Medical Weight Loss: Playing the Long Game

Many patients with obesity receive suboptimal care. With a primary focus on managing chronic conditions, clinicians may fail to treat their underlying cause.

Associated with heart disease, cancer and diabetes, obesity can significantly reduce life expectancy. In the decade between 2000 and 2010, the prevalence of severe obesity increased by 70%. Although medical treatments for severe obesity exist — such as bariatric surgery and pharmacotherapy — even patients who receive regular medical care for chronic conditions are unable to lose weight.

“For a variety of interrelated reasons, patients are often not very successful in achieving long-term weight loss,” states Marcio Griebeler, MD, Director of Obesity Programs in Cleveland Clinic’s Endocrinology & Metabolism Institute. “Likewise, as providers, we often fall short in this respect, at least in part because we don’t always treat obesity as a disease.”

The Obesity and Medical Weight Loss Center at the Endocrinology and Metabolism Institute was designed as a non-surgical weight loss and medical weight management program committed to helping people achieve and maintain weight loss success while improving the comorbidities associated with obesity. “We try to personalize patients’ medical care and optimize weight loss by offering evidenced-based and multidisciplinary strategies for weight loss,” Dr. Griebeler says. The team creates a customized weight loss plan, which can include:

• Individualized guidance from a care coordinator
• Regular visits with a physician, nurse practitioner and dietitian
• Personalized exercise programs
• Management of stress, anxiety, depression and eating disorders
• Help with sleep disorders that can hinder weight loss, including inadequate sleep, obstructive sleep apnea
• Peer-to-peer support at shared medical appointments
• Prescription weight loss medication

There are no quick fixes

Helping patients lose weight is difficult to achieve in a single office visit. Providers often find themselves offering multiple advice to patients with obesity regarding nutrition and exercise, while simultaneously trying to manage obesity-related comorbidities, all in one 20-minute appointment.

“Obesity is a complex problem, and we need to uncover the medical and behavioral issues that may be contributing to a patient’s obesity. We are moving away from the standard recommendation of ‘eat less, exercise more,’ as this is an oversimplification at the very least. Some patients don’t eat that much, but they aren’t eating the right things at the right times. Our patients spend an hour with a dieticians during their initial visit to our clinic, and a lot of that time is spent discussing what, when and why the patient is eating. The main goal is to decrease the urge to eat,” Dr. Griebeler continues.

More touch points

The Obesity and Medical Weight Loss Center supports patients with more touch points. Part of this is accomplished by its team of teams approach – a multidisciplinary team of specialists who help optimize a patient’s health and weight loss efforts. The team includes endocrinologists, internists, nurse practitioners, dieticians, exercise physiologists and clinical psychologists. These additional touch points are also made possible thanks to innovations like virtual visits and shared medical appointments.

“When it comes to weight loss, we want to have as much interaction with a patient as possible. And that doesn’t mean that we have to see the patient every month. With remote monitoring, we can monitor weight and activity, then we can provide virtual e-coaching recommendations.”