Our aim with the SmartWeightTM programme is to improve the health and wellbeing of our patients. For some, relatively small reductions in body weight lead to significant health improvements – in sleep apnoea, tiredness, depression or mobility. Success is different for every patient, so right at the start of your programme, we will work with you to define your personal goals.
For example, your key goal might prevention of further weight gain; maintenance of your best weight; higher energy levels; or improved glucose control. So setting an achievable and personalised target is vitally important, and very often it will be the “best” weight that you can realistically sustain in your normal everyday life.
Our programme will identify and address the causes of your weight gain, as well as the barriers to effective weight management. We will investigate any reduction in your metabolic rate, unhealthy eating habits, or lack of exercise – and look into the reasons for them. We will:
- Advise you on the risks to your health of excess weight, and the benefits of even modest weight loss
- Provide you with a long term strategy and ways to sustain changes in your routine
- Use dietary recommendations, advice on increased physical activity, psychological motivators, antiobesity medications or bariatric surgery as treatment options for individual patients
- Provide you with the knowledge and the resources to help you understand your individual weight management issues
- Refer you to specialists for any specific health problems requiring treatment
What are my options?
Our expert clinical team will discuss all available options with you. These depend on the seriousness of your weight issues, and other related health problems, and your ability to cope with long term calorie restriction.
There are four treatment recommendations:
- Lifestyle changes (diet, mental health, physical activity) and medication with drugs
- Lifestyle changes alone
- Lifestyle changes and devices (Endobarrier, gastric balloon, AspireAssist)
- Bariatric Surgery (usually either gastric bypass or sleeve gastrectomy)
The easiest, safest and simplest option, best suited to patients with relatively minor weight problems, remains lifestyle adaptation – cutting down on calories, and taking regular exercise. Where these changes become part of your daily life, you can achieve long term weight loss.
For patients who are heavier, formally defined as obese, and beginning to develop harmful health problems because of their weight, the use of drugs can now play a very important role.
Medication can be used in combination with devices inserted into the stomach to achieve rapid weight loss, but such devices have the disadvantage that they need to be removed after a short time. So using proven drugs, together with long-term lifestyle changes, is often the best way to lose weight, without the tendency to regain it.
For severe forms of obesity, the only real long term solutions either a gastric bypass operation or a sleeve gastrectomy (procedures collectively known as bariatric surgery). Weight loss is usually but not always largely maintained for more than 20 years after these procedures, with resulting improvements in longevity, and disappearance of many obesity associated health problems including diabetes.
What is bariatric surgery, gastric bypass and sleeve gastrectomy? And is there an alternative?
Not all seriously obese patients elect for surgery, while others are in such poor health that they can’t risk surgical intervention. In such cases, patients may feel they then face a lack of evidence-based alternatives.
The effects of gastric bypass surgery can now be mimicked in part through pharmacological treatment. As we consume a meal, a hormone called GLP-1 affects the brain’s response to food. It is usually present about 20 minutes after eating. The increase is seen at greater levels in patients who have had gastric bypass.
Liraglutide (Saxenda) is a drug that acts in the same way as the hormone GLP-1. It helps overweight people to feel satiated soon, and to feel full for longer, enabling them to achieve weight loss.
At London Medical we have been using Saxenda extensively in treating diabetes, and more recently as a highly effective treatment for obesity; so effective, in fact, that it has now become an integral part of our SmartWeight programme.
SmartWeightTM – The Way to Change – What to expect
All patients begin with the kick-start 6 weeks SmartWeight Programme. At your first visit:
- There will be an initial assessment by either Dr Christina Prechtl or Ms Carin Hume on the likely requirements of your programme. Your current situation in terms of eating habits and exercise will be assessed, together with your motivation to change, and the obstacles to success you have faced in the past. This assessment will serve as our benchmark for monitoring your progress in the future. An initial personalised food plan will get you started – this will change as you communicate your progress to your dietitian. Initially, and with the influence of your medication, we will be strict in ensuring that you can start well and achieve initial weight loss, which is always greater in the first few weeks, as a higher percentage of water rather than fat, is lost.
- A first consultation with an Endocrinologist – either Dr Chahal, Dr Miras, or Dr Abraham – on the same day, or at another time if that would suit you better.
- Initial fasting blood tests to include FBC, ESR, routine biochemistry, thyroid function, fasting insulin, fasting lipids.
- Baseline DEXA body composition analysis, in order to assess the extent of visceral fat and its loss as the programme progresses. Visceral fat (the fat in liver, the abdomen, the heart and pancreas) is a metabolically active fat compartment associated with an increased risk of diabetes and cardiovascular disease and hypertension and raised triglyceride. It is associated with increased risk of diabetes, heart disease and strokes. Increasing exercise levels will assist in changing the amount of muscle mass present.
- Initial resting metabolic rate and respiratory quotient using the ECal system, on your current diet. You will be asked to breathe in and out of a mouthpiece for 5 minutes while sitting quietly in order to give us a measurement of your resting energy expenditure. From this, we can estimate your total energy expenditure in a day and this allows us to prescribe you a calorie restriction based more on fact than guesswork. Many overweight people feel that they gain weight because their metabolism is “slow”. There is no truth in this as obesity is associated with a higher metabolic rate though it may be less than for somebody with equivalent height, weight, gender and muscle mass. We consider it helpful to get a direct measure of a patient’s resting metabolic rate, particularly as it will fall with weight loss and dietary prescriptions will need to be modified. The test will be repeated later in the programme.
- Instruction and support in starting injectable daily treatment with Saxenda (Liraglutide). The costs of the drug are included in the first 6 weeks and are available at a substantial discount thereafter for patients continuing with the SmartWeight programme. It is believed that continued use of this medication is essential in helping prevent weight gain in the future.
- Two further consultations with your dietitian over the next 6 weeks. These do not have to be face to face consultations, but can include video conferencing, email or phone communications. They will assess well-being, side effects and progress on the prescribed plan.
What happens after the first six weeks of my participation in the SmartWeight programme?
Most patients will have lost about 5% of their starting weight in this first period (depending on gender and initial metabolic rate) and will have made a start in adjusting to a different lifestyle and new eating habits.
We now want to support you in continuing your weight loss as and later help you sustain your body weight long term. Unless you were unable to tolerate the medication, you will be encouraged to continue with it as this helps in sustaining your achieved weight loss.
For the next 20 weeks, in Phase 2 of your programme, you will continue to work with your dietitian and other doctors in making changes to your eating behaviour and lifestyle. Your programme will be personalised, and you should continue to lose weight and be making permanent changes in your lifestyle.
At the end of this 20 week period, we’ll measure your body composition and metabolic rate and you will see your endocrinologist again. From this point on, a personal ongoing plan will be agreed with you so that you continue to be seen and monitored and encouraged to stick to your agreed strategy, and maintain a healthy weight.
What is not included?
Some patients may need consultations with other specialists (for example, a consultant psychiatrist or sleep apnoea consultant), or blood tests, electrocardiograms, and other specialised tests – all of which would be separately charged.
If you require more frequent support or help than provided within your SmartWeight programme – including additional consultations or weekly support – these will be charged in addition.
After the initial 6 week period, the cost of Saxenda will be charged separately, but at a discount reduced price for SmartWeight programme participants.