Obesity affects a significant portion of the population, and many individuals find it challenging to lose weight through diet and exercise alone. Medically supervised weight loss programs offer a structured and supportive approach to weight management, addressing the complexities of weight loss with a team of healthcare professionals. These programs focus on proper nutrition, physical activity, and healthier lifestyle choices, providing individuals with the tools and guidance needed to achieve and maintain a healthy weight.
Understanding Medically Supervised Weight Loss
Medical weight management is a non-surgical program designed to help people lose weight and maintain that weight loss. This approach emphasizes building daily habits for a healthy lifestyle, differentiating it from dieting alone. A key aspect of these programs is the personalized support from a team of experts, including a doctor and a dietitian, who provide guidance, support, and accountability. Depending on individual needs, the team may also include nurses, physical therapists, and psychologists.
Who Benefits from Medical Weight Loss Programs?
Good candidates for medical weight management are individuals who have struggled to maintain lifestyle changes, have a BMI that qualifies them for the program, or have medical or psychological conditions that prevent them from undergoing bariatric surgery. The Weight Management Program at NYU Langone welcomes anyone who has a weight concern and hopes to gain a sense of control over their weight.
Components of a Medical Weight Loss Program
A typical medical weight management program includes several key components:
Medical Evaluations: Comprehensive medical evaluations are conducted to identify any underlying weight-related conditions, such as type 2 diabetes, high cholesterol, thyroid disorders, or sleep apnea. Additional tests may be recommended based on an individual's medical history and physical exam. Many medical conditions can worsen as a person gains weight. Weight loss is often the best way to manage these conditions, which include metabolic diseases, such as type 2 diabetes, and movement issues, such as osteoarthritis of the knee and osteoarthritis of the hip.
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Medication Review: Clinicians review current medications to identify any that may contribute to weight gain. Many medications used to manage conditions such as diabetes, depression, seizure disorders, arthritis, and high blood pressure contribute to weight gain. They may suggest alternative medications or ways to manage these conditions with lower doses, in collaboration with the patient's primary care physician.
Metabolic Rate Testing: Metabolism analysis helps determine an individual's metabolic rate, which is a calculation based on body fat, muscle mass, age, gender, and fluid retention. This information is used to create a diet strategy focused on consuming fewer calories than the body burns in a day. The testing is quick, painless, and does not require a blood test or fasting.
Individual Meal Planning: Planning meals in advance, understanding the nutritional value of foods, and maintaining accountability are crucial for weight loss success. Participants learn how to create a healthy eating plan and maintain a food diary.
Mindful Eating and Nutrition Planning: Mindful eating is a cornerstone of medical weight loss programs. Discussions cover eating habits, triggers for eating, and how to distinguish "head hunger" from true metabolic needs. Strategies for managing stress without food are also explored. Registered dietitians teach participants how to read food labels and menus, understand food composition, and incorporate nutritional knowledge into their daily lives while balancing family preferences.
Self-Monitoring Tools: Participants are guided on which self-monitoring tools, such as bathroom scales, food diaries, and label reading, are best suited for them and how often to use them.
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Exercise Guidance: Providers help participants set exercise goals that align with their current fitness level and can be implemented at a gym, at home, or in the community. Guidance is provided to make physical activity more enjoyable and easier to maintain as a healthy habit, based on professional guidelines such as those from the American College of Sports Medicine.
Group Support: Many programs offer group sessions to help participants build skills for successful weight loss, adopt a healthier lifestyle, and maintain long-term weight loss. Weight maintenance programs provide ongoing support to prevent weight regain, including weekly weigh-ins and group participation.
Weight Loss Medications
Medications can be a valuable tool for weight loss when used as part of a comprehensive weight management plan that includes dietary changes and exercise. They work best as part of a larger medical weight management program that includes a balanced diet and regular exercise. Medications can lower your set-point body weight. This means the brain stops defending a higher weight and is comfortable at a lower weight. Instead of having hunger going up and metabolism going down, medicines can use hormonal changes to address the physiologic responses to weight loss. To find the best fit, doctors may prescribe a limited amount of a medication for a trial period of 4-6 weeks to assess results.
FDA-Approved Weight Loss Medications
The FDA has approved several prescription medications for weight loss, which work through various mechanisms:
Phentermine: This medication stimulates the nervous system, reduces appetite, and promotes feelings of fullness. On average, individuals lose about 4-5% of their initial weight after one year.
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Orlistat (Alli®, Xenical®): Orlistat is available over-the-counter as alli® and is also available in a higher dose prescription called Xenical®. Both are FDA-approved for weight-loss and work by decreasing the amount of fat your body absorbs. It is taken three times daily before meals containing dietary fat. Orlistat only allows your body to absorb two-thirds of the calories from the fat you consume. On average, individuals lose about 5% of their initial body weight.
Contrave® (Naltrexone and Bupropion): Contrave® was FDA-approved in 2014 and combines two medications, Naltrexone and Buproprion, which were previously approved for other medical conditions.
Qsymia®: Qsymia® is a weight-loss drug initially approved by the FDA in 1959. Traditionally, Qsymia® is used to prevent migraines and seizures.
Saxenda®: Saxenda® is an injectable medication approved by the FDA in 2014 to treat type 2 diabetes. It works by increasing the body’s natural production of insulin, which helps regulate blood sugar levels.
Wegovy®: Wegovy® is an injectable prescription medicine designed for adults with obesity or excess weight who also have weight-related medical problems, aiming to help with weight-loss. It is a glucagon-like-peptide-1 (GLP-1) receptor agonist that is engineered in the laboratory. In the Wegovy® STEP studies, the average weight-loss ranged from 15 to 17% of the participant’s starting weight.
Zepbound®: Zepbound® is an injectable medication that mimics the naturally occurring GIP and GLP-1 hormones released by the intestines into the bloodstream within minutes after we ingest food. In four SURMOUNT studies of individuals taking Zepbound® for 72 to 88 weeks, the average weight-loss was 15-25% of the individual’s starting weight.
Important Considerations for Weight Loss Medications
Safety and Side Effects: FDA-approved medications are generally considered safe and effective, but side effects can occur. Common side effects include nausea, constipation, and diarrhea. It is crucial to discuss potential side effects with a healthcare provider.
Insurance Coverage: Insurance coverage for prescription weight loss medications varies by state and insurance provider. Some patients may be able to get coverage for prescribed weight loss medications through their health insurance, but each plan is different.
Individual Response: Everyone responds differently to medications, and weight loss is highly variable. It is important to have realistic expectations and work closely with a healthcare provider to monitor progress and adjust treatment as needed.
Meal Replacement Programs
Meal replacement programs use nutritionally balanced, low-calorie foods to replace one or more meals per day. These programs offer a convenient and controlled way to manage calorie intake while ensuring nutritional needs are met. When used as part of a structured program under the supervision of a weight management provider, meal replacements can help achieve and maintain weight loss goals.
GLP-1 Weight Loss Program
A new GLP-1 Weight Loss Program is designed to complement the use of GLP-1 medications typically prescribed for the management of diabetes, sleep apnea, cardiovascular disease, and obesity. The program integrates the use of meal replacement products, which contain prebiotic fiber and probiotics to help manage medication side effects such as nausea and gastrointestinal discomfort, along with ingredients to help maintain and build muscle.
Concerns about Meal Replacement Programs
A primary concern with meal replacement programs is the ability of participants to successfully readjust to eating healthy, self-prepared foods following the meal replacement phase. These programs work as a transition to a healthier, self-prepared nutrition plan while offering education and support.
Lifestyle Modifications
Lifestyle modifications are a critical component of any successful weight loss program. These changes involve adopting healthier eating habits, increasing physical activity, and addressing emotional and behavioral factors related to food.
Healthy Eating
A weight loss diet typically includes less refined carbs and more fiber-rich food and lean meats. That’s because foods that are lower in fat and higher in fiber tend to have fewer calories and fill you up more. It’s important to remember that no food is “bad” or completely off-limits.
Exercise
Regular physical activity is essential for weight loss and overall health. Most people will benefit from a combination of cardio, strength training and flexibility exercises.
Addressing Emotional and Behavioral Factors
To lose weight (and keep it off), it’s important to address your attitudes and emotions related to food. Weight control isn’t always as simple as balancing what you eat with what you do.
Finding a Medical Weight Loss Program
Several institutions offer comprehensive medical weight loss programs. Some examples include:
NYU Langone Weight Management Program: With locations in Manhattan, Brooklyn, Long Island, and Suffolk, this program offers nonsurgical medical weight loss methods focusing on nutrition, physical activity, and lifestyle choices.
Brigham and Women's Hospital Center for Weight Management and Wellness: This center offers personalized plans combining medication and nutrition, including calorie-controlled plans, meal replacement plans, and combination plans.
Inova Medical Weight Loss Program: This program is directed by a board-certified bariatrician and provides expert advice on essential weight-loss strategies.
Making an Appointment
To learn more about medical weight loss options, it is recommended to schedule an appointment with a weight loss expert. Some programs offer in-person and online provider visits.