What to Look for in a Medically Supervised Weight Loss Program

January 6, 2021

Medically Supervised Weight Loss Programs

Retail weight loss stores have increased in popularity over the years with many new programs proclaiming they have THE solution to weight loss. In social media, there are countless companies and influencers making similar claims.

We are constantly being sold the solution to weight problems but there is not much science backing many of the claims up. The FDA has shut some of these companies down due to false advertising.  While some of these programs or diets can have short term success, most fail with sustaining the weight loss, leading to weight regain.  Some give up and proceed with bariatric surgery as the only alternative. 

Medical weight loss clinics may be the answer to the sharp divide between retail fad diets and drastic surgical options. However, many of these clinics are located in hospitals or large medical centers.  The medical feel seems uncomfortable for many and so the treatment of obesity in the market is primarily done by the Weight Watchers and Jenny Craig’s in the marketplace.

Recent, trendy diets such as Paleo, Keto, and intermittent fasting can all be effective tools to be used in a medical weight management program. However, they should be supervised by a medical professional in order to ensure proper nutrition is maintained and other health problems are addressed as well.

Obesity is a metabolic disease. Obesity is best treated by a specialist trained in obesity medicine or surgery. This healthcare provider can treat all of the issues that may be hindering weight loss such as joint problems, autoimmune diseases, hormonal problems such as diabetes, thyroid problems, and mood disturbances. 

To address the weight without considering these other conditions is why long-term success is so poor. There is no quick fix to weight loss and weight loss surgery is not an easy way out. Losing weight requires a long-term commitment to medical care like any other chronic conditions such as diabetes and hypertension.

What a Medically Supervised Weight Loss Program Provides

Medical bariatricians (weight loss providers) and bariatric (weight loss) surgeons are specially trained in weight management and many are boarded in Obesity Medicine. That means they did extra training after residency to be certified in weight management or weight loss surgery. Obesity is a disease caused by a biological dysfunction that stems from a combination of a person’s genetics, environment, and lifestyle.  

The popular consensus is that obesity is primarily a lifestyle problem.  If you just eat less and exercise more, you will lose weight. For many of us that may be true. However, for those who struggle to keep weight off, we know lifestyle changes alone will usually not get them to their goal weight.  If there is success in reaching the goal, the weight tends to come back on and the person regains all their weight and then some.  

A medical weight loss provider will look at the big picture. The provider reviews the patient’s medical history, including past surgical history, medications, allergies, social history, family history, and previous attempts at lifestyle changes. Only after understanding the health history and completing diagnostic testing can a provider prescribe an appropriate treatment.

Labs are a vital tool of any medically supervised weight loss program. Most programs will have a panel of blood tests looking for hormonal problems, micronutrient deficiencies or other diseases that may contribute to a weight problem.  

Tests for Insulin resistance and diabetes are often done. If you don’t have diabetes, you may have a precursor to diabetes called insulin resistance.  That means your insulin levels are elevated.

The role of insulin is to put glucose inside the cell. If it is too high, you will store the sugar by changing it into fat. The cause of insulin resistance is unknown, but it is thought to be tied to chronic inflammation. Having patients go on a low carbohydrate or even ketogenic diets help treat insulin resistance and diabetes. About 80% of patients coming to our clinic are insulin resistant or diabetic.

There are several FDA approved weight loss medications. These work via different mechanisms. Some work on the brain by reducing hunger, cravings, improving mood, and energy. Phentermine is an example of this. Other drugs work in the gut or periphery with insulin resistance and diabetes. Saxenda and Metformin are examples of these types of medications. The addition of medication may significantly help patients adhere to a diet and improve glucose metabolism. 

Understanding your body’s composition and how well it burns calories is important to know how best to create a pathway for weight loss. A DEXA scan (dual-energy X-ray absorptiometry) is a low dose X-ray that measures lean body mass (muscle and bone) and fat mass.  It is more commonly used for bone density and can diagnose bone diseases such as osteoporosis. 

This study is a simple 10-minute office exam that doesn't require you to undress or go into water. It will reveal your total percent body fat and visceral fat (located around the intestines) which is associated with metabolic syndrome. As a person loses weight, we want to track the amount of fat loss versus the amount of lean body loss. Losing too much muscle will cause a decrease in resting calorie expenditure.

As an example, we use an indirect calorimeter to measure the calories our patients burn at rest. It is also a simple office test that takes about ten minutes. This is a useful tool to set daily calorie goals. Many people will say they have a slow metabolism and the calorimeter will show that and allow us to define a daily caloric needs that will preserve lean body mass while losing fat mass. 

Nutritional guidance is the essential support needed for weight loss.  Many retail diet centers sell meal replacement shakes or prepared foods. These plans make it simple to follow calorie or macronutrient recommendations for weight loss. 

Clients buy the shakes or food and in return receive coaching and other support. Although we offer ketogenic or protein meal replacement shakes, our dietitians will customize the meal plan based on the person’s medical history, biometric results, lab results, and lifestyle. Some diets work by decreasing daily calorie intake or carbohydrates or by increasing protein intake through whole food meal plans. One diet is not recommended for all. 

How do you know which diet is best will depend on multiple factors and the dietitian can help recommend the right dietary plan for your goals and lifestyle.  They will also provide recommendations for micronutrient (vitamin) supplementation.  It is common to find vitamin deficiencies in overweight people. These need to be treated with proper supplements. 

Many vitamins sold in stores are not good quality and have contaminants.  Dietitians can provide you good resources for vitamins and follow up with you and your provider to make sure the deficiencies are being corrected.  Sustainable weight loss requires long-term diet changes and dietitians are key to educating you about healthy foods options and providing the correct supplements for your needs.    

Many people believe in the energy expenditure equation which means weight loss occurs when the calories eaten are less than the calories expended.  

This formula does not account for underlying medical problems such as diabetes, autoimmune diseases, hormonal problems, and side effects of many medications that affect overall metabolism. Some people have a very slow metabolism due to low lean body mass. If patients burn more calories through cardio or resistance training, it should increase weight loss.

Resistance training can help to increase lean body mass which improves the resting metabolic rate. However, gaining muscle also increases weight and won’t be reflected by the scale.

Exercise requires good nutrition. If you don’t have a proper amount of carbohydrates for a long work out, you will tire more easily.  If you don’t eat enough protein to build muscle, you won’t increase lean body mass. The DEXA scan can help monitor progress by showing your lean body mass versus your fat mass. The scale will not show that.  I have seen many patients lose fat and gain muscle when they eat proper nutrition.  

Furthermore, local personal trainers are an excellent resource for coaching and direction with fitness. We encourage people to seek out their local gyms or find something they love to do. That could be hiking, golf, tennis, running, or walking.  

Moving more is essential for improving lean body mass, your mood and feeling better. 

Every medically supervised weight loss program needs to have support and accountability. If you are only meeting with a provider monthly, it is very easy to not stick with the prescribed plan. I have found that at least weekly touchpoints are required for people to stay engaged.   

As an example, we use an app called Healthy Transformations to help with that. It gives daily engagement with clients that provides them with support and accountability.

The app connects with a scale and their fitness tracker or step counter. They log in their food intake daily. Alerts are sent to our coaches if clients gain weight or don’t go on the scale several days. We can video call or text each other through the app.  It also has a library of educational resources.

The Take-Away of Medically Supervised Weight Loss

Losing weight is not easy. It requires ongoing support and encouragement to help people reach their goal weight.

We offer 3 or 6-months medical weight loss programs because that is the usual length of time that people can stay engaged with a program. Typical weight loss is ten pounds a month. 

Once clients reach their goal weight, we keep them in a maintenance program to help them sustain it. It is not about selling a meal plan, a supplement, or some magic pill that changes your metabolism.

It is about treating the whole person and helping them reach their goal. That goal may not be a number on the scale but rather, something they wish to do or a medical condition that is a problem for them. It may be that they just want to feel better.

It takes a team and it takes someone who is very knowledgeable about metabolic diseases. A comprehensive medical weight loss program will help you to lose excess weight and keep it off. It is about transforming lives! 

Read more articles on ObesityHelp by Dr. Peter Billing!

ABOUT THE AUTHOR One of the nation’s foremost experts in bariatrics, Peter Billing, MD, FACS, serves men and women in both Lynnwood and Kirkland, Washington, with a range of weight loss solutions. As founder and owner of Transform Weight Loss, he and his dedicated team offer compassionate and customized care to anyone seeking freedom from obesity. An industry veteran with more than 20 years of experience, Dr. Billing is heralded as an innovator and early adopter of some of the most groundbreaking bariatric and metabolic procedures.

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