What is medical weight loss?
Medical weight loss is defined as a weight management program that is developed and monitored by a medical professional, either a family doctor or specialist physician. In medical weight loss, the therapeutic program is approached as a doctor would for any disease and the management is based on individual factors. Obesity is classified as a disease and is one of the leading causes of heart disease in developed nations. Obesity is curable and in many cases it does not require lifelong medical attention.
Weight Loss, Gain & Management Principles
The basic measure of energy is by the unit known as the calorie. Physical activity uses energy (output) that can be measured in calories. Food supplies the body with fuel for energy (input) which can also be measured in calories. Therefore the calories in food is the energy potential of food. The calorie is a very small unit of measure and food and exercise is usually measured in kilocalories (kcal). However over the years, this has been termed as calorie so currently, any reference to calories in food or exercise actually refers to kilocalories. In the metric system, energy is measured in kiloJoules (kJ).
There are three basic principles which weight management is based upon.
- Calorie input (food) is greater than calorie output (exercise) then a person will gain weight.
- Calorie input (food) is less than the calorie output (exercise) then a person will lose weight.
- Calorie input (food) is equal to calorie output (exercise) then a person will maintain a constant body weight.
However, there is an additional factor that has to be taken into consideration in a healthy person and that is the body’s basal metabolic rate (metabolism). A person with a high metabolism can consume more calories than they use for physical activity without gaining weight.
Taking this into consideration, medical doctors can assist patients with constructing and implementing a medical weight loss plan.
Diseases that Cause Weight Gain
A number of medical disorders can contribute to weight gain and this plays a key factor in any weight management program. A medical doctor will have to prescribe or alter the necessary medication needed to treat any underlying disease or the weight management plan will fail. Some of the common conditions that may contribute to weight gain include :
- Hypothyroidism (refer to Hashimoto’s thyroid disease)
- Cushing’s syndrome
- Growth hormone deficiency
- Eating disorders
- Hormonal disorders
- Insulin resistance
There are other conditions that may contribute to weight gain, some of which are genetic, but these are rare. Many people suffering with obesity often claim to have a genetic disorder since their parents or siblings also suffer with the obesity. However in most cases, obesity is due to environmental factors and inappropriate learned behavior in relation to proper nutrition and exercise. In these cases, psychotherapy and dietary awareness is necessary.
Medical Weight Loss Procedure
A medical weight loss program is only considered after the supervising doctor completes a thorough patient personal and family history. Here all factors that may be contributing to weight gain are taken into consideration. Other diseases, even if unrelated to weight gain, are identified. The aim of this thorough case taking and physical examination is to identify all pre-existing medical disorders, exclude any diseases that may be suspected and give you a clean bill of health before you start your weight management program.
Diagnostic investigation may be necessary to diagnose or exclude any of the diseases identified in the case taking and physical examination. Even if there are no other medical disorders, a doctor may request a cardiovascular evaluation to verify that you are not at risk of a heart attack should you begin the exercise component of your weight management program. Diagnostic investigation like blood tests may also be necessary to verify your blood glucose tolerance, cholesterol levels and any vitamin or mineral deficiencies.
Assessment for the weight management component of your consultation may include the following :
- Your body weight, height and body mass index (BMI).
- Your body circumference measurements (in inches or centimeters) of different parts of your body.
- Measure of body fat in the main areas like your abdomen with the use of body fat calipers.
- Your regular eating habits and physical activity which may be recorded in a journal for up to 2 weeks prior to the start of the program.
Body fat and circumference are two important measurements that have to be taken into consideration apart from body weight. At times in a weight loss program, the body weight may stay constant (plateau) although the body fat or measurements will reduce. This allows the proper benchmarking and setting appropriate goals in the weight management program.
Weight Management Program
A medical weight loss program should be developed by a medical practitioner after considering your individual case history, family history, risk factors for life threatening disorders and general health status. A weight management plan may be divided into five components, all of which may impact on the weight loss goals of the patient.
- Eating plan
- Exercise schedule
- Weight loss surgery
- Weight loss drugs
Eating Plan for Medical Weight Loss
This is the single most important aspect of any weight management program as the prevalence of obesity in this day and age revolves around the excess consumption of high calorie foods. A doctor may take one or more approaches to developing an individual eating plan in conjunction with a dietitian.
Low Calorie Foods
Certain foods have a lower calorie content ounce-for-ounce compared to other foods. A diet of low calorie foods will reduce the daily calorie intake without reducing the quantity of food. This prevents hunger, which may drive the person to binge on high calorie foods as a means of alleviating any cravings.
Low GI (Glycemic Index) Foods
The glycemic index (GI) is the measure of the rate at which foods are broken down, absorbed and increase the blood sugar level. If the blood glucose increases, the body secretes the hormone insulin into the bloodstream to control the glucose levels. Insulin forces cells to take in more glucose, converts some of the blood glucose into glycogen which is stored in liver and muscle cells and the remaining glucose is stored in fat cells. Therefore maintaining a healthy and constant blood glucose will prevent blood ‘sugar’ spikes.
High GI foods, mainly refined, processed and convenience foods, cause these sudden ‘sugar rushes’ in the the blood. The body has to secrete insulin and store excess glucose as fat. Low GI foods slowly release their ‘sugar content’ into the bloodstream, maintaining a constant glucose supply which the cells can use at a moderate rate. This prevents the need for storing excess glucose as fat for later use. This process may be disordered in a person with diabetes, impaired glucose tolerance and insulin resistance.
Increased Protein Intake
There has been much hype over the high protein, low fat and no carbohydrate diets in recent years and these eating plans can be dangerous. The body needs all three food types, carbohydrates, protein and fat, for proper functioning. Protein has a distinct benefit over the other food types. Ounce-for-ounce protein has a lower calorie content than fat or carbohydrates. Protein also triggers the satiety center in the brain, which plays a part in ‘telling’ the body when we are hungry or not. Since protein has this unique effect on the satiety center, even in low quantities, it areduces hunger pangs.
Protein is an important component for the body’s structure, especially the muscle cells. The muscle cells are unique in that they have the highest metabolic rate from any other cell, even when at rest. If there is a lack of protein, the body sources protein from the muscle cells and this causes the muscles to shrink and ultimately use less energy, even at rest. The protein requirements for each person differs and your medical doctor will make an estimate of your daily protein intake depending on your weight, age, physical activity and current needs.
Low Fat Intake
Fat provides three times the calories, ounce-for-ounce, than carbohydrates. While fat is a necessary part of any diet , as it plays an important role in the nerve linings, an excess intake of fat will contribute to weight gain. Fat also contributes to blockage of the arteries and is a major contributing factor to coronary artery disease. Under the supervision of your doctor and a dietitian, the appropriate amount of fat intake can be assessed and incorporated into your eating plan.
Eating small meals regularly, up to 5 or 6 times a day, is more beneficial than eating fewer meals. This assists your weight loss goals by :
- maintaining constant blood glucose levels.
- ‘resetting’ the metabolic rate.
- preventing the ‘starvation’ hormone response.
The ‘starvation’ hormone response occurs in persons who are deprived of food or opt to eat only 1 or 2 big meals in the day. The body needs a constant supply of energy and if deprived of food for long periods, it will trigger a hormonal pathway which stores food and utilizes only the bare minimum for sustaining the body. This survival mechanism causes an increase in body weight (excess calories stored) and fatigue (fewer calories used). Eating small meals regularly will usually increase the metabolism. However this metabolic rates will maintain itself unless a proper eating plan is maintained for an 18 to 24 months at which point your body will continue at the new ‘set point’.
Food Intolerances and Allergies
A medical practitioner can assist with identifying the signs and symptoms of a food intolerance or allergy and run the proper diagnostic tests to make a conclusive diagnosis. This will greatly assist a dietitian in developing your eating plan accordingly.
Exercise Schedule for Weight Loss
Exercise is important in ensuring a balanced approach to weight management. By expending more calories through exercise, any excess calorie intake can be offset by physical activity. Exercise also assists with increasing endorphin levels, the ‘feel good’ hormone, and serotonin, which plays an important role in enhancing moods. These are important considerations in allowing the patient to feel better about themselves and helps to prevent binge eating or comfort eating.
However in persons who are obese or overweight and considered t high risk for a heart attack, a strenuous exercise program can be dangerous. Ideally an exercise program would incorporate at least 20 minutes of cardiovascular exercise three times a week. Exercising less than this or infrequently can strain the heart more than being inactive. After a cardiovascular assessment and in conjunction with your body’s abilities and needs, your doctor will assist you in choosing the most suitable exercise routines for your weight management program. At times, a biokineticist or certified fitness trainer may be consulted to ensure that your exercise regimen meets with your weight loss goals.
Eating disorders and inappropriate eating habits are often a learned behavior from childhood. At times it may be due to ignorance, while at other times it may be a form of emotional assistance in dealing with stressful situations (‘comfort eating’). Psychotherapy assists you in dealing with any emotional issues, treating depression and helping you set and achieve mental and emotional goals to coincide with your physical weight loss benchmarks.
Weight Loss Surgery
Weight loss surgery is not considered as a first option for any patient unless other measures have failed. Weight loss surgery is known as bariatric surgery and the most common procedure is the gastric-stapling. This is a form of restrictive bariatric surgery that serves to reduce the stomach size and limit food intake. Previously other forms of bariatric surgery involved malabsorptive surgery where the crucial parts of the gastrointestinal tract were bypassed in order to prevent the body from absorbing food. The most common practiced method was jejuno-ileal bypass surgery (JIB), which has now been banned in most countries due to the danger associated with malnutrition, vitamin and mineral deficiencies and certain medical complications.
Weight Loss Drugs
Proper weight loss drugs differ significantly from over-the-counter (OTC) diet pills. Weight loss drugs either suppress the appetite (appetite-suppressants) or alter absorption of fat from the gut (fat absorption inhibitors). These are scheduled drugs that require a doctor’s prescription and should only be used as part of a medical weight loss program.
There has been many cases where other drugs have been used for weight loss purposes. This includes the use of synthetic thyroid hormones to increase metabolism, diuretics to increase water loss and ephedrine OTC diet pills which stimulates thermogenesis (heat production) in the body by burning more calories. Ephedrine diet pills is now banned in many countries but herbal and nutritional supplements containing ephedrine still appear on the market occasionally. These drugs are extremely dangerous and can lead to a host of complications, some of which are life threatening. Synthetic thyroid hormones and diuretics are scheduled drugs and should not be used by any person for weight loss unless a doctor has prescribed it to treat an underactive thyroid or water retention respectively.