Obesity Medicine

Common Questions

What is an Obesity Medicine specialist?
Should I see an Obesity specialist for weight loss?
What is a realistic expectation of my weight loss results?
Why should I see a medical specialist for weight loss?
How does your program work?
What tests do you include in your initial examination?
Why should I choose your program over others?
How do you follow my progress?

What is an Obesity Medicine specialist?

An Obesity Medicine specialist is a licensed physician (Doctor of Medicine [MD] or Doctor of Osteopathy [DO]) who has received special training in obesity medicine (bariatrics)- the medical treatment of overweight and obesity and its associated conditions.  An Obesity Medicine specialist (or bariatrician) addresses the obese or overweight patient with a comprehensive program of diet and nutrition, exercise, lifestyle changes and, when indicated, the prescription of appetite suppressants and other appropriate medications.  While any licensed physician can offer a medical weight loss program, members of the Obesity Medicine Association (OMA) have been exposed, through an extensive continuing medical education program, to specialized knowledge, tools and techniques to enable them to design specialized medical weight loss programs tailored to the needs of individual patients. If needed, they can modify the programs as the treatment progresses. OMA members are uniquely equipped to treat overweight and obesity and associated conditions. A physician-supervised medical weight loss program may be the safest and wisest way to lose weight and maintain the loss. Overweight and obesity are frequently accompanied by other medical conditions such as type 2 diabetes, hypertension, vitamin deficiencies and others. A bariatric physician is trained to detect and treat these conditions, which might go undetected and untreated in a non-medical weight loss program.


Should I see an obesity specialist for weight loss?

The National Institute of Health (NIH) guidelines stated that a person should see a physician to lose weight if any of the following apply:

  1. You are trying to lose more than 15 – 20 pounds -and/or-
  2. You have any health conditions -and/or-
  3. You are taking any medications -and/or-
  4. You are planning to take medication to lose weight

 
The American Board of Obesity Medicine defines an obesity medicine physician as:
An obesity medicine physician is a physician with expertise in the sub-specialty of obesity medicine. This sub-specialty requires competency in and a thorough understanding of the treatment of obesity and the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity.

The obesity medicine physician employs therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy.

The obesity medicine physician utilizes a comprehensive approach, and may include additional resources such as nutritionists, exercise physiologists, mental health professionals and bariatric surgeons as indicated to achieve optimal results. Additionally, the obesity medicine physician maintains competency in providing pre- peri- and post-surgical care of bariatric surgery patients promotes the prevention of obesity, and advocates for those who suffer from obesity.
 
Because they are specialists, weight loss with an obesity medicine physician is a complete program focusing not only on weight loss but also on weight maintenance.  They are skilled in helping overweight patients deal with their personal highs and lows during a weight loss program.  They are also experienced in the roadblocks of becoming successful in controlling the disease called overweight and obesity.

What is a realistic expectation of my weight loss results?

Dr. Joudeh has trained with Drs. Scott Rigden and Allen Rader, and he has modified his program based on decades of their research and experience.  Dr. Rader has tracked the average weight loss over ten years of over 15,000 patients making at least three visits to the clinic.

97% of patients lost weight by their first follow-up visit.  The average weight loss of the first month is:

Beginning Weight (lbs) Number of Patients # lost wt first month # that did not lose wt first month # losing weight
>400 91 79 1 99%
375 - 399 84 71 1 99%
350 - 374 131 115 3 97%
325 - 349 266 226 8 97%
300 - 324 500 420 11 97%
275 – 299 959 810 28 97%
250 – 274 959 810 28 97%
225 – 249 2265 1957  58 97%
200 – 224 3130 2675 72 97%
175 – 199 4855 4193 117 97%
150 – 174 2655 2210 105 95%
< 150 606 474 30 94%
15776 13345 451 2.5%  

However, long term loss and maintenance is actually more important than first month loss.  Over 80% of patients that make at least three visits lose enough weight (5%) to reduce their risk of diabetes by 50%.   Most patients will eventually transition to the Maintenance Plan after they lose more than 10% of their body weight.   Remember, another person’s results will not predict your outcome, but the numbers are presented to give you an idea about the success stories our program is creating.

Overweight and obesity is a very complex medical disease.  Very often, unrecognized or undiagnosed medical conditions are associated with weight gain.  These conditions may prevent weight loss or worse, be harmful to you if not recognized and treated.  A medical weight loss specialist can test for these metabolic conditions, and subsequently treat them.


How does your program work?

History and physical exam is done by Dr. Joudeh.

Weight, measurements, and vital signs are obtained.

Medication history is reviewed to determine if anything is affecting one’s metabolism and stifling ability to lose weight.
Laboratory evaluation is done to assess metabolism, vitamin/mineral deficiencies, and weight comorbidities. Discussion occurs regarding the 4 elements of weight control: NUTRITION, METABOLISM, BEHAVIOR & PSYCHOLOGY. Medications and nutritional instructions are included. 

Contact the clinic with specific questions about the first visit procedures.  At the first visit, the physician may order certain blood tests.  These tests include blood chemistries, liver functions, kidney functions, serum triglycerides, total cholesterol, good cholesterol, bad cholesterol, CBC (white and red blood cell counts) and thyroid blood tests. EKGs are often obtained, depending on your medical history, physical and other factors. These tests are not done unless necessary. Typically, follow-up visits are monthly. In both research studies and Dr. Joudeh’s clinical experience, patients who are supervised monthly achieve the best results.   Monthly visits allows us to motivate patients, monitor drug response and any potential side effects, and foster patient accountability to avoid weight loss pitfalls or lapses into prior dietary habits.

After completion of the active weight loss phase, patients are encouraged to enter our maintenance program.  This is when weight loss has stopped or weight goal has been achieved, and the focus is on maintaining the weight off.  This phase is as important as the weight loss phase, but is less frequent. Some see us on a quarterly basis and others just communicate their weight by phone or email.  These patients understand that this is a lifelong disease and have been instructed at what specific weight they may need to return to the clinic.  Our ultimate goal is to help a person achieve the best weight that can be attained comfortably and maintained comfortably.

What tests do you include in your initial examination?

Dr. Joudeh does only the blood test and EKGs that he assesses to be necessary.  There are multiple causes of overweight and obesity that may be identified in some screening labs.  Also, many consequences of overweight and obesity may cause abnormalities in blood testing. These must be identified in the beginning in order to have a successful and healthy weight loss program.

Why should I choose your program over others?

  • Successful results
  • Experience
  • Professionalism
  • Scientific Knowledge
  • Compassion & Understanding

 
Successful Results and Experience

Dr. Joudeh’s mentor, Dr. Rader, has tracked over 15,000 patients treated based on our clinic protocol. Four out of five patients that enter our weight loss programs for just three visits lose enough weight to reduce their long-term risk of diabetes by at least 50%. Patients that lose weight in the program have improved their lipid profile (cholesterol and triglycerides) equal to or better than commonly used cholesterol medicines. Many patients are able to come off blood pressure medicines, lipid medicines and antidepressant medicines, or even reduce their need for arthritis treatment.

Dr. Rader’s Weight Loss Results vs. Diet Studies

The A to Z weight loss study
from Journal American Medical Association and IWL computer records

  Atkins Zone LEARN Ornish IWLRader
# Patients 77 79 73 76 8951
Avg wt begin 189 184 187 189 216
Avg wt loss 10.3 3.5 5.7 4.8 30.0
% wt loss 1 year 5.4% 1.9% 3.0% 2.5% 13.9%

 

We have professionals, nonprofessionals, MD’s as well as nurses who are patients in the program.

Professionalism
The Obesity Medicine Association has set criteria that all bariatricians are encouraged to follow. These “principles of excellence” include: always putting the patients’ welfare above all, avoiding value judgments concerning a patient’s behavior, complying with all state and federal laws, providing adequate and truthful information to the patient about their disease, and cooperating fully with other physicians in providing medical care to every patient.

Scientific Knowledge
As a specialist in weight loss medicine, Dr. Joudeh has passed a rigorous written examination on the field of obesity.  Dr. Joudeh attends national conferences on obesity and nutrition to maintain current knowledge on the advances in the treatment of obesity.  He constantly researches the latest information on weight loss, metabolism, and diabetes so that he can offer his patients a treatment plan based on sound scientific evidence. 

Compassion and Understanding
We provide an atmosphere of care and understanding. There is a great deal of weight bias at home, in the community, and in the workplace.  In our clinic, we foster respect and we work together on the weight loss journey.  There will be ups and downs.  Do not miss your appointment because you may have ‘slipped up’ and are worried about the doctor being disappointed.  On the contrary, we are here to help, especially when things might not be working out as planned.  Together, we can achieve a healthier lifestyle and more optimal health.

How do you follow my progress?

The monitoring of a patient involved in a weight loss program is essential. The rate of weight loss, the amount of weight loss, vital signs, percent body fat and percent lean tissue, emotional stability, and biochemical health must all be considered while a patient is losing weight.

Dr. Joudeh is an obesity medicine specialist specifically trained to know how and when to follow-up with patients.  Most patients are monitored by monthly visits to the office.  Sometimes a patient needs more frequent visits for closer observation, training, and motivation. Several programs are available to treat all aspects of a patient’s specific needs.

Based on information from the patient history, previous patient results, a physical exam, blood tests, and the first month results, Dr. Joudeh is able to predict what weight loss should be expected after that first follow-up visit.  If expected weight loss is not obtained, Dr. Joudeh knows the questions to ask, necessary tests, and medication changes that might help the patient achieve those expected results.

Training patients for weight loss maintenance begins on the very first visit. Information from national weight loss conferences, previous patients, his personal weight loss maintenance, and information from the national health-care weight loss registry is used to help determine an appropriate maintenance plan for every patient.

With each patient, he establishes weight guidelines to help everyone be prepared for struggles with his or her weight loss.  All patients have a safety plan and know when to return to the office.

Other Frequently Asked Questions

Q: Do I need an appointment?

In order to be on the FDA-approved appetite suppressants, it is a requirement to meet with Dr. Joudeh on a regular (usually monthly) basis.  Because of the amount of time involved addressing metabolic and weight issues, this usually needs to be a separate visit from routine checkups and acute sick visits.

 Q: Are there any side effects?

While there may be transient (temporary) mild side effects, there are generally no major side effects from any of the medications and there has not been any negative long-term side effects associated with the prescription appetite suppressants we use.  If a particular medication does not work for you we simply stop it and discuss other medication or treatment options.

Q: Do you accept insurance?

Yes, we work with your insurance for billing purposes.  However, if you do not have insurance coverage for weight management/obesity counseling, we offer a fee for service.

Q: Do you have a guarantee?

No. We do not promote a quick fix weight loss and we do not agree to false advertising with promotions such as ‘lose 20 pounds a week,’ etc. No matter what program we put you on, we are not able to monitor all of your food intake. If you continue to consume liquid calories (like soda and juice) daily, you may not lose weight. If you follow our program as directed, you will not only lose weight but you will become healthier and decrease your risk of cardiac and metabolic disease.

Q: Do you offer HCG?

NO. It is the position of the Obesity Medicine Association that the use of HCG for weight loss is not recommended. In addition, the FDA and FTC recently deemed the use of HCG for weight loss to be fraudulent and illegal.

Q: Is your program safe?

Yes, our program is safe and effective.

Q: Do I have to eat/purchase special foods?

No. You do not have to purchase our protein shakes, bars, etc. Our program promotes healthy eating with a lifestyle change. You can continue to eat meals with your family and go out to restaurants with a better understanding of how and what to eat.  However, for those interested in our protein-sparing modified fast program, we do have a meal replacement program available.

 Q: How much weight will I lose?

Everyone is different on how much weight they will lose in a given time. Our first month average is between 5 and 15 pounds, followed by 1-2 pounds/week for normal healthy weight loss.

 
Q: What kinds of medications do you offer?

Dr. Joudeh has trained on all the FDA approved prescription appetite suppressants including Phentermine (Adipex), Phendimetrazine (Bontril), Diethylpropion (Tenuate), Lorcaserin (Belviq), Buproprion/Naltrexone (Contrave), Phentermine/Topiramate (Qsymia),  & Liraglutide (Saxenda).  The first 3 medications are the ‘older generation’ and the most commonly used due to their efficacy, cost-effectiveness, and long history of success.  However, depending on a patient’s individual profile, Dr. Joudeh can prescribe any of these, or even a combination if appropriate.  He also sometimes uses other medications on an ‘off-label’ basis.
 
Q: Will I be hungry on this program?

No! We have multiple options for controlling hunger.

Q: Will I gain my weight back after finishing the program?

The goal of our program is not only short-term weight loss but also long-term weight maintenance. We teach you how to modify your lifestyle so that when you lose the weight, you will be able to maintain it. We also determine an action plan for when to return to our clinic if you have a flare of weight gain.
 
Q: How long do I have to be on the program?

The length of time people participate on our program varies widely. You may only need a few months, or you may need a year or two depending on your individual situation.  The National Weight Control Registry suggests that once a person has achieved a weight loss maintenance for at least 2 years, there is a much higher likelihood at maintaining that weight off in the long term.  The most important thing is that when you choose to leave our program, to at least have an understanding of when it may be time to return to clinic for reevaluation.
 
Q: Is the program safe for children?

The appetite suppressants are FDA approved for ages 16 and above.  However, we still offer lifestyle and family counseling for children of all ages, and after discussion for individual patients, Dr. Joudeh may use certain medications on an ‘off-label’ basis for certain individuals younger than 16.
 
Q: I have high blood pressure and diabetes, will I be able to be on your program?

Of course! Our goal is to get you to lose weight so that you no longer need to be on multiple medications.  Many of our patients entering our program are on several medications for diabetes, hypertension, hyperlipidemia and arthritis, and when they lose weight, they feel better and are able to reduce their medication burden.