Doctor's Choice Weight Loss Review: Uncover the Truth Behind the Hype!

Obesity is a major health problem that affects millions of people. Effective treatments have been limited, but new medications and programs are showing promise. This article examines various weight loss options, including lifestyle changes, medical treatments, and surgical interventions, to provide a comprehensive overview of the current landscape of weight management.

The Mayo Clinic Diet: A Lifestyle-Focused Approach

The Mayo Clinic Diet is a weight-loss program developed by Mayo Clinic experts that emphasizes sustainable lifestyle changes. It focuses on incorporating healthy eating habits and increasing physical activity. The program aims to help individuals lose weight and maintain it long-term by adopting new, enjoyable habits.

Two-Phase Structure

The Mayo Clinic Diet is structured into two main phases: "Lose It!" and "Live It!".

Lose It!: This initial two-week phase is designed to jump-start weight loss, with participants potentially losing 6 to 10 pounds (2.7 to 4.5 kilograms). It involves adopting five healthy habits, breaking five unhealthy habits, and incorporating five bonus healthy habits.
Live It!: The second phase is a lifelong approach to health, focusing on food choices, portion sizes, menu planning, physical activity, and sticking to healthy habits. During this phase, individuals may continue to see a steady weight loss of 1 to 2 pounds (0.5 to 1 kilogram) per week until they reach their goal weight.

Key Principles

Portion Control and Meal Planning: The Mayo Clinic Diet simplifies healthy eating by teaching individuals how to estimate portion sizes and plan meals. It does not require strict calorie counting.
Healthy Weight Pyramid: The program utilizes the Mayo Clinic Healthy Weight Pyramid to guide food choices, emphasizing filling but low-calorie options. Each food group in the pyramid promotes health-conscious selections.
Physical Activity: The program recommends at least 30 minutes of daily physical activity, with even more exercise for additional health benefits and weight loss. It provides an exercise plan that includes walking and resistance exercises to maximize fat loss and improve mental well-being. It is advisable to consult with a doctor or healthcare provider before starting any new physical activity program, especially for those who have been inactive or have a medical condition.
Flexibility and Choices: The Mayo Clinic Diet offers a choice of five different eating styles at various calorie levels and allows for sweets in moderation (no more than 75 calories a day).

Safety and Considerations

The Mayo Clinic Diet is generally safe for most adults. However, it is essential to consider the following:

Fruit Intake: While fruits are healthy, they contain natural sugars that can affect carbohydrate intake. Individuals, especially those with diabetes, should balance fruit and vegetable consumption.
Individual Health Conditions: People with diabetes or other health conditions should work with their doctor to adjust the Mayo Clinic Diet to their specific needs, such as prioritizing vegetables over fruits.

Medical Weight Loss Programs and Medications

Medical weight loss programs often involve a team of healthcare professionals who provide personalized treatment plans. These plans may include lifestyle modifications, prescription medications, and ongoing support.

Lifestyle Health: Weight Loss & Wellness at Lahey Hospital & Medical Center (LHMC)

Lifestyle Health: Weight Loss & Wellness at Lahey Hospital & Medical Center (LHMC) offers a comprehensive approach to weight loss, focusing on personalized treatment plans tailored to individual goals, lifestyles, and overall wellness. The program emphasizes ongoing care, recognizing obesity as a chronic condition.

Team Approach: The LHMC program includes physicians board-certified in Obesity Medicine, as well as specialists in endocrinology, psychology, and nutrition. These providers have advanced training in behavioral health, diabetes education, and other areas related to weight loss.
Convenience and Support: LHMC offers convenient appointment times, free parking, and a supportive environment. The program aims to remove barriers to weight loss and help patients sustain their weight loss in the long term.

Weight Reduction Medications

Weight reduction medications can be used as an adjunct to caloric restriction, exercise, and behavioral modification when these measures alone have not resulted in adequate weight loss. However, it's important to note that weight loss due to medication use is generally temporary, and there is a potential for physical dependence and addiction.

When to Consider Medication: Individuals who cannot maintain weight loss through behavioral weight loss therapy and are at risk of medical complications of obesity may benefit from weight reduction medications.
Initial Response: Tests with weight loss drugs have shown that initial responders tend to continue to respond, while initial non-responders are less likely to respond even with an increase in dosage. If a person does not lose 2 kg (4.4 lbs) in the first four weeks after initiating therapy, the likelihood of long-term response is very low.

Specific Medications

Several weight loss medications have been developed and used, each with its own mechanism of action, indications, and contraindications.

Didrex (Benzphetamine Hydrochloride): Indicated for short-term management of exogenous obesity in patients with a BMI of 30 kg/m2 or higher who have not responded to diet and exercise alone. It is contraindicated in patients with advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, and glaucoma.
Contrave (Naltrexone and Bupropion): A combination of an opioid antagonist and an aminoketone antidepressant, indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with a BMI of 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity.
Orlistat (Xenical, Alli): A reversible inhibitor of gastric and pancreatic lipases that prevents the breakdown and absorption of fat. Xenical is available in 120mg capsules, and Alli is available over-the-counter in 60mg capsules. Supplementation with fat‐soluble vitamins is recommended. Orlistat is contraindicated in persons with chronic malabsorption syndromes and cholestasis.
Qsymia (Phentermine and Topiramate): A combination of a sympathomimetic amine anorectic and an antiepileptic drug, indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults with a BMI of 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related comorbidity. It is contraindicated in pregnancy, glaucoma, hyperthyroidism, hypersensitivity to sympathomimetic amines, and within 14 days of taking monoamine oxidase inhibitors.
Belviq (Lorcaserin): Was approved in June 2012 by the FDA as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of 30 kg/m2 or greater (obese) or 27 kg/m2 or greater (overweight) in the presence of at least one weight-related co-morbid condition. However, it was later withdrawn from the market due to safety concerns.
Saxenda (Liraglutide): A once-daily injection of a glucagon-like peptide-1 (GLP-1) receptor agonist, approved for chronic weight management in adults with obesity (BMI ≥30 kg/m2) or who are overweight (BMI ≥27 kg/m2) with comorbidities. It is contraindicated in patients with a personal or family history of medullary thyroid carcinoma (MTC) or in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2).

Ozempic and Similar Drugs

Ozempic, Wegovy, and Mounjaro are drugs that have gained attention for their significant weight loss effects. Ozempic is used to treat diabetes, while Wegovy is a higher dose of Ozempic, and Mounjaro is a dual-action drug that affects both GLP-1 and GIP receptors.

Effectiveness: These drugs can yield an average weight loss of 15 to 20 percent, significantly higher than previous options.
Considerations: While effective, these medications can cause side effects such as nausea, reflux, and abdominal cramping. In rare cases, they can lead to pancreatitis. Adherence to the medication regimen is crucial, as weight regain is common upon discontinuation.
Cost and Insurance: Ozempic costs about $1,200 a month, depending on the dose. Insurance coverage may depend on whether the patient has diabetes or is morbidly obese.

Bariatric Surgery

Bariatric surgery is a more invasive option for weight loss, typically considered for individuals with severe obesity who have not achieved success with other methods.

Comparison with Medication

Weight Loss: Bariatric surgery can result in more significant weight loss than medication alone, particularly for individuals who are severely obese.
Accessibility: Bariatric surgery was previously only available to a small percentage of the population eligible for it.
Long-Term Management: Obesity is often a lifelong condition, and even after bariatric surgery, patients may require ongoing management. Some patients may use medications like Ozempic after surgery to further enhance weight loss or manage weight regain.

Mechanisms of Action

Bariatric surgery, such as gastric bypass and sleeve gastrectomy, works by altering the digestive system to reduce food intake and absorption.

Hormonal Changes: These surgeries can lead to a blast of GLP-1, a hormone that releases insulin and reduces hunger. They also affect other hormones, such as PYY, which promotes satiety.
Nerve Impulses: Bariatric surgery touches on the distension of the stomach and signaling fullness much sooner when you eat from nerve impulses to the brain, not just hormonal impulses to the brain.

Additional Factors in Weight Management

The Role of Capsaicinoids

Energy Intake Reduction: Capsaicinoids, found in chili peppers, have been shown to reduce energy intake. A meta-analysis indicated that capsaicinoid ingestion prior to a meal reduced ad libitum energy intake by 309.9kJ (74.0kcal) during the meal (p < 0.001).

Very-Low-Energy Diets (VLED)

Efficacy and Safety: Evidence supports the safe use of VLED for up to 3 months in supervised conditions for patients who fail to meet a target weight loss using a standard low-fat, reduced-energy approach. Studies have demonstrated significant weight loss and improvements in blood pressure, waist circumference, and lipid profile in the longer term following a VLED.

Indirect Calorimetry

Personalized Energy Goals: Indirect calorimetry can be used to measure resting metabolic rate (RMR) and develop personalized nutrition energy goals. Studies have shown that participants who received personalized energy goals based on measured RMR lost significantly more weight than those who received a standard care equation.

Psychological and Social Factors

Societal Beliefs: Societal beliefs often place blame on individuals for their weight, which can hinder them from seeking effective treatment.
Addiction: A percentage of patients may have an addiction to certain foods, particularly carbohydrates, which can complicate weight management efforts.
Mental Health: Mental health issues such as depression, anxiety, and addiction can play a big role in obesity, and in response to obesity treatments.

Emerging Trends

Combination Therapies: Researchers are exploring the potential of combination therapies that involve multiple drugs or combination drugs to target multiple hormones involved in appetite and satiety.
Primary Medical Treatment within Bariatric Programs: Some bariatric programs are expanding to offer primary medical treatment, providing both medical and surgical management options to patients.

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