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After rapid weight loss, the loads are lighter, but the movement pattern is still heavy. Clients often: Stay in a wide, externally rotated stance Over-grip with toes Roll onto the outside or inside edges of the feet in old, familiar ways Knees & hips Obesity research shows: Greater and more variable knee joint loads and altered gait patterns in people with obesity compared to normal-weight controls

doi: 10.1038/nrendo.2013.251 32 BrgiH

Russel, and T

kidney stones) or kidney disease Have glaucoma or other eye conditions Have liver disease Have weak or brittle bones Have breathing or lung problems Have a history of metabolic acidosis Struggle with depression, mood problems, or suicidal thoughts/behaviors Have an upcoming surgery Are on a ketogenic diet Have diarrhea Bottom line: topiramate for weight loss Topiramate can be an effective tool for weight loss, particularly when combined with lifestyle changes, such as a healthy diet and regular exercise

The aggressive clinic-supervised protocol achieved nearly 4 the fat loss of the moderate protocol