What Is Medical Weight Loss?


Medical Weight Loss Involves Non-Surgical Medical Care For Obesity and its Complications Including Metabolic Syndrome

The term "medical weight loss" gets tossed around a lot these days yet few people seem to every stop and define it. It's really very simple though. It just means using medicine (as opposed to surgery) to assist patients with weight loss. Medical weight loss has been around for a long time but it has not always been such a good thing. Partly this is because we haven't had great luck in the past with some weight loss medications like fen-phen, but things are changing. As I write this in the year 2012, we are on the cusp of the "Qnexa era" of medical weight loss and though I remain somewhat skeptical that Qnexa will prove very useful, I may be proven wrong. At any rate, this much is clear: obesity is epidemic in America and something has to be done. Fortunately, with or without Qnexa, we have a number of very safe and effective older weight loss medications that can help appropriately selected patients.


The Three Essential Components of Medical Weight Loss:

1:Careful Medical Evaluation of Each Patient: 

    • to determine cause(s), consequences, co-morbidities (weight related medical conditions) and to rule-in and rule-out appropriate treatment options.

      • Medical history
      • Weight history
      • Physical examination
      • Laboratory testing
      • Anthropometry (body measurement techniques starting with tools as simple as an accurate scale and as complex as bioelectric impedance or DEXA 

2: Immediate and Appropriate Management of Any and All Uncontrolled Weight-Related Illness

    • This is where a medical doctor can help far more than a lay-practitioner. Generally, I work to stabilize and control all of my patients' weight-related health and medical problems (if they have any) BEFORE starting weight loss. This can include issues such as regulating blood pressure and blood sugar, treating low thyroid function or, when a patient presents with a complex medical problem, referring that patient to a medical specialist.

3: Aggressive Medical Treatment of Weight:

    • Patients don't come to me to to pussy-foot around with a serious weight problem and I respect and agree with that attitude. To that end, the medical therapies that I employ may include the following modalities (remember that each patient is unique and treatment varies according to health and need):
      • Prescription weight loss medication. The details of these medications are covered elsewhere.
      • Diet prescription. Again, this is explained in much greater detail elsewhere.
      • Exercise prescription (ditto)
      • Counselling and education
      • Referral for Bariatric Surgery when needed 

Medical Weight Loss is NOT a Cure


Medical treatment of obesity is not a cure. Without serious and lifelong changes in eating habits and activity, the weight loss caused by medications like phentermine or Qsymia will return when the medication is discontinued.

WHAT IS BEHAVIOR MODIFICATION?

It sounds like something for three year olds who are stuck in potty training. It's a stupid name. So what is behavior modification really?

Have you Ever Promised Yourself Something and then Broken That Promise?

That is what 'behavior modification' is about. It's about why people who are very intelligent and very committed can toss all of their brains and willpower out the window from time to time. But more than it is about WHY we sometimes sabotage ourselves, behavior modification is about about how to change that behavior in the future. Probably the best form of behavior modification for most people is called "Cognitive Behavioral Therapy" (CBT). CBT is basically just a simple way of analyzing behavior we don't like, determining what sequence of events, thoughts and feelings precede that behavior and then setting out to manage those events, thoughts and feelings so that they produce a different outcome than self-sabotage. It's not hard and its not humiliating and it really works. 
Effectiveness of Medical Weight Loss


On AVERAGE in carefully controlled clinical trials, SOME weight loss medications cause a loss of as much as 10-18% of starting body weight (versus 3%-6% for placebo [fake medication]). This means that a 300 pound person could expect to lose something like 30-54 pounds taking a modern weight control medication. 

Does this sound disappointing to you?

It probably does. So allow me to point out a couple of things:

  1. These are REAL numbers from REAL studies done in major universities, not hype from an unreliable source. In other words, this is the honest truth and the honest truth is that the average weight loss with the best modern medical therapy available is between ten and eighteen percent of starting body weight. From a medical perspective, these numbers are amazing and they give us hope that many of the terrible health consequences of obesity can be reduced or mitigated with medical help.
  2. These numbers are AVERAGES. Some people lose far less and some people lose far more. In my personal experience, the difference depends upon effort. People who are highly motivated to change their lives find that weight loss medications can work as an effective tool to help them lose significantly greater amounts of weight. Let me also make an observation about most clinical trials for weight loss drugs:
    1. Participation is free. Sad to say it, but this often means that volunteers recruited into these studies join them without feeling much reason or pressure to make lifestyle changes. The attitudes of many volunteers can be summarized as "if it works, great if it doesn't, I've lost nothing". Compared against highly motivated people actively seeking a medical weight loss program, we should expect volunteers to generally lose less weight.
    2. The principle goals of clinical trials are to determine safety first and statistically significant weight loss second. In other words, clinical trials are VERY cautious endeavors  that are not designed to determine MAXIMUM effectiveness, just SOME effectiveness.
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