Weight Management - The SUSTAIN Clinic

Our mission is to provide a safe and supportive environment for you to talk
about weight. We focus on sustainable long term treatments to empower you to find
your “Best Weight”.

 

What is Obesity?

  • Obesity is a complex medical condition.
  • Obesity is a genetically conferred, neurological and hormonal disease that is
    heavily influenced by our environment.
  • Obesity is a disease that needs and deserves treatment.
  • Obesity Quickdraw Video here.

Obesity myths:

  • Obesity is not a lack of willpower or lifestyle issue.
  • Obesity is not your fault.
  • Obesity is not as simple as “eat less and move more”.
  • Diets are not a treatment for obesity.
  • Health is not just about weight, look past the scales to gain health.
  • Population based interventions focus on prevention and not treatment.
  • Body Mass Index (BMI) is a measure of size and not necessarily health.

What is Weight Bias?

  • Weight Bias: beliefs about a person’s values, skills, abilities, or personality based
    on their body weight and shape.
  • 88% of people living with obesity report having been stigmatized, criticized or
    abused as a direct result of their weight.
  • People living with obesity experience weight bias and discrimination from
    strangers, educators, employers, health professionals, media and even friends and
    family.
  • What are examples of weight bias in healthcare? Being denied medical treatment
    based on weight or all health problems blamed on weight
  • Bias can cause shame or blame, anxiety, depression, poor self-esteem and body
    dissatisfaction that can lead to unhealthy weight-control practices.
  • Weight Bias Video here.

What is “person first” language?

  • Putting a person before a diagnosis, it describes what a person "has" rather than
    asserting what a person “is."
    People are not defined by Obesity. We do not say someone “is cancer”, we say
    that they “have cancer”.
  • We should talk about a “person with obesity” and not an “obese person”.

What is “Best Weight”?

  • Best Weight: the weight you achieve while living the healthiest lifestyle you can
    truly enjoy and sustain.
  • We have less control over our weight than we think we have.
  • Factors we cannot change; genetics, ethnicity, sex, age, metabolism. We need to
    focus on things we can modify; food choices, portion size, sleep, exercise, screen
    time, stress, time management.

Why is it so hard to lose weight and keep it off?

  • Sometimes the “diets” we follow are neither enjoyable nor sustainable, once we
    break the “rule” it loses power over us psychologically.
  • As humans, our bodies were designed to resist weight loss and survive in times
    when food was scarce.
  • When we lose weight our biology and metabolism adapt to encourage weight
    regain.
  • The environment we live in is considered “Obesogenic” - it encourages cheap,
    convenient, tasty, calorie laden processed foods and a sedentary lifestyle.

Treatment Options (evidence based):

  • Lifestyle/behavioural:
  • Mindful eating, exercising and building powers of restraint and resilience.
  • Identifying triggers and high risk times for overeating.
  • Dietary modification, portion size and healthy eating.
  • Support & accountability.
  • Pharmacotherapy/Medication:
    - Liraglutide (Saxenda): once/day injectable medication
    - Naltrexone/Bupropione (Mysimba in EU, Contrave in US) - twice per day oral
    medication.
    - Orlistat (Xenical): three times per day oral medication.
  • Bariatric Surgery: Gastric Sleeze, Roux-en-Y Gastric Bypass, Duodenal Switch
    Procedure.

What is the Best Diet?

  • The “Best Diet” is one you enjoy and can sustain in the long term.
  • It should focus on healthy eating, balanced nutrition, portion sizes and real foods.
  • Studies have shown that, when it comes to weight, no one diet/pattern of eating is
    better than another. We must end the fad diet wars that may promote disordered
    eating and promote unsustainable eating.

What drives us to eat?

  • Body Hunger: feeling physically hungry - regulated by your gut, blood sugars and
    fatty tissue. Can be helped by eating regularly (appropriate amounts), balanced
    meals and limiting high sugar and high fat foods
  • Reward Hunger: This is controlled by the brain - emotional, stress-related and
    “mindless” or unconscious eating. This can cause us to eat even if we are not
    physically hungry and often foods that are pleasurable and calorie dense. This
    pattern of eating may have developed as a coping mechanism.

 

The Sustain Comprehensive Program Visit Outline - What we do for You


Session 1
-
Intro to program
- Weight/Medical/Social History
- Obesity as a chronic disease & Bias/Stigma
- Overview of treatment options: Lifestyle & Behavioural/Pharmacological/Surgical
- Handout: Obesity Facts & Expectations, Why are more people struggling with weight?
- Homework: Food tracker form


Session 2 Topics
-
Value Clarification
- Calorie & Activity Tracking
- Handout: Values and Reflection

Session 3 Topics
- Expectations and Best Weight
- Weight Set Point
- Wanting/Reward learning

Session 4 Topics
- High risk times and triggers
- Planning & Mindful Eating (portion sizes and decision making)

Session 5 Topics
- Calorie deficit
- Acceptance
- Handout: Working towards best Weight and Calorie Deficit

Session 6 Topics
- Permission Thoughts & Barriers
- Restraint/Resilience
- Handout: Permission thoughts

Session 7 Topics
- Restaurant eating/Weekends/Special Occasions
- Diffusion and Urger surfing

Session 8 Topics
- Pharmacotherapy & Bariatric Surgery

Session 9 Topics
- Maintaining losses and motivation long term
- Lapse versus Relapse and reversing small weight gain

Session 10 Topics
- Overeating and Emotional Eating
- Physical Activity
- Handout: Exercise and Weight
- Restaurant eating/Weekends/Special Occasions
- Diffusion and Urger surfing

 

Programme Options and Costs:

 

Assessment & Advice Consultation (All patients start with this)

Service:

- Initial consult with doctor for 45 minutes + paperwork = 1 hour of doctor time

- Suite of bloods based on doctor’s clinical judgement

Pricing:

- €200 assuming patient signs up to any Programme

- €225 if patient does not proceed with any Programme

 

Programme 1 – Assist

Clinical Service:

- Follow-up with the patient after minimum 12 weeks for 1 appointment (15 minute slot)

- Other follow ups as required

Pricing:

- €100 for 1st visit after 12 weeks

- €75 for 2nd visit if required

 

Programme 2 – Enhance

Clinical Service:

- Combined care to include a Dietician

- 3 consultations at Week 4 (Dietician, 30 minutes), Week 8 (Dietician, 30 minutes) & Week 12 (Doctor, 15 minutes)

Pricing:

- €300

 

Programme 3 – Thrive

Clinical Service:

- Combined care to include a Dietician

- 5 consultations over a 12 week period with Week 2 (Dietician, 30 minutes), Week 4 (Dietician, 30 minutes), Week 6 (Doctor, 15 minutes), Week 8 (Dietician, 30 minutes) & Week 12 (Doctor, 15 minutes)

Pricing:

- €550

 

Programme 4 – Resolve

Clinical Service:

- Intense combined care to including Doctor and Dietician

- 9 consultations over a 19 week period with Week 1 (Dietician, 30 minutes), Week 2 (Dietician, 30 minutes), Week 3 (Doctor, 15 minutes), Week 5 (Dietician, 30 minutes), Week 7 (Dietician, 30 minutes), Week 9 (Doctor, 15 minutes), Week 11 (Dietician, 30 minutes), Week 15 (Dietician, 30 minutes) & Week 19 (Doctor, 15 minutes)

Pricing:

- €950

 

Useful Books and Leaflets

  • Lets Talk about Weight
  • Gene Eating - Giles Yeo PhD (ISBN-13: 978-1643131276 , ISBN-10: 1643131273)
  • Why we eat (too much) - Dr Andrew Jenkinson (ISBN-10 : 024140052X, ISBN-13 : 978-0241400524)

Useful Links:

  • https://asoi.info/public/
  • https://eurobesity.org
  • https://obesitycanada.ca/public-resources/
  • Irish Coalition for People living with Obesity (ICPO)

Useful Videos

Links for Healthcare Professionals

  • https://www.worldobesity.org/training-and-events/training/scope/e-learning
  • https://obesitycanada.ca/resources/
  • https://obesitycanada.ca/guidelines/chapters/
  • http://www.mdbriefcase.net/phm/LandingPage.aspx?
    phm=OPTiMO&regionID=16&utm_campaign=445043_mdBriefCase%20volunteer
    %20programme&utm_medium=email&utm_source=Dotmailer&dm_t=0,0,0,0,0
  • https://obesitymedicine.org/category/podcasts/