Losing weight and maintaining a healthy lifestyle can be challenging. Physician-assisted weight loss programs offer a structured and medically supervised approach to help individuals achieve their weight loss goals. These programs combine medical expertise, personalized plans, and ongoing support to address the complex factors that contribute to weight gain.
What are Physician-Assisted Weight Loss Programs?
Physician-assisted weight loss programs are one-on-one treatment options that take place in a medical office. These programs are supervised by physicians and other healthcare professionals trained in obesity medicine. These programs offer personalized strategies and medical supervision, which sets them apart from self-directed weight loss attempts. The costs of these programs vary depending on the services offered. Your health insurance company might cover all or some of this treatment. If you have additional obesity-related health conditions such as high blood pressure or type 2 diabetes, they might affect your coverage for these treatment options. For long-term weight management, having a healthcare team that you feel comfortable with and who is trained in obesity medicine is crucial. If you do not currently have a physician that meets your needs, you should explore working with another physician.
Components of a Comprehensive Program
A comprehensive physician-assisted weight loss program typically includes several key components:
Medical Evaluation and Assessment
At the beginning of the program, patients undergo a thorough medical evaluation. Patients may have undiagnosed type 2 diabetes, high cholesterol, thyroid disorders or sleep apnea. Additional tests may be recommended based on your medical history and your initial physical exam. This assessment helps to identify underlying health conditions, evaluate weight-related risks, and determine the most appropriate treatment plan. The UCLA Medical Weight Management Program collects the following information in order to develop personalized weight loss programs:
- Initial measurements: Weight, vital signs, body composition (measuring lean muscle and body fat via bioimpedence analysis)
- Testing: Blood tests (comprehensive metabolic panel and lipid panel) and EKG
- Physician (+/- dietitian) visit: Weight history, eating habits, medication review, detailed nutrition plan
Metabolism analysis helps to determine your metabolic rate, which is a calculation based on body fat, muscle mass, age, gender, and fluid retention. Your metabolic rate helps to determine how many calories your body burns while at rest. The testing, which uses a body composition analyzer, is quick, painless, and does not require a blood test or fasting.
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Personalized Nutrition Plans
Individualized nutrition therapy is a cornerstone of physician-assisted weight loss programs. Registered dietitians create tailored meal plans that consider individual needs, preferences, and goals. The centerpiece of the UCLA Medical Weight Management Program dietary program is to match each patient’s protein intake to the individualized protein their body needs. The scientific literature supports this approach to control hunger and give patients the best opportunity to lose weight without losing muscle. These plans often emphasize balanced macronutrient intake, portion control, and mindful eating habits.
Mindful eating is a cornerstone of care. Eating habits, triggers for eating, and how to distinguish “head hunger,” which is wanting to eat even though you are not truly hungry, from your body’s true metabolic needs are discussed. Ways to manage stress that do not include food are also discussed. Knowing how to read food labels and menus to find the best choices, as well as understanding food composition, plays a part in mindful eating. Registered dietitians teach how to incorporate nutritional knowledge into a busy life while also balancing family’s food preferences.
Physical Activity Guidance
Exercise is a crucial component of weight loss and overall health. Physician-assisted programs provide guidance on incorporating regular physical activity into daily routines. Providers help you set exercise goals that are aligned with your current fitness level and that can be used at your local gym, at home, or in the community. Guidance is provided that makes physical activity more enjoyable, and therefore easier to maintain as a healthy habit. Recommendations are based on professional guidelines such as those from the American College of Sports Medicine.
Behavioral Therapy and Counseling
Addressing the psychological and emotional aspects of eating is essential for long-term success. Behavioral therapy and counseling help patients identify and modify unhealthy eating behaviors, manage stress, and develop coping strategies.
Medication Management
In some cases, prescription medications may be used to support weight loss efforts. The FDA has approved seven 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. Medications that control feelings of hunger can often help you stick with a new eating plan. Medications are a tool for weight loss and work best when used as part of a comprehensive weight management plan that includes dietary changes and exercise. 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. These medications can help to control appetite, increase feelings of fullness, or affect how the body absorbs fat.
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Ongoing Support and Monitoring
Regular follow-up appointments and monitoring are essential to track progress, adjust treatment plans, and provide ongoing support. Physician-supervised weight-loss programs are one-on-one treatment options that take place in a medical office.
Types of Dietary Programs
Dietary programs are personalized for each patient based on food preferences and body composition testing. To attain low calorie intake with adequate protein, meal replacements (e.g. protein shakes, bars, soups) are frequently used. A wide variety of products are available for purchase. The four broad dietary programs include:
- Very low-calorie diet (VLCD): Meal replacements plus vegetables
- Modified very low-calorie diet (MVLCD): Meal replacements plus one meal per day
- Low calorie diet (LCD): Some meal replacements with mostly whole food
- Maintenance program: Some meal replacements with mostly whole foods
Meal Replacement Programs
Pre-packaged meal replacement plans are a medically supervised weight-loss program. They use meal replacement options along with lifestyle modifications and behavior change counseling to help people reach and maintain their weight-loss and health goals. These programs work as a transition to a healthier, self-prepared nutrition plan while offering education and support.
Meal replacements can be an effective tool choosing nutritionally balanced, low-calorie foods. They offer a convenient and controlled way to manage calorie intake while ensuring nutritional needs are met. These products are designed to replace one or more meals per day and are often formulated with balanced macronutrients, vitamins, and minerals to support overall health.
When used as part of a structured program, under the supervision of one of weight management providers, meal replacements can help to achieve and maintain weight loss goals.
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FDA-Approved Weight Loss Medications
Several FDA-approved medications can be incorporated into physician-assisted weight loss programs. Here's an overview of some common options:
Phentermine
Phentermine is a prescription-only weight-loss medication that has been FDA-approved since 1959. It works by acting on chemicals in your brain to decrease your appetite and contains a mild stimulant to boost energy levels. On average, 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)
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. For individuals who are already consuming a low-fat diet, this medication may not be as effective since their calorie intake from fat is already reduced. People taking Orlistat should supplement with a multivitamin, as they are at an increased risk for vitamin deficiencies. Side effects are limited but can include cramps, gas, stool leakage, oil spotting and gas with discharge.
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. Alli® is a lower-dose version of the prescription drug Xenical® (orlistat), taken before meals to reduce fat absorption. About 25% of the fat consumed isn’t absorbed, passing through as bowel movements. Alli® complements a healthy lifestyle, included a balanced diet, regular exercise and adequate hydration by drinking plenty of water. The average weight-loss with alli® is about five to ten pounds over six months. It is designed to increase your weight-loss while you focus on living a healthy lifestyle. A balanced diet containing some dietary fat is necessary for alli® to be effective. You will not see much a difference with your weight if you are already following a strict low-fat and low-calorie diet. 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.
Contrave
Contrave® was FDA-approved in 2014 and combines two medications, Naltrexone and Buproprion, which were previously approved for other medical conditions. The most common side effects of Contrave® include nausea, constipation, headache, dry mouth, vomiting and dizziness.
Qsymia
This combination medication was approved by the FDA in 2012. Qsymia® is a weight-loss drug initially approved by the FDA in 1959. Traditionally, Qsymia® is used to prevent migraines and seizures. The extent of weight-loss can vary depending on the dosage. 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
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. The effectiveness and safety of Wegovy® have been demonstrated through the Semaglutide Treatment Effect for People with Obesity (STEP) program, involving 4,500 individuals worldwide affected by obesity or classified as overweight with co-existing medical conditions due to excess weight. Participants received lifestyle counseling and were randomly assigned either Wegovy® or a placebo for 68 weeks. 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
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. This is a 30-50-pound weight-loss for someone weighing 200 pounds. The most common side effects include nausea, diarrhea, constipation and vomiting.
Benefits of Physician-Assisted Weight Loss
- Personalized Approach: Programs are tailored to individual needs and goals.
- Medical Supervision: Healthcare professionals monitor progress and address any health concerns.
- Comprehensive Support: Programs offer a range of services, including nutrition counseling, exercise guidance, and behavioral therapy.
- Improved Health Outcomes: Weight loss can lead to improvements in blood pressure, cholesterol levels, and blood sugar control.
- Long-Term Success: Programs focus on sustainable lifestyle changes for lasting weight management.
Who Can Benefit?
Anyone with a body mass index (BMI) of 30 or over can benefit from a medical weight loss program. Body mass index measures your body fat relative to your height and weight. You may also be a candidate for this program if you are experiencing other weight-related conditions, such as high blood pressure, type 2 diabetes or sleep apnea. People who are affected by obesity and have had limited success losing weight on their own may benefit from medically supervised weight loss. Women who have polycystic ovary syndrome or a history of gestational diabetes have unique vulnerabilities related to insulin resistance. Providers work intensively with you to develop safe, effective meal plans that can jump-start and accelerate weight loss. There are several options for those who need to lose weight prior to a medical procedure. It can even help people who have tried traditional diet plans but have been dissatisfied with the results.
- Individuals with obesity (BMI ≥ 30)
- Individuals with overweight (BMI ≥ 27) and weight-related health conditions
- Those who have struggled to lose weight through diet and exercise alone
- Individuals seeking a structured and medically supervised approach
- Those who need to lose weight to be eligible for a fertility procedure
Special Considerations
Weight Loss and Fertility
Losing weight can increase chances for pregnancy. Through the Weight Management for Increased Fertility Initiative (WIFI), a medically-supervised, fertility-focused weight management program, participants receive personalized guidance to help with pre-pregnancy weight loss and lifestyle changes.
Managing Weight-Related Medical Conditions
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. These conditions can be managed while you lose weight and optimize your overall health.
Review of Medications
Many medications used to manage conditions such as diabetes, depression, seizure disorders, arthritis, and high blood pressure contribute to weight gain. There may be alternative medications or ways to manage these conditions that allow you to take less medicine. Clinicians work with your primary care physician to suggest helpful strategies.
Finding a Program
When choosing a physician-assisted weight loss program, consider the following factors:
- Credentials and experience of the healthcare team
- Program components and services offered
- Personalized approach and ongoing support
- Cost and insurance coverage
- Location and convenience
The Importance of Long-Term Weight Management
Due to the high rate of weight regain, weight loss maintenance is equally as important as weight loss. Therefore, a long-term medical weight maintenance program to continue to provide support is important. Losing weight and maintaining your healthy weight is a life-long venture. Proper nutrition, exercise and other lifestyle modifications are essential to a successful and long-lasting outcome. Weight maintenance program is 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.
Self-Monitoring Tools such as the bathroom scale, food diaries, and label reading can all help you reach your weight loss goals and maintain a healthy weight. It is important to figure out which self-monitoring tools are best for you, and how often you should use them.