The Multidisciplinary Program

We are convinced that the management of the complex disease of obesity is most effectively accomplished by using diverse techniques, including dietary modification, physical activity, guidance in nutrition and behavior modification, and psychological support and counseling as needed. We offer this array of interventions and encourage patients to work with their provider to develop the approach they believe will be most useful for them.

Upon meeting with our providers and completing a comprehensive history and physical examination, patients and providers work together to choose an appropriate initial and long-term plan. Initially, most patients - but not all - begin with one of three general "programs": a meal replacement program ("Program A"), in which the majority of daily calories come from prepackaged foods; a mixed food and meal replacement program ("Program B"); or a food-based weight loss program ("Program C"). These general programs are then individualized for each patient based on preferences, tastes, lifestyle, and many other factors.

Most patients initially choose a meal replacement program. There are numerous scientific studies showing these programs to be highly effective and safe. We find them to be a useful initial plan for aggressive weight loss; most patients find that they enjoy the meal replacements and feel little hunger. Patients on Program A consume 700-1000 calories per day of a high-quality meal replacement shake or bar, accompanied by several servings of low-fat dairy (e.g., milk, yogurt, cottage cheese), fiber supplementation, and vitamin and mineral supplements. In this program, patients are able to minimize much of the the food stimuli, food decisions, and food judgments in order to facilitate their progress. This point should not be understated; many patients report that the most important part of this program is the opportunity to "take a break" from the multitude of food decisions that practically take over their everyday lives. Weight loss on the meal replacement program is usually rapid and comfortable.

Patients on Program B consume the equivalent of 2 meals daily using meal replacements combined with 600-800 calories of individualized healthy meals or snacks.

Patients on a food-based program work with the medical and nutrition staff to develop an individual approach to food selection and calorie control. Since no one food program suits the needs of all patients, each program is formulated to satisfy the preference of each patient.

Although the majority of our patients begin with one of these three broad categories of treatment, many use our services differently. Some choose to use us as impartial experts to help decide if obesity surgery is right for them. Others primarily prefer to be involved with our group classes. Others are interested in using weight loss medications as part of a lifestyle program under the supervision of medical specialists. Still others prefer to use our exercise facility and work with our exercise trainer. Our goal is to help each patient get what they need from our resources.

Most patients are seen weekly by the professional staff. Medical tests are used to monitor the patient's status and are obtained at intervals consistent with the particular program.

A carefully formulated support program accompanies the weight loss phase. Small groups of patients (usually about 4-8) meet one or more times each week in a professional program with a structured curriculum. The nature of obesity, control techniques, and factors involved in its management are discussed. Support, education and reinforcement are incorporated into the groups as well as specific information about the disease and its control.

Psychology groups address a broad range of psychological, emotional, and situational issues that play a significant role in eating, weight loss, and maintenance. Groups topics include exploring stress factors related to gaining and losing weight, discussion of the roles that eating and body image play patients' lives, emotional eating, eating impulses, binge eating, relapse intervention, and others.

A series of behavior modification classes are designed to help patients learn to incorporate new behaviors and strategies for weight management into the reality of their lives. Additionally, individual psychological counseling is available for patients who choose to focus on these issues as part of a sustaining management effort.

A nutrition education and counseling program is conducted by the staff's dietitians in individual sessions and a series of structured seminars. The seminars include an 8-week class series designed to facilitate long-term weight control.

An exercise program designed to meet the needs of obese patients, and accommodating the patients' varying exercise experience, is conducted in our gym during regular office hours (including evenings and Saturdays). The exercise program begins with a comprehensive physical activity assessment conducted by our exercise staff. Use of the gym and access to the staff for individualized personal training sessions is included in the cost of the program.

Additionally, in conjunction with the Department of Surgery at the George Washington University Medical Center, our staff works with surgical patients to develop an individual program for the long-term management of their post-surgical care.

The second part of the comprehensive weight management program involves the maintenance of weight loss. It is emphasized that obesity can be (and often is) controlled, but it is not a curable disease. Long-term maintenance depends upon life-long effort.

During the initial phase of the maintenance program, patients continue weekly consultations with the physician and dietitian. The frequency of visits is eventually adjusted depending upon the patient's progress and stability. Patients are encouraged to attend group meetings specifically organized for maintenance issues, either for support or reinforcement.

A major factor in long-term maintenance is the recognition that if control falters, the patient can utilize the appropriate techniques to re-establish control. For this reason, the components of this program's counseling, group sessions, exercise and medical consultations are continually available.