Medical Weight Loss and Bariatric Surgery Program Orientation

Take the Weight-Loss Quiz After the Video 

[Transcript]

Welcome to Froedtert & the Medical College of Wisconsin Medical Weight Loss and Bariatric Surgery Program Orientation. Congratulations. Your journey toward a healthier you starts today. 

Kate Glasenapp, a nurse practitioner and weight-management specialist, will briefly walk you through an outline of the orientation we have for you. We're going to start with the program basics, which is introducing you to the team. The next would be the plan, and then the expectations of both your providers, as well as the expectations that your providers have of you. We will look at treatment tools. This would be lifestyle strategies, including nutrition, exercise and stress management, medications, weight-loss surgery and then we'll wrap up. 

Our program is one of the very few programs in the state of Wisconsin where both medical and surgical weight-loss experts, as well as other specialists, provide a comprehensive approach to weight management. Together with you, we develop a personalized treatment plan for management or a roadmap for success. Excess weight is often accompanied by other health conditions, and our multidisciplinary team is uniquely qualified to take care of individual needs. 

Obesity matters because it contributes to a number of health conditions. And on the flip side, there are many health conditions that will contribute to obesity. Risks of fatty liver, heart disease, diabetes, many cancers, infertility, kidney disease, joint inflammation, knee, hip pain or osteoarthritis, poorer outcomes of mental health such as depression and anxiety, and certainly more all increase with obesity. 

Getting started, the first step is the completion of this orientation. Next, you may want to check with your insurance to see what services are covered - appointments, diagnostics, surgery, medications, etc. Then, you need to complete the precheck process. 

Here's your team: advanced practice providers, nurse practitioners and physician assistants. You may have a diabetes educator if you have prediabetes or diabetes, and a dietitian. We have pharmacists, physical therapists and your physician. And your first meeting will be with one of our endocrinologists. Psychologist, members of our surgical team — and this would be if you should decide to pursue a surgical path — and members of our administrative and clinical support staff. 

In terms of our commitment to you, we offer a comprehensive one-year program for weight loss followed by a maintenance program. In that first year, we recommend visits every one to three months with a member of the team. We'll develop a treatment plan specific to your individual needs, which will include diagnostics, lab work, medications and possibly referrals. 

For your first appointment, it's critical that you complete the precheck requirements. Completing this online form gives you time to consider your weight history, your challenges and what you're looking for in our weight management program. This information is then used by your provider at your first appointment and allows for a more comprehensive meeting. Three days prior to your appointment, the precheck will open. That's why it's especially important that you have your MyChart notifications on. Then you'll be alerted that you have this precheck available to complete. An online comprehensive weight history form is part of the precheck. No paperwork will be sent to you. Be sure to complete the entire precheck. If you arrive at the clinic for your first appointment and this is not done, you will have to complete it at the clinic prior to your appointment. If you don't have enough time to complete it in the clinic, which is often the case, then your first visit may be shortened, or you may be asked to reschedule your first visit. There will also be a precheck for any follow-up appointments. It's also critical that these prechecks be completed. 

We are weight-management specialists who practice according to guidelines — understanding that everyone has unique needs, experiences and expectations. We offer a comprehensive evaluation with one of our physicians or an advanced practice provider. We have referrals to specialists determined by your individual needs. Then, our medically supervised weight-loss follow-up appointments may be offered in terms of individual appointments and/or shared medical appointments. We provide safe and effective programming, and it's essential to expect that no matter what your circumstances in life, if you are invested in the program and lifestyle change, you may expect to lose a minimum of 5% of your weight in 6 months. We have a responsibility to help you achieve your goals, offering you the appropriate tools along the way, with the support of health care specialists. 

You are committing to a 12-month program. The plan is to offer you an appointment every one to three months with a member of the team or in a shared medical appointment. This is an important commitment, and therefore we're asking you to plan ahead, to take these appointments seriously, and to let us know at least 24 hours in advance if you are unable to keep your scheduled appointment. 

Shared medical appointments are a group medical appointment in a setting of a small group, anywhere from four to eight patients. They are 60 to 90 minutes in duration, and they're offered both in person and virtually. They are facilitated by one of our weight-management specialists, and they provide attention to your individual weight-loss issues. The focus is on ongoing education and support. And in this setting, you'll get the support not only of your weight-management specialist, but of people who are also experiencing some of the same challenges and successes that you are. It's important that you know that these medical appointments in the group setting are covered by insurance. We offer these because we know that more frequent appointments, at least monthly, are proven to be more successful for weight loss. So, many patients will supplement their individual appointments with the group appointments. 

Looking at your weight-loss progress, at three months, there should be clear evidence that you're investing in lifestyle changes, that you have pursued any referrals that you previously agreed upon, and that you are achieving an average weight loss of at least a half a pound per week. 

At six months, if you don't achieve that 5% weight-loss goal, then we'll take a moment and re-evaluate things. Perhaps we should consider shared medical appointments. Or you may want to consider weight-loss surgery at this time. Or one other thought is that this may not be the time for you to pursue weight loss, and you may want to consider taking a break from the program. 

At one year, we will plan for follow-up appointments at least every 3 months for continued weight-loss support or for weight-loss maintenance. 

One of the challenges we have is when patients fail to keep appointments. This takes valuable time away from other patients. If you don't show for your initial consultation or that first appointment, your program will then be put on hold, and you will not be able to reschedule starting the program before a six-month wait. 

For any follow-up appointments with any of our specialists, if you have more than two same-day cancellations or more than one no-show in 6 months, all future appointments will be canceled, and you'll be advised that your program is on hold. You will have the option to contact us after a six-month hold if you decide to resume the program. We will not contact you. You must know that if you are in a six-month holding period, no medication refills will be authorized. These guidelines are set in place primarily to give you every opportunity to take advantage of our program. If there are frequent cancellations and no-shows within that first six

 months to a year, it's been proven that you will struggle to achieve the goals that you are intending to achieve. It's important that at any point during your program, you let us know if this is not the best time for you to be pursuing weight loss. We do understand that life happens. There may be situations that have come up that have taken your attention, and therefore you cannot focus on this weight-loss venture like you had intended. It also may be our observation as a team that our program is not currently meeting your needs. We will discuss this with you. Together, then, we will develop a plan for you and suggest how to best recommit to the program going forward. 

When we look at treatment tools for weight loss, we start with the lifestyle strategies. 

• Nutrition
• Exercise
• Stress management 
• Other behavioral strategies

Medications may be part of this plan, and weight-loss surgery, also referred to as bariatric or metabolic surgery. We look at nutrition. It's important to understand that any change, any small change to a healthier diet or meal plan, is better than no change at all. We say this because oftentimes we get the question, "Which diet is the best diet for me?" There are options to look at total calories versus macronutrient composition. And what that means is looking at fat, looking at protein first, looking at the carbohydrate content of our meals, looking at balancing our portion sizes. 

Perhaps there's a trend toward clean eating, getting rid of some preservatives. Some people just focus on the elimination of things such as alcohol, sweetened beverages or concentrated sweets. Just starting with eliminating one factor that may be contributing to weight-loss challenges. 

Meal replacements or prepackaged meals are a strategy. 

Some people would like to investigate intermittent fasting, which may or may not be right for you. 

And there are certainly plenty of fad diets out there, and there will be many to come. 

The reality is that there is no one best diet. The nutrition plan that you follow will be developed with you and your dietitian. And the best diet that we can recommend is one that fits into your lifestyle and one that is sustainable. 

Exercise therapy is an essential ingredient in weight-loss efforts. We do know that the benefits of exercise extend well beyond weight loss. It can improve overall physical fitness as well as emotional health and well-being. Without exercise, you'll lose muscle along with fat. And if there's more than a 5% weight loss of muscle, that can mean a lower basal metabolic rate, which is the rate that your body will burn calories at rest or while you sleep. It may mean that future attempts to lose weight will be more challenging, and it can increase your risk of weight regain. When you lose this muscle, you will find that you need to keep eating less and less in order to keep losing weight. And at some point, this is just not realistic, nor is it healthy. 

We'll move into behavioral strategies, and there are many. We've listed some of them here for you. Self-monitoring or tracking your progress is critical to your success. There are many things to track and many ways to track. You may want to consider keeping a food diary or tracking your steps, and this can be done with an app, or it can be done with paper and pencil. 

You would perhaps want to consider weighing yourself at least once weekly. Daily weights can be problematic and also failing to weigh at all will not allow you to see what your progress is. 

Some people like to consider keeping a food and mood journal to simply understand the relationship you have with food. Controlling or changing eating triggers, goal setting, behavioral contracting and reinforcement, looking at your social support. Who is in your corner? Who's your cheerleader? Problem-solving skills, addressing disordered eating behaviors, things such as grazing behavior, snacking at night, binge eating and then the nutrition education, as well as meal planning and modification of physical activity. 

Pharmacologic therapy or anti-obesity medications or weight-loss drugs — it really doesn't matter what you call them. They are add-on tools. They are not a replacement for your lifestyle strategies. They are to be combined with the basics of your lifestyle strategies — stress management, healthy sleep, proper nutrition and routine exercise. Looking at some of the basics of our weight-loss medications, one question is how well they work, or the efficacy of these medications. That does depend on the person and on the medication. But on average, we may see a 1- to 2-pound weight loss per week. There are years of research, as well as real-world experience, when we address the safety of these medications. Your providers have had years of experience in prescribing these medications to patients. There are potential side effects, as there are with over-the-counter medications and supplements. Keep in mind that there may be reasons why a medication is not right for you. Perhaps it will interfere with one of the other medications you're on, or you may have an underlying health condition that, in prescribing one of these medications, we may put you at risk. Keeping in mind the cost of these medications, they can be expensive, and they may not be covered by your insurance. There also may be specific guidelines by your insurance company, and the medications are covered if you meet certain criteria, and the medications may be discontinued at any point for any reason. This is something to always keep in mind. 

In terms of durability, it's important to know that these medications do not cure obesity. Weight regain is a reality once the medication is stopped. But weight regain is a possibility no matter what strategy you use for weight loss. The important thing is to gain all of the healthy strategies for a healthy lifestyle. And then, without the medications, you have the greater potential to maintain your weight loss. 

A look at weight-loss surgery, and we do have two programs under one roof. Many of our experts work both in the medical and the surgical programs. Remember that bariatric surgery has its own orientation that covers information specific to the surgical program. The surgical program has guidelines and insurance mandates that need to be followed to get you safely and successfully to and through surgery, if that is the option you choose. A candidate for bariatric surgery would be somebody who is an adolescent or adult with an elevated BMI or body mass index. And that's a ratio of your height and your weight. If you aren't sure what your BMI is, that would be on your after-visit summary or in your record, and any of your providers can help you understand what your body mass index is. 

Persons who have severe medical problems due to obesity are candidates for surgery. And on average, people who are about 100 pounds overweight would be candidates for surgery. It's important to know that you do not need to have an excess of 100 pounds to qualify or to be a good candidate for bariatric surgery. It's time to consider surgery if you have failed multiple attempts at nonsurgical weight loss, and if you are committed to changing your habits lifelong for better health and well-being. 

Who may not be a candidate for surgery? Well, factors that suggest metabolic surgery may not be safe for an individual would be those persons with an unstable medical condition, the use of any tobacco product, and an inability or an unwillingness to quit, untreated or inadequately treated mental health issues, and/or addictions to alcohol or drugs and other issues considered by the team to put a person at risk for unsafe surgery or recovery. 

If you're undecided and you are uncertain whether you want the medical or the surgical weight-loss journey, you really don't need to decide that now. Get started on your journey. Keep asking questions and continue the conversation not only with your health care providers, but also with the people in your life who support you. We can certainly help. Many of us work in both the medical and the surgical programs. So, we can help answer your questions. 

The question now is, is our program right for you? 

• Are you ready and able to commit to the program? 
• Are you ready and able to invest in lifestyle change and tracking your progress? 
• Are you ready to follow up on the referrals to the weight-management specialists on our team? 
• Are you ready to do some goal setting, invest in your goals, and be ready to review them at each visit? 

And if the answers are yes, then you are in the right place and ready to start your journey. 

Just to wrap up, we like you to know that the Froedtert & the Medical College of Wisconsin Medical Weight Loss and Bariatric Surgery program offers the greatest opportunity to achieve success — whether you want to reach your goals through medically supervised weight loss alone or in combination with weight-loss surgery. Remember, you may need to check insurance coverage along the way, and it's important to let us know if your insurance coverage changes. Thank you for your interest in our program. We look forward to partnering with you on your weight-loss journey.