Q: Are there any special pills involved in this program?
A: No mega-dose vitamins or minerals are used. No water pills, shots, or secret preparations are used. The vitamins and minerals that are provided are standard preparations used in standard doses. They are carefully selected and balanced to meet the needs of patients on a low calorie diet.
Q: I want to keep my regular physician involved in my medical care. Can I do this?
A: We strongly encourage that you include your physician in your weight management program. Our staff will be happy to review the details of the program with your doctor and keep him or her informed of your progress as you proceed. We can send your physician a summary letter when you have finished the weight loss phase of the program and will include copies of all your pertinent laboratory and electrocardiographic studies. Regular and routine medical care unrelated to weight loss should be provided by your primary care or specialist physician. Our physicians are specialists in internal medicine, endocrinology, and preventive medicine and will be happy to coordinate your care with your physician.
Q: Are there side effects or risks associated with this program?
A: Any weight loss program will produce some occasional side effects. These are generally infrequent and well tolerated. Most resolve within a few days or weeks. Our staff will review and provide you with a summary of the potential side effects when you start the program. It should be emphasized that we have encountered no serious or significant problems in almost 30 years and in treating nearly 10,000 patients. We have had no patients who have required hospitalization or experienced unmanageable complications because of the program. The potential side effects of these weight loss programs are likely far less frequent and less troublesome than the risks of untreated obesity.
Q: Will I be able to continue my regular activities while I am on this program?
A: Yes. Patients are urged to continue their regular activities including employment and exercise programs. Patients on either the food-based or meal replacement program ordinarily feel entirely well.
Q: How successful is this program in getting people to lose weight?
A: About 75% of the patients who start the program will lose more than half of their excess weight. About 45% will reach a goal weight. This compares favorably with traditional programs for weight loss which ordinarily report that less than 5% of their patients lose 40 or more pounds.
Q: What about long-term maintenance? How good is this program at assuring that I can maintain my weight loss?
A:No program can fully assure you that you will maintain your weight loss. Our goal is to provide regular and comprehensive support from medical, nutritional, behavioral, and psychological perspectives and work with you to build healthful and moderate habits and techniques of weight maintenance that you can incorporate into your life. No one should be unrealistic about the difficulty of weight maintenance or that obesity can be "cured" Our goal is to help each patient lose weight, learn new techniques for maintaining the weight loss, minimize weight-related medical complications, and improve quality of life.
Q: My physician recently did a physical examination on me. Can I use the results of this as part of the initial evaluation for this program?
A: Yes. We are happy to avoid duplication of recent studies. Our physicians will review your medical history and discuss the studies with your physician. If they are applicable, we can avoid repeating the studies and avoid additional and unnecessary costs.
Q: Can I find out more about the program before starting and committing myself to it?
A: Yes. You can call or visit the office to discuss the program with our staff. You can see one of the members of our staff for an initial consultation without making any commitment for any studies beyond that or any participation in the program. (There will be a professional fee for this initial consultation.) An initial orientation session (no charge) is held for all new patients; prospective patients are welcome to participate in a discussion about the nature of obesity and the organization of the program and to meet various members of the staff. Spouses and other members of your family are welcome to attend.
Q: So much of my success in weight loss depends upon the assistance of my husband (or wife) and yet there often seems so little that he (or she) can do. Is there any way in which my spouse can be involved and become familiar with the problems I am having?
A: Yes. Some of the sessions in our groups are oriented to family members. Concerned individuals in your family are urged to attend these sessions and the initial orientation meeting. Additionally, spouses may attend physician visits as appropriate.
Q: I'm afraid that I'll be ravenously hungry. How is it possible that I won't be hungry while eating so little food on a meal replacement program?
A: This is one of the most frequently asked questions. Usually, people on the meal-replacement (Program A) plan are comfortable and satiated. We understand that the issue of hunger is complex and controlled by so many biological and social/emotional factors that it is difficult to assume that there is a single, simple explanation for hunger. It is clear that distracting hunger is rarely a problem. This decrease in hunger is believed to be related to hormonal stabilization and/or the relative amounts of protein and carbohydrate in the meal replacement diet. Although patients will occasionally feel the sensation of wanting to eat, they usually recognize that there is no need to do so.
Q: What about medications that I am currently using?
A: Our medical staff will review your medications with you before you start the program. Most medications will not interfere with the weight losing process and are safe to continue. Some will need an adjustment in the dose or frequency of use. Our staff physicians can coordinate the use of your medications with your physician or can adjust them for you as you proceed with your weight loss. In some cases, successful weight loss will decrease or eliminate the need for medications, particular those for high blood pressure or high cholesterol.
Q: How often will it be necessary for me to visit the office?
A: During the initial weight loss period, patients are usually most successful when they visit the office weekly for medical and nutritional supervision, support, classes and seminars, group sessions, and/or exercise programs. The group sessions and exercise classes are usually scheduled at the same time as their medical visit. The regular structure of weekly visits is important in sustaining and reinforcing the continuation of the effort and the weight loss. Our office hours include a mix of daytime, evening, and Saturday appointments to best fit everyone's schedule. Group sessions and exercise classes are also held at those times. After successful weight loss has been achieved some patients prefer to visit the office every other week or once every month.
Q: My experience with psychologists and psychiatrists has been negative and I am reluctant to participate in the group sessions. Is it an obligatory part of the program?
A: Of course not. However, we strongly believe that the class and group sessions are an important and intrinsic part of the process of weight loss and maintenance. Although there is no absolute requirement that every patient attend the group sessions, we have found that patients who participate in the classes and groups are about twice as likely to succeed in their weight losing efforts as those who decline to participate. Not all of the classes are psychologically based; many focus on nutrition and behavior modification. Because our charges are based on the assumption that all patients participate in groups, there is no reduction in the fees for patients who choose not to do so.
Q:About how rapidly can I expect to lose weight?
A: The rapidity of weight loss on any program depends on the particular program used, the degree of compliance, the typical interruptions that are part of usual life events, and the unique metabolic characteristics of each patient. For example, tall, young men tend to lose somewhat more rapidly than shorter women. Occasionally, patients reach a plateau in the progress of their weight loss. The explanation for this plateau in an otherwise consistent patient is not likely related to changes in the rate of fat loss. Patients, even those who are absolutely consistently compliant, rarely lose the same amount of weight each week. Plateaus and variations in the rate of weight loss are related to shifts in water retention and biological shifts in total body water.
Q: How many calories will I be able to eat when I resume a regular diet?
A: This varies substantially from one person to another. We will develop an individualized set of recommendations about your food and dietary patterns before you are ready to reintroduce food. We will adjust this as necessary, depending on weight stability, level of activity, and individual patient preference. In general, most people need about 1400-2000 calories daily to maintain their weight.
Q: Why bother? I know I can lose weight, but I've lost and gained weight so many times that I am very pessimistic about my ability to sustain a normal weight. Is it worthwhile to try another diet? Isn't it dangerous to bounce up and down?
A: Most chronic diseases have a fluctuating pattern of symptoms and disability. Obesity is not different. Techniques for assured long-term control do not exist, but many good techniques help patients who are willing to maintain a continuing, deliberate, long-term effort. Weight loss is an intense process, but of relatively short duration. Weight maintenance is less intense; the difficulty with weight maintenance is primarily because it lasts indefinitely.
Most patients who have not been able to maintain control have never participated in a comprehensive program or have never learned appropriate maintenance techniques. Many of these patients have never been at a comfortable normal weight and even after reducing their weight, they continue to struggle with old and tired procedures for dieting to lose those last few pounds. These patients have never truly tried a maintenance program. Even if control is not perfect and some weight is regained, many patients recognize that they are significantly more comfortable, often for long periods of time, when they can maintain their weight below their maximum. Again, as with most chronic diseases (diabetes and arthritis are good examples), the obese patient is clearly healthier and more comfortable when under control, even if there is a possibility of a recurrence of loss of control.
It is sometimes suggested that "yo-yo" dieting damages or irrevocably changes the already slow metabolism that is often a part of the problem for many obese patients. Careful studies have refuted these claims. Calorie restriction of any sort temporarily slows metabolism. Metabolism recovers, however, upon stabilization of intake and maintenance of weight loss. There is no permanent change in metabolism. No one suggests that weight cycling is a prudent form of management. The issues surrounding fluctuating weight loss emphasize that the complex task of weight loss should be done carefully so as to avoid the possibility of weight cycling, regardless of any impact this might have upon metabolism.
Q: Does the meal replacement diet provide adequate nourishment to keep me healthy? How can I get all the nutrients I need using so few calories?
A: Everyone needs water, protein, essential fats, a complement of vitamins and minerals, and a source of energy. The meal replacements provide a sufficient amount of protein and other nutrients. This is supplemented with essential fats and fiber, electrolytes, and water. Vitamin and mineral preparations are provided in a carefully balanced set of supplements. The source of energy, which is usually carbohydrates and fats in ordinary diets, is primarily derived from stored body fat. The stored fat is used as a metabolic fuel, much as ordinary food is used to provide energy. All patients are well nourished; in fact, many patients are probably better nourished than they would be on a standard American diet.
Q: I often feel a sense of anonymity in weight management clinics. I don't always know who the doctor is and the doctor sometimes doesn't seem to know me. How is this program organized so that I can feel comfortable that someone will be responsible for my care?
A: A number of professionals on the staff will be involved in your care. This is one of the greatest advantages of a multidisciplinary approach to the management of this complicated problem. We will use the professional skills and experience of dietitians, behavior therapists, psychologists, and exercise therapists, along with physicians and nurse practitioners. Although many people will probably be involved, we have established careful systems to assure that individual staff members are kept informed of your status and progress. We do not have temporary or "moonlighting" employees. On average, the members of our professional staff have been with our program for a decade or longer. The ultimate responsibility for your care will be with the physician and will be coordinated with the rest of the professional staff.
In addition, we have a strict and absolute policy for protecting the privacy and confidentiality of your medical status and your records. Information is shared among the staff only on a "need to know" basis and with a determination to assure that this is done only when professionally appropriate.
In any case, we are comfortable that you will know the names of the people who are responsible for your care. More important, each of these people will know who you are and what is happening with your care.
Q: Are diet medications useful?
A: Yes, in many cases. Though we only use medications for a minority of our patients, and even though medications do not "cure" obesity, they can be useful for certain patients. Some of our patients use the medications to assist in weight loss while others have use them as part of a maintenance program.
There are a limited number of medications currently available. They vary in how they can be used with other drugs, potential side effects, and their appropriateness for each patient. The medications should be used to complement other aspects of a comprehensive program.
Patients should expect that the medications will be most effective if they are used in a continuing way; short-term efforts have transient benefits. This is much the same as when using medications to control blood pressure, cholesterol, blood sugar, or in the management of any chronic disease.