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How do you help patients to keep the weight off once they’ve reached their goal?

Dr. Khani, it seems very easy to lose weight as such but have you experienced that patients regain back weight quickly? If so, how do you address that issue?

Once a patient has lost weight and can maintain the same methods and attitude, they can control their weight. It is true that it can be very difficult to maintain lost weight because between six months to a year, patients will experience changes to their body. Such changes include a return of ghrelin hormones which cause feelings of hunger and the decline of their metabolic rate due to lower calorie intake. Patients whom are unaware of these changes are likely to experience what is called a fat attack which causes weight gain.  We explain to our patients from day one that fat attacks will occur and plan accordingly to prepare for this with what we call a Fat Attack Action Plan.

A Fat Attack Action Plan serves as a contract, detailing how the patient will maintain and control their weight. The plan is broken into three zones; green, yellow, and red. Each zone corresponds with the weight of the patient and depending on the current zone their weight places them in, different actions are to be taken in correlation with their condition. The green zone can be considered the safe or controlled zone in which a patient’s goal is to continue without deviations from their current techniques and methods to maintain their weight unless changes occur. The yellow zone is the cautious zone, in which a patient’s goal is to revert back to the green zone due to an increase in weight. Methods to return to the green zone from the yellow zone may include an increase in physical activity, a change in diet, lower calorie intake, a detox program, meditation, use of a flex belt to strengthen core muscles, and increased attendance in the support groups. The red zone is the panic zone, patients who find themselves in the red zone are recommended to make an appointment for treatment and consultation.

Different institutions have different definitions of what is considered good weight management. The National Institute of Health (NIH) considers ten percent weight loss and maintenance for a year successful weight loss. Another institute, the National Weight Control Registry (NWCR), the largest prospectors study in the last ten years, considers thirty pound weight loss maintained for a year successful weight loss. Suppose we have a test patient we can observe named John whom currently weights two-hundred pounds and previously weighted two-hundred and fifty pounds at the start of his weight loss program. John has reached his weight goal but now he wants to maintain this weight so we prepare his Fat Attack Action Plan which is similar to the asthma action plan that asthma patients use so that they are prepared for any complications and in John’s case, he will know what to do if his weight goes up. Weight fluctuates on a daily basis and with this taken into consideration, John will be considered to have maintained his weight or be in the green zone if it does not rise above two-hundred and four pounds. If John’s weight were to be between two-hundred and five pounds to two-hundred and nine pounds, he would be considered to be in the yellow zone which would require John to be more alert, cautious, and increase his physical activity to revert to the green zone. Lack of awareness could cause John to also fall into the red zone, placed between two-hundred and ten pounds and above.