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A medical toolbox to help patients lose weight

Posted April 10, 2015

Kerry Carlson was not eating last Thanksgiving. She did not join her family for the holiday until they had finished the main course. She didn’t care about desserts and drinks so those weren’t a problem. In December, she skipped all her holiday parties.

Wajahat Mehal, MD, discusses options for losing weight. Then he tells patients to go home and think about the best options for them. Image credit: Robert A. Lisak

Wajahat Mehal, MD, discusses options for losing weight. Then he tells patients to go home and think about the best options for them. Image credit: Robert A. Lisak

Carlson, who owns a landscaping company, was taking off 100 pounds with the support of the Yale Metabolic Health & Weight Loss Program, a new program that provides evidence-based alternatives to surgery to take off the weight. Growing up in a family of athletes, she was always active, and loved skiing and tennis. But at 43, plantar fasciitis was restricting her activity; she’d fallen into putting off eating until noon and getting takeout, usually pasta, pizza or dishes with creamy sauces. Last year, her doctor gave her iron infusions for anemia.

“I wanted be healthy and not be the biggest person in the room,” said Carlson. “I’m a master gardener. I know what I should and shouldn’t be eating.”

Weight Loss Without Surgery

Carlson is a typical patient who tried other weight-loss programs, but they either didn’t work, helped to a degree, or the dropped pounds just came back later. She wasn’t interested in bariatric surgery; she’d had abdominal surgeries before and didn’t want another one.

She is certainly not alone. Connecticut has an adult obesity rate of just over 23 percent in 2013, and that is one of the lowest in the country. “Bariatric surgery is the best option for some people, but the majority are candidates for nonsurgical weight loss,” said Wajahat Mehal, M.D., director of the Yale program.

Mehal, Louis Chaptini, M.D., Leah McManus R.D., and Carol Eggers, A.P.R.N. combine intensive nutrition counseling with medical management, and provide advice on exercise. Each patient gets a personalized plan. First Mehal spends a half hour or more listening to their history, past weight loss attempts, and expectations.  He discusses options and tells them to go home and think about them. “My telling people what to do just doesn’t work. It’s important for them to really think and then tell me what they want to do,” he said.

Arsenal of Strategies

Patients are surprised at what’s possible. A focus on obesity since the 1990s has resulted in a powerhouse of effective strategies. They can try one of several medications (four of them approved by the FDA in the last year) that suppress appetite. These alone can bring a 7-10 percent weight loss—enough to eliminate risks for some related diseases. The OPTIFAST® Program, a medically supervised 12-week full-meal replacement program, brings weight loss in the range of 30-60 pounds.

In addition, patients schedule regular visits with the program’s registered nutritionist, and may participate in group sessions and mindfulness-based stress reduction training. There are also endoscopic interventions, including transoral sleeve gastroplasty, which can reduce stomach volume by 80 percent without the risks of gastric bypass surgery. The practice is connected to a network of other specialists who can help with weight-related issues.

But the primary concern is the root cause: the weight.

Losing Weight for a Kidney Transplant

Motivation is a key ingredient, but many patients already have that. Joseph Ferrucci blames a body weight that was well over 200 pounds on breaking his wrist in two places and overeating out of frustration. When his doctor told him he was at risk for heart attack or stroke, he managed to lose most of the extra weight on his own, then he hit a plateau.

“No matter what I did, I couldn’t get any more weight off,” Ferrucci said. Then kidney disease forced him to undergo dialysis, and he was told he’d have to lose 31 more pounds to be eligible for a transplant. “I am going to be 74 in April, and I know my chances of recovery (from a transplant) are going to diminish as I get older,” he said.

He used OPTIFAST®, which meant consuming bars, shakes and soups that have been designed to provide necessary nutrients without excess calories.Nutrition advice was critical since his kidney condition limited him to 20 ounces of water a day and he’d need to embark on a vitamin program upon completing OPTIFAST®. Support helped as well. “They gave me nothing but compliments, between the doctor and dietician and the people who worked there,” he said.

Carlson was ready to make changes as well, but she wanted medical supervision. Exercise had been difficult. “I would be sitting on the couch for 45 minutes and then get up and my leg would buckle,” she said.

She used OPTIFAST® and an app the nutritionist provided called MyFitnessPal. She followed the program’s advice on enlisting her family, convincing her husband to restrict his snacking to his office. “I used to go on diets and not tell anybody. They said, ‘You have to tell people. It helps keep you on the straight and narrow.’ ”

Weight Loss Pays Off

While research continues on treatments for obesity, the program is already helping patients lose enough weight to improve symptoms and sometimes cure such related conditions as diabetes, high blood pressure, fatty liver diseases and sleep apnea.

As Easter approached, Carlson had lost 75 pounds and was feeling a new energy. “I know I’m on the right track,” she said. She no longer has trouble stretching past her stomach in yoga. “My goal is to run a 5k road race next year.”

Ferrucci had lost the 31 pounds he needed for a kidney transplant and has no doubt he will lose more. “I feel it is very personal and you have to make the choice. I made up my mind,” he said. Once he gets a new kidney, he said, “I’ll be able to go back to a normal life.” His goal, once recovered: Fly with his wife to Italy, buy a car there and spend a summer traveling around the countryside. He’ll be watching what he eats.

Source: Yale University

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