Causes of Obesity and Weight Gain
We realize losing weight is challenging, but we’re with you every step of the way. Taking small steps over time leads to long-term success. Although “fad diets” may help people lose weight quickly, they inevitably gain the weight right back. At Froedtert & the Medical College, we’ll help you change underlying behaviors and lifestyle choices, so you can achieve a healthy weight and change your life in a positive way.
What Should You Expect?
When you arrive, you are greeted by one of our medical assistants, who will weigh you, take vital signs, blood pressure, and measure your waist. You are asked a number of screening questions, including questions that help us decide whether we should refer you to a sleep specialist to evaluate for sleep apnea – a common condition for people who are overweight or obese.
Next, you’ll meet with a nurse practitioner and endocrinologist who will further evaluate you. They’ll ask you what motivates you to lose weight and make sure you understand why achieving a healthy weight is important. They’ll also discuss your history of weight loss issues and efforts to overcome weight gain, ask you about your eating patterns and what you think might be a factor in overeating, such as stress.
The team reviews your individual medical history, including surgeries and medications you may be taking to uncover any connection between these factors and weight issues. They’ll also ask about your family to help determine whether there is a genetic propensity for weight gain.
The final step is a complete physical exam.
Next, we’ll talk with you about your goals, to make sure they’re realistic and the best choice for you long term. One person’s goal may be to achieve weight loss through bariatric surgery, while another person simply wishes to be able to breathe or move more easily. In other cases, a person may wish to lose 50 pounds, while their health dictates they may actually need to lose 100 pounds.
We’ll work closely with you to make sure you understand your treatment plan and the reasoning behind it, so that you are comfortable committing to it fully.
Role of Different Specialists
Patients see an endocrinologist for the initial evaluation and are then followed closely by our multidisciplinary team of specialists. An endocrinologist continues to monitor all aspects of treatment.
- Endocrinologist – Evaluates for endocrine issues (such as diabetes or thyroid disorders) which may impact weight
- Advanced practice nurse – Follows the patient to adjust treatment (in consultation with the endocrinologist) and help each patient stay on track
- Dietitian – Completes a nutrition evaluation; formulates a meal plan to facilitate weight loss
- Exercise physiologist – Develops an individualized exercise program for the patient
- Physical therapist – Helps patients who have physical limitations related to their weight (e.g., can’t walk on a treadmill; need to do sitting exercises or have other physical limitations) and forms an individualized exercise program
- Psychologist/behavorial therapist – Intervenes in cases where a patient has expressed psychological issues in dealing with weight or food
- Sleep specialist – Determines whether a patient has sleep apnea and provides treatment
Your Treatment Plan
Your weight loss plan will include a complete range of components, depending upon the results of your evaluation.
Nutritional Recommendations, Education and Eating Strategies
Like all of our staff, our registered dietitians are interested in you as a person and understand that people have diverse needs, wants and experiences. The focus goes beyond losing weight or lowering cholesterol. Together, we’ll look at eating patterns that make the most sense to change, and examine changes that will have the most impact. The dietitian may ask you to keep a food journal. Examining your current eating patterns will shape our nutritional recommendations. Following a nutritionally sound diet ensures you’ll receive all of the nutrients you will need to stay healthy while losing weight.
We also place a strong emphasis on education, to help you understand how many calories you should take in, how much fat is appropriate to include in your diet and how all of this impacts weight. The dietitian will help you understand how your eating habits affect your ability to make positive changes toward your goals.
To help you lose weight more efficiently, our exercise physiologists will guide you toward moving more and leaving a sedentary lifestyle behind. After an assessment of your exercise capabilities, we’ll create a daily 20 to 30 minute routine you can achieve with confidence. If you have physical limitations, a physical therapist will help you learn to work within those limitations. The ultimate goal is 45 to 60 minutes of daily exercise.
Sound like a lot? We’ll help you get there!
Patients seeing the weight loss team have access to the cardiac rehabilitation gym at North Hills Health Center in Menomonee Falls for a nominal fee. Members of the cardiopulmonary rehabilitation program are on hand there to answer questions, guide you and supervise your exercise.
In addition, we’ve partnered with the Wisconsin Athletic Club to provide one-month free memberships to help you achieve your fitness goals.
Psychological and behavioral therapy services are an integral part of the comprehensive approach within the Froedtert & the Medical College of Wisconsin Comprehensive Weight Loss Center. Therapy is important for long-term weight-loss, because it may help you cope with underlying thoughts, feelings, emotions, or behaviors that influence weight gain. Often, depression, anxiety or other mental health concerns co-exist with obesity, and it's important to address these concerns while you follow a weight loss plan.
There’s a difference between psychotherapy and behavioral therapy. Psychotherapy is a general term for individual counseling, where people can meet and talk with a trained professional one-on-one for a variety of concerns. In contrast, behavioral therapy is a specific form of therapy based on the idea that our behaviors are a product of learning and that maladaptive behaviors can be changed by learning new ones. Cognitive behavioral therapy is another form of therapy that examines how thoughts affect emotions and behaviors and the importance of changing those.
Emotional issues can have a powerful impact on eating patterns. For example, feelings such as anxiety, sadness, anger or frustration can lead you to eat more often or in higher amounts than they would normally. Eating to excess can provoke additional emotions such as sadness or guilt, and may make you feel worse. This can result in more excessive eating — resulting in weight gain and a variety of other health concerns. In turn, these concerns can influence more negative feelings. Using food to cope with emotions or stress creates a vicious cycle that can be difficult to overcome.
A trained professional will help you identify and change a variety of thought patterns and behaviors. Food journals are beneficial for gaining insight into the reasons you overeat, or why you might be tempted to overeat again. Changing thoughts about food can help change eating behaviors and unhealthy habits. Overall, therapy helps people make positive changes for life.
People who want to lose weight arrive with a variety of issues that have influenced their weight gain. Stress, anxiety, depression, low self-esteem, life changes, such as a job loss or divorce, illness, injuries, and past abuse or trauma are several examples of issues that may influence weight gain or emotional eating.
Psychotherapy and behavioral therapy can enhance self esteem and personal well-being. Many people notice an improvement in body image and relationships, and they may start to become more socially active and feel more self worth. The transformation can be very empowering, providing a sense of accomplishment and increased confidence as you move through your weight loss journey.
Conditions such as high blood pressure and diabetes go hand in hand with obesity in what is known as metabolic syndrome. If you or your doctor desires, your weight loss team will treat you for these contributing conditions as part of the weight management process. If your have diabetes or high blood pressure and it isn’t well-controlled, an adjustment in medication may be helpful. Your weight loss team will also monitor you for any medication side effects. In addition, as you lose weight, the need for hypertension drugs or insulin may decrease and dosage is modified accordingly. In other cases, a patient may be receiving treatment for an unrelated condition with medications that can cause weight gain. Every attempt is made to modify medications so that you can achieve weight loss successfully.
We’re happy to work in conjunction with your doctor on managing medications you may take for other conditions.
Medications for Obesity
For some people, combining weight loss medications with lifestyle and behavioral changes results in a weight loss of 10 percent to 12 percent. However, available weight loss medications are not for everyone, and whether or not to include medications in your treatment plan will be given careful consideration, depending on your individual health situation.
Drug therapy for obesity is still in its infancy. There are currently two Food and Drug Administration (FDA) approved medications for long term use in managing obesity: sibutramine (Meridia®) and orlistat (Xenical®). Orlistat is available by prescription or over the counter as Alli®. These medications are only recommended for people with a BMI (body mass index) higher than 30, or a BMI higher than 27 with other risk factors (e.g., diabetes, high cholesterol, controlled high blood pressure).
Many other medications are now being tested in clinical trials. Although none have yet matched the weight loss achieved with bariatric surgery, several have fulfilled effectiveness and safety criteria and are in the FDA approval process.
For some individuals, bariatric surgery is the only effective long term option for weight loss. The Bariatric Surgery Program at Froedtert & the Medical College of Wisconsin has helped hundreds of obese patients lose weight by offering the laparoscopic adjustable band and other bariatric procedures. Our holistic, multidisciplinary approach addresses all aspects of health — including psychological and medically related conditions — before, during and after surgery.