What We Believe and Why We Believe It

The program in this clinic has been developed for safe and effective weight reduction and control. The purpose of this document is to give readers an understanding of the goals and methods we use. 

The first goal of the program is improving the overall health of our patients. The second goal, is weight loss - specifically, weight loss at a steady and safe rate. Finally, but of no less importance than the first two goals - and, in our experience, the most difficult goal of all - is the prevention of weight regain.

The majority of the patients who enter our program have already tried many different weight loss programs and have had varying degrees of success. We have patients who have tried everything from the "Water Weight Loss Program" their neighbor read about in Good Housekeeping™ to expensive (and sometimes dangerous) over-the-counter medications, advertised to - by themselves - make you lose weight, "while you sleep," no less.

Rule #1: Abolutely nothing will "make" you lose weight. Hopefully, after all you have been through, you are ready to make yourself lose weight. Because, if you haven't already figured this out, you are the only person that can do anything about your habits and lifestyle.

What makes weight loss such a difficult task? There is no simple answer. How much a person eats and weighs, is a complex relationship. For some people, being overweight is simply a result of overeating. For these few, merely cutting back on the food they eat will result in weight loss.

However, for most people that are overweight, eating behavior is not the entire reason for their body weight. Complex genetic factors, metabolic, physiologic, and biochemical changes eventually determine for each person their individual tendencies to either become overweight or to be "skinny." This is why the weight loss and the maintenance programs should not be taken lightly. Being obese is a life-long disease. Read that again. Think about it. Obesity is not a personality trait. Obesity is not a reflection of laziness, lack of self control, or any of the "Seven Deadly Sins" (sloth, gluttony, etc.).

Obesity is a disease. It is no less serious a medical problem than high blood pressure, diabetes, or asthma. Just as there is no "7-Day Program to Cure Diabetes," there is no "7 Day Diet" or "30-Day Diet." What you are about to embark upon through the clinic is a lifelong program to improve your health and, as a result of these lifestyle changes, improve your body composition. Weight loss often occurs during this process but should not be the sole goal. The sooner you get your eyes off the scales and on your lifestyle, the better.Success at changing a life of unhealthy habits is not easy but it can be done.

But your success is dependent on 3 major factors:

1. Your determination
2. Understanding of the program, and
3. Adherence and continuity (i.e. staying with the program)

The best immediate and long term results will be made when several different approaches are applied at the same time. Contrary to the hype from the press and some health professionals you might have read elsewhere on the Internet, remember this: Diet medications alone (prescription or "over the counter") will not result in successful long-term weight loss.  Don't believe the inflated claims and down right lies you hear on some television infomercials. The current "hot" item in the weight loss drug market is "cortisol suppressors" (like Relacort™ and Cortislim™). Some time ago it was "fat blockers." If the advertisement sounds "too good to be true," it most assuredly is.

Neither will simply starting an exercise program or "dieting". But, when all components are combined in an integrated, controlled, supervised program - sensible eating, regular exercise and appropriate medication - you can get the maximum benefit toward achieving a healthier you. And, you just might lose body fat and build some muscle tissue along the way. Both changes in body composition will improve your chances to keep weight regain at a minimum.

Our Program Policies:

1. The program will be discontinued if sufficient progress has not been achieved during the first 4 weeks. Our experience has shown that, if little or no progress has been made in the first month, this program will not work for you.
2. The program will be discontinued for noncompliance with the program costs. Payment is due on a regular, per visit program.
3. Medications reported as lost or stolen will not be refilled or redispensed.
4. Cost of the program or laboratory is nonrefundable - there are no exceptions.

The Clinic will not consider:

1. Children under the age of 18 years old. There is an excellent pediatric program at the University of Alabama (Birmingham) that specializes in intervention for the family and the child with obesity.
2. Pregnant or breast-feeding women, obviously.
3. Patients with glaucoma (an eye disease), without prior approval of the patient's ophthalmologist.
4. Uncontrolled hypertension (high blood pressure).
5. Uncontrolled migraine headaches which require medications more than once or twice per month.
6. Diabetics on insulin who are not capable of or not willing to monitor their blood sugars daily.
7. Patients with a history of heart attack within the past 2 years or with significant, recurring angina (heart pain). Patients with known heart disease will require written clearance from their cardiologist to participate in our program.
8. Uncontrolled epilepsy (seizures) with the last seizure being less than two years ago.
9. People who are enrolled in a drug rehabilitation program (voluntarily or court-ordered) which requires frequent drug testing.
10. People whose weight is not at least 30 per cent above their standard, ideal body weight - BMI of 30 or greater.

Definitions of Terms Use

• Appetite Suppressants - Also, may be referred to as "anorectics." These are medications used to help during dieting and weight loss to accelerate your metabolism (see below) and reduce the stress associated with hunger. Medications have a very important but, also, very short-term, limited role in successful weight reduction. Other factors are dieting, behavior modification, and improved physical activity. We will discuss more about these medications in a later section of this manual.
• Bariatric Physician - Medical doctors specialized in the treatment and prevention of obesity. Bariatric medicine is a recognized specialty of the American Medical Association. for example, other recognized medical specialties are cardiology (heart), dermatology (skin), and pulmonary (lung).
• Calorie - These are units of energy stored in food. For example, a gram of fat contains 9 calories; a gram of carbohydrate or a gram of protein contains 4 calories of food energy.
• Carbohydrates - These are foods made by plants that include simple sugar and starches. Examples include potatoes, corn, fruits, vegetables, and wheat. The liver and fat cells changes sugars and starches not burned by your body into fat deposits. Your body needs only small (about 40-60 grams per day) amounts of carbohydrates to function normally.
• Fats - These are foods primarily used to efficiently store energy. They also store vitamins in the body and make foods you eat taste better. Reducing the amount of fats in the diet is almost always recommended, especially in people with a tendency toward abnormally high levels of cholesterol and triglycerides. Cholesterol regulation is only just now beginning to be understood but it definitely depends on your genetic background, inactivity, smoking, and a diet high in saturated fats and refined sugars.
• Minerals - These are chemicals used by the body for normal metabolism. An example would be iron which is used to make new red blood cells and calcium, which is used for bones and teeth.
• Obesity - A medical condition defined by a body weight of more than 30 per cent above ideal weight.
• Morbid Obesity - A truly life-threatening medical condition where a person's body weight is 50 per cent or more above their ideal weight. It can be as low as 30 per cent above ideal body weight when it exists in patients with other medical conditions such as diabetes, heart disease, or uncontrolled high blood pressure. A more correct term is "clinically-severe obesity."
• Metabolism - A complex chemical process which is defined as the rate at which a person utilizes (or, more simply, burns) calories. The "metabolic rate" can be slowed down by certain medical conditions (such as low thyroid function), crash-diet programs, and age. Metabolism can be increased and made more efficient with increased physical activity or certain medications (such as anorectics).
• Protein - These are the third type of food (along with carbohydrates and fats) and the most important to the body. Living cells require them for their normal function and their intake in the diet are necessary for rebuilding damaged or aging cells and growth. Proteins are built from individual chemicals called amino acids, which number about 25. The best sources of high quality proteins come from meats, fish, poultry, and eggs.

Other Important Considerations:

Obesity is the most common disease in this country. Over 35 per cent of people in America today are obese - and the percentages are increasing in all age groups, races, and sexes. That's over 70 million people with a single disease. The poor health that results from being overweight is directly related to the degree of the obesity and the length of time it is allowed to exist. Damaging effects of obesity on health are well-proven and clearly documented in the medical literature. Fortunately, losing weight and achieving your ideal body weight and maintaining it will return an obese person to a normal life expectancy. A few of the systems in the body affected by obesity are:

• Heart - Being overweight contributes to congestive heart failure, premature blockage of the heart arteries, angina pectoris and, eventually, a heart attack.
• Diabetes - Obese patients have four times the risk of developing diabetes than patients with normal body weight. Further, if you have diabetes, weight loss can usually greatly improve control of your elevated blood sugar and can, often, allow your doctor to reduce your requirements of insulin or oral medications.
• Blood Vessels - Obesity can lead to stroke, hypertension, varicose veins, and phlebitis (blood clots in veins). Hypertension, for example, is twice as frequent in obese people as in those with normal body weight. As in diabetes, weight loss can even improve control of high blood pressure.
• Osteoarthritis - Being overweight increases the strain and everyday "wear-and-tear" on all weight bearing joints. These include the back, hips, knees and ankles.
• Sexual and Reproductive Functions - Obese women often have irregular menstrual cycles and, in pregnancy, can greatly increase the risks of carrying and delivering an infant.
• Psychological - One should never underestimate the impact of obesity on the patient and virtually every aspect of their lives. The most common effects are depression (often, unresponsive to usual antidepressant medications), social isolation and markedly lowered self-image. The psychological impact certainly varies from person to person and is not, completely, related to the degree of obesity.

The Role of Medications in Weight Reduction:

The most important factor in weight reduction and maintenance is, simply put, your determination and continued effort. This is true if your goal is minimal weight loss to look better or if you are dealing with life-threatening morbid obesity. If you stick with the program, you will stop gaining weight and start losing pounds. The rate that you lose weight and the amount that you lose is unpredictable at the start. You will have a better idea of what you can expect after following the manual for 4 weeks. Even then, it will not be possible to tell you when you should reach the final end-point. Obviously, the more severe the obesity, the more time it will take to reach your maintenance (final, ideal) weight.

Medications are important tools in an integrated weight loss program. With them in the program, your weight loss is more predictable and more significant.

The most significant results can be expected when all the tools of a weight loss program are integrated into one system - diet restrictions, medications, behavior modification, and increased exercise - and applied together at the same time. Specific medications in this program are selected on an individual basis. Your physician considers many factors - including age, existing medical conditions, other medications you are already on, severity of the weight problem, and previous weight loss program failures - are a few we consider.

Of course, we use only proven, non-experimental, oral medications in our program. "Water pills" (diuretics), amphetamines, hormones, or other unapproved or herbal medications are not used in this program. If indicated after a physician's evaluation, we use FDA-approved, individually-selected prescription medications from the start of the program for several reasons:

1. to achieve more significant early weight loss, and
2. to help you restructure your eating habits, and
3. to reinforce your confidence and motivation.

We have found, through years of experience, that If you start losing weight right away, you are more confident in yourself and the program and will stick with it during the long, difficult weeks and months ahead. Later, we may use medications on an intermittent basis to prevent weight regain and to maintain weight loss. We will discuss the maintenance program in depth later.

Note: Certain medications are safe to use, when supervised by a physician, and are an important part of an integrated weight loss and control program. Sometimes, a patient who uses strong medications, with serious potential side-effects, for their hypertension, diabetes, or depression will feel strangely guilty for using medications for the treatment of their obesity. These feelings are entirely irrational, given the prevailing public and professional attititudes about weight loss medications. We firmly believe that obesity is no less important than these other conditions and that treating them obesity, aggressively, with medications is no less important. Always remember that obesity is a lifelong illness and requires an aggressive treatment program just like the treatment of any other chronic, life-threatening illness. To feel guilty about taking medications, when indicated, for obesity makes no sense if you do not feel guilty taking medications for your other medical illness, particularly when many of these diseases may be caused by the underlying obesity. This is an important point for you to understand. Also be aware that weight loss will make control of your other medical illnesses (particularly hypertension, diabetes, and the other conditions discussed earlier) easier. With loss of just 10% of your body weight, you may find that you will be able to cut back - if your doctor agrees - with some of your other medications. For that reason, we need to be as aggressive as we can in starting your weight loss.

How long should a patient be on medication for weight loss? The length of time will be different for each patient. It might be a few weeks. It might be a few months. As a general rule, we will use these medications for as long as a person shows benefits from them (in the absence of side-effects, of course). "Continued benefits" are defined as improvements in your well-being, health, and step-by-step weight loss.

Remember: With or without medications, there is no such thing as a short-term treatment of any chronic condition. Obesity is a chronic condition.

Benefits of Medications For Weight Loss

• Use of medications may make weight loss safer. Weight loss and serious dieting in an unsupervised fashion, on your own, can become a major psychological stress factor. The longer you try to diet, particularly when you have a lot of weight to lose, the more stressful it can be. First, there is typical hunger and stomach cramping. Next, comes irritability, fatigue, insomnia, headaches, weariness, and even serious depression. Medications can help with the process of losing weight by removing these stress factors and preventing the symptoms that follow.
• Medications, in a supervised fashion, can improve metabolic efficiency. Medications can help you to continue weight loss week after week, month after month, in a rate usually superior to weight loss with diet alone.
• Medications can also help you to maintain your new, lower, healthier weight. Medications can help you go through an "appetite retraining" process. Long after we have stopped the medication, you will find that much smaller amounts of food will satisfy your appetite. This is what we mean by "appetite retraining." Once you have learned to control food portions and eliminate habitual eating, you will be on your way to weight control.