I have focused my medical efforts on medical weight loss and the medical treatment of the overweight/obese since 2010. My residency training was in Physical Medicine and Rehabilitation and my practice was initially directed towards Pain Medicine. My training and my experiences with Pain Medicine patients demonstrated the need for a comprehensive treatment approach, especially for weight loss patients. Successful medical weight loss treatment requires integrative attention to the psychological, medical, dietary, and physical factors contributing to the patients’ overweight issues, which I have incorporated into my approach for helping those with weight issues.
Being overweight/obese has been assessed to be a chronic condition comparable to entities such as hypertension and diabetes. These conditions cannot be treated in a programmatic fashion with a beginning and an end. Just as we always strive to be healthy, I stress the need to be continuously mindful of our weight on a long-term basis. Our weight is determined by a dynamic process and our treatment measures reflect the need to adjust and adapt to the fluid nature of the factors affecting our weight. The range of patients that seek our services is also very broad: people from their 80’s to teens, people weighing 400 lbs to 100 lbs, people with multiple medical issues to others without any issues except for their weight concerns, those with great willpower to those needing much support. As there is much variability patient to patient and visit to visit for each patient, our treatment approach cannot be programmatic, but must be flexible and adaptive. I describe our practice as medical treatments of a medical problem, and not as a predetermined and/or scripted weight loss program. Private insurance plans cover our services as we bill for medical office visits addressing a medical problem. We get reimbursed on a visit-by-visit basis. The number of covered visits is determined by how long patients’ BMI remain in the overweight or obese range.
Obesity is a multifaceted matter. One component is excess weight/fat, which is attended to with dietary changes. However, the dietary changes are not permanent. Upon reaching one’s weight goals, patients are allowed to resume eating their personally desired foods but are taught how to make daily adjustments to maintain their weight. Patients are guided to be in active control of their weight rather than passively hoping they do not regain weight. During both the weight loss and weight maintenance phases, there are dietary principles from which patients can modify to meet their preferences. During both phases, increasing vegetables/plant-based foods and decreasing processed foods are emphasized.
Psychological factors also affect our weight. A major evolution in our treatment approach has been our shift in emphasis from focusing on the mechanics of dieting to the mental and psychological changes necessary for sustained success. We try to keep the changes to be implemented small in order to minimize the stress and to reduce the amount of willpower (of which each of us have only a finite amount) needed. We try to make these adjustments become habits for our patients so they can be incorporated into our patients’ daily routines. We strive for mindset changes in our patients.
With the above principles of treatment, over 80% of our patients lose at least 10 % of their starting weight and 56% lose 15% of their starting weight. We have numerous patients who achieve weight loss beyond these figures, as many have lost over 75 lbs or over 33% of their starting weight. For obese patients, 5% weight loss is deemed sufficient to produce positive health benefits. For a new drug to be approved by the FDA as a weight loss drug, it must demonstrate 5% weight loss in their subjects. I feel our clinic is one of the most successful on Oahu in helping people lose the greatest amount of weight, but in a minimally stressful manner. We recognize how hard it is to change our relationship to eating/foods and try to make the process as easy and enjoyable as possible.