good enough for me.  I didn’t believe Jackson could fake a statement like that.  And I never questioned the man’s heart again. 

President Obama, we need that kind of eloquence and honesty right now.  We need you to do that kind of soul-searching and let us in on the result.

As President Obama tries to remake the American health care system, the gutting of psychiatry by insurance company policies and other administrative forces is a good lesson in what to avoid. 

The endless red tape inherent in dealing with many insurers and the loss of professional autonomy to insurance company “reviewers,” has led many of the best and brightest psychiatrists and psychologists to accept no insurance reimbursement at all.  Psychiatrists have, if you will, acted out Atlas Shrugged, Ayn Rand’s cautionary tale of what can happen when institutions throttle individuals.  They’ve walked away and taken their gifts as healers with them.  In fact, when I refer patients to other mental health care professionals, it’s very challenging for me to find clinicians I consider in the top echelons of my field who will accept third party reimbursement of any kind.  A brain drain has siphoned off access to some of the wisest counsel available in psychiatry, except for those willing to pay cash, and I believe the same could happen (or greatly accelerate where it already is happening) in other medical specialties.

The influence of insurance company policies has also led to the public being served by professionals from allied health fields, such as clinical nurse specialists.  The need or desire for these companies to save money, which will only be accelerated by the current Obama plan, means social workers and nurses are the preferred providers of psychotherapy and medication evaluations to those battling depression and schizophrenia and bipolar disorder.  This phenomenon could find its reflection in the firm ground of internal medicine and endocrinology and obstetrics and other specialties yielding to intellectual quicksand, in which the knowledge and skills of physicians often disappear from the landscape entirely.

There’s nothing inherently wrong with getting your health care from physician assistants and nurses.  But these folks didn’t go to medical school, and didn’t complete residencies, and if I were confronting a serious condition I’d want to be treated by people who had.  I’d pay for it out of my own pocket.  And my guess is that we’ll end up having to.

Oh, one more thing:  Not only did many psychiatrists walk out on the system, lots of the ones who stayed let their practices be shaped by insurance company reimbursement policies that pay them more to prescribe medications than to talk to people.  So there are a whole bevy of shrinks who’ll see you for ten minutes once a month and just write you a prescription.  It actually pays pretty well, even if it leaves them out of seventy percent of what can restore patients—effective, expert psychotherapy.  That medical art is in danger of extinction.

See, Obama’s eight principles for overhauling health care address economics, access, prevention, safety and cost.  They don’t address how to preserve the core of the world’s most successful, powerful, inventive health care system ever:  the contributions and creativity and commitment of America’s physicians.

President Obama has mentioned many times that the health reforms he is proposing will not alter the health care of those who already have health insurance and want to keep what they have. But this is NOT the view of most practicing physicians — myself included. I may be one of the most vocal, but I am not alone.

1.  First of all, there is a critical and growing shortage of primary care physicians. Only about 2 percent of the current medical school graduating class is going into primary care. Those of us who already practice primary care are overwhelmed and many are quitting. The public insurances have the most trouble. Surveys show that 50 percent of doctors don’t take Medicaid, and in 2008, the Medicare Payment Advisory Commission found that 28 percent of Medicare patients looking for a primary care physician couldn’t find one. This problem will only get worse under any Obama plan. You may have new government-provided insurance, but you may not be able to find the doctors who take it. And if you do, they may be buried under a pile of paperwork, or be too busy changing over to the new Electronic Medical Records system to spend time with you.

2.  More than 150 million Americans have employer-provided health insurance. But if there is a public option, your employer may stop providing you with insurance. You may be compelled to take the public option, which will probably provide you with less real health care choices.

3.  If the public option grows bigger, because private insurers find they can’t compete, expect care to be rationed, as the government makes choices to try to contain costs. Reimbursements to doctors will be cut, as they have been under Medicare and Medicaid, but also, you may not be able to get dialysis if you are over a certain age, or you may have to wait on long lines for procedures, as they do in Canada.

4.  Bottom line — extending a system that already has too few primary care doctors who are overworked to the entire population does not bode well for prevention or quality of medical care. The costs will continue to spiral upward, and access will decrease rather than increase. A better approach would be to work on re-organizing the health care system towards prevention rather than intervention BEFORE expanding it. One way would be to pay for the education of primary care doctors and create a task force to treat the uninsured.

For more on my take on public health insurance and how doctors view it, check out my oped in Monday’s NY Post.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

 I don’t want to be picky, but I have to admit that as a fear expert I was more affected by President Obama’s statement a few weeks ago in response to the emerging swine flu threat that we should all wash our hands, then I was to Vice President Biden’s blatant misstatement about not flying on planes. Let me explain: clearly, we carry many bacteria and viruses on our hands, and in fact most of our stomach viruses as well as cold viruses are passed back and forth this way. It is hard to fault anyone for recommending hand washing, but consider that Obama’s statement carried the subliminal message that we might be carrying this virus, despite the fact that the statistical chances of that then and now remain extremely low.

The president followed that up by asking Congress for $1.5 billion to prepare us for this flu, an amount that seems totally reasonable until you consider what other health care needs it might be taken away from. Stockpiles of the anti-flu drug Tamiflu will have to be discarded if they aren’t used in 5 years, and we still have no idea what the extent of spread or severity of this swine flu virus will be. Preparing a vaccine seems wise, taking needed resources away from current pandemics like TB, HIV, or even the yearly flu does not.   It is paramount that at a time when our government is considering expanding the system for health coverage, that issues of allocation and proper use of resources be at the top of the list.

The Centers for Disease Control and Prevention has been front and center during the initial stages of the swine flu outbreak, and they have been very effective at identifying and tracking the virus, somewhat less effective at explaining it in context during press conferences (this may have something to do with the nature of the beast – press conferences themselves immediately become amplified).

I have more of a bone to pick with the World Health Organization in terms of their poor conveyance of contextual information. The WHO all too often seems like “fright night” though they too have been tremendous when it comes to “boots on the ground.”

Check out my article in today’s Slate magazine about how the WHO has dealt with swine flu.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

The search for a “presidential dog” has dominated the headlines since President Obama’s campaign.  It has been reported that President Obama’s 10-year-old daughter, Malia, is allergic to dog hair, and thus starts the search for a “hypoallergenic” dog.  Many of my patients find themselves with the desire to have a pet, despite a pet allergy as well. 

There is a myth that pet allergies are caused by animal hair!  It is actually a protein found in pet skin/dander, saliva and urine that causes the allergy.  Hairless dogs are still going to have at least some allergen. Some dog breeds, are said to be “hypoallergenic,” as they shed less, but no dog breed is completely 100 percent hypoallergenic.  

In some cases, there are individual differences between breeds, and a particular pet allergy sufferer may do better with one breed as compared to another.  Lastly, it has been postulated that perhaps female dogs might produce less animal allergen, but the jury is still out on this one! 

You may look for breeds with shorter hair and less shedding, although there isn’t any real scientific evidence this will really help.  Some allergists have also advocated that there may be an advantage to keeping a dog that tends to keep their coat throughout the year. Also, there is a consideration to selecting a smaller dog, as these animals may shed less dander than a bigger dog.  Other factors discussed are the animal’s temperament or disposition that might make frequent bathing more feasible.

Tips that can help reduce dog allergy suffering:

• Create a pet-free bedroom

• Wash bedding in hot water

• Bathe your dog frequently and have a non-allergic family member perform grooming

• Use a HEPA air purifier, double bag and/or HEPA vacuum cleaner/home A/C,  and as well as vacuuming carpets, cleaning walls

• Shampoo carpeting frequently or better yet, go with wood or washable tile/linoleum flooring

• Increase time your pet spends outside, when the weather allows
 
• Visit an allergist to discuss treatment options
 
Nevertheless, there are no guarantees that an individual who is truly allergic to pets (about 10 percent if those with allergies) will tolerate living with a pet dog or cat.  What I have found helpful is actually trying out a pet on a “temporary or trial basis” for a future pet, to ensure a successful ending to this story.  An even better strategy is to begin allergy treatment before getting a pet if you are allergic, including allergy injections! 

For more information on pet allergies go to: http://www.aaaai.org/media/news_releases/pressrelease.asp?contentid=8326

For for home and animal allergy management tips check out: http://www.allergyandasthmarelief.org/animal_allergens.html

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine. He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology. No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Over the weekend, someone asked me if President Obama’s lift of the ban on federal funding for embryonic stem-cell research could lead to higher rates of abortion. At first, I was a little stunned by the question, but I began to think about all the potential problems, and ultimately my answer was “maybe.”

The reason my answer was “maybe,” is because in an unregulated world, the possibilities of science for profit become even larger. There is a gap between the expectations of many patients and the realities of what current science can offer us.

With the world entrenched in a global economic downturn, the business of science can easily take over, sometimes outweighing the medical implications. Already, years of research ― especially with umbilical cord stem cells ― have led to significant discoveries that, although seem very impressive in the laboratory, have failed to make their practical application in clinical medicine.

I hope that President Obama doesn’t rush into fully lifting the embryonic stem-cell research federal funding ban without the proper checks and balances that are necessary to keep the ethical and protective side of science always in the forefront.

These are interesting times we’re in ― to say the least. Over the past couple of weeks, we have all been concentrating on “Octomom” from California, and with new developments in the story everyday, it’s easy to see why she’s been the topic of conversation. I was following the story too, calling for an ethical investigation of the fertility clinic from day one, but with the state of our economy and the country experiencing what could be one of the most pivotal moments in American history, I want to move past that story.

I think it’s time the media starts concentrating on the changes that the Obama administration will be proposing in the future and some of the ideas that have already been approved.

Now, let’s look at the facts … The American health care system needs help! Why? Well, because it is filled with inefficiencies and overpriced operational costs.

How did it get like that? Well, it’s possible the American health care system has seen a lot of the same issues as our financial sector ― which we all know by now is quite a mess. Our financial experts have given us many explanations for the current economic crisis: Many blame the banks for recklessly handing out loans and credit, some blame the public for borrowing more money than they could ever repay, then there’s all the greedy Wall Street executives making profits off back of funds that don’t even exist, and who can forget those elaborate Ponzi schemes that went unnoticed by federal agencies for years.

Well, believe it or not, we have a lot of the same things happening in health care. We have some patients that demand every test in the book on the basis of what they’ve read or seen on television, hospitals that have been enamored with demands because of technological advances and profit margins, and doctors that have concentrated on sub-specialty service, rather than primary care and prevention.

So now, we are all looking to President Obama’s stimulus bill to see how he will resolve these problems. Some of his proposed ideas are very interesting. Electronic medical records, for instance, provide us with computerized data entry on patients, a way to track symptoms, disease processes, a way to dramatically decrease the overutilization of certain tests, minimize medical mistakes both by physicians and hospitals. And down the road, it might even decrease costs.

But many critics worry about privacy issues. I totally agree that patient confidentiality should always be protected. I remember when the new HIPPA laws came into effect under President Clinton, I could not even discuss a patient’s medical condition or get a second opinion from a colleague without getting a written consent from the patient.

But I think that before we start throwing good money in to solve the problems bad money got us into, the way previous financial stimulus plans have, we need to really understand how our current health care system is working, and address the issues that got us here in the first place.

Click here to share your thoughts on my Facebook page.

Barack Obama has just become the President of the United States, which is a 24 hour job, 7 days a week, for the next 1,460 days.  One may say becoming president is quite a stressful job.  Stress compromises our immune system which can ultimately result in cardiovascular disorders, diabetes and hypertension. Stress also increases heart rate and blood pressure, just to name a few. Also, stress can alter your blood sugar levels, leading to mood swings, fatigue and hypoglycemia. To avoid these risks, one essential ingredient Obama must fill up on is fiber. According to the American Dietetic Association the average American should be receiving 20-35 grams of fiber daily, but are currently only receiving between 9-11 grams.  Many studies have shown that increasing your fiber intake will reduce the risk for cardiovascular disease, diabetes, cancer and hypertension. Maintaining a healthy lifestyle is essential for President Obama.

Here are some tips to provide Obama the strength and ability to lead our country:

Fill up on fiber and protein.
Make sure every meal is a combination of fiber and protein.  Fiber and protein are the two nutrients that take the longest to digest.  It is this perfect combination of foods that keeps your serum glucose levels consistent, leading to improved energy throughout the day.  In addition, since fiber has 0 calories per gram, and protein has 4 calories per gram, you are guaranteed the least caloric intake with the most food intake.  Eating small, frequent meals helps to stabilize blood sugar and keep energy levels consistent.  In addition, it helps to prevent you from becoming ravenous at night which leads to poor food choices and less portion control, which eventually leads to overeating. Lean protein like grilled fish, which is often a choice for Obama, helps to fill you up on few calories without filling your glycogen stores. Instead of legs and thighs, try buying chicken breasts, which will save you countless calories and unsaturated fat. Switch from chop meat to lean, ground turkey. Choose lean cuts of meat like sirloin and filet and steer clear of marbelized fat meats.

Eat more fruits and veggies.
While reports have said that Barak Obama enjoys high fiber veggies like broccoli and spinach, by simply adding more produce to his diet, he will find that he’ll begin eating less and thereby maintain a healthy weight without making any additional dietary changes. Filling up on fiber-rich vegetables and fruit adds bulk and satiety to any diet without excess calories. Plus, you’ll get the extra health benefits of crucial vitamins and minerals.  Some other fiber rich choices include cauliflower, artichokes, heart of palm, apples, berries and pears.

Don’t skip breakfast.
Although being President barely leaves one time to breath, Obama must take a minute to eat breakfast. Recent research shows that eating breakfast can actually help you shed pounds by jump starting your metabolism for the day. A breakfast consisting of fiber and protein is the ultimate combination because these nutrients will fill you up on the fewest calories. Switching from white bread to whole wheat as well as from white rice and pasta to brown rice and whole wheat pasta, will not only save you calories, but provide you with fiber and essential nutrients.  Some delicious and satisfying breakfast options include a high-fiber cereal (5 grams or more) with skim milk and berries or an egg white omlette with veggies and a slice of whole wheat toast.

Eat 3 meals daily. 
Although this may be difficult for someone who has to run a country, eating at least 3 meals and a snack daily is a must. Eating throughout the day helps to keep your blood sugar from dropping too low, therefore avoiding the symptoms of hypoglycemia which tend to lead to overeating. Having lunch mid-day is a great way to incorporate more fiber into your diet, as well as keep you feeling fuller, longer and prevent you from overeating at late-night meetings. Your best bet for dinner is to start with a broth-based vegetable soup and a small salad with the dressing on the side.  This combination helps to provide you with both protein and fiber, and fills you up while adding a minimal amount of calories. You’ll find that you will fill up quicker, and hold off temptations for seconds.

Enjoy snacks.
Since it’s wise to eat something small at least every 3 hours, having a snack isn’t an indulgence — it’s an important part of your diet. Eating small snacks can help prevent you from becoming ravenous throughout the day and into the night. Carb-only snacks raise your blood sugar quickly then cause it to drop below normal. When that happens, you tend to eat anything you can get your hands on. However, what you choose as a snack can make a big difference on your energy and your mood. And often what most people choose is too high in calories and fat and leaves you hungry soon after. Snacks should be between 100-200 calories, which is just enough to satisfy you without sabotaging your health. They should also be a combination of fiber and protein, since fiber and protein are the two nutrients that take the longest to digest and keep you full and satisfied on fewer calories. Sample snacks include, 1oz. of pistachios with 8 dried apricots, Gnu Flavor and Fiber Bar, or a pear with 2 tablespoons of peanut butter.

Don’t drink your calories.
Research shows that our bodies do not register calories from fluids.  Meaning that the amount of calories that your drink contains has absolutely no effect on your satiety level meaning your drink will not fill you up. Stick with calorie free beverages like unsweetened iced tea, water and Crystal Light flavor packets.
In addition, reports say Obama has a few favorite drinks and foods that he often can be found sipping or munching. These are all a great addition to any healthy diet. Some of these include:

Fiji Water: Water is important for all bodily functions, and staying hydrated helps fight fatigue while helping you stay in shape by avoiding any excess calories or carbohydrates. Obama can often be found sipping Fiji water. Fiji water is a smart choice because it contains naturally- occurring electrolytes for optimal hydration, unlike purified water which adds them.

Cuties: One of Obama’s favorite snacks is Cuties. These are small, simple, super sweet and seedless, making this a perfect snack for Obama to have while jetting on Air Force One or simply hanging with his girls in the Oval Office.  Cuties are the newest addition to the orange family. Two of these cute little mandarins contain 4 grams of fiber, 400 milligrams of potassium and 300 percent of the daily value of vitamin C.

Pistachios: While consuming all types of nuts can lead to an excess of calories, with pistachios you get more bang for your buck.  A 1 oz. serving of pistachio nuts is equivalent to 160 calories and 49 nuts.  This is compared to 23 almonds or 18 cashews for the same amount of calories. Not only are pistachios a great source of both fiber and protein, but they also contain antioxidants and vitamin B6, which studies have shown to be a stress fighter. Although nuts do contain healthy fats which are believed to lower cholesterol, eating straight from the bowl can easily lead you to munch through 1000 calories. In a recent study done at Eastern Illinois University, researchers confirmed that people are more influenced by perception then hunger. When a group of people were given the same amount of pistachios, shelled and unshelled, they ate 45 percent less nuts when they had to open them. This small study shows that by making small changes such as choosing in-shelled pistachios, which slow down consumption time, one can curb calorie intake dramatically. Pistachios also contain the highest amount of fiber compared to most other nuts, as well as heart healthy monounsaturated fats, which have been shown to lower cholesterol.

Spinach: This is a great way to combat stress. It is rich in beta carotene, which helps boost the immune system. The body converts beta carotene into vitamin A, which itself has anti-cancer properties and immune-boosting functions. Spinach also contains iron and folate which can help reduce the risk for heart disease.

Broccoli:  Another one of Obama’s favorite vegetables is broccoli. Nutrition experts at the University of Pennsylvania School of Medicine say having a daily dose of vitamin C can help alleviate stress because it is a prevailing antioxidant used to keep the body healthy.  So continue filling up on broccoli and other high-fiber vegetables.

Protein Bars: Thank goodness for protein bars! These convenient, pre-packed, pre-portioned meals that are simple, mess-free and portable, are the perfect snack for the President of the United States of America! With so many different brands on the supermarket shelves, grabbing one while on the run is a simple way to satisfy your hunger… NOT SO FAST!!! Many of these “energy bars” although marketed as “healthy” are simply glorified candy bars. Gnu flavor and fiber bars are one of your best options. Gnu bars have less than 150 calories and 3 grams of fat, but contain 12 grams of fiber — nearly half of the daily recommendation. These high-fiber, low-fat bars are a savior when you’re in a car, at the office or the gym. Choose from any of their 5 tasty flavors including cinnamon raisin, chocolate brownie, peanut butter, banana walnut, and orange cranberry.

Tanya Zuckerbrot, MS, RD is a nutritionist and founder of Skinnyandthecity.com.    She is also the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com.