Medical WeightLoss Program

Roxana Merz, MDMedical

Director, BariatricianSeptember 26th, 2015

2

I have no conflicts of interest or relevant financial interests in making this presentation

I will be discussing off-label use of phentermine

2

Disclosure

3

Understand what the Allina Medical Weight Loss Program can offer patients

3

Learning Objectives

4

A medically supervised, comprehensive, multidisciplinary programRecognizes obesity as a chronic diseaseCollaboration with the Penny George Institute for Health and

Healing/Livewell Fitness CenterWorks in cooperation with the Allina Health weight loss surgery

program to provide a full spectrum for obesity treatment

4

Allina Medical Weight Loss Program

5

To assist patients in losing weight to improve their health and weight related comorbid conditions, and to improve their quality of life

To provide patients the tools for successful long-term weight maintenance

Weight loss goals; –5-10% of initial weight –Additional goals thereafter, individualized to patient

5

Goals of Treatment

6

Physician supervised/use of medicationsRegistered dietitiansExercise consultations and monitoringHealth coaches Behavioral modification built into program

-Referral to behavioral health therapist as needed

6

Program Components

7

Treatment focused on weight loss3-12 month durationVisit Schedule:

MD and dietitian bi-weekly – first 4 weeks monthly–through month 6 every 3 months-after month 6

Exercise staff and health coach Alternating visits throughout program

7

Active Weight Loss Phase

8

Follows Active Weight Loss PhaseStarts once patient has achieved weight loss goalAssists patient in maintaining new lower weight1-2 year durationVisit Schedule:

Every 3-6 months with MD, dietitian, exercise staff and health coach Return as needed with weight gain

8

Maintenance Phase

9

Criteria:Age > 18BMI > 30Weight < 600 poundsAware of enrollment fee/self pay component6 months post-partum, not breast feedingNo current psychological instabilityNo active chemical use

9

Referral Information

10

A mix of insurance and self-payMedical and dietitian visits covered by

insurance*Exercise and wellness coaching costs covered by

package pricing/self-pay component

* Patients are counseled to verify insurance benefits prior to first clinic visit .

10

Program Costs

11

Length of Program Cost

3 months $369

6 months $469

12 months $519

11

Medical Weight Loss Package Prices

12

Length of Program Cost

3 months $249

6 months $349

12 months $399

12

Medical Weight Loss Employee Package Prices

13

Program 3 month cost

Seattle Sutton $1764Jenny Craig $1638Nutrisystem $957Slimgenics varies

*Internet spring 2014

13

Community Weight Loss Programs

14

Annual financial savings:

$1,092 if eliminate $3/day spent on junk food, fast food, or alcohol

$468 by splitting restaurant meals in half and bring home to make additional meal

$520 saved if reduce the # of meals eaten away from home by 2 per week

Retrieved June 6, 2014 from http://njaes.rutgers.edu/healthfinance/health-behaviors.asp

14

Potential Savings with Weight Loss

15

Medication savings; average decreased cost:

Patients followed in medically supervised weight loss program who lost 44 pounds resulted in:

Patients with a Diagnosis of: Monthly Yearly

Diabetes $215$2,579

Hyperlipidemia $124$1,486

Hypertension $107$1,287

GERD $81 $974

Retrieved June 6, 2014 from http://www.obesity.org/news-center/is-medically-supervised-weight-loss-for-obesity-cost-effective.htm,Nov14,2013

15

Potential Savings with Weight Loss

16

75 patients enrolled 91% female Average age 47 years Average initial BMI 40.41

32 patients had completed 12 weeks of program

16

Results; First 6 months

17

Initial Visit(N=75)

4 week visit(N=70)

8 week visit(N=48)

12 week visit(N=32)

Weight Loss (lbs)

Average 6.32 10.49 14.39

% of initial weight (average) 2.5% 4.2% 5.7%

5% weight loss (or more) 4 patients6%

21 patients44%

19 patients 59%

10% weight loss (or more) 0 patients 0 patients 5 patients16%

PAVS (Physical activity vital sign)

Minutes per week 63 126 159 212

% increase 221%

17

Allina MWL Program Results; First 6 months

18

Demographics-38 year old-female-obesity related co-morbid conditions: type 2 diabetes, PCOS, hypercholesterolemia

Program-completed 3 month package-phentermine 37.5 mg daily

18

Case Study #1

19

Measure Initial visit 3 month Total Change

Weight 276.5 lbs 259.9 lbs -28.7 lbs

% Weight loss ---- ---- -10.4 %

BMI 43.4 38.89 -4.51

Waist measure 52.75” 48.75” -4”

Hip measure 58” 53.25” -4.75”

PAVS (# of minutes of exercise/week)

225 630 +405

19

Case Study #1; Results

Type of Medication Initial visit Final visit

Oral Type 2 DM agents 2 2

Cholesterol lowering agents 1 1**

Antihypertensives 0 0

** Advised patient to discuss decreasing med with PCP

20

Lab Initial 3 month

Hgb A1c 7.1 5.9

Fasting glucose 108 NA

Fasting lipid panel

Total cholesterol 286 154

Triglycerides 275 171

HDL 33 28

LDL 198 92

Non-HDL 253 126

Ratio 8.67 5.5

20

Case Study #1; Results

21

Demographics– 39 year old– female–obesity related co-morbid condition: low back pain

Program– completed 6 months of a 12 month package– phentermine 37.5 mg

21

Case Study #2

22

Measure Initial visit 6 month Total Change

Weight 279.8 lbs 236.6 lbs -43.2 lbs

% Weight loss ---- ---- -15.4 %

BMI 48.46 40.98 -7.48

Waist measure 57” 47” -10”

Hip measure 56.25” 52.5” -3.75”

Waist to hip ratio 1.01 0.90 -0.11

PAVS (# of minutes of exercise/week)

40 120 +80 also focused on intensity of exercise

22

Case Study #2; Results

23

Lab Initial 6 month

Fasting lipid panel

Total cholesterol 214 176

Triglycerides 173 85

HDL 55 50

LDL 124 109

Non-HDL 159 126

Ratio 3.89 3.52

23

Case Study #2; Results

24

Demographics– 44 year old– female–obesity related co-morbid condition: low back pain/sciatica(lumbar

disk herniation)– found to have metabolic syndrome, elevated triglycerides

Program– completed 6 months of 12 month package– phentermine 37.5 mg, metformin– reports significantly less back pain

24

Case Study #3

25

Measure Initial visit 6 month Total Change

Weight 182.4 lbs 153 lbs -29.4 lbs

% Weight loss ---- ---- -16.1 %

BMI 32.38 27.16 -5.22

Waist measure 42.0” 37.75” -4.25”

Hip measure 45.0” 38.5” -6.5”

PAVS (# of minutes of exercise/week)

0 180 (month 5 at 420) +180

25

Case Study #3; Results

26

Body Comp Study* Initial visit 6 month Total Change

Percentage of Body Fat (%) 48.9 40.6 -8.3

Body Fat Mass 89.3 62.2 lbs -27.1 lbs

Skeletal Muscle Mass 50.9 49.4 lbs -1.5 lb

Basal Metabolic Rate 1282 kcal 1261 kcal -21 kcal

*In-Body 230

26

Case Study #3; Results

27

Program Details

Location:– ANW Bariatric Center, Piper Building Suite 401– Future;

United Hospital, West Health and Unity Hospital Long range potential for “hubs” at AHC sites

Future Offerings:– Low calorie diets/meal replacement products– Support Groups

28

ANW Medical Weight Loss Clinic

Immediate appointments available…

ANW Bariatric Center Piper Building, Suite 401

913 E. 26th StreetMinneapolis, MN 55407

612-863-7501

29

Thank you!

Please contact me for questions:

Roxana Merz, MDBariatrician

Medical Director, Medical Weight Loss Clinic612-863-1217

(Staff only please)