The Medical Model for Weight Management

Setting Weight Loss Goals

Most people have preconceived and
unrealistic notions about what constitutes “successful” weight loss based on
myths perpetuated by the commercial weight loss industry and not supported by
scientific evidence. A permanent weight
loss as little as 5% of initial body weight (a 300lb person losing 15lbs) can
confer significant health benefits including reduction of blood pressure,
cholesterol, blood sugar, reduction in pain from arthritis, improvement in
control of asthma, gatroesophogeal reflux as well as an overall improvement in
subjective well-being. A typical patient
in the Medicalizing Overweight/Obesity Program achieves a 10 to 15%
permanent weight reduction with the health benefits one would expect with such
a weight loss.

Setting short-term obtainable
milestones produces superior results compared to setting a single long-term
goal. Ideally, patients should attempt to lose 3% to 5% of their body
weight quarterly (every 3 months) for one year
. This would result in a
weight loss in the 10 to 18% range for the year. As an example, a person who
weighs 300 pounds can reasonably expect to lose between 9 and 15 pounds in the
first 3 months and 30 to 54 pounds after one year.

Any individual embarking on a
medical weight management program should understand the following facts:

  1. Because overweight/obesity is a
    chronic medical condition, any weight loss achieved with the use of
    medications, in most cases, will require the continuation of these
    medications indefinitely
    to maintain the weight loss.
  2. Depending on the weight loss medication
    being used, weight loss effect usually plateaus somewhere between 3 and 18
    months. The effect of the medication thereafter is no longer on weight
    loss but on weight maintenance.
  3. As in the treatment of any
    other chronic disorder, combinations of medications are
    often necessary to achieve optimal results.
  4. Weight loss medications simply
    may not work for, nor be tolerated by, some individuals.
  5. For those individuals unable to
    achieve a clinically significant weight loss (>10% within one year)
    with this program, Bariatric Surgery may be a reasonable
    option for those individuals that meet the NIH (National Institutes of
    Health) criteria for such procedures.

Lifestyle Modification in
“Medicalizing Overweight/Obesity” program

Weight loss can only occur when
the amount of calories consumed by eating is less than the calories expended by
physical activity. Weight loss medications do not change this equation, but
merely tip the balance in favor of successful weight loss. Therefore, what one
eats, how much one eats and how much one exercises are still the most essential
determinants of long-term weight loss success.

The best available scientific
evidence for which life style interventions work for permanent weight
loss is from the National Weight Loss Registry established in 1994 by Rena
Wing, Ph. D form Brown Medical School, and James O. Hill, Ph. D from the
University of Colorado. This is the largest prospective investigation of
long-term successful weight loss and weight maintenance. The average weight loss
in this group was 66 pounds and it was maintained for an average of 5 years.
They found four types of behavior common to the National Weight Control
Registry participants: 1) eating a low-fat, high-carbohydrate diet. The types
of carbohydrates were high in fiber and low in sugars; 2) eating breakfast
almost every day; 3) frequent self-monitoring of weight; 4) participation in a
high level of physical activity (the equivalent of walking for one hour briskly
on a daily basis).

claims or recommendations beyond these behavioral changes have very little
scientific evidence to support them. Therefore, it is strongly recommended that
these 4 behaviors be incorporated into a given patients’ weight loss program.
In all fairness, it should be pointed out that the National Weight Loss
Registry did not include individuals using medical or surgical interventions
and was strictly designed to demonstrate the behavioral aspects of individuals
who were able to permanently lose a clinically significant amount of weight.

This is Part Two in a series of articles on the topic of Medicalizing
Overweight and Obesity
, so make sure to look at the next issues for the