FREE Medical Weight Loss Certification Training Manual (Updated 2023)

Medical Weight Loss Training provides you with our FREE Medical Weight Loss Certification Training Manual. Please contact us for your complete online training for Physicians, Physician Assistants (PA), Nurse Practitioners (NP) and Registered Nurses (RN).

How to start a medically supervised weight loss clinic: a Beginner’s Guide to Prescription Medications.

Are you a healthcare provider looking to enhance your approach to weight loss management? Have you ever wondered if there’s a more comprehensive and effective strategy to help your patients achieve lasting results? If so, it’s time to explore the world of comprehensive medical weight loss training protocols. This article is your gateway to unlocking a new level of expertise and understanding in the realm of weight management. Discover how integrating evidence-based practices and advanced training can revolutionize your ability to guide patients toward their weight loss goals. Read on to elevate your expertise and transform patient outcomes.

Introduction to Obesity

Obesity is defined as body mass index (BMI), which is a ratio of weight and height, greater than 30 kg/m2.  BMI between 25 and 30 kg/m2 is considered overweight.  An obese individual has amassed fat to the degree that it has multiple negative health effects, as it increases the likelihood of hypertension, diabetes, heart disease, specific cancers and various other diseases.

Pathophysiology

Leptin, ghrelin, and other mediators are involved in regulation of appetite, adipose tissue storage, and insulin resistance.  Leptin signals the level of fat storage in the body.  Produced by adipose tissue, leptin increases appetite when storage levels are low and decreases appetite when storage levels are high.  Most obese individuals are categorized as leptin resistant and administration of leptin does not correct obesity in most patients.  Ghrelin triggers an increase in appetite when the stomach is empty and is produced by the stomach.  Both control appetite on the hypothalamus.  Any deficiency or resistance along this pathway may contribute to obesity. 

Causes

Anecdotal belief suggested that obesity was due to low metabolism, as obese people ate little, but gained weight.  Research seems to indicate otherwise, as an obese individual typically has greater energy usage to maintain their increased BMI.  

The major cause of obesity is excess consumption of food and inadequate physical activity.  It is a simple math equation of input minus output.  Additional causes of obesity can be attributed to genetics, medical or psychiatric illness.  Many other social influences contribute to the cause ranging from access to fast food, insufficient sleep, higher age of maternal pregnancy, and amount of automobile usage.

Diet

Since 1971, the average caloric increase is 335 calories per day in women and 168 calories per day in men.  The primary source of the extra calories is due to sweetened beverages and potato chips.  In addition, consumption of fast food meals quadrupled from 1971-2000.  Within the same time frame, the obesity rate in the USA increased from 14% to 30%.  Clinical tests also prove that obese patients consistently under-report their food consumption when compared to normal BMI patients.  The national calorie consumption averages are 2800 calories per day for males, and 1800 calories per day for females.  The average person reports 30% – 40% less consumption than what one actually consumes in a day.

The average dinner plate has gotten larger in the past 50 years.  Eating out has increased 200% from 1975 to 1997.  A larger portion is also served in restaurants.  While intake of fruits and vegetable serving is higher, up to 17% of all vegetable intake is due to potatoes in French fries.  Cheese consumption is up, but due to pizzas and cheeseburgers. 

Lifestyle

Automotive transportation, labor saving technology, and television have resulted in an increase in sedentary lifestyles.  Up to 60% of the world’s population gets insufficient exercise.

Lack of sleep is associated with weight gain as less than 7 hours of sleep resulted in an increased risk of obesity.  Less than 6 hours of sleep increased the risk to 27%.  Children aged 6 -12 who got less than 10 hours of sleep a night showed 3.5 times greater incidence of obesity than those who got 12 hours of sleep.  It is believed that sleep deprivation leads to increased insulin, cortisol and ghrelin, and decreased growth hormone and leptin.  The current recommendation is that adults receive at least 7 hours of sleep, 8 hours optimally.  

Genes

There is no evidence of a Mendelian pattern of inheritance.  Adoption studies show that there is stronger correlation with biological siblings than with half siblings.  Also, adopted children had BMI that correlated with the biological parent’s than with adopted parents.  Genes may play a role as research has shown that when food is abundant, genes controlling metabolism and appetite predispose a patient to become obese.  Several rare genetic syndromes also cause obesity (Prader-Willi, Cohen, etc.).

Medical and psychiatric illnesses

Along with genetic causes, various congenital and acquired conditions such as Cushing’s syndrome, hypothyroidism, and other psychiatric disorders can contribute to obesity.  Medications, such as insulin, antipsychotics, antidepressants, steroids, hormones, can also cause weight gains.

BMI

Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.  It is calculated by dividing the patient’s weight by the square of the patient’s height.

BMI = kg/meters2

BMI = pounds * 703 / inches2

Various online calculators and tools exist to simplify this formula for your office.

Health Effects

As one of the leading causes of preventable deaths, average life expectancy is reduced by six to seven years for obese patients.  Severe obesity (BMI > 40) can reduce life expectancy by up to 10 years.

CDC states that overweight and obesity increases the risk of the following diseases.

• Coronary heart disease
• Type 2 diabetes
• Cancers (endometrial, breast, and colon)
• Hypertension (high blood pressure)
• Dyslipidemia (for example, high total cholesterol or high levels of triglycerides)
• Stroke
• Liver and Gallbladder disease
• Sleep apnea and respiratory problems
• Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint)
• Gynecological problems (abnormal menses, infertility)

Epidemiology

Prior to the 20th century, obesity was rare.  The WHO in 2005 estimated that at least 400 million adults worldwide (10%) were obese.  WHO predicts that obesity will overtake malnutrition and infectious disease as the most significant cause of poor health.  Obesity rates are rising even among poorer, developing countries.

Society

It is estimated that Americans spent $60.9 billion on weight loss. Obese workers had higher rates of absenteeism and disability leaves.  This increases cost for employers, while receiving decreased productivity.  Therefore, obese people are less likely to be hired for a job and receive fewer promotions.  Obese children are frequent targets of bullies.

A fat acceptance movement has started with organizations like National Association to Advance Fat Acceptance and International Size Acceptance Association.  However, obesity has not yet received the same type of support as the civil rights movement.

Benefit of weight loss

The Framingham heart study shows that weight loss resulted in lower blood pressure and lipid profiles.  Studies have shown up to 20% reduction in mortality due to weight loss.  Risk is lowered in obese patients with hypertension, dyslipidemia and diabetes.  

Management of Obesity

Assessment of your patient begins with a thorough history and physical.  The patient’s weight history should be reviewed, even from childhood.  Any prior weight loss attempts should be discussed and analyzed as to their source of failure.  Current medication history is important as many of the drugs cause weight gain as its side effect.  Complete social history is important, discussing prior drug addiction, alcohol consumption and smoking history.

Psychotropic agents

Antidepressant drugs (tricyclic antidepressants, monoamine oxidase inhibitors)

Antipsychotic drugs

Lithium

Anticonvulsant agents

Valproic acid (Depakene)

Carbamazepine (Tegretol)

Steroid hormones

Corticosteroids

Estrogen, progesterone, testosterone or other anabolic/androgenic steroids

Insulin and most oral hypoglycemic agents

Based on clinical research, we know that obese patients typically have unrealistic goals.  An obese patient, who initially weighed 218 pounds, described their final weight of 135 pounds (38%) as their dream goal, 150 pounds (31%) as being happy, and 163 pounds (25%) as being acceptable, but 180 pounds (17%) as disappointing.  Therefore, it is important to manage your patient’s expectations and engage in a realistic discussion prior to their treatment.  Remind your patients that besides weight loss, the goals should include improved self-esteem, stamina and health.  A 500 daily calorie deficit will result in 26 pounds weight loss within 6 months.  Using safe weight loss methods, they can lose 10% of their body weight over 6 months.  On average, patients can expect 8% weight loss over 12 months.  When looking at long term numbers, it is important to look at maintenance.  Rapid initial weight loss typically does not translate into long term weight loss maintenance.

Behavioral Strategies

Successful management of the obese patient involves multiple behavioral strategies, such as self-monitoring, stimulus control, cognitive restructuring, stress management, and social support.  

Self-Monitoring

Food diaries (listing calories, fat grams and food groups) , physical activity logs, and weight measurements are essential to creating awareness.  Consistently, research has proven that self-monitoring is associated with improved treatment outcome.  Patients report that it is one of the most helpful tools in their treatment.  However, research shows that more obese patients do not accurately self-record their diet intake.

Stimulus Control

Patients should identify cues that increase patient’s overeating and inactivity.  For example, if the patient noticed that they are eating snack foods while watching TV, they might benefit from only eating snacks at the kitchen table or just removing snack foods from the house.  

Cognitive Restructuring

Cognitive restructuring identifies automatic thoughts which can be a negative view of one’s self or an unrealistic view of their weight loss expectation.  Many obese patients have low self-esteem and unrealistic views about how much weight loss is possible.  A research study found that patient’s expectations were typically greater than what was realistic.  Most patients in this study lost 10% of their body weight and were disappointed with the results.  

Stress Management

Stress reduction techniques are designed to distract the patient from the stress and to prevent stress related issues.  Stress has been shown to be one of the primary predictors of overeating and relapse back into weight gain.

Social Support

Social support from family, community-based programs, or involvement in other social activities have shown to increase success of losing weight and maintaining weight loss.  These programs do not need to be focused on weight loss.  Peer support has shown to help patients become more self-confident, deal with stress, and develop new interpersonal skills.

Effectiveness of Behavior Modification

The use of multiple strategies is associated with greater weight loss.  Drop-out rate is generally low.  Many studies show an average weight loss of 1 pound per week and 17.6 pounds over about 20 weeks.  Behavioral treatments typically last 20 weeks, and at 10 months after the treatment termination, most patients were able to maintain about 2/3 of their initial weight loss.  

Assessing Treatment Outcome

Successful treatment should not only be limited to weight loss.  Improvements on metabolic profile, comorbidity, physical activity, self-esteem and psychological status, and quality of life should also be measured.  Methods for measuring and maintaining these outcomes should be incorporated into the patient’s program.

Exercise

While the American Heart Association recommends a minimum of 30 minutes of moderate exercise 5 days per week, the Labor Department states that only 16% of Americans exercised on an average day.  CDC states that fewer than 2 in 10 Americans get the recommended exercise recommendation. Exercise causes muscle to burn energy from fat and glycogen storage. As muscle mass increases, stamina and intensity increases.  Then, the muscle becomes efficient at burning fat.

Exercise is shown to be more beneficial in weight loss maintenance than initial weight loss.  Only 9% of the study population could maintain the weight loss without continuing or increasing their exercise routine.  Research shows that a dose response curve exists where very intense exercise leads to greater weight loss.  A meta-analysis shows that while using exercise alone leads to weight loss, combination with dieting showed a greater weight loss.  Also, a single bout of exercise will increase a person’s basal metabolic rate by 5% -15% for up to 48 hours.  While resistance training is better at increasing lean muscle mass and increasing the metabolic rate, aerobic exercise is better at generating immediate weight loss.

Various barriers prevent your patients from exercising (job, finances, time, stigma, etc.).  Altering one’s daily routine, such as taking the stairs instead of the elevator or bicycling to work, has shown to be effective in burning calories.  A pedometer is also useful for counseling your patients and setting daily step goals.  Initial goal of 120 minutes of exercise per week is recommended (minimum of 200 minutes per week is recommended). At least 20 minutes of exercise was required to trigger the metabolic response of fat burning, muscle development and appetite suppression. 

Surgery

Bariatric surgery is considered by many to be the most effective treatment.  It is associated with long term weight loss and decreased mortality.  However, the cost and potential complications limit its widespread use.  In 2009, up to 350,000 Americans underwent this operation.  This is significantly higher from 63,000 in 2002.

Typically, surgery is recommended for the severely obese (BMI > 40) who failed traditional methods and pharmacological intervention.  Variable surgical options are available, but the two most common are gastric banding (reducing the volume of the stomach to create early satiety) and gastric bypass (reducing the surface area of the bowel to reduce absorption).  

Bariatric surgery produces long term weight loss, as one study showed 14% to 25% weight loss at 10 years and 29% decrease in mortality.  Postoperative complications are common ranging from infection, DVT, hemorrhage, hernia, bowel obstruction, leakage, dumping syndrome, to nutritional deficiencies.  Complications ranged from 10% to 20%.  A study shows that after one year, gastric bypass procedures show 30% more weight loss than gastric banding procedures.  

Diet

Most clinical practice guidelines recommend dieting and exercising.  Dieting typically results in short term weight loss.  Long term weight loss typically requires lifestyle modification.  Even then, success rates range from 2% – 20%.

Many types of diets and dietary recommendations exist on the market.  Diets are generally divided into four categories:

Low Calories

Very Low Calories

Low Fat

Low Carb

A meta-analysis in the New England Journal of Medicine found no difference between the three main types of diet (low fat, low carb, low cal).  At two years, all three forms of the diet resulted in 2 – 4 kg weight loss in all studies.  Very low calorie diet falls outside of the three main types of diet.  Due to the numerous side effects and dangers associated with this diet, close monitoring by a physician is highly recommended.

Low Calorie Diet (LCD)

Overview

Low Calorie Diet is simply what you’d expect from dieting: low calories.  The goal of this type of diet is to maintain an energy deficit of 500 – 1,000 calories per day.  This results in weight loss of 0.5 kg (1.1 lb) to 1 kg (2.2 lbs) per week.  Calorie restriction without malnutrition has been shown to improve age-related health diseases and to slow the aging process in animals and fungi.  Human studies are still ongoing.  

Efficacy

A NIH study of 34 randomized controlled trials determined that LCDs lowered body weight by 8% in the short term over 3 – 12 months.  

Treatment Protocol

Most diets can be considered low calorie diets as they mostly function to reduce daily caloric intake.  DASH (Dietary Approaches to Stop Hypertension) by NIH and Weight Watchers are examples of LCD. 

Safety / Side Effect

As with all diets, consultation with a physician is recommended.  Several studies revealed loss of muscle mass and muscle strength as well as loss of bone in the hip and spine. 

Very Low Calorie Diet (VLCD)

Overview

Very low calorie diet is a diet of 800 calories per day or less.  VLCDs are usually commercially prepared formulated, liquid meals that contain all the essential protein, fat, vitamins, and minerals.  Consumption of carbohydrates is optional.  However, small amounts of carbohydrate consumption will prevent ketosis, diuresis, and electrolyte abnormality.

Efficacy 

The VLCD is prescribed on a case to case basis for rapid weight loss (about 1.5 to 2.5 kilograms or 3 to 5 pounds per week) in patients with Body Mass Index of 30 and above, for an average total weight loss of 44 pounds over 12 weeks. The health care provider can recommend the diet to a patient with BMI between 27 and 30 if the medical complications the patient has due to overweight present serious health risk

A study in 1997 showed that short term use of VLCD was more effective than mild calorie restriction in improving glycemic control and promoting substantial weight loss.

Numerous clinical trials have shown VLCD to be highly effective in about 80 percent of outpatients and give an average weight loss of 2 kg/week which is comparable to that seen in complete starvation. 

Treatment Protocol

Studies recommend staying under 800 calories per day with protein intake of about 40-55 g/day without carbohydrates, and about 25-30 g/day when carbohydrates (30-45 g/day) are consumed. Mixtures of meal replacement products, such as bars, shakes, or manufactured meals may be used.  Some researchers state that VLCD should not be followed longer than 4 weeks. If necessary, a second or third VLCD can be attempted by the patient with a 2 month interval on a well-balanced low calorie diet.

A sample diet plan is as follows:

Breakfast: Any amount of tea or coffee, no sugar (green tea recommended), only one tablespoonful of milk.

Lunch:

1. 100 grams (3.5 oz) of boiled or grilled meat or fish (No salmon or tuna) without fat or oil. 
2. One type of following vegetables: cabbage, tomatoes, celery, onions, asparagus, spinach, beets, cucumbers
3. One small breadstick or hard toast.
4. One apple, orange, or one-half cup of strawberries (No bananas)

Dinner: Same as Lunch

Grapefruit diet is a type of VLCD where grapefruit is included with every meal

12 days on – 2 days off

Breakfast

1/2 Grapefruit 

2 Eggs & 2 Slices Bacon

Lunch

1/2 Grapefruit 

Meat 

Vegetable

Dinner

1/2 Grapefruit 

Meat 

Vegetable

Safety / Side Effect

VLCD should be undertaken by an obese patient under medical supervision whose health risk is greater than any risk of the diet itself.  Many patients report minor side effects such as constipation, weakness, nausea and diarrhea.  Dietary fiber is recommended to reduce some of these minor side effects and reduce hunger.

Sudden deaths, ventricular arrhythmias and QT interval prolongation have been documented in VLCD.  During 1977 and 1978, during or shortly after a VLCD, 17 obese adult Americans died suddenly of ventricular arrhythmias.  Cause may be due to mineral (calcium, copper, potassium, magnesium) deficiencies due to the diet.  A careful overview of the EKG prior to this diet is mandatory.

Although gallstones are common in obese patients, they are more common after rapid weight loss.  Gallstones form due to decreased contraction of bile by the gallbladder.  It is unclear if the diet is responsible for the gallstone formation or the amount of weight loss.  

Contraindications for VLCD

Cardiac, Renal, Liver or Gallbladder disease

Pregnancy

Psychiatric Illness

Substance Abuse

Conclusion

VLCD is shown to cause rapid weight loss, but has limited long term success.  In the long term maintenance of weight loss, VLCD is no more effective than modest diet restriction of 1200 – 1500 cal diets.  

VLCD vs LCD

Meta-analysis shows that VLCD achieves rapid weight loss compared to LCD.  However, VLCD did not produce greater long-term weight losses than LCD.  One notable difference was found in a study that showed that VLCD resulted in significantly larger decreases in food craving at the end of the 5th week, compared to LCD.  However, the study concluded that food craving diminishes with calorie restriction. 

hCG Diet

Overview

The popular hCG diet utilizes the principles of VLCD with hormone therapy. Human chorionic gonadotropin (hCG) is a glycoprotein hormone produced by the developing embryo and the placenta during pregnancy.  Luteinizing Hormone (LH), also known as Gonadotropin-releasing hormone (GnRH), is produced in the pituitary gland and has similar structure and properties as hCG.  

Dr. Albert Simeon, a British Endocrinologist, formed his hypothesis based on two groups of patients: pregnant women in India and children with Froelich’s Syndrome.  

The pregnant women in India were on a low calorie diet due to their poverty.  He noted that pregnant women lose fat rather than lean muscle.  His theory was that hCG produced by the fetus was programming the body to consume adipose tissue in order to support the pregnancy.  Froelich’s Syndrome, which is a syndrome that is a result of decreased levels in LH from the hypothalamus, causes obesity, growth and sexual retardation.  Suboptimal level of LH in the hypothalamus, which contains the brain’s hunger center, is associated with increased food intake.  When Dr. Simeon treated his patients with low doses of hCG, he noted that his patients also lost fat.  Dr. Simeons started to use daily hCG injections in combination with a Very Low Calories Diet (VLCD) on his patients who wanted to lose fat without losing any muscle.  He claimed that patients will achieve the following: “a) lose weight quickly, b) not feel weak, c) not be hungry, and d) lose fat from those parts of the body where it tends to remain longest during normal dieting (i.e. stomach, hips, thighs, upper arms).”

The current theory maintains that hCG injection is a hypothalamic appetite suppressant.  It also has an adipocyte effect, as lipolysis is enhanced on a VLCD diet while preserving lean muscle.  Exercise is not needed to lose fat, and some practitioners advocate against exercising while on this diet.  

Efficacy

The efficacy of the hCG diet is of great controversy.  Journal of the American Medical Association and the American Journal of Clinical Nutrition issued a warning saying that hCG is neither safe nor effective as a weight-loss aid.  A meta-analysis study in 1995 has found that “there is no scientific evidence that HCG is effective in the treatment of obesity; it does not bring about weight-loss or fat-redistribution, nor does it reduce hunger or induce a feeling of well-being.”  It further concluded “that the effect of the Simeons therapy can be attributed to a diet of 500 kcal, but that the HCG has no specific effect”. However, the meta-analysis did state that one of the study “claimed effect of HCG is that patients no longer feel hungry and/or find it easier to keep to the diet because they feel good about it.”

A small retrospective study in 2010 that reached statistical significance showed that “sublingual hCG appeared to be significantly better in weight loss than a similar meal replacement diet.”  A recent study in 2011 on older men with androgen deficiency concluded that “3 months of treatment with twice weekly r-hCG demonstrates sustained androgenic effects on hormones and muscle mass.”  

The FDA has required the labeling and advertising of hCG to state the following:

“HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or ‘normal’ distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.”

Its proponents will state that hCG enhances compliance as it reduces side effects of VLCD and increases the patient’s basal metabolic rate.  Many practitioners will state that a patient on this diet will lose 1 to 2 lbs per day without feeling hungry, lose weight proportionally, and feel a sense of well-being.

Treatment Protocol

Dr. Simeon’s protocol requires 26 days.  Every day, 125 IU of hCG is injected subcutaneously next to the belly button or intramuscularly elsewhere.  hCG is available in various forms: injectable (125IU), nose spray (250IU) or oral (500IU) through a compounding pharmacy.  

The following dietary recommendations are given to the patient. 

Day 1 and 2

Patients are allowed to eat to capacity.

Day 3 – 23

Begin the 500 calories diet for 21 days.

Days 24 – 26

Stop hCG injections after 24 injections.  hCG may stay within the patient’s body for 3 days.  Continue the 500 calories diet until day 26.

After 30 days off of hCG protocol, the treatment protocol may be repeated one additional time.  

Dietary restrictions

All foods are allowed except starch and sweet fruits.  Sample meal is explained in the VLCD section.

Multivitamin and multimineral supplementation is highly recommended.  

Most health providers use 600 – 900 calories for daily restriction, rather than the strict 500 calories.  

The Simeon protocol is attached with the training packet provided. 

Safety / Side Effect

Side effects recorded include irregular menstruation, anaphylaxis, edema, migraine headaches, and pregnancy (fertility increases).  This is contraindicated in patients with multiple systemic diseases, COPD, Asthma, PCOS, fibroid, endometriosis, breast cancer, CHF, gout and seizure disorder.  

Conclusion

The controversy around the hCG diet is ever present.  Even while a meta-analysis study has found that “there is no scientific evidence that hCG is effective in the treatment of obesity,” hCG weight loss centers are opening up across the US.  Also, there are legions of hCG patients who claimed that the diet was miraculous and that they did not feel hungry at all.  Physicians will report anecdotal stories of weight loss success and breakthrough results.  Currently, there are reports of new research papers coming out in support of hCG diet which will further ignite the controversy.  

Due to the hCG buzz, the homeopathic industry also came out with their homeopathic hCG.  The United States FDA stated in 2011 that this product is illegal and fraudulent.  There is no evidence that oral, over-the-counter hCG products are effective weight loss supplements.  Furthermore, hCG is a peptide hormone, which would easily be degraded by gastric enzymes rendering them ineffective.   

Low Fat Diet

Overview

As the name suggests, this diet consists of low levels of saturated fat and cholesterol with high intake of whole grain, vegetable and fruits, moderate intake of nuts and low fat diary, and low intake of meats and sodium.  Fat gets bad press, but is needed for good health.  Fat supplies energy and fatty acids.  Fat soluble vitamins such as A, D, E, and K are essential.

Efficacy

The benefit of this diet is also under debate.  Many sources recommend this type of diet as it reduces the risk of coronary heart disease and stroke in women.  A study in JAMA challenged the prior belief that a low fat diet lowered the risk of breast cancer.  A Cochrane review in 2002 stated that low fat diets were no more effective than other diets in achieving long lasting effects.  

Treatment Protocol

The American Heart Association recommends that 20% – 30% of the calories should be from fat, with less than 10% from saturated fat.  An average American consumes 35% of the calories from fat and ingests 12% of saturated fat.  Key to limiting fat is reducing meat and dairy with saturated fats, fried foods and margarines with trans-fat, and corn oil with polyunsaturated fatty acid.

Safety / Side Effect

It is essential that a dieter does not cut out essential fatty acids and numerous vitamins that are missed in a low fat diet.  Also, a dieter may cut out fat, but increase their carbohydrate intake.  “Bad carbs,” such as corn syrup, can replace the fat that is not consumed.  

Pritikin Diet

Overview

Nathan Pritikin was diagnosed with heart disease in his early forties.  He created a diet that focuses on taking food straight from nature in the form of various nuts, beans, legumes and other unprocessed foods. The Pritikin Diet is based on a very-low-fat, low-sodium, high-fiber diet and exercise to decrease the risk of coronary heart disease.

Efficacy

Many studies analyzing the Pritikin diets have found the diet showed improvement in most coronary heart disease risk factors: body mass index, blood pressure, serum glucose, cholesterol, and serum triglyceride.  A meta-analysis on diabetics found that 74% on oral medications were free of drugs and 44% on insulin were free of insulin after three weeks of the program.  

Treatment Protocol

The focus of the Pritikin Diet is to focus back to the roots of nutrition, where only unprocessed food was available. Amounts of food consumed were also much smaller than the large plate portions we find today in homes and restaurants. This diet advocates food amounts that would have been true to their description of sustenance, to sustain life, at one time and would not contribute to obesity. The Pritikin Diet allows for many small portions of unprocessed foods. It does not provide room for foods that are high in fat or calorie content as well as those far removed from nature.

On this diet, up to six meals per day are permitted. Daily fat content is only ten percent, which may make dieting a little difficult at times. It focuses mostly on vegetables, grains and fruits.

At the Pritikin Program, all subjects are treated with a comprehensive diet and exercise program. The diet consisted of 10%–15% of calories from fat, 15%–20% from protein (primarily from plants but also from seafood), and 65%–75% from carbohydrates (comprising whole grains, vegetables, and fruits), and contained about 40 g/1000 kcal of fiber. Salt was limited to <1500 mg/d and cholesterol to <100 mg/d. Alcohol, tobacco products, and caffeinated beverages were not allowed. Subjects also received instruction for a personalized exercise program (outdoor walking plus daily exercise classes) for a

total of 45–60 minutes of aerobic exercise performed to achieve a heart rate of 70%–85% of maximal heart rate.

Safety / Side Effects

One of the main issues from the Pritikin diet is that the dieters gain the weight back, because very few people have the amount of time for meal preparation. Vitamins may become deficient due to an insufficient amount of fats in the diet, causing problems in the skin and nervous system. Also, a 1000 to 1200 calories diet with 10% of fat may be sustainable for the short term but difficult in the long-term.

Nationwide Centers

Medi-Weightloss Clinics

www.mediweightlossclinics.com

Patients come in once a week for monitoring and once a month check-ups and lab work.  Counseling is performed by physician assistants or nurse practitioners.  Medication is dispensed in house.  Online resources and fitness programs are available to patients.  This franchise nationwide program has three phases:

1. Acute weight loss: 500 – 600 calories/day with high protein, 2 servings of vegetables or 1 fruit and 1 vegetable + appetite suppressant
2. Short term maintenance: raise the calorie levels and wean off suppressants
3. Wellness: emphasis on exercise, support and skills to keep the weight off

Cost

$268 for the initial consultation, lab work, EKG, and start kit/medication.

$70 per week for prescription drugs, vitamin injection and counseling.

$20 – $40/ month additional for vitamins, supplements and colon cleanser.

Center for Medical Weight Loss

www.centerformedicalweightloss.com

Started in Long Island by Dr. Kaplan, the Center for Medical Weight Loss has expanded nationwide.  Physicians get a territory to operate under the center’s brand.  Access to new clinical studies and research, seminar training and advertising support is offered by CMWL.  

Patients are started on a low calorie diet (800 – 1200/day) with nutritional bars, hot soups, snack foods and shakes produced by the company.  Prescriptions (such as phentermine) are also used.  Weekly appointments are tapered off when the patient achieves progress.  Counseling of behavior modification and lifestyle changes are emphasized.  

Cost 

Varies.

Some charge $19 for an initial consultation.  Fees range from $75 to $650 per month, depending on the patient’s need and location.  Monthly price typically includes weekly counseling, check-up, food, and medication.

Physicians Weight Loss Center

www.pwlc.com

Founded in 1979, PWLC is one of the oldest nationwide chains.  They have several systems of weight loss based on the goals of the patient.  Patients are offered daily visits for the first two weeks, then three times per week for the rest of the program.  Variety options from regular food, meal replacement with Medifast, to nutritional supplements are available to the patient.  Prescription medication is used by PWLC.  

Cost

Depends on the system that the patient signs up for.  For the original PWLC diet, there is the $199 registration fee, plus cost of EKG and blood work, plus $58/week for products and supplements.  

Registered Dietician vs. Nutritionists

Both specialists use a variety of techniques focused on an individualized program (body, diet, medication, exercise, and lifestyle analysis; diet and lifestyle plan) to achieve weight loss for their patients.  However, nutritionists do not possess a medical degree.  Registered Dieticians require a 4 year degree and a mandatory internship, and typically work in more medical environments.  

Cost

RD spends up to an hour per session and can charge $75 – $195 for initial consult and $65 for follow ups.

Nutritionists also spend up to an hour per session and charge $40 – $85 per hour.

Office Based Physician Weight Loss

Many physicians have added weight loss to their primary practice to help their obese patients and to increase their income.  Some physicians have developed their own program, based on current dietary guidelines.  Some have teamed up with a local nutritionist, registered dietitian or a fitness gym.  Analysts estimate that only about 5% of the physicians are substantially involved in offering a weight loss program to their patients.  Obesity is still not thoroughly taught in medical schools or in residencies.  

Cost

Physicians will typically charge from $100 – $250 for the initial consultation.  This can be billed to the insurance company, while some charge patients out of pocket.  It should be noted that most insurance companies do not cover diet plans.  At least a monthly follow up and lab tests are recommended.  When it comes to prescription drugs, there are two types of practices: dispensing and non-dispensing.  A practice that dispenses medication from the office gains extra income.  This comes with additional requirements that we recommend that you check with your state board about becoming a licensed dispenser of pharmaceutical drugs.  

The criticism about individual office-based weight loss practices come from lack of structure.  Many physicians will add weight loss as a “cash cow.”  Many offices will only provide initial screening exams, a prescription and a diet recommendation.  Many offices do not have a support counseling staff in the office and will refer patients out.  In addition, most offices do not offer exercise programs.  Patients are left with an incomplete weight loss package as they lack that additional support that is crucial to the patient’s success.  Therefore, nationwide franchise weight loss centers are better organized and provide a more comprehensive weight loss package.  

Appetite Suppressants

Two classes of anorectic drugs are currently available: noradrenergic and the serotonergic agents. Norepinephrine, serotonin and dopamine are neurotransmitters in the hypothalamus (the appetite center), which is thought to play a role in energy intake, energy expenditure, substrate utilization, and adipose storage.

Holistic Approach

Acupuncture

Weight loss is not one of acupuncture’s traditional goals.  It is unclear as to its role in weight loss.  Acupuncture may help you relax, which is useful if your patients eat because they are stressed or depressed.   Most of the studies evaluating acupuncture and weight loss are limited by short duration, inadequate placebo controls and non-standardized treatment.  Few controlled trials do offer positive results though.  Acupuncture may be a potentially useful adjunct in weight loss, but it still needs more careful study.  

Mindfulness and Meditation

Mindfulness is a nonjudgmental method of giving attention to the present moment.

Mindfulness encourages the practitioner to eat only when hungry to avoid eating purely out of habit.  It encourages the opposite of eating on the run, where one is disconnected from the body’s response as one is eating.  This all prevents eating when one is not hungry and stopping when full.  

Meditation is about focusing your attention on your breath, thoughts and feelings.  People use it to deal with anxiety, stress, pain, sleep problems, depression, and to feel better.  

Research indicates that mindfulness and meditation can be a good behavioral modification in combination with diet and exercise. 

Hypnosis

Combining hypnotic suggestions with other behavioral methods can help a person make lifestyle changes.  According to the Mayo Clinic, studies have shown an average of 6 pounds of weight loss through hypnosis.  However, the research is still scarce.  

Prayer

Faith-based weight loss books such as The Hallelujah Diet, and The Prayer Diet have become popular.  They suggest that people are mistaking spiritual hunger with physical hunger. These books encourage people to turn to God for their emotional pains rather than food.   These approaches typically include a support group as well.  There are no good clinical studies to support this approach.  However, a recent meta-analysis “indicated small, but significant, effect sizes for the use of intercessory prayer.”

Medical Weight Loss Protocol Options

You have several options of starting a medical weight loss facility.  The easiest option is to join a nationwide chain.  This comes at a price as there will be additional fees to your practice (franchising a zone, advertising, material, support products, etc.) or require a profit sharing agreement.  You can explore our list of vendors listed in the training packet for a list of companies that you can contact.

Running your own independent weight loss clinic is also a possibility.  If you have an existing practice where your patients know and trust you, then you are one step ahead of the competition.  Being a physician gives you another advantage in that you can prescribe medications to your patients. Non-medical weight loss programs are limited to diet, behavior modification and exercise.  

A combination of full medical evaluation, EKG, lab, diet plan, exercise plan, behavior modification, nutritional counseling, and/or medication is recommended.  Below are a few of the medical weight loss option that is available to add to your practice:

Using an existing Diet Plan

You can use a commercially available diet plan, such as Weight Watchers, Medifast or Nutrisystem and provide medical supervision as an adjunct.  Using these meal replacement plans eliminate the need to formulate your own diet plan.  The physician’s primary role would be to evaluate your patient for complications, behavioral support, and prescription assistance to aid in weight management.  A study in the Lancet indicated that when overweight patients were referred to Weight Watchers by their doctor, in a 12 month period, they lost more than twice as much weight when compared to the patients who only received standard care from their physician.

Use a physician managed diet plan:

Most diet plans should be medically approved by a physician, but the very low calorie diet and ketosis diet should be closely monitored.  This is due to high risk of severe complications and rarely death.  

Start Up and Marketing

It doesn’t matter how excellent your weight loss program is, if nobody knows anything about it.  You can spend a lot of time understanding the literature on weight loss, developing a program and training your staff, but it will be fruitless if you can’t get the word out.  Using keywords such as “medical weight loss“, “physician supervised” or “doctor managed” will help you stand out from the non-medical weight loss companies.

Developing a business structure that fits your practice, business partner relationship or medical malpractice requirements are important subjects that you need to discuss and plan ahead.  

Will you open up a new practice, add on to your practice, or devote one or two days a week to seeing patients primarily for weight loss?  

Are you going to hire an ancillary support staff, like a nutritionist, or will you train your current staff?  How will you train your staff?

Are local dieticians, nutritionists, health clubs or personal trainers interested in a joint partnership?

Do you have a business plan and a cash flow plan for building this business?

What are your marketing strategies?  What is your online advertising plan?  Website?  Email marketing?

In setting up your pricing, you should ideally call your competitors and send in a secret shopper.  Your secret shopper should find out the fees for the plan, additional fees (follow up, lab, supplements, medication, etc.), hours of operation (evening hours), insurance billing, support classes (group or evening classes) and type of additional support provided.  

Offering the following products for sale will add additional income to your practice per patient:

Phentermine adds around $20 each month

Meal replacement adds around $30 – $60 each month

Supplement adds $20 – $40 each month

hCG program adds $100 – $400 each month 

All the profit numbers vary with your local competition and your cost for the products purchased. 

Starting up a business and marketing are subjects that can require a four year degree in a college.  We have tried to condense the crucial information into an online seminar.  For more information on start-up and marketing, we recommend you sign up and learn on www.cosmeticmedicalconsulting.com

Medically supervised weight loss certification training online

For more information, contact us at [email protected] or call us at (212) 470-8059 TODAY!

Originally published at Medical Weight Loss Training