Content courtesy of Akron Beacon Journal
This month's Healthy Actions column, which is a monthly look at a medical topic of interest with a local expert, focuses on medical weight loss programs coordinated by a physician.
Dr. Manjinder Kaur is an endocrinologist and director of the Medical Weight Loss Program at Western Reserve Hospital in Cuyahoga Falls.
Kaur said there have been advancements in anti-obesity medications and other treatment tools in recent years.
This is an edited version of my interview. There is also a Beacon Journal podcast of the interview available.
What is a physician-supervised medical weight loss program?
We have a non-surgical weight loss program and a surgical weight-loss program at Western Reserve. In our program, we offer patients non-surgical tools, lifestyle changes, medications, guidance and support.
When would a patient come see a specialist?
Obesity is a chronic medical condition and it should be identified as such. When we think of any medical problem like high blood pressure or diabetes, we go seek help from from our physicians. For obesity, patients feel like they need to take care of this themselves and somehow they have to figure it out.
Since it is a medical problem, they should seek help from their primary care physician or medical weight loss specialist to help them get to their goal weight.
Obesity can increase the risk of various different metabolic diseases like diabetes and hypertension. Weight loss can make a huge impact on those patients.
Patients can start with their primary care physician and get a referral or they can call us directly.
Generally, a patient with a body mass index greater than 30 or a BMI greater than 27 with a weight-related condition like diabetes, hypertension or sleep apnea will qualify for a medical weight loss program.
Who treats patients for obesity?
We have three endocrinologists who also are obesity medicine certified, which means we’ve gotten extra training to help treat patients with additional tools. We also have two dietitians and a nursing staff.
With obesity, patients sometimes don't feel comfortable bringing up their concerns. There's a lot of obesity bias and stigma. We provide a safe space for patients where they can feel comfortable, not feel judged and bring up their concerns.
What treatment options are available?
Anti-obesity medicines may help with a certain amount of weight loss. We offer a multi-pronged program for weight loss. That includes lifestyle changes and diet and nutrition is a must.
Sometimes patients have every intent to eat healthy and they have the knowledge, but they’ll need the help of a dietician to work with us and the medication.
We meet patients where they are. Maybe they just want to talk to a dietician and start there.
We also have structured meal-replacement programs for interested patients. Typically, we replace some of their calories with meal replacements, which are healthier options than what they may be eating.
There are also partial meal-replacement plans, working with the dietitian.
Is there a duration for how long patients might do meal replacement?
It really depends. It’s not for all of our patients. Some patients prefer having a plan and some work with a dietician to eat healthy. We have some patients who maybe after three months feel like they’ve got the new skills and structure and accountability in place and they can replicate that at home.
I have other patients who have been on meal-replacements for two years now. That depends on the degree of weight loss needed. Perhaps they were not a surgical weight-loss candidate, but we started them on this program and they were able to get results and come off their insulin and other medications.
Similarly, is there a duration a patient may be part of your weight-loss program?
Weight is a chronic medical problem, so that means regular attention from the doctor and from the patient. So even when they get to the goal, weight loss patients know that losing weight is hard, but keeping it off is even more challenging.
Patients continue to follow up.
How do you help patients who lose the weight and then may gain it back?
We first talk to patients to change their mindset that it is a medical problem so it requires long-term attention. You’re not going to one day arrive at your goal weight and stay there and forget about it.
Secondly, the whole point of anti-obesity medication, just like medication someone may take to keep the blood pressure stable, is you may need additional treatment options in addition to lifestyle changes. There’s no one cause for obesity. It’s physiological, genetic and environmental.
The Food and Drug Administration (FDA) has approved these meds not just for weight loss, but for maintenance.
When a patient arrives at a certain weight and asks if he or she should stop the medication, a lot of times I have the discussion that you can always stop it. But in the long run because this is a chronic medical problem, you're probably going to need this for a longer period of time. Some patients may do OK without the medications and are able to maintain keeping the weight off or gain some weight. Other patients quickly realize that they feel hungry and are not able to stick to their eating plan so they want the medications long-term.
What part does exercise play in your programs?
Exercise is very important. We all know it's important for our cardiovascular health and mobility. In weight loss, studies show that exercise plays a big role in helping maintain the weight off that you have lost.
We focus first on nutrition and healthy eating and then we build in the exercise. When patients come for our structured program, they're here every two weeks. Part of that appointment includes education on various important topics that help patients keep the weight off, such as how not to emotionally eat, how to get enough sleep and how to handle stress and exercise is a big part.
Some patients work with their trainers but we start where the patients are comfortable. It may be a 15-minute walk every day and showing up consistently for that and then building on that.
Why do some people say “My friend is losing 20 pounds and I do the same things and I can’t lose anything?”
That's because you and your friend are not the same person. We all have different genetics. Excess weight has different causes. It’s not just about diet and exercise. Those play an important role, but your genetics, your family history, your environment, your stress, your sleep, your age, your gender and where you are in life — all of those can contribute.
Things have really changed in the last few years. A few years ago, we had limited options to offer patients other than telling them to exercise and eat right. But now the newer anti-obesity medications are offering 20 to 25% weight loss, which is comparable to what we consider a successful bariatric surgery for weight loss.
If you are doing exercise and eating right and you're not getting the results, don't get discouraged. Maybe there's a cause that's not being addressed. It could be a different medical issue or side effects of medications. That's when you seek medical care and an individualized plan for you.
What about products on the general market that promise magic weight-loss results?
Weight loss is multi-billion dollar industry. Patients may be paying thousands of dollars up front or buying supplements over the counter that promise quick results.
They may not be safe and most of the supplements are not FDA approved, so we don’t know about the safety. A physician-medical weight loss program or your primary care physician will look at your medical history and medications and monitor you to help you safely lose weight.
In what cases would someone consider bariatric surgery?
Criteria would be a body mass index greater than 40, or BMI greater than 35 with met with weight related conditions like diabetes, sleep apnea or hypertension. We do have medical and surgical weight loss at Western Reserve Hospital and work together. We may have patients who start with us and may need or want more weight loss, so we get them started with the basics to eat healthy and keep the weight off that they lose. If they match the criteria for surgical weight loss, we will coordinate with that department.
Do you have any other tips?
A lot of patients have lost and gained weight over the years and it is frustrating. But pursue the medical weight-loss option, if not with us than anywhere where they have a physician who is experienced in this. There’s a lot more treatment options now compared to even a few years ago.
Prioritize your health and think of just taking one step at a time rather than thinking of the big ladder that you have to climb.
Believe you can do this and we are here to guide you, encourage you and offer you tools that you do not have on your own to help you get to a healthier weight.
To read previous Healthy Actions columns, go to www.tinyurl.com/BettyHealthyActions
Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ To see her most recent articles and columns, go to www.tinyurl.com/bettylinfisher.