Medical Nutrition Therapy
At BMC, the Weight Management Program staff is dedicated to the medical and surgical management of obesity. A national leader in the field, the program provides comprehensive, convenient, and effective care. The staff of registered, licensed dieticians guide and encourage patients as they learn how to make lifelong changes in eating behavior, food choices, and activity levels. Combined, this work helps patients reach their goals through eating plans, behavioral support, and exercise.
For most weight management patients, the first appointment will be a group class taught by one of the Registered Dieticians. The class will provide initial diet information so that patients can begin making lifestyle changes. Following the class, patients will meet with a dietician individually to assess immediate and long-term nutrition needs and create an individualized plan. This plan will take into account any potential medical issues, as well as personal lifestyle choices. Subsequent appointments will be scheduled as needed to assess progress, provide support and additional counseling, or to modify the plan.
To make an appointment, please call (617) 638.7470.
The full array of weight management options include:
Balanced Calorie Deficit Diet
This dietary plan helps patients learn to make improvements in food choice, portion size, and food preparation that will help them to lose weight. This diet regulates caloric intake by food type: 30% from fat, 20% from protein, and 50% from carbohydrates. After the dietician determines the appropriate caloric intake for weight loss, the patient will be given written materials to help choose foods wisely from six food groups: dairy, protein, grains/starches, fruit, vegetables, and fat. Typical weight loss is 1-2 pounds per week.
Low Fat, High Protein, High Fiber Diet
In this plan, the emphasis is on increasing protein, reducing starchy carbohydrates, and eliminating added fats. Fruit and vegetable intake is liberal. Amount of weight loss will depend upon the number of calories that are eaten and amount of physical exercise daily. Weight loss may range from 1-4 pounds per week.
This diet is low in saturated fat, cholesterol, and total fat while being rich in potassium, magnesium, calcium, protein, and fiber. The program is designed to improve eating and exercise habits. Individuals choosing this program will have six months of free access to http://www.dashforhealth.com/ which will provide information about food, food preparation, eating out, losing weight, and getting fit. The website also allows patients to track progress in areas such as weight, blood pressure, and exercise. Typical weight loss is 1-2 pounds per week
Protein-sparing Modified Fast
A short-term approach that limits food choices and portion sizes. This diet consists mostly of poultry, fish, and lean beef while carbohydrates (breads, cereals, pasta, rice, fruit, and most vegetables) are eliminated, resulting in faster weight loss.
Food and Formula Diet
A patient’s daily intake consists of three shakes or soup plus 1-2 small meals, 1 HMR vitamin and 2 quarts of water, or other non-caloric fluids. This diet provides 800-1400 calories per day and leads to steady, predictable weight loss. HMR Benefit Bars are available as snacks and HMR Meals are available for meal replacement.
Full Liquid Formula Diet
Meals on this diet are in the form of chocolate or vanilla frappe-like drinks or soup. Typically a patient will consume 5 shakes per day. This diet eliminates food choices completely. For some patients, such a restrictive diet is easier because there are no choices to make. The liquid diet is a complete, nutritionally sound meal plan. The patient will transition back to whole foods over a prescribed period of time. Please note: Insurance will not cover the cost of the shakes.
Diet and Pharmacotherapy
In some cases the dietician or physicians at BMC will recommend a diet in conjunction with pharmacotherapy, utilizing FDA-approved medications to reduce appetite or block fat absorption. These medications MUST be combined with one of the above eating plans or they won't be effective. No weight loss medication has been FDA approved for indefinite use.
Physical activity is an integral part of the weight management program at BMC. It speeds the weight loss process, prevents significant loss of lean body tissue (muscle), and increases metabolism. More importantly, physical activity appears to be one of the major determinants of successful weight loss maintenance.
The medical team will work hard to provide ideas and opportunities for increased daily activity. The program offers patients reduced cost memberships at some local fitness centers, a free weekly yoga class, and a walking group.
The key to a successful exercise regimen is to start slowly and gradually increase the level of activity. Too much too soon often results in fatigue and discomfort that discourages people from sustaining an exercise program. Even short walks are a good place to start and studies show that even minimal amounts of exercise can have big benefits.
Group Support Sessions
Americans live in a fast-paced, high-stress, unhealthy food environment which can set the stage for poor eating habits. The behavior modification classes offered in the program help patients build the skills necessary to lose and maintain weight. When willpower wanes, as it does for nearly everyone, “skillpower” can lead you to success.
The focus of the classes is on nutrition, physical activity, and control of high-risk situations. When a patient enters the program, they are encouraged to record food intake daily and to participate in a weekly interactive educational group session. The belief is that a patient’s success depends on regular attendance, conscientious record keeping, and commitment to a maintenance program.
Group sessions are held weekly as follows (sessions are about 1 hour):
Wednesday, 11:00am and 5:30pm
Behavioral Therapy Support
Most people who struggle with weight management don't eat because they are hungry; they eat in response to environmental and emotional influences. To address eating behaviors, the underlying causes of overeating need to be addressed. When group support isn't sufficient, patients will be referred to a clinician specializing in the psychology of eating and weight management. By developing strategies to reduce or eliminate factors blocking successful weight loss, patients will have a greater likelihood of long-term success.
Boston Medical Center has been awarded the American Society for Metabolic and Bariatric Surgery (ASBS) Bariatric Surgery Center of Excellence designation by the Surgical Review Corporation. Surgical weight loss may be recommended for patients who are more than 100 pounds or 100% above their ideal body weight. The Center offers both Roux-en-Y gastric bypass and the Adjustable Gastric Band surgery. Both are minimally invasive, laparoscopic procedures.
- Roux-en-Y Surgery: the gold standard for gastric bypass surgeries. This procedure reduces the size of a patient's stomach so that they can feel satisfied after eating smaller quantities of food. Most patients who undergo this surgery develop intolerance to sweet and high fat foods, which also limits caloric intake.
- Adjustable Gastric Banding: (also known as the LAP-BAND) is a procedure in which a hollow band made of silicone rubber is placed around the top of the stomach squeezing the stomach to make a small pouch. The narrow opening between the small pouch and the lower stomach allows food to stay in the pouch longer, thus providing a feeling of fullness that reduces appetite.
While long-term results with these surgeries have been excellent, as with any surgical procedure, there are risks. Consequently, in addition to the weight criteria mentioned above, surgery is typically restricted to those who cannot achieve and maintain sufficient weight loss on one of BMC’s dietary programs. Prior to surgery, a weight loss of 5-10 % is necessary to help reduce surgical risks. Patients will initially work with clinicians to achieve modest weight loss before being referred to the surgical team. For more information about surgical weight loss, please visit the Weight Loss Surgery website or call 617.414.8052.