You see the doctors on TV, on billboards everywhere, in
magazines. They're competing for patients not just with other
doctors, but with celebrities like Valerie Bertinelli and Sarah
Ferguson.
That's because these doctors are offering to help you lose
weight.
In the past, people struggling with weight went to self-help
programs or picked up a diet book. The biggest controversy was
about which bestseller to buy Atkins or South Beach, low-fat or
low-carb. Despite the obvious connection between weight and health,
few doctors dealt with obesity issues.
"Twenty years ago, if a patient wanted to lose weight, the
doctor would just say, 'Push away from the table,'?" said Dr.
William Dudney, a Tampa psychiatrist who has focused on weight loss
for more than 15 years, longer than most.
But as Americans have gotten heavier and some doctors' wallets
lighter, all that has changed. Now one local doctor advertises
himself as "your best medicine for weight loss." Another has
patients doing TV commercials about the pounds they've dropped.
"It's amazing, the number of clinics that have opened up,"
Dudney said.
The number of doctors signed up to take a national test in
September certifying them as weight loss experts has increased by
half over last year, says the American Board of Bariatric Medicine.
Medical weight loss clinics can be pricey they include an
upfront fee and ongoing charges sometimes reaching $250 a month.
But they are a hit with patients, and doctors say that generally,
they can, in fact, help many patients lose weight. Some doctors
argue they can do more for patients, helping them with underlying
medical problems or psychological issues that have pushed them to
overeat.
"For me, it's the discovery of knowing you have a support
system," said Tampa resident Laurie Johnson, who has lost more
than 50 pounds under a doctor's care.
Still, even some doctors say that some of the new clinics are
motivated more by money most weight loss programs aren't covered
by insurance, so patients pay cash than by concern about weight.
They worry about patients getting unnecessary medicine,
supplements or going on extreme diets. And, in the end, there's
always the question of how long the doctors' plans work.
"The problem here is that it's easy to set up a program to help
people lose weight," said Dr. James O. Hill, one of the nation's
best-known experts on weight control. "Physicians can put people
on a diet. They can help people lose weight."
So far, so good? Hill, a Colorado scientist and co-founder of
the National Weight Control Registry, says not so fast.
"The hard part is keeping it off," he said. "The question is,
are doctors' programs any better at that? The answer is, I'm
skeptical. Are these really programs that help, or are they taking
your money?"
To Lori McKelvy, it's an investment in her health.
"It's money well spent," said McKelvy, 41, of Dade City.
"When you're heavier, you're depressed. I wasn't feeling good. I
was having reflux, achy joints, knee pains that I have never had."
Once a bodybuilder who weighed 97 pounds, McKelvy, who's a
petite 5-1, gradually see-sawed up to 168.
Since going to see Dudney, McKelvy has lost 30 pounds over six
months. She has 15 pounds to go and is confident about making her
goal. She has overhauled her diet, stopped eating out and thrown
out the junk food. She's taking an appetite suppressant prescribed
by Dudney and meets with him once a month to talk about how things
are going.
"I had tried numerous times and would gain it right back,"
McKelvy said. "I'd lose 10 or 15 pounds and gain that back plus
five more."
She doesn't think she could have lost the weight without
Dudney's help. She hasn't felt any side effects from the drug and
said Dudney checked for potential health problems and other issues
that might have contributed to weight gain, before she began.
"He doesn't just prescribe stuff and say, 'See you later,'?"
McKelvy said. "There's a lot more to it than just giving us
medicine."
Despite the myriad theories on the best way to lose weight, many
Tampa Bay weight loss clinics bear certain similarities.
Doctors start with medicine: checking blood pressure, insulin,
thyroid, hormone imbalances. Patients with certain health problems
may get drugs or different diets. Many will get appetite
suppressants and vitamins, often with injections. They get an
eating plan and come in often, usually once a week.
Despite their popularity, there's no evidence that injections of
vitamins or the hormone hCG which women normally produce during
pregnancy work. And some doctors say that appetite suppressants
which include Adipex-P, Bontril, and Tenuate shouldn't be used
because they're stimulants that can raise blood pressure.
"There's no evidence that any of them work on any long-term
basis," said Dr. Sidney Wolfe, health research director at Public
Citizen. "As soon as you stop taking them, your weight goes back
up, unless you've done other things."
Other doctors say the drugs can be effective, but caution they
should be used carefully and strategically. They think some clinics
give too many pills.
When her patients want drugs, she starts them on the lowest
dose, said Dr. Lisa Saff Koche, Johnson's doctor.
"Patients are getting more and more educated," Koche said.
"They know that drive-by high-dose appetite suppressants and very
low-calorie diets are not sustainable for a way of living."
The medical workup is often most important to her patients, she
said. They also change how they think about food.
"A lot of times people need accountability," she said. "They
have questions and don't understand what to eat."
Dr. Cesar Lara, who has three Pinellas County weight loss
clinics, said about 75 percent of his patients take appetite
suppressants. Many also start on extremely low-calorie diets,
ranging from 500 to 1,400 calories a day. "It's not a diet to live
by," Lara cautioned. His program includes meetings about healthier
eating habits.
When Seminole resident DeDe Pollard decided to lose weight last
year, she did it without such drugs.
"Are you going to take an injection for the rest of your
life?" she said.
A doctor recommended a different option: Weight Watchers. Since
then, she has lost 100 pounds and plans on 100 more.
"They're teaching me," she said. "It's the quantity and the
choices I make."
Advocates for such programs say Pollard is proof that you don't
need a doctor to lose weight.
Even Dr. Howard Eisenson, director of the Duke University Diet
and Fitness Center, agreed. But he also said that doctors are
finally realizing that they can be a part of making sweeping
changes to patients' lifestyles.
"It's been a tough problem to get physicians energized about
treating obesity, because for a long time they felt it was
hopeless," he said. "The tide has definitely shifted. People are
starting to appreciate that lifestyle is at the core of a
successful effort."
Lisa Greene can be reached at greenesptimes.com or (813)
226-3322.
Weight loss plans
Medical weight loss
Drugs: Often include appetite suppressants, such as Tenuate or
Bontril; may also include drugs for diabetes, cholesterol or other
conditions.
Cost: Typically, an upfront fee of around $150 to $200, plus a
weekly fee around $55 to $65; supplements and vitamins can cost
extra.
What you get: Weekly meeting with doctor and/or other staffers,
such as a nutritionist, counselor or physical trainer.
Extras: Vitamins or hormone injections, although some question
their effectiveness and safety.
Weight Watchers
Drugs: None.
Cost: Programs average $10 to $12 a week; an initial fee of $20
to $30 is sometimes waived.
What you get: Weekly weigh-in and meeting with a group of fellow
dieters, led by a group leader who has successfully lost weight.
Extras: Web site with chat rooms, recipes, etc.
Jenny Craig
Drugs: None.
Cost: Biggest expense is the food, usually $12 to $18 per day;
plus a varying program fee; one program is $20 for 20 pounds.
What you get: Packaged food that gradually transitions to menus
and recipes you cook; weekly one-on-one meetings with an adviser to
discuss your diet and eating issues.
Extras: Meetings can be in person or by phone; Web site with
chat room, recipes, etc.
c.2008 St. Petersburg Times