Weight: Weight Loss Programs at MUSC

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Dr. Gray: Hello, this is Dr. Kevin Gray from the Medical University of South Carolina. Today I'm speaking with Dr. Pat O'Neil of the Weight Management Center. Thank you for being with us.

Dr. O'Neil: Hi, thanks for having me.

Dr. Gray: Dr. O'Neil, we've talked about how weight management is different for different people, and I would imagine that there's not a one size fits all program at the Weight Management Center, and I'm guessing that there's a large variety of programs. Can you give us an introduction to some of the programs?

Dr. O'Neil. Right. We like to say that we're here to help people with a little or a lot to lose, and we've designed our programs and services accordingly. To start with, I might mention that we have a multi-disciplinary staff, which includes physicians such as yourself, psychologists such as me, a registered dietitian, a registered nurse, an exercise specialist and other psychology staff. We are staffed that way because we try to help people make some long term lifestyle changes. And for lifestyle changes we use the abbreviation ABCDs, for changes in activity level, behavioral patterns, cognitive or thinking patterns, dietary patterns, and then the S you can throw in for social support, because that's so important. So we try and incorporate that approach into all the services and all of the programs we offer to people who come to our center to learn about ways we can help them.

Dr. Gray: So it's a multi-disciplinary approach. That's certainly a lot of different individuals working on weight management. In what sort of ways, say I'm a patient who's giving you a call saying you know, I really want to get my weight under control. How do you introduce a potential participant into the programs you have, and how do you help somebody make that choice about what might be right for him or her?

Dr. O'Neil: Right, that's really important, because we've got to have a good fit, and the first thing we do is we try and send people some written information as well as schedule them for an information session in which we present information to very small groups of patients about all our different programs. And we also have time to answer questions that people have on a one to one basis as well. We look at what an individual's weight loss goals are likely to be, or what they're weight loss goals are for them. Obviously someone who's trying to shed ten pounds has different needs from someone who's trying to lose fifty to 100 pounds. We offer some one or two session programs for people who really just need some information, a little bit of guidance, and then can take it on their own after that. For people who need more than that, who need more accountability, who need more structure, we have several different structured programs that we can offer them.

Dr. Gray: What's the most popular program at the Weight Management Center?

Dr. O'Neil: Probably our most popular program is called the Focus Plan, and this is a fifteen week program for folks with brief visits every week, no more than about a half hour. You come in and meet with one of our professionals, either the dietitian, or exercise specialist, or one of the psychology staff, and for the Focus Program try to select the most essential elements of lifestyle change. We designed it for busy people, and from the response that we've had there's a lot of busy people around here. It's meant to be efficient, and it's meant to focus people's efforts and time and attention on the most important things such as self-monitoring, recording food intake, such as setting specific behavioral goals, such as working on that exercise program. And so people meet with the dietitian several different times, and with the exercise specialist, and with our behavioral staff, because it takes more than knowing what to do. A lot of times you have to have a little incentive system going with yourself to stay motivated. The diet is also designed for people who are pretty busy, who want a somewhat faster weight loss than they might achieve with a strict food based diet, and our diet in the Focus Program in the first eight weeks requires a meal replacement product. We use nutritional supplements in the form of shakes and in the form of bars. And so it's a combination of shakes and bars plus one meal, one very restricted meal, with lean meat, and non-starchy vegetables, and a fruit serving, so people can sort of have the best of both worlds. You have the nutritional balance and the convenience, and the limited variety that's so helpful initially that you get with these meal replacement products, and at the same time you get a little diversion from that when you get to have your food as part of that plan each day.

Dr. Gray: Is there an alternative program out there that would cater to people who maybe need a more dramatic weight loss in a short period, given their mounting health concerns, or otherwise.

Dr. O'Neil: Right. We have what we call our Health Fast Program, and this is for people who are trying to lose at least fifty pounds or more, and very often they are trying to lose more than that. It's for people who are at a body mass index, or BMI of thirty or above, which places them in the obese category, and whose weight is sufficiently high that it's really placing them at risk. And many of the people who come into this program already are experiencing problems with blood pressure or blood sugar, or blood cholesterol, or triglycerides, or their knees and ankles are giving them trouble. So this is for people who are either already feeling or are worried about feeling some of the physical consequences of obesity. Now what makes the Health Fast Program different is that a, it involves some medical screening more than our other programs do, but the reason for that is because for the first twelve weeks of this program, people go off of all regular food completely. And so they're maintained on a nutrition supplement based plan that provides roughly 800 calories a day, including eighty grams of good quality protein, and they take it in small servings spread out over the day. Now as you know this has to be done under physician monitoring, so they're seen each week by one of our physicians, and our physicians also monitor blood work on a regular basis, so that they can follow things such as their potassium levels and their liver function tests and things like that.

Dr. Gray: Well certainly in having had colleagues and friends who have gone on a relatively extreme diet, where they've gone on a relative fasting for a period of time, one of the trickiest parts is transitioning back into eating quote unquote normal food. How do you handle that within the Health Fast Program?

Dr. O'Neil: Right, it is a real challenge, and it does require a lot of thought and a lot of structure. Once our patients have completed the supplement only phase of our program they start working pretty intensively with our registered dietitian, and she puts them on a structured sequence of food plans, so that gradually they're removing the amount of supplements that they're using, and they're gradually increasing the amount and the variety of food that they take in. We don't want people going overnight from all supplement to all food. Usually when people are on the supplement phase of this program they feel like they've got a greater amount of control over their intake then they have previously. And so we do our best to try to help them retain that control and that sense of mastery as they move back onto food. It's so important that when people start any weight loss program, but particularly one like this, that they start thinking from day one how am I going to maintain this, and what are my patterns going to be like once the initial phase of this diet is over

Dr. Gray: So it sounds like you've really got a broad range of programs for people who need to lose a little to people who need to lose a lot, and, I understand that in addition to your clinical programs, you are involved in a number of research studies. Can you tell me a little about that?

Dr. O'Neil: That's very true, and this is another one of the kinds of services that we offer people in the Charleston area. As you know from your work with us we do trials for a number of corporate sponsors who are assessing potential weight loss medications, and these trials run the gamut from those that run maybe twenty to twenty four weeks to those that go as much as two years. They vary quite a bit in terms of the other sorts of weight loss interventions that are included, but many of them also include some dietary counseling and behavioral counseling to a greater or lesser extent. There's an awful lot of work being done now in trying to find pharmacological interventions, medications that will help people both to lose weight and to maintain their weight loss once they've achieved it. And there's a lot of work, a lot of progress being made here. I think people will be seeing an advancement in the next five to ten years. But the way that that happens is by centers such as ours, that there are specialized research centers offering clinical trials for patients who are willing to participate as subjects.

Dr. Gray: So it sounds as though you're keeping the balance between your using evidence based practice within your clinical programs, but at the same time you're researching potential practices that could be incorporated later on.

Dr. O'Neil: We try and do both of those things, and it's very important that when you're approaching weight loss and weight management that you pay attention to the things that have been shown to be effective, and the ones that have been shown to be not effective.

Dr. Gray: Dr. O'Neil do all of your programs involve the use of nutrition supplements?

Dr. O'Neil: No, not at all. We also have what's called the First Step Plan, and this utilizes a very heart healthy food based diet that people follow. It promotes a more gradual rate weight loss, but we know that many people prefer this kind of diet because it fits in better with their lifestyle, it doesn't require them to have to have to eat things differently from what their family's eating. And we include that as part of an overall lifestyle change approach.

Dr. Gray: Dr. O'Neil the topic that's been in the media a great deal is bariatric surgery, or surgery to help with problems of obesity. What's your perspective on what should prompt an evaluation for bariatric surgery rather than, perhaps, a behavioral treatment plan?

Dr. O'Neil: Weight loss surgery is absolutely a very viable option for the person who's weight represents a significant medical problem to them, and who's been unsuccessful to other approaches to loosing weight. We work along with the weight loss surgery program here at MUSC with Dr. Carl Burn and his colleagues. Dr. Burn and his colleagues offer both a bypass procedure, as well as a banding, a laproscopic banding procedure. And patients who wish to learn more about that program can get in touch with them and attend a no charge community information presentation program that's offered on a monthly basis. Surgery can be very effective for the person who's not been able to make it work any other way. It is a decision that should not be entered into lightly. People should make certain that they know what they're getting into. They should understand the type of procedure that may work best for them, and they should make certain that the surgery team that they're working with has a lot of experience, because that's the best predictor of having a very experienced team such as the one here at MUSC.

Dr. Gray: Dr. O'Neil, thank you so much for providing an overview of the many programs for weight management at MUSC and in general. How can our listeners get in touch with the Weight Management Program to see if a program there may be beneficial to them?

Dr. O'Neil: Well, there's a number of ways. They can email us at wmc@musc.edu, they can visit our website at "http://www.muschealth.com/weight", or they can call us at 792-2273, which you can remember as 792-CARE

Dr. Gray: Thank you again Dr. O'Neil.

Dr. O'Neil: Thanks a lot.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at 1(843) 792-1414. That's 1(843) 792-1414.

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