Frequently Asked Questions


What is a Bariatrician?

A bariatrician is a licensed physician (Doctor of Medicine (MD or Doctor of Osteopathy)) who, as a member of the American Society of Bariatric Physicians (ASBP), has received special training in bariatric medicine - the medical treatment of overweight and obesity and its associated conditions. Bariatricians address the obese patient with a comprehensive program of diet and nutrition, exercise, lifestyle changes and, when indicated, the prescription of appetite suppressants and other appropriate medications. (The word bariatric stems from the Greek word barros, which translates as heavy or large)

While any licensed physician can offer a medical weight loss program to patients, members of the ASBP 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 and modify the programs, if needed, as the treatment progresses. ASBP 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.



What Are Some Medical Weight Loss Tips?

According to the ASBP, a comprehensive medical weight loss program should include the following:
  1. An initial patient work-Up to include medical history, physical examination, appropriate laboratory studies and an electrocardiogram if there is past or present evidence of cardiac disease or if the patient has coronary risk factors
  2. Appropriate counseling on: Diet and nutrition, including reduced calorie diets and very low calories diets (VLCD) and dietary supplements when needed. * Exercise, tailored to the capabilities and limitations of the overweight patient to ensure safe and effective exercise. * Behavior modification (lifestyle changes), to include discussions of proper eating habits, dealing with stress-related eating, family meal planning changes, healthful snacking, etc.. Prescription appetite suppressants, if indicated, as an adjunct to a comprehensive medical weight loss program, and other madications.
  3. If the use of appetite suppressants or other medications is indicated, the patient should be informed about the potential risks of such medication and the physician and patient should weigh the risks of the medication against the benefits, i.e Do the small risks of the medications out-Weigh the health risk of the patient remaining obese. (The use of appetite suppressants is not indicated for patients with only a small amount of weight to lose.) Often, the loss of only 5 to 10 percent of a patient's initial weight can lead to significant improvements in health status.
  4. Adequate periodic follow-up and counseling, to include a program to help the patient maintain the weight loss that has been achieved.

What About Medications and Special Diets?

Bariatricians have a wide range of tools to offer their overweight patients, including special diet and nutrition products, individualized exercise programs, suggestions for lifestyle changes and prescription medications. if indicated.

Prescription anti-obesity medications can be a useful adjunct to a medical weight loss program, when used as part of a comprehensive program including diet and nutrition changes, exercise, and lifestyle modification. Medications alone will not lead to successful weight loss and maintenance. These medications are intended for patients who have a great deal of weight to lose, and not for someone who wants to lose 5 or 10 pounds or drop a dress size. Many of the appetite suppressants and other medications available today have a long history of safe and successful use. New medications are being researched and will be available after clinical testing and FDA approval.

Just as there are some risks and side effects with almost any medication, including aspirin, acetaminophen and birth control pills, so may there be side effects and risks with anti-obesity medications. For most people, the side effects are minimal and of short duration. Bariatricians are trained to know how to prescribe the drugs properly and monitor patients taking these medications. Obese patients, particularly those with comorbid conditions. such as diabetes and cardiovascular disease, may be at greater risk from remaining obese than the risk they might incur by taking the medications. The decision to prescribe anti-obesity medications must be made by the bariatric physician and the patient after carefully weighing the risks of the medications vs. the risks of remaining obese.

Bariatricians frequently prescribe low calorie diets or very low calorie diets (VLCD) along with vitamins and nutritional supplements, together with exercise and lifestyle changes to bring about a relatively rapid loss of weight. The VLCD, especially, should only be used under the careful supervision and monitoring of a physician and other health care personnel trained in its use.

What are the Different Categories of Diet Medications?

Just as there are side effects of any medications, such as aspirin and penicillin, so are there side effects of taking appetite suppressants. Some common side effects are dryness of the mouth, dizziness, abdominal pain, diarrhea or constipation, nausea, difficulty sleeping, nervousness, increased blood pressure and headache. Most of these drugs affect the body's nervous system. While they generally suppress appetite. some may also alter the way the body burns calories.

Among the best-known medications:
  • AMPHETAMINES (amphetamine, dextroamphetamine, methamphetamine) are strong stimulants that are no longer recommended by most authorities for weight control because they are highly addictive. Potential side effects include heart palpitations, elevation of blood pressure, gastrointestinal disturbances and insomnia. Amphetamines are prescribed for problems other than obesity such as attention deficit disorder and narcolepsy.
  • APPETITE SUPPRESSANTS Phentermine was first approved by the Food and Drug Administration in 1959 as a "short term (a few weeks) adjunct in a regimen of weight reduction based on caloric restriction." It is sold under the brand names lonamin, Adipex, Fastin, Sanobase, Obenix and Zantryl. Among other drugs of this type are phendimetrizine, mazindol, and the over-the-counter diet aid phenylpropanolamine (Accutrimt Dexatrim). Sibutramine, which is being marketed as Meridia, the newest prescription appetite suppressant, became available in February 1997.
  • ORLISTAT which is being marketed as Xenical, became available In the US in May 1999. Not an appetite suppressant. Ortistat is a lipase inhibitor or "fat blocker" drug. It prevents the absorption of about 30 percent of dietary fat by the digestive tract. It is meant to be used in conjunction with a reduced-calorie diet. Some side effects, which are generally mild and transient, may include oily spotting, flatulence with discharge, fecal urgency, oily evacuation and fecal incontinence. Maintaining a diet of no more than 30 percent of calories from fat may minimize these side effects. The medication also reduces the absorption of fat-soluble vitamins; patients are advised to take a daily supplement that contains vitamins A, D, E and K as well as beta-carotene. Also known as ALLI over the counter.
  • LEPTIN is a form of the human protein made in fat cells. It is currently in human clinical trials and may help reduce body weight and fat through curbs on metabolism and appetite. Always consult a licensed physician before taking any medication.


How Are Overweight and Obesity Defined?

The body mass index (BMI) is the most popular tool for defining what is healthy weight, overweight and obesity today. The BMI is calculated by multiplying weight in pounds by 703 and then dividing by the height in inches squared. This approximates BMI in kg/m2. The 1998 Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults, developed by the National Heart, Lung and Blood Institute, recommend the following classifications for BMI:
  • Underweight -BMI less than 18.5
  • Normal weight -BMI 18.5 to 24.9
  • Overweight -BMI 25 to 29.9
  • Obesity - BMI 30 to 34.9 (Class 1)
  • Obesity - BMI 35 to 39.9 (Class 2)
  • Extreme Obesity -BMI greater than 40 (Class 3)
BMI does not actually measure body fat, but generally correlates well with the degree of obesity. For example, a person who is 5 feet, 7 inches tall and weighs 150 pounds would have a BMI of 23, well out of the range of obesity. A person of the same height and weighing 200 pounds would have a BMI of 31 would be considered obese. BMI charts are widely available, often a 10 to 15% reduction in an obese person's body weight can bring about a significant reduction in the person's health risk from obesity. This "healthy" weight loss does not always equate with a person's "cosmetic" weight loss goals.



How is Obesity and Health Risk Measured?

Currently, several different measures are used to evaluate a patient's weight status and potential health risk. However, a complete evaluation includes assessments of a person's age, height and weight, fat composition and distribution, and the presence or absence of other health problems and risk factors.

Height-weight tables indicating "ideal" weight have been in use since 1959 but have their shortcomings. A newer measure of obesity that is gaining in popularity among researchers and clinicians is the body mass index (BMI). BMI is the body weight in kilograms divided by the square of the height in meters ([weight in kg] ÷ [height in meters]2).

BMI does not actually measure body fat, but generally correlates well with the degree of obesity. The categories of obesity developed by the World Health Organization are:
  • BMI 25 to 29.9 - Grade 1 obesity (moderate overweight)
  • BMI 30 to 39.9 - Grade 2 obesity (severe overweight)
  • BMI > 40 - Grade 3 obesity (massive/morbid obesity).
Using a BMI table, a person 5'6" tall weighing 140 pounds would have a 8MI of 23, well out of the range of risk. That same 5'6" person weighing 190 pounds would have a BMI of 31, in the range of Grade 2 obesity.

A BMI of 27 or higher is associated with increased morbidity and mortality; this is generally considered the point at which some form of treatment for obesity is required. A BMI between 25 and 27 is considered a warning sign and may warrant intervention, especially in the presence of additional risk factors.