Why do we see Overweight and Obesity as chronic diseases?
The negative effects of overweight and obesity have been well documented. Reduced life span, increased inflammation, mood disorders, infertility, diabetes, and greater risk of certain cancers are just a few of the ways excess weight impacts health. It is a CHRONIC and PROGRESSIVE disease. If left untreated, the disease and its consequences tend to get worse over time for most patients. That is why we must think about ongoing treatment and disease management, not just short-term weight loss.
Why do we advise daily weights for patients in the maintenance phase?
Chronic diseases require monitoring. Just as a person with hypertension should check her blood pressure periodically or a patient with diabetes monitor his blood sugars, so should a patient with overweight keep an eye on the scale. The National Weight Control Registry tracks thousands of patients who have lost thirty pounds or more and kept it off for at least one year. Their data shows that the majority of enrollees check their weight daily.
What is Insulin resistance and why is it important?
Insulin is an important hormone whose primary function is to regulate blood sugar levels. Usually, there is ½ to 1 teaspoon of sugar in the 5 quarts of blood of the average adult. In response to a rise in blood sugar after eating, insulin is released from the pancreas. The insulin moves excess sugar into cells, returning blood sugar levels to the normal range. As a person gains weight, an excess of sugar and sugar fats (triglycerides) is stored in cells. In turn, cells start to become resistant to the effects of insulin in an attempt to stop additional sugar from entering. But the body wants blood sugars to stay in the normal range, so the pancreas secretes increasingly larger amounts of insulin. This state of elevated insulin levels and low, normal, or slightly elevated blood sugar is called insulin resistance (pre-diabetes and metabolic syndrome are also commonly used.) High insulin levels block weight loss and create increased cravings for carbohydrates. Obviously, treatment of this vicious cycle of elevated insulin levels, overconsumption of carbohydrates, and weight gain is critically important to successful weight loss.
Why do patients reach a weight loss plateau?
There are multiple reasons for a patient to experience a weight loss plateau. There are focus reasons: vacations, celebrations, and holidays don’t disappear just because someone is trying to lose weight. There are biochemical explanations, such as insulin resistance or hypothyroidism, which we know how to identify and treat. There are also metabolic factors that we do not yet know how to identify, or if we do, for which we have not yet developed effective therapy. Leptin resistance is a good example of this; scientists have discovered that some patients with obesity are resistant to the satiety hormone leptin, but attempts at developing an effective drug treatment have so far been unsuccessful. Whatever the reason for a plateau, it is important that you do not just abruptly stop treatment. We want to continue disease control by focusing on weight maintenance, even when not in active weight loss.
What happens once I reach my Goal weight or plateau of weight loss?
At some point, all of us will reach the end of ACTIVE weight loss. For some patients, that may be at what was originally set as a goal weight. For others, it may be before a goal weight has been achieved, but where meaningful weight loss has stopped; that stop in active weight loss may be long-lived or just a temporary plateau. Once it becomes clear that you have reached a healthy weight or plateau, we transition our focus from active weight loss to weight maintenance. During the transition phase, the dosage and frequency of weight loss medication will be gradually reduced. As we drop the amount of medication that you are taking, we will gradually increase the time between visits to our clinic. Our goal is to find the lowest amount of medication and lowest number of visits that still allow you to keep your disease in check.
Do I need to schedule an appointment for my first visit?
Yes. During your initial consultation you will speak with our Nurse Practitioner where she will thoroughly review your medical history, your current medication regimen, and your specific health and weight loss goals. She also spends as much time as needed ensuring adequate nutritional information is covered during your visit. This visit typically lasts about 20-30 minutes; we respect your time, but also want to make sure you are equipped with all the necessary information and tools needed for long-term success.
Do you accept health insurance?
No. Unfortunately most health insurance agencies do not cover weight loss programs, therefore we do not accept them. We do, however, accept FSA/HSA cards and are happy to print a detailed receipt if you’d like to submit that to your insurance company for possible reimbursement.
Can anyone take phentermine?
No. You are not a good candidate for phentermine if you have uncontrolled hypertension, glaucoma, hyperthyroidism, a history of heart attack and/or stroke, irregular heartbeat, are currently pregnant or breastfeeding, or if you take a medication of the MAOI class. Also there are specific criteria your body mass index (BMI) must meet to be a good candidate.
Can you take the prescriptive medication and the injections together?
Yes. Most of our medications, supplements, and injections are safe to take together. In fact, most individuals like to mix at least two supplements or injections to maximize and accelerate their results.