Weight Management Program - Lose Weight and Keep Weight Off

Dr. Robert Briskin is a member of the American Society of Bariatric Physicians, an organization devoted to treating patients medically who are overweight. Over sixty percent of adults in the U.S. are currently overweight, and 27% are considered obese. Obesity is the second greatest health risk in the U.S., after cigarette smoking. It is estimated that over 300,000 avoidable deaths occur each year due to the complications of obesity. These complications include: sudden cardiac death, heart attacks, strokes, high blood pressure, respiratory problems, including sleep apnea, degenerative arthritis, certain cancers, esophageal reflux, type II diabetes, lipid disorders, fatty liver, accidents, among other maladies.

VIP Weight Management offers a comprehensive weight management program, including diet ( low calorie, very low calorie, balanced deficit), individualized exercise program, behavioral modification, and medications when appropriate. This is a medically supervised, individualized program. We see our patients every other week, weigh them, check their weight, blood pressure, abdominal girth, Body Mass Index, and review their food and exercise diaries. We prescribe medically-approved medications when appropriate, based on the amount of overweight and co-existent medical problems. We follow the guidelines set forth by the American Society of Bariatric Physicians, which is a national professional medical society comprised of licensed physicians trained in the medical management of weight disorders (bariatrics).

Lose Weight and Keep It Off

Like anything that is a fad, fad diets come and go. Unfortunately, so does the weight some people lose when on them. Medical weight loss management is different. True medical weight loss programs are comprehensive approaches, offering a spectrum of options for people who want to lose weight for the long term.

People who are under the watchful eyes of medical weight loss management teams, including physicians, nutritionists, behavioral and physical therapists and surgeons, tend to change not only their approaches to eating, but also their approaches to life, said Robert Briskin, M.D., Internist and Bariatrician.

Overweight? The risks to your health are great

People who are overweight are at greater risk for cardiovascular disease, hypertension, diabetes, stroke, blood clots, hypoventilation syndrome (the inability to breathe adequately), sleep apnea, degenerative joint disease, and some forms of cancer.

Overweight is the adult population is usually based on one's body mass index, or BMI. BMI can be determined by dividing a person's weight in kilograms by height in meters squared. The World Health Organization considers BMI in the normal range to be 18.5 to 24.99. "For example, the BMI for a five-foot, eight-inch person who is 160 pounds would be 24," Briskin said. "If you're 6-feet tall, a body mass index of24 would correspond to a weight of 180 pounds."

People who have a BMI of 25 to 29.9 are considered overweight, and 30 or greater are obese. BMIs of more than 40 are considered morbidly obese, according to Briskin.

"The health risks associated with obesity increase with the extent of the overweight," he said. "The distribution of fat also determines health risks. A man with fat concentrated in the abdominal area has greater health risks, generally, than a woman whose fat is concentrated more in the hips, thighs and buttocks."

Evaluating the overweight patient

One reason that medical management of overweight patients is so important is that medical doctors first assess patients' overall health. "There are certain medical conditions and some genetic conditions that are associated with being overweight; so you want to make sure you are not missing a medical cause, before starting a weight loss program," he said.

"As a team, we also look into other factors in a person's life that could be contributing to their weight problems, such as emotional issues, anxiety or depression. Family predisposition to obesity could be involved in 25% or more of cases," Briskin said. "You really have to take a complete history and physical to understand how to approach the problem so that people can keep the weight off."

The weight loss journey

There are several components to a weight loss program. Most programs start with diet- generally a low-calorie diet, prescribed specifically for a patient by a doctor, and, possibly a nutritionist.

"With the use of food diaries, we can determine the best way patients can get the nutrients they need in the best possible combinations of proteins, fats and carbohydrates for weight loss," Briskin said. "Diet is a key component. It is a first line therapy, along with other elements."

Exercise and behavioral modification are also within the realm of first-line approaches. Doctors might also prescribe medications, along with diet, exercise and behavior modification, if patients are at particular risk for or have other health complications related to their being overweight.

"I do not go into medications unless someone is significantly overweight; they have not succeeded with diet, exercise and behavior modification; or if the risks of the overweight exceeds the risks of the drugs," Briskin said.

Medications that help people to lose weight include sibutramine, a prescription medication that makes people feel full sooner; orlistat, a medication that prevents some fat calories from being absorbed into the intestines; and prescription appetite suppressants, such as phendimetrazine, mazindol and phentermine. According to Briskin, doctors should be cautious when prescribing medications that suppress appetite or make people feel full sooner because they can affect blood pressure and heart rate. Patients taking medications that mal absorb fat should understand that "these types of medication can help patients lose about a third of the fat in the diet in the stool. While they do not generally affect patients' blood pressure levels, doctors have to give patients fiber and vitamins so that they can avoid other undesirable side effects."

Surgical options for weight loss are generally reserved for people who have tried conservative approaches under the supervision of medical management teams but have not been successful.

"I have seen great success with nonsurgical options," Briskin said. "Some of my patients have lost as much as 90 pounds and kept it off for at least two years. The good news, however, for those who do not reach their goals with the more conservative approaches is that surgical options are available, and when performed by a surgeon with experience in the procedures, they can have great long-term success."

According to Briskin, bariatric physicians become patient coaches, of sorts, who safely guide many overweight patients to healthier, happier lives, free of the burden of extra pounds. "Obesity is the second greatest health risk after cigarette smoking. It is estimated that there are 300,000 avoidable deaths a year that occur due to complications of obesity," he said. "Medical complications are only compounded by psychosocial components of being overweight. People that are obese might also be depressed, be discriminated against in the workplace, or think less of themselves because of their physical appearance. With a professional team in place, we address all the important dynamics in that person's life and help that patient meet his or her goals for the long term. "