Clinical Programs - Weight Loss Programs: Obesity

Content provided by the Faculty of the Harvard Medical School

Clinical programs

These programs are run by health care professionals, either in private practice or at hospital-based centers. Many of these programs are staffed by multidisciplinary teams that may include doctors, dietitians, exercise therapists, and psychologists or social workers, who provide a wide range of services, such as nutrition education, medical care, behavioral therapy, and guidance on exercise.

The mainstay of clinical programs used to be a very low-calorie diet of 800 or fewer calories a day, which is at least 400 calories per day less than conventional diets. Very low-calorie diets feature commercially prepared liquid formulas, such as Optifast, that replace all of the food in a patient's diet and induce a rapid loss of about 20% of his or her initial weight over 12 to 16 weeks — as much as 5 pounds a week. This type of diet is considered appropriate only for patients with a BMI greater than 30 who need to lose weight quickly and for health reasons. Other clinical programs offered in the United States include Health Management Resources and Medifast/Take Shape for Life.

As part of the program, people on very low-calorie diets should have regular medical checkups to identify any adverse health effects. Patients should also have counseling to help them adjust to the diet, as well as guidance on how to reintroduce regular food once the diet is over. Many programs also offer support groups to help people maintain their weight loss by adhering to a low-calorie diet and getting regular physical exercise. Very low-calorie diet programs usually cost between $1,000 and $2,000 for three months.

Today, however, clinical programs are now inclined to recommend a more moderate low-calorie diet in conjunction with a program of exercise and behavior modification. For one thing, very low-calorie diets have been associated with complications in some people, including chemical abnormalities and irregular heartbeats. And in the long run, such diets are no more effective than conventional low-calorie diets in which people consume about 1,200 calories daily. For patients with obesity — and for those who are overweight but at high risk for obesity-related complications — clinical programs now often combine behavioral-based treatment with weight-loss medications or surgery.

Last updated:	June 20, 2007