Office-Based Weight-Loss Program
Introduction
Every patient has a particular reason, or reasons, which brought about the weight problem.
Your reason may be to do with an excess of calories consumed relative to calories burned up; or it may be a significant lack of calories burned up relative to intake of food.
And these factors may be influenced by genetics or circumstances in life such as surgery and muscle loss.
This weight loss program comprises individual consultations with Dr Neil Peace with the objective of creating a tailor-made weight-loss program for each individual.
Format
The first visit, of 1 ½ to 2 hours duration establishes the contributions to being overweight. In addition, this first visit includes an overall (broad-brush) description of the components needed for weight loss for that person plus specific recommendations for getting started.
Most patients are seen at 2 weekly intervals. At each visit progress is assessed. Adjustments are made or new techniques introduced depending on the results. As weight loss proceeds ideas are introduced to reduce the chance of weight regain.
Most patients attend 2 weekly until both doctor and patient are confident that weight loss is proceeding as planned. Individual need then determines the frequency of visits.
What Techniques Are Used?
A wide range of techniques are tailored to each overweight individual. Nothing is automatic. Patients vary markedly in the number of techniques that need to be applied in order to bring weight loss. The following are a few of the techniques used but in no particular order.
- Variation in timing of meals
- Variation in food choices
- Aerobic exercise (walking, cycling etc.)
- Calorie controlled diets
- Dealing with drop in motivation (happens to everyone)
- Resistance exercises (mostly use of weights)
- Food diaries
- Use of personal trainers
- Medications for weight loss
- Overcoming barriers to progress
- Home delivered foods
- Use of gyms and personal training studios
- Blood tests to exclude medical causes for excess weight (thyroid etc.)
- Dealing with plateau phases
- The occasional use of holidays for weight loss
- Role of alcohol
- Anticipating problems
- Creating structures for long-term weight control
- Role of Very Low Calorie Diets (VLCD)
- How to manage arthritic pain
- How to deal with speed of eating
- Weight maintenance techniques
- How to deal with medical problems during weight loss
- Role of depression in weight problems
- Exercise diaries
What Research Do We Believe In for Weight Loss Advice to You?
How does one separate good medical research from poor research? And how does this influence our advice to patients?
Published research, say in a medical journal, is viewed by experts in the field and their criticisms are either published or take the form of a review on the subject. Readers are alerted to any errors or incorrect conclusions.
Unpublished research has not been reviewed by experts and could contain major errors or major biases, both of which might make the conclusions of the research invalid.
Hence our advice only comes from published research.
What are the variables in published research which influence the believability of the results? We are influenced by,
- The publication in which the research appears
After all, research published by a vitamin company, in their own journal, showing major benefits from their vitamin X, could be subject to a bias.
- The number of subjects studied in the research
Certain minimum numbers of subjects are needed in order to be sure that the result claimed is not due to a chance event. If just four subjects taking vitamin X all got better, then the maker of vitamin X could claim that their vitamin X cures the condition. However, it is possible that all four would have got better anyway - a chance result.
- The presence of a control group
If the maker of vitamin X gave the vitamins to 20 people and they all got better then the manufacturer might say that vitamin X cures the condition. But if another 20 people were given a tablet which looked like vitamin X but contained only sugar and they all got better then the manufacturer cannot say that it was the vitamin X which cured the condition. Thus a control group can influence the conclusion of the research.
- The number in the control group
If the situation above contained only 4 control subjects and the active treatment group contained 50 subjects then it is possible that the results in the control group were due to chance and thus not comparable with the active group.
- The ability of the researchers to eliminate other factors accounting for the result other than the variable they are testing
Research mostly needs to eliminate any variable, or control for any variable, which is not the subject of the study. If a group of 100 subjects were given vitamin X and 90 of them got better the manufacturer might claim that their vitamin X cured the condition. However, the fact that all 100 subjects returned from a holiday to Thailand was not mentioned could be a major influence on the subjects getting better. Hence the factor of travel has not been eliminated as a possible cause for improvement and therefore the research conclusion could be invalid.
- Whether the researchers are “blinded” from seeing the result as the research is conducted
Imagine research on a group of 100 subjects. Half receive a placebo and half are given the vitamin X. Then, after a month, the subjects were examined to see the result. If the person examining the subjects knows who received vitamin X and who received placebo then the examiner might be biased in their observations. The examiner must be "blinded" as to the treatment received - that is, the examiner must not know whether the subject had placebo or active, at the time of the examination.
- Duration of follow up
A study of 12 weeks, in the case of weight loss, is not long. Any study reporting a positive result from just 12 weeks research is subject to speculation as to how the result would look at 26 weeks and 52 weeks, such is the problem of regaining after weight loss.
- Whether the researchers were financially supported by the company making the product under study
Research paid for by the manufacturer of vitamin X must demonstrate that the research was not influenced by the provider of the money.
- Whether the researchers had a financial interest in the product being studied
If Dr Bloogs was to gain financially from the result of the research then he or she must demonstrate that their financial involvement has not influenced the result.
- The reputation of the researchers
Well known and reputable researchers may have much to lose if they publish research later found to be affected by their bias. This research therefore carries slightly more weight.
- The reputation of the research institution
Well known and reputable research institutions have much to lose if they publish research later found to be incorrect or inaccurate. Therefore research from these institutions carries slightly more weight.
- Whether the current research is completely novel or is an analysis of previous novel research
A major new finding, completely at odds with previous results, needs to be repeated in order to ensure that some external factor does not account for the major new finding. This is particularly true of research suggesting an active treatment for patients. Doctors are naturally reluctant to offer new treatments unless the research has been repeated. Doctors do not want to expose their patients to treatments which are subsequently shown to be ineffective or worse, to cause harm.
We read medical research on weight problems almost daily. We accept as valid information which fits into the category of good quality medical research. Many patients see this as dreadful conservatism on our part. It must look boring to our patients. Why?
We are not proposing a magical solution. We are not saying that weight loss will be easy if you use our services.
We are saying that we take the best information and apply it to you and never give up.
Most of our patients have been through many previous weight loss attempts at organizations promising to make the weight loss easy, or promising to use a product which is the key to weight loss. The fact that the overweight patient comes to us is testimony to the fact that these promises of an easy solution or a product which is the key to weight loss, has failed.
Our job is to bring weight loss for our patients, both short term and long term weight loss. Our job is to make weight control as uncomplicated as possible using proven methods, not unreliable techniques.
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