Weight loss can be a challenging journey, often filled with frustration and setbacks. Many individuals find it difficult to achieve and maintain weight loss on their own. Medically managed weight loss programs offer a structured and supportive approach, utilizing the expertise of healthcare professionals to create personalized plans that address individual needs and goals. These programs integrate various strategies, including dietary modifications, exercise plans, behavioral counseling, and, in some cases, medication, to facilitate safe and effective weight loss.
Understanding Medically Managed Weight Loss
Medically managed weight loss programs are overseen by physicians and other healthcare professionals, such as registered dietitians, nurses, and therapists. These programs provide a comprehensive assessment of an individual's health status, weight history, and lifestyle to develop a tailored plan that addresses their specific needs. Unlike commercial diet programs, medically managed programs prioritize safety and long-term success by incorporating evidence-based strategies and ongoing medical monitoring.
The Importance of Professional Guidance
Attempting to lose weight without professional guidance can be risky, especially for individuals with underlying health conditions. Healthcare professionals can assess potential risks and benefits of different weight loss strategies, monitor progress, and make adjustments to the plan as needed. They can also provide education and support to help individuals develop healthy habits and maintain their weight loss over time.
Key Components of Medically Managed Weight Loss Programs
Medically managed weight loss programs typically include the following components:
- Comprehensive Assessment: A thorough evaluation of an individual's medical history, weight history, lifestyle, and eating habits.
- Personalized Plan: A customized weight loss plan that addresses individual needs, goals, and preferences.
- Dietary Modifications: Guidance on healthy eating habits, portion control, and meal planning.
- Exercise Recommendations: Recommendations for physical activity that are tailored to an individual's fitness level and abilities.
- Behavioral Counseling: Support and strategies for overcoming emotional eating, managing stress, and developing healthy coping mechanisms.
- Medical Monitoring: Regular check-ups and lab tests to monitor progress and identify any potential health concerns.
- Medication (if appropriate): Prescription weight loss medications may be considered for individuals who meet certain criteria.
Types of Medically Managed Weight Loss Programs
Several types of medically managed weight loss programs are available, each with its own approach and level of intensity. Some common types include:
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Calorie Controlled Plans
These plans emphasize healthy eating habits and portion control. Participants consume only healthy foods they purchase themselves, with guidance from a registered dietitian who designs a meal plan based on their preferences. For the Calorie Controlled Plan, you qualify with a body mass index (BMI) of 32 or above. Healthcare professionals use BMI to check your risk for weight-related diseases. It’s based on a formula that considers your current weight and height. While it’s not a perfect method, BMI can be a useful health indicator for many people.
Meal Replacement Plans
These plans involve replacing some or all meals with liquid meal replacement shakes or other pre-packaged foods. Meal replacement plans are well-studied tools that help people achieve their weight loss goals.
- Partial Meal Replacement: Some meals are replaced with liquid meal replacement shakes, while others consist of healthy foods purchased at the supermarket or prepared at home.
- Total Meal Replacement: All meals are replaced with liquid meal replacement shakes, typically five or more per day, along with prescribed vitamin and mineral packets. This provides complete nutrition while initiating weight loss.
Medication-Assisted Weight Loss Plans
These plans combine healthy eating with FDA-approved prescription medications for weight loss. These medications can lessen appetite or create a feeling of fullness earlier.
Prescription Weight Loss Medications
The FDA has approved several prescription medications for use in people with a BMI more than 30 or a BMI more than 27 when a patient has additional obesity-related conditions. The average weight-loss resulting from prescription weight-loss drugs is 5-21% of your starting weight. It is important to know that everyone responds differently to medications. Insurance coverage of prescription weight-loss medications varies by state and by insurance provider. Some commonly prescribed medications include:
- Phentermine: A stimulant that decreases appetite and boosts energy levels. Individuals lose about 4-5% of their initial weight after one year. Because Phentermine is a stimulant, it may increase your blood pressure and heart rate. Therefore, it’s essential to be monitored by a healthcare professional experienced in prescribing it.
- Orlistat (Alli®, Xenical®): Decreases the amount of fat the body absorbs. On average, individuals lose about 5% of their initial body weight. Side effects are limited but can include cramps, gas, stool leakage, oil spotting and gas with discharge. People taking Orlistat should supplement with a multivitamin, as they are at an increased risk for vitamin deficiencies.
- Contrave®: Combines Naltrexone and Buproprion. The most common side effects of Contrave® include nausea, constipation, headache, dry mouth, vomiting and dizziness.
- Qsymia®: Combines Phentermine and Topiramate. At the lower dose, 62% of individuals on Qsymia® lost 5% of their starting weight, which is approximately a 10-pound weight-loss for a person weighing 200 pounds. The most common side effects include dry mouth, constipation, and tingling sensations in the face, arms, hands and feet. Insomnia may occur if taken later in the day.
- Saxenda®: An injectable medication that increases the body’s natural production of insulin.
- Wegovy®: An injectable glucagon-like-peptide-1 (GLP-1) receptor agonist. In the Wegovy® STEP studies, the average weight-loss ranged from 15 to 17% of the participant’s starting weight. For someone weighing 230 pounds, this equates to 35 to 39 pounds lost. Wegovy® should not be used in patients with a history of severe allergic reactions to Semaglutide, as well as those with a personal or family history of medullary thyroid carcinoma or a rare condition called Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Common side effects include nausea, diarrhea, vomiting and constipation. Additionally, Wegovy® may lead to hypoglycemia (low blood sugar) if taken with certain diabetes medications such as sulfonylureas and insulin.
- Zepbound®: An injectable medication that mimics the naturally occurring GIP and GLP-1 hormones. 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. This is a 30-50-pound weight-loss for someone weighing 200 pounds. The most common side effects include nausea, diarrhea, constipation and vomiting.
Over-the-Counter Weight Loss Medications
- Alli®: Alli® is the only FDA-approved over-the-counter drug for weight-loss. It is not recommended for children under 18 years of age or adults with a BMI below 25. About 25% of the fat consumed isn’t absorbed, passing through as bowel movements. The average weight-loss with alli® is about five to ten pounds over six months. A balanced diet containing some dietary fat is necessary for alli® to be effective. Regular use of alli® may require a multivitamin to prevent nutrient deficiencies. Side effects are limited to the gastrointestinal system and may include gas, cramps, stool leakage, oily spotting and gas with discharge.
Benefits of Medically Managed Weight Loss Programs
Medically managed weight loss programs offer numerous benefits compared to DIY approaches or commercial diet programs:
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- Personalized Plans: Tailored to individual needs and goals, increasing the likelihood of success.
- Medical Supervision: Ensures safety and addresses any potential health concerns.
- Comprehensive Support: Provides education, counseling, and ongoing support to promote long-term behavior change.
- Improved Health Outcomes: Can lead to significant improvements in weight-related health conditions, such as type 2 diabetes, high blood pressure, and sleep apnea.
- Sustainable Weight Loss: Focuses on developing healthy habits that can be maintained over time.
Choosing the Right Program
Selecting the right medically managed weight loss program is crucial for achieving optimal results. Consider the following factors when making your decision:
- Program Components: Does the program offer the components that are most important to you, such as dietary counseling, exercise recommendations, behavioral therapy, and medication management?
- Healthcare Professionals: Are the healthcare professionals experienced and qualified in weight management?
- Program Cost: What is the total cost of the program, and does it include medical assessments, meal replacements, medications, and ongoing support? Visits are covered by insurance and medications may also be covered by insurance, depending on the individual insurance plan.
- Program Location and Schedule: Is the program conveniently located and offered at times that fit your schedule?
- Program Philosophy: Does the program's philosophy align with your own values and beliefs about weight loss?
The Role of Support Groups
As part of many plans, all active program participants are invited to take part in group sessions designed to help you build skills for successful weight loss and a healthier lifestyle, as well as longer-term weight loss maintenance.
Weight Maintenance Programs
Weight maintenance programs are for those who’ve reached their weight loss goals and desire additional support to prevent weight re-gain. The program includes weekly weigh-ins and weekly group participation.
Success Stories
After years of yo-yo dieting, Maya turned to the Center for Weight Management and Wellness at Brigham and Women’s Hospital. She lost nearly 50 pounds by choosing a treatment approach combining medication and nutrition.
Finding a Program
Several reputable medical centers and healthcare organizations offer medically managed weight loss programs. Some examples include:
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- Brigham and Women's Hospital
- Kaiser Permanente
- NYU Langone
- UCLA Medical Weight Management Program