An introduction to the intensive weight management programme

This programme is aimed at people who are overweight or obese and this is affecting their health, or likely to affect their health in the future. It aims to maximise the amount of weight loss that can be achieved using diet, exercise and lifestyle changes, as well as drugs that have been licensed for treating the overweight and obesity. The programme is based upon much research over the past 20 years and it has been extensively evaluated for safety as well as effectiveness.

Low and very low calorie diets have been shown to produce weight loss consistently, speedily and ‘easily’. These diets are usually liquid because this ensures that the diet is low in calories (energy), contains adequate protein and other nutrients, is ‘portion controlled’, and cheap and easy to follow. Interestingly although such diets are bland and boring, people usually report that they are easier to follow than conventional diets and that while on them, hunger levels are low. Many people report improved mood and rapid health benefits.

However, one cannot stay on a low energy liquid diet (LELD) forever, so unless other strategies are implemented for when the LELD ends, this approach is not effective in the long term. A number of studies have shown that combining a period of time on a LELD with treatments focussing on behaviour change, and the use of drugs that are effective at treating the overweight and obesity, can give better results in terms of weight loss and health compared to ‘ordinary’ diets or using drugs to produce weight loss. The average weight loss in such studies has been about 13%, with most of this weight loss maintained one to three years later.

This is a medically supervised programme; at the start of the programme one of our consultants will review your notes. We have access to the doctors at all times so if a query is raised with a specialist nurse or specialist dietitian during consultation then we will liaise with the wider team. An appointment with a consultant can also be arranged and wider liaison with other medical teams who manage your care will take place as appropriate.

Our intensive weight management programme works as follows:

Phase one: The initial weight loss phase.

This phase will last for ten weeks, during which your source of nutrition will come from a milk-based diet (or an alternative if required for medical or other reasons) with mineral and fibre supplements. You are aiming to achieve a 10% weight loss during this period.

The diet is low in energy (calories) but not unusually so. The diet is composed entirely of fluids – no solid foods at all. While getting started is a challenge, most people report after the first day or two they do not feel hungry and find the diet easy to follow.

However, of note for some a liquid style approach is not always appropriate and therefore a solid version of the programme is also available.

Discussion on an individual case by case basis will ensure the right plan is in place for you.

Phase two: After eight weeks you will move to the next phase.

In this phase solid food (if on liquid only) will be introduced from a limited choice of meals and snacks, usually with medication to help you build upon the initial weight loss and to maintain the weight loss. For many this is the trickiest part but we will give you regular support to help you manage this and you should expect to lose at least a further 5% of your weight.

Phase three –long term prevention of weight regain:

After eight weeks you will then receive more advice and support in developing skills to prevent weight regain in the long-term.

You will be expected to attend your appointments regularly over the duration of the programme. You will see different members of the multi-disciplinary team. You may need alterations in the medications you are taking (for example blood pressure or diabetes medications) and we will advise on this.

You will also be expected to fully engage in the lifestyle and behaviour change part of the programme. This will involve you keeping records at times about your diet and activity levels, doing ‘homework’ or reading background information and answering quizzes, and to fully engage in a programme to increase your physical activity and fitness.

You must therefore be able to commit to the programme, not only by being available for your booked appointments but also by following all of the components of the programme. If you have a long holiday planned, a change in job or personal circumstances imminent, this may not be the right time for you to start the programme – in which case you should let us know so we can plan a start date that will be more appropriate.

You are welcome to have a family member, partner or friend present during your appointment as we encourage patients to enlist the support of others when trying to manage their weight. However, it is important to note that this is a medical treatment programme and the elements in phase 1 and phase 2 will be prescribed to you based on your individual needs and as such must not be followed by anyone else.

If you have any queries please do not hesitate to contact the obesity team via telephone on 01223 348124.