What we cover:
Long-term weight management
- What is medical weight management?
- How to tailor the weight loss conversation within the time constraints of a consultation
- The importance of follow-up appointments for medical weight management
- 3 steps for an effective follow-up appointment
- How long should obesity be treated for in clinical practice?
- Useful weight management resources
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.1
Despite multiple weight loss strategies available, around 80% of individuals with overweight do not succeed in maintaining long-term weight loss.2 Calorie-restricting diets are a popular method used for weight loss, yet weight loss maintenance is not typically achieved.3 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.3
Medical weight management aims to promote:
- Weight loss
- Weight maintenance
- Prevention of weight regain.1
A comprehensive approach should be taken which emphasises realistic weight loss to achieve a reduction in health risks.1
The typical clinical care pathway begins by determining the degree of overweight and obesity through height, weight, BMI and waist circumference measurements.1 Then an individualised, realistic and sustainable weight loss goal is set: 5-15% of body weight or 0.5/1.0 kg a week.1
How to tailor the weight loss conversation within the time constraints of a consultation
Watch this video with Associate Professor Gary Kilov for an overview of how to bring up the weight loss conversation within the time constraints of your consult.
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.4 In addition, a meta-analysis has shown that
frequently scheduled support meetings are an independent predictor of
greater weight loss.5 A study into patient preferences
demonstrated that 78% of patients felt regular reviews were a useful
component of weight loss management.6
Healthcare professionals are uniquely placed to discuss excess weight with their patients and can incorporate weight loss discussions into daily practice. The key to maintaining weight loss in the long-term is sustained behavioural change.4 Short-term interventions cannot yield continual positive outcomes without persistent support.4 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.4
Consider how patients' whānau and friends might be able to further support long-term weight management. Identify other relevant services that could also play a part, e.g. other healthcare professionals including Māori health providers, Whānau Ora, exercise groups, and other community-based organisations.7
Three 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, healthy eating, improved sleep or stress management ensures a de-stigmatising approach.8
As well as focusing on achievements other than weight loss, it is important to be mindful of the language used. Words such as “fat” have worse implications than "individuals with obesity" or defining the grade of obesity.8 It is also important not to ascribe blame to individuals and to remind them that obesity is a complex medical condition.
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.9
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.10
- 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.11
- 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 be considered as part of a comprehensive obesity management strategy.1 However, weight loss medications should be used as an adjunct to lifestyle changes.12 Bariatric surgery aids long-term weight loss, improves comorbidities and improves quality of life.1 It should be considered for adult patients with a BMI ≥40.0 kg/m2 or with a BMI 35.0–39.9 kg/m2 and co-morbidities, in whom surgically induced weight loss is expected to improve the disorder.1 This includes patients with type 2 diabetes and other metabolic disorders.1
- Re-evaluate weight-related complications: Once the weight loss has 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.10
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.5 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.13 Comprehensive lifestyle interventions which provided an average of 1 to 2 treatment sessions per month, typically produced mean weight losses greater than those produced by usual care.13 Indeed, high-intensity lifestyle interventions such as in-person meetings twice a month in the first 6 months (≥14 sessions in the 6 months) typically produced greater weight loss compared to less frequent follow-up.13 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 7–12.14 Other protocols have used a more intense follow up in the initial 6 months and then followed up at the 9th,12th and 18th month.15 If resources do not exist for this frequency of follow-up, then a telephone appointment may be used or an online program.16
How long should obesity be treated for in clinical practice?
In this short video, Associate Professor Gary Kilov discusses the necessity of long-term obesity management.
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
Resources Page.
References
- Yumuk V, et al. Obes Facts. 2015;8(6):402–424.
- Ohsiek S, Williams M. J Am Acad Nurse Pract. 2011;23(11):592–601.
- Mann T, et al. Am Psychol. 2007;62(3):220–233.
- Hall KD, Kahan S. Med Clin North Am. 2018;102(1):183–197.
- Lenoir L, et al. Obesity (Silver Spring). 2015;23(9):1771–1777.
- Tan D, et al. Med J Aust. 2006;185(2):73–75.
- New Zealand Ministry of Health. Clinical Guidelines for Weight Management in New Zealand Adults. 2017. Available at: https://www.health.govt.nz/system/files/documents/publications/clinical-guidelines-for-weight-management-in-new-zealand-adultsv2.pdf (Accessed August 2024).
- Fulton M, Dadana S, Srinivasan VN. Obesity, Stigma, and Discrimination. StatPearls. Treaure Island(FL): Jan 2024.
- Caterson ID, et al. Diabetes Obes Metab. 2019;21:1914–1924.
- Soleymani T, Daniel S, Garvey WT. Obes Rev. 2016;17(1):81–93.
- Weight Management: State of the Science and Opportunities for Military Programs. Washington (DC) 2004.
- Yanovski SZ, Yanovski JA. JAMA. 2014;311(1):74–86.
- Jensen MD, et al. Circulation. 2014;129(Suppl 2):S102–S138.
- Fitzpatrick SL, et al. Am J Med. 2016;129(1):115.e1–e7.
- Martin PD, et al. Obesity (Silver Spring). 2008;16(11):2462–2467.
- Turer CB. Am J Med Sci. 2015;350(6):485–497.
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