As a doctor, I work with bariatric surgery patients before or after procedures – and I support patients who want to lose weight without surgery.
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So how do I advise patients about weight loss?
First, it depends on what the patient is interested in pursuing: surgical or non-surgical weight loss.
If it is surgical weight loss, then I must make sure the patient is a qualifiable candidate by clinical standards:
- A body mass index of 35 or greater with diabetes mellitus, sleep apnea or other serious co-morbid condition(s)
- Or a body mass index of 40 or greater, with or without associated diseases
Weight loss based on individuals
If someone sees me with interest in non-surgical weight loss, then the process is more individualized. By that, I mean everyone is different and the plan is tailored to them.
While we all know that weight loss occurs through restricting calories and increasing exercise activity, how one person gets there might be uniquely different from another person.
High protein, low carbs
Typically, what’s called a ketogenic diet plan works best, where the carbohydrate intake is low and the protein percentage is significantly higher.
These types of diets must be physician- supervised because people can experience electrolyte imbalances with resulting serious adverse effects if not corrected. However, the weight loss is very good, even when exercise is only moderately performed.
Secret of successful patients
What really matters is understanding that the most important part of losing weight is maintaining the weight achieved – whether through surgical or non-surgical means. Maintenance is the hardest part of the process for most patients and is where the work truly begins.
The key to maintaining weight loss? Work harder. Yes. Hard to swallow – you’ve worked so hard already!
But by the time you have hit your goal, exercising shouldn’t feel so daunting or exhausting. At this time, your muscles should have adapted to the activity and created a memory, which prompts you to move even when your mind hasn’t fully committed.
Therefore, when you come off a limited diet, it doesn’t mean the entire plate is yours. You still have to control your portions. And exercising is still not an option. In fact, exercise will need to be increased in duration and intensity to accommodate for the extra calories.
However, it is perfectly common and normal for patients to reach their target goal weight, lean back and say, “aahhh”, now I can relax. Oh no, no, no, I say with a smile. Now the work begins!
And that is the secret of the successful patient. He or she does not stop exercising even if the calorie intake is a bit more.
Role of medications
Sometimes, I do help my patients along with an appetite suppressant if applicable, not necessarily to lose weight but more so to help with weight maintenance during this period.
The medication I typically use is Adipex or Phentermine, but now the FDA has approved Qsymia and Lorcaserin, so I do have a few choices for my patients.
Occasionally, I will utilize a medication which has a side effect of weight loss but was not intended for weight loss. This is referred to as “the off-label” use of a drug and the patient has to be fully aware of the pros and cons of using the medication in this manner.