Top Docs: Slim Chance

It seems people trying to shed pounds turn to every go-it-alone resource—gyms, a blog, the Whole30 hashtag—before they even think about seeking help from a hospital. Perhaps they don’t realize that hospital services go beyond bariatric surgery. Behavior modification programs, also called nonsurgical medical weight loss, are catching on as overweight and obesity rates in the U.S. near 70 percent, and doctors (if not insurance companies) are treating obesity as a chronic disease.

These physician-supervised programs traffic in familiar language about lifestyle change, like exercising regularly and improving nutrition. But they do more than preach common knowledge. They offer accountability, medical supervision, and multidisciplinary treatment. The result is an individualized plan based on your medical history, and frequent support to stick with it.

IU Health relaunched its Bariatric Surgery & Medical Weight Loss Program in September. Patients first meet with a doctor for an evaluation and physical exam. A resulting plan might include weekly or biweekly check-ins, nutrition counseling with a registered dietitian, grocery store walk-throughs, support groups, and medications, if necessary. The initial evaluation runs $120 to $160, and follow-up visits are $60. Medication tends to cost $12 to $15 per box, according to IU Health.

Medical bariatrician Eve Olson with Franciscan Physician Network Weight Loss Specialists says about half of her patients prefer to be treated medically rather than surgically. Patients report weekly for three months, then visits taper off until they reach their goal weight and switch to maintenance appointments. If you’re looking for a straight-shooter with compassion, Olson fits the bill. “With eating, so much has become like Pavlov and his dogs,” she says. “We’ve just conditioned ourselves to eat for myriad emotions. We don’t even know we’re doing it.” Franciscan’s program includes classes to conquer emotional eating as well as the services of dietitians and a clinical psychologist.

The most aggressive treatment short of surgery is an intensive behavior modification program, like Riverview Health’s. Patients use a meal supplement for 20 weeks to lose, on average, 40 to 45 pounds during that time, according to doctor Dawn Ayers. They also attend lectures, call their weight-loss counselor every week, and fulfill an exercise requirement. “We have an 80 percent success rate at getting to a goal weight and keeping it off for a year,” Ayers says. “Most patients aren’t on medication. We don’t need it in this program.”

One thing behavior modification programs don’t offer? Judgment, especially as doctors learn more about food and the brain. “Obesity isn’t the patient’s fault,” says Ayers, an endocrinologist who specializes in thyroid issues. “Your whole biochemistry changes. The activity in the pleasure/reward center of a lean, thin person’s brain is completely different.” But doing something about the condition? As one IU Health patient who lost 120 pounds puts it, “It was my fault if I stayed overweight.”

Top Docs on Obesity

Kick the Can. “One pop a day equals 15 pounds of weight gain a year. I see patients whose entire weight gain over the last 10 years has been pop.” —Eve Olson, medical bariatrician, Franciscan Physician Network Weight Loss Specialists

Cancel Cancer. “A lot of cancers are hard to treat. The International Agency on Research for Cancer came up with 13 cancers—40 percent of all cancers—in which obesity plays a large role in promoting. With my specialty, multiple myeloma (a rare blood disease), the pre-cancer condition sometimes disappears when the patient loses the weight. We need simple intervention instead of massive chemotherapy.” —Rafat Abonour, hematology oncologist, IU Health Simon Cancer Center

Start Small. “Every time you lose 10 percent of your body weight, you can improve your overall health. And studies have shown that people who wear pedometers increase their activity level by 20 percent.” —Theresa Rohr-Kirchgraber, adolescent and internal medicine, Eskenazi Health