What to expect:
Medical weight management for long-term treatment success
As the impending global obesity pandemic grows, the prevalence of over 200 possible complications of obesity is set to rise.1, 2 Medical weight management has the potential to prevent these obesity-related complications but maintaining weight loss is typically challenging.3 However, there are evidence-based approaches which increase the likelihood of long-term sustained weight loss.
What is medical weight management?
Medical weight management is medically supervised weight loss support from a healthcare professional. It encompasses lifestyle change, medical and surgical treatment approaches. It may include nutrition advice, physical activity advice, cognitive behaviour therapy, prescription weight loss medication or referral for bariatric surgery.4
Despite multiple weight loss strategies available, around 80% of
individuals with overweight do not succeed in maintaining long-term
weight loss.5 Calorie-restricting diets are a popular
method used for weight loss, yet weight loss maintenance is not
typically achieved.6 Trials have shown that, in the long
term, between one to two-thirds of those on such a diet regained more
weight than they originally lost.6
Maintaining weight loss is difficult due to a range of biological
mechanisms, including genetic factors, hormonal changes, adaptive
thermogenesis (decreased resting metabolic rate), and neural
factors.7 These multiple factors undermine weight loss and
promote weight regain in individuals attempting even modest weight
loss.7 In addition, factors like social support and
psychological factors can both influence weight loss
Medical weight management aims to promote:
- weight loss
- weight maintenance
- prevention of weight regain.4
A comprehensive approach should be taken which emphasises realistic weight loss to achieve a reduction in health risks.4
The typical clinical care pathway begins by determining the degree of overweight and obesity through height, weight, BMI and waist circumference measurements.4 Then an individualised, realistic and sustainable weight loss goal is set: 5-15% of body weight or 0.5/1.0kg a week.4
The importance of follow-up appointments for medical weight management
Evidence indicates that frequent follow-up visits to discuss weight maintenance can have a significant positive effect on weight management.9 This applies to both adults and children. In addition, a meta-analysis has shown that frequently scheduled support meetings are an independent predictor of greater weight loss.10 A study into patient preferences demonstrated that 78% of patients felt regular reviews were a useful component of weight loss management.11 Given that obesity is a chronic disease, long-term support from healthcare professionals is recommended in managing this problem.11
Healthcare professionals are uniquely placed to discuss excess weight with their patients and can incorporate weight loss discussions into daily practice. In fact, an analysis of more than 5000 patients with overweight and obesity showed that if their doctor had a direct discussion telling them they were overweight, they were significantly more likely to report a 5% weight loss.12
The key to maintaining weight loss in the long-term is sustained behavioural change.9 Short-term interventions cannot yield continual positive outcomes without persistent support.9 Ongoing interaction with healthcare providers has been shown to improve long-term outcomes indicating that follow-up appointments provide essential support in achieving long-term behavioural change.9
Specifically, follow-up appointments provide essential
- Accountability: As patients prepare for the social interaction between them and their healthcare provider during a follow-up visit, there is inherent accountability.13 This perception of accountability increases patients’ motivation to adhere to treatment and to clinical protocols.
- Goal achievement: Primary care physicians who have successfully supported patients with behaviour change typically used frequent follow-up to celebrate goal achievement together.14 Follow-up appointments also allow the patient to work towards small, feasible steps towards healthier behaviours which is another key tool utilised by physicians who succeeded in supporting patients to change their behaviour.14 Each follow-up can target a different step towards the overall goal.
- Modification of treatment: Self-monitoring is a weight-loss behaviour linked to weight loss success.9 Follow-up appointments allow physicians to encourage self-monitoring and allow tracking of a patient’s progress by using self-monitored data. Lack of adherence can be anticipated, and countermeasures taken to modify the treatment plan.9 Similarly, if patients are responding well, the treatment plan can be adapted accordingly to focus on maintaining weight.
- Opportunity to ask questions: Obesity and overweight are highly stigmatised and patients can fear shame and self-blame.15 However, this stigma can be countered with education tailored to the patient’s knowledge base and follow-up appointments foster a space where there is continued dialogue and patients become receptive to support from healthcare professionals.15
3 Steps for an effective follow-up appointment
1. Assess progress for weight maintenance
At the follow-up appointment, talk to your patient about what has been working well and what challenges they have faced.
- Retake measurements: Calculate your patient’s BMI and waist circumference.
- Assess weight loss progress: Acknowledge achievements and adjust goals where necessary.
- Acknowledge lifestyle achievements: Make it clear to your patients that measuring weight is not the only reason for the visit: recognise achievements other than weight loss. Focusing on other health-related achievements such as increased exercise, eating healthily, improved sleep or stress management ensures a de-stigmatising approach.16
As well as focusing on achievements other than weight loss, it is important to be mindful of the language used when consulting. Words such as “fat” have worse implications than “unhealthy weight” or “body mass index”.16 It is also important not to ascribe blame to individuals and to remind them that obesity and overweight are multifactorial diseases with a complex aetiology.
2. Modify treatment approach
It is important to modify or intensify treatment, where necessary, to overcome weight regain. Consider each patient's weight history and current situation to determine a follow-up plan for treatment.15
Explain to your patients that preventing weight regain is the cornerstone of lifelong weight management, for any weight loss techniques which they may be using.17
Evaluate lifestyle measures: Follow-up appointments should
include an evaluation of the patient’s current meal plan, eating
habits and physical activity. Measurements taken can be used as part
of this evaluation process. If the activity plan is monitored and
modified accordingly, this is associated with improved outcomes.18
If metabolic testing is available, then this can be used to reliably estimate a patient’s metabolic rate. However, this can be very time-consuming and requires a rigorous protocol.19 Focusing on lifestyle measures and monitoring BMI and other measurements is the most common approach.
- Assess needs for pharmacotherapy and other interventions: If appropriate for your patient, discuss treatments beyond lifestyle, such as continued pharmacotherapy or other interventions. Pharmacotherapy has been proven to be efficacious in weight loss and should form part of a comprehensive obesity management strategy.4 However, weight loss medications should be used as an adjunct to lifestyle changes.20 Bariatric surgery aids long-term weight loss, improves comorbidities and improves quality of life.4 It should be considered for adult patients with a BMI ≥40.0 kg/m2 or with BMI between 35.0 and 39.9 kg/m2 and co-morbidities, in whom surgically induced weight loss is expected to improve the disorder.4 This includes patients with type 2 diabetes and other metabolic disorders.4
- Re-evaluate weight-related complications: Once the weight loss has been stabilised, re-evaluate the weight-related complications. If the complications have not improved, the level of approach should be considered, or complication-specific interventions should be employed.17
3. Make a new appointment
Ensure to have frequent follow-up visits with your patients to support them on their weight loss journey. This continued support helps patients in maintaining a healthy weight.
A greater consultation frequency is a determinant of successful weight loss maintenance.10 There is variation in the recommended frequency of follow-up appointments. The Obesity Society Guideline for the Management of Overweight and Obesity in Adults (2013) found evidence for a range of follow-up frequencies.21 Comprehensive lifestyle interventions which provided an average of 1 to 2 treatment sessions per month, typically produced mean weight losses of greater than those produced by usual care.21 Indeed, high-intensity lifestyle interventions i.e. recommend in-person meetings twice a month in the first six months i.e., ≥14 sessions in the six months typically produced greater weight loss compared to less frequent follow-up.21 However other frequency schedules have also been proven to be effective including weekly visits in the first month, twice a month visits in months 2-6 and monthly meetings in months 7-12.22 Other protocols have a used a more intense follow up in the initial 6 months and then followed up at the 9th,12th and 18th.23
If resources do not exist for this frequency of follow-up, then a telephone appointment may be used or an online programme.24 You can also refer your patients to Truth About Weight™ for more information. Truth About Weight™ is an online educational resource where your patients can find information about the science of obesity, its causes and treatment options.
Useful weight management resources
Click on the resources below to download support materials to aid you in delivering high-quality consultations for your patients with obesity.
If you found these resources valuable, click on the envelope icon above to share them with your colleagues, and support other medical professionals in their daily practice.
For further support materials and resources on how to manage your
patients’ weight effectively, visit the Rethink Obesity
- Bhat SP, Sharma A. Current Drug Targets in Obesity Pharmacotherapy - A Review. Curr Drug Targets. 2017;18(8):983-93.
- Yuen M. ER, Kadambi N. A systematic review and evaluation of current evidence reveals 236 obesity-associated disorders. The obesity society 2016.
- Paixao C, Dias CM, Jorge R, Carraca EV, Yannakoulia M, de Zwaan M, et al. Successful weight loss maintenance: A systematic review of weight control registries. Obes Rev. 2020;21(5):e13003.
- Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. European Guidelines for Obesity Management in Adults. Obes Facts. 2015;8(6):402-24.
- Ohsiek S, Williams M. Psychological factors influencing weight loss maintenance: an integrative literature review. J Am Acad Nurse Pract. 2011;23(11):592-601.
- Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. Medicare's search for effective obesity treatments: diets are not the answer. Am Psychol. 2007;62(3):220-33.
- Evert AB, Franz MJ. Why Weight Loss Maintenance Is Difficult. Diabetes Spectr. 2017;30(3):153-6.
- Karfopoulou E, Anastasiou CA, Avgeraki E, Kosmidis MH, Yannakoulia M. The role of social support in weight loss maintenance: results from the MedWeight study. J Behav Med. 2016;39(3):511-8.
- Hall KD, Kahan S. Maintenance of Lost Weight and Long-Term Management of Obesity. Med Clin North Am. 2018;102(1):183-97.
- Lenoir L, Maillot M, Guilbot A, Ritz P. Primary care weight loss maintenance with behavioral nutrition: An observational study. Obesity (Silver Spring). 2015;23(9):1771-7.
- Tan D, Zwar NA, Dennis SM, Vagholkar S. Weight management in general practice: what do patients want? Med J Aust. 2006;185(2):73-5.
- Pool AC, Kraschnewski JL, Cover LA, Lehman EB, Stuckey HL, Hwang KO, et al. The impact of physician weight discussion on weight loss in US adults. Obes Res Clin Pract. 2014;8(2):e131-9.
- Oussedik E, Cline A, Su JJ, Masicampo EJ, Kammrath LK, Ip E, et al. Accountability in patient adherence. Patient Prefer Adherence. 2019;13:1511-7.
- Greene J, Hibbard JH, Alvarez C, Overton V. Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels. Ann Fam Med. 2016;14(2):148-54.
- Caterson ID, Alfadda AA, Auerbach P, Coutinho W, Cuevas A, Dicker D, et al. Gaps to bridge: Misalignment between perception, reality and actions in obesity. Diabetes Obes Metab. 2019;21(8):1914-24.
- Fulton M, Srinivasan VN. Obesity, Stigma And Discrimination. StatPearls. Treasure Island (FL)2021.
- Soleymani T, Daniel S, Garvey WT. Weight maintenance: challenges, tools and strategies for primary care physicians. Obes Rev. 2016;17(1):81-93.
- Weight Management: State of the Science and Opportunities for Military Programs. Washington (DC)2004.
- Compher C, Frankenfield D, Keim N, Roth-Yousey L, Evidence Analysis Working G. Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. J Am Diet Assoc. 2006;106(6):881-903.
- Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74-86.
- Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 Pt B):2985-3023.
- Fitzpatrick SL, Wischenka D, Appelhans BM, Pbert L, Wang M, Wilson DK, et al. An Evidence-based Guide for Obesity Treatment in Primary Care. Am J Med. 2016;129(1):115 e1-7.
- Martin PD, Dutton GR, Rhode PC, Horswell RL, Ryan DH, Brantley PJ. Weight loss maintenance following a primary care intervention for low-income minority women. Obesity (Silver Spring). 2008;16(11):2462-7.
- Turer CB. Tools for Successful Weight Management in Primary Care. Am J Med Sci. 2015;350(6):485-97.
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