Trim the fat

Dr. Angela Harden-Mack stands in the education room inside the Winchester Bariatric Center beside a line of supplements that are some of the tools provided to patients to assist in weight loss. Rich Cooley/Daily

Weight loss is a popular practice in America, but can be difficult to achieve.

Though products that advertise fast results are tempting for those who have struggled to lose or maintain weight, Dr. Angela Harden-Mack, of the Winchester Medical Center Bariatric Program, cautions against using programs that guarantee specific results.

“Everyone in our country has done some type of diet before, but not every one will work for each individual,” said Harden-Mack. “Our bodies respond to food differently. Our body is regulating weight in a different way, so the idea is, the goal is, to match the treatments to what your individual needs are.”

The Bariatric Program located at 347 Westside Station Drive, started in 2006 and works by determining the needs of each patient. Though treatment might eventually include medication, Harden-Mack said it starts with behavior therapy, nutrition therapy and exercise therapy.

She and other medical staff address the causes behind a patient’s weight challenges, which she said can include eating too much, not choosing the right foods for one’s physiology or health concerns, side effects from medications, hormonal changes, perimenopausal symptoms and untreated sleep apnea.

After determining whether a patient is underweight, overweight or obese, she assesses risk factors and causes of weight irregularities before prescribing an appropriate treatment plan.

“We have the ability to approach this as the chronic disease that this is, and that’s very important,” she said.

“Chronic diseases, whether it’s obesity, or diabetes, hypertension, etcetera — there are certain steps that we take to manage it and certain treatment guidelines that we use,” she said. “This is a disease, so we educate patients to understand that this isn’t something that’s going away. And we advocate the comprehensive approach and ongoing management so once you lose weight there’s a maintenance plan in place. And this is in line with treatment guidelines.”

A treatment plan is based in part on a patient’s body mass index, which measures relative size based on height and weight. If a BMI is at least 27, indicating a patient is overweight, she said it would be appropriate to talk about medication. If 35 or higher, then it’s appropriate to consider surgery, such as gastric bypass.

Medications used through the program are appetite suppressants and work similarly but have varying results depending on the patient.

“Phentermine is the oldest, and so we have the most experience with that one,” Harden-Mack said. Of the medications she prescribes, “that seems to have the greatest results in terms weight loss and appetite suppression and satiety.”

Previously, Phentermine has been combined with the drug Fenfluramine to make “Fen-Phen,” a weight loss drug pulled from the market after it was blamed for causing pulmonary hypertension and heart-valve problems.

Since Fenfluramine was determined to be the cause of medical issues, Phentermine has returned as a widely used appetite suppressant. It’s approved only in certain cases, however, and Harden-Mack said bariatric staff members monitor patients through their use of Phentermine.

The Bariatric Program uses medication often in preparation for surgery, but patients have to qualify, and some insurance companies require that patients follow a mandated diet for up to a year before covering a surgery.

Ideally, a weight loss plan would begin without medication, which Harden-Mack said is never a requirement of medical assistance through the program.

The goal of prescribing medication is to assist in weight loss, but she said it’s only appropriate for three to four months before it becomes ineffective. That’s why it’s important to have a plan in place for maintaining any weight loss, so patients don’t regain.

“We’ve seen individuals here that do extremely well without medication,” said Harden-Mack.

The greatest patient success she witnessed through the program was a man’s 52-pound loss in nine weeks using only the nutrition plan.

Many patients can lose 50 to 52 pounds in 18 to 20 weeks, some with medication and some without, but she said a realistic goal is to lose ½ to 2 pounds a week.

Sometimes treatment includes the use of high protein snacks and meal replacement products by Premier Protein, Atkins or Myoplex.

Obesity or excess weight impacts multiple body systems, and Harden-Mack said conditions like blood sugar, cholesterol and fatty liver or chronic diseases like diabetes can be improved through weight management and weight loss.

Diabetes in particular, she said, has responded to gastric bypass surgery, for patients who haven’t had diabetes for long.

“We can’t say that it cures, but we definitely can say that it’s in remission,” Harden-Mack said.

With the addition of nutrition and exercise, she said blood sugar among diabetic patients is reduced.

“That’s phenomenal, because diabetes is one of the major chronic illnesses, and [because of] the amount of money we spend in terms of care,” she said.

Even a small amount of weight loss, like 5 to 10 percent of a patient’s weight is significant enough to improve a person’s health.

“We get excited when patients come in and share with us the improvements that they experience,” Harden-Mack said.

Contact the Bariatric Program at 540-536-0010.

Contact staff writer Josette Keelor at 540-465-5137 ext. 176, or jkeelor@nvdaily.com