13 - Medical Weight Loss: Secrets of Top Weight Management Teams

Hello, welcome to the "Scientific Weight Loss Course." I am Jessica.

Through the previous courses, I've already taught you all the eighteen

martial arts of scientific weight loss. But I estimate that many

students might still be curious: What's the difference between my

current self and professional weight loss institutions? How do

professional doctors help people lose weight?

In this lecture, I'll take you to see the weight loss training camp at

our National Cardiovascular Disease Center. Of course, Jessica

isn't taking you to watch the excitement, but to teach you a standard

process for making weight loss plans through how we help people lose

weight step by step.

Let me add that the pathway I'm describing below is not only from our

center, but also the obesity management guidelines formulated by the

WHO, the United States, Europe, and China's most authoritative medical

organizations based on tens of thousands of experiments by medical

experts. Although top weight loss centers have slightly different

facilities, we all follow the same process.

Determining Whether to Lose Weight or Not

When a person comes to our weight loss center, the first thing we do is

evaluate. Evaluate what? Evaluate whether to lose weight or not.

First see if weight loss is needed, then discuss how to lose weight -

this is a matter of principle.

The judgment method is similar to what we discussed earlier. As

mentioned before, the normal BMI for Asians should be between 18.5-24,

which is the most important indicator for judging whether a person

needs to lose weight. Specifically—

If this person's BMI is less than 18.5, we won't give them any chance

to lose weight - further weight loss would be playing with their life.

If this person's BMI is between 18.5-24, and their body fat percentage

and body shape also meet the standards mentioned in the first lecture,

then they don't need to lose weight either. Of course, if their body

shape doesn't qualify, such as having a too-thick waist or a small

belly, which is neither attractive nor healthy, then we would recommend

weight loss.

What if BMI is greater than 24? Logically, this would be overweight and

should require weight loss. However, when actually facing them, our

handling standards are slightly more lenient. If this person is still

quite healthy, with no "three highs," no risk of diabetes, and no

obesity-related diseases like sleep apnea syndrome or fatty liver, we

would recommend weight loss but wouldn't require it. If they don't want

to lose weight, as long as their weight doesn't increase further,

that's OK too. If this person is thinking about losing weight, that's

even better.

If this person has any of the diseases mentioned above, or although no

diseases have been detected, their BMI has already exceeded 30, then

regardless, we would strongly recommend they accept weight loss

treatment.

Assessing Individual Conditions and Setting Goals

If after evaluation we confirm the person needs to lose weight, what do

we do next?

The second thing we do is still evaluation - evaluating this person's

lifestyle. This step is very important, as it not only helps us find

the cause of their obesity but also identifies problems in their

current lifestyle. Only by clarifying these two issues can subsequent

treatment be more precise.

Let me give an example. My best friend Xiao Man, when she came to me

for weight loss, I first had her recall in detail her weight loss

journey and lifestyle.

In college, Xiao Man was also a campus beauty. At 1.73 meters tall, she

weighed only about 62kg. But seven years ago, Xiao Man unfortunately

suffered from depression. From then on, her weight skyrocketed,

gradually reaching 78kg. After that, she always had the idea of losing

weight and intermittently tried twice, even hiring a fitness trainer

once, but the effects weren't significant.

Xiao Man is a nurse who has to work night shifts three times a week.

Her dinner during night shifts is basically fast food, finished in the

car on the way to work. Also because of her busy work schedule, apart

from taking care of her child, she has almost no exercise.

While listening, I took notes, and by this point, I had drawn Xiao

Man's weight loss process into a chart. The horizontal axis of the

chart is time, and the vertical axis is her weight. Can you imagine a

winding weight curve in the chart? At every point where her weight

changed dramatically, I would mark the major events happening to her at

that time, her three-meal habits, exercise situation, emotions, sleep,

work pressure, medications taken, illnesses suffered, etc. - as

detailed as possible.

This is the lifestyle analysis that Xiao Man and I did together. It was

from this chart that Xiao Man first understood her weight history and

learned about each of her failures.

We quickly found a special event in the chart - depression. This was

the cause of Xiao Man's biggest weight change and the reason why all

her subsequent weight loss attempts were difficult to maintain. As for

her lifestyle problems like always eating fast food during night shifts

and lack of exercise, these were of course also issues we needed to

solve.

After clarifying this problem, I set a small goal with Xiao Man: within

6 months, lose 10% of her body weight, about 8kg. As long as this goal

is achieved within 6 months, it would be considered successful weight

loss.

Students, don't think this is too slow. This is a conclusion jointly

summarized by countless medical experts—

If BMI is less than or equal to 35, it's best to reduce 5%-10% of

current body weight within 6 months; if BMI exceeds 35, you can reduce

10%-15% of body weight in 6 months. After 6 months, set the next round

of plans.

Setting goals this way has three benefits: First, moderate difficulty

that can be achieved with effort; second, healthy - even if the

"three-body goals" haven't been reached after 6 months, the risk of

various diseases is greatly reduced; third, less likely to rebound.

Many of our excellent weight loss students have problems with setting

this short-term goal. "Haste makes waste" - often the weight loss

report card is still on the way when the weight rebounds.

You might think, if it rebounds, just lose weight again, what's the big

deal? But actually, the rebound cycle of weight is more harmful to the

body. It's better to stay fat than to lose weight and then gain it

back.

Determining Plans and Implementing Treatment

Xiao Man had never received standardized weight loss treatment before,

so the first thing I recommended to her was lifestyle treatment, which

is the lifestyle adjustment mentioned earlier.

Of course, at our weight loss center, it's much more professional than

doing it at home ourselves. There's a multidisciplinary team

specifically serving Xiao Man. This includes doctors, clinical

nutritionists, exercise physiologists, and psychological therapists.

Over 6 months, 36 face-to-face weight loss courses covering diet,

exercise, and psychology. You see, this directly corresponds to the

three parts of our lifestyle management. Specifically—

In terms of diet, through oxygen metabolism levels, we determined her

basal metabolic rate. Then, we tracked Xiao Man's typical life for

three consecutive days, recording in detail every bite of food she ate

and every exercise she did. Finally, combining Xiao Man's eating habits

and body fat goals, we designed a personalized weight loss meal plan

for her.

What if Xiao Man couldn't cook? We would directly provide her with

nutritional meals or help her choose meal replacements. The clinical

nutritionist would review with Xiao Man at least once a week to see her

dietary situation for that week. If needed, the meal plan would be

adjusted promptly.

In terms of exercise, we had Xiao Man undergo a cardiopulmonary

exercise test to find the exercise intensity at which she burns fat

most efficiently. Then, the exercise physiologist would accompany Xiao

Man for aerobic exercise at this intensity three to five times a week.

To achieve body shape goals, after aerobic training, there would be

several sets of core muscle strength training, focusing on her waist,

abdomen, hips, and thighs.

In terms of psychology, which was also Xiao Man's biggest problem,

after detailed psychological assessment, we prescribed antidepressant

medication for Xiao Man and had a psychological therapist regularly

conduct 12 sessions of psychological and mindfulness therapy with her.

After 6 months, Xiao Man steadily lost 8.5kg, achieving her goal.

But the weight loss treatment didn't end there. We still conduct

monthly phone interviews with Xiao Man to see how she's maintaining her

healthy lifestyle. Now, a year and a half later, this weight loss

achievement is still maintained.

You see, it's actually all what we discussed earlier, except we have a

dedicated team, more precise testing equipment, and personalized

one-on-one service. Normally, as long as you follow what we discussed

earlier, you'll likely succeed.

What to Do If Weight Won't Come Off and How to Maintain

What if the 6-month lifestyle intervention isn't successful?

At this point, we would consider more strict behavioral interventions,

such as combining meal replacements, closed training camps, special

medical dietary treatments, etc.

If this person's BMI is greater than 27 and they have some

obesity-related diseases, such as high blood pressure, high blood

lipids, cardiovascular and cerebrovascular diseases, we can consider

using weight loss drugs like orlistat; if they have diabetes, we would

consider metformin or liraglutide treatment. Similar to metformin,

liraglutide is also a drug that can treat diabetes and achieve weight

loss effects. If this person's BMI is greater than 30, even without any

diseases, we can also recommend they start drug treatment.

If BMI is greater than 35 and combined with severe diabetes, or

although there are no other diseases, BMI has already exceeded 40, we

would recommend they consider weight loss surgery.

Of course, if weight is lost, one must maintain the attitude of "the

revolution is not yet successful, comrades must continue to work hard"

and persist with the lifestyle habits of these 6 months. Many studies

show there's a simple maintenance method - weighing yourself at least

once a week is the best motivation for yourself.

What I especially recommend you pay attention to is that exercise

needs to be maintained at more than 200 minutes per week, not the 150

minutes we mentioned during weight loss - it needs to be stricter.

If conditions allow, you can join long-term weight loss programs of

more than a year, contacting professionals at least once a month.

All of these will greatly reduce the possibility of rebound.

Key Points

1. Before starting weight loss, you must do a comprehensive evaluation.

2. The small goal for weight loss: lose about 10% of your body weight

in 6 months.

3. Always start with lifestyle adjustments first, and only consider

other weight loss methods if unsuccessful.

4. For more precise personalized weight loss plans, consider going to

professional weight loss centers.