Weight Management

Whether or not you have diabetes, losing weight is one of the very best things you can do for your health. But it can seem a daunting challenge. At the London Diabetes Centre, we’re here to provide all the expert help and support you need to develop – and follow – a truly personalised weight management programme…

For a specialist Consultant appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

What is obesity?

Obesity is a medical condition where excess body fat has become detrimental to a person’s health. In particular, obesity can lead to serious health complications like type 2 diabetes, heart disease, and sleep apnoea, amongst other things. Obesity is typically caused by an excess in food consumption, lack of physical activity, and genetic susceptibility.

For a GP appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

Obesity and diabetes

Excess weight can cause many health problems, and when someone is obese, it’s much more likely that they’ll develop serious medical conditions like diabetes.

Body Mass Index (BMI) is not always 100% accurate, but it’s a useful guide to check if you are carrying too much weight.

To calculate your BMI, divide your weight in kilograms by your height in metres; then divide the answer again by your height:

  • a BMI of 25 to 29.9 means you are considered overweight
  • a BMI of 30 to 39.9 means you are considered obese
  • a BMI of 40 or above means you are considered severely obese

Another guide is your waist measurement:

  • Men with a waist circumference of 94 cm or more and
  • Women with a waist circumference of 80cm or more are more likely to develop obesity-related health problems.

In particular, “central obesity” – when you carry excess weight around your abdomen and liver – is a major risk factor.

For a nurse or dietitian appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

In any case, if you are overweight – even if you just need to lose a few pounds – we’re here to help. And by doing so, you’ll not only reduce your chances of developing type 2 diabetes, but also protect yourself against a range of serious and sometimes life threatening conditions, including:

  • coronary heart disease
  • stroke
  • high blood pressure
  • obstructive sleep apnoea
  • some types of cancer, such breast, prostate and bowel cancer
  • osteoarthritis
  • infertility
  • physical challenges
  • psychological problems including stress, anxiety and depression

How can losing weight improve my health?

Losing weight can be a daunting and difficult task, but it can have major benefits in terms of your health and wellbeing.

In fact, research shows that losing just 5-10% of total body weight can have significant health benefits leading to improvement in glycaemic control, a reduction in blood pressure and cholesterol levels.
A little bit of weight loss can go a long way to improving your quality of life and life expectancy.

For a specialist Consultant appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

How we can help you lose weight

The most common cause of obesity is when more calories are consumed, than burned off. This excess energy is stored in the body as fat.
Although over-eating and physical inactivity are the main drivers of obesity, some other factors can play a role:

  • genetics
  • medications
  • psychological factors
  • poor sleep quality

A personal approach to helping you take control

At the London Diabetes Centre, we take a tailored approach to weight loss. We’ll assess your risk factors, past medical and social history and current lifestyle, and then provide the help and support you need, on a personal one-to-one basis.

We’ll help you to take control of your weight, and improve your general health. And we’ll put our team of experts on the case – not just consultants, who will assess your medical risk factors, and consider medication if appropriate; but also psychologists and cognitive behaviour therapists, sleep apnoea specialists, and physiotherapists.

For a GP appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

A healthy eating programme that’s right for you

Of course, we’ll also focus on diet – by far the single most important factor in weight management.

Working closely with you, one of our expert dietitians will tailor a personalised menu programme that’s exactly right for you, also taking into account healthy eating, behaviour change, increasing movement and exercise and improving quality of sleep.

London Medical Smartweight Programme

Our aim with the SmartWeightTM programme is to improve the health and wellbeing of our patients.   For some patients, relatively small reductions in body weight lead to significant health improvements – in sleep apnoea, tiredness, depression or mobility.   Success is different therefore for every patient and, right at the start of your programme, we will try to define this for you.   It may be, for example, prevention of further weight gain, or maintenance to your best weight, or higher energy levels or improved glucose control.  So setting an achievable target for you is important and this is often the “best” weight that you can sustain in a normal routine life.   Our programme will identify and address the causes of your weight gain as well as the barriers to weight management.   We will investigate any reduction in metabolic rate, overeating, reduced physical activity and the reasons for them.   Some of these factor pose significant barriers to weight management.

  • We will advise you on the risks to your health of excess weight, and the benefits of even modest weight loss.
  • We will provide you with a long term strategy and ways to sustain changes in your routine.
  • We will use dietary recommendations, increase in physical activity, psychological motivators, antiobesity medications or bariatric surgery as treatment options for individual patients.
  • We will provide you with the knowledge and the resources to help you understand your own case.
  • We will refer you to specialists for specific problems when these are relevant to your case.
  • For a nurse or dietitian appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

What are my options?

The clinical expert team at London Medical will discuss all available options with you.   These depend on the extent of your obesity and other related health problems, and your ability to cope with long term calorie restriction.

There are four treatment recommendations usually:

  • Lifestyle changes (diet, mental health, physical activity) and medication with drugs
  • Lifestyle changes alone
  • Livestyle changes and devices (Endobarrier, gastric balloon, AspireAssist)
  • Bariatric Surgery (usually either gastric bypass or sleeve gastrectomy)

The easiest safest and simplest option, best suited to patients with mild obesity, remains lifestyle adaptation so that less calories are consumed on a daily basis and regular daily exercise becomes part of daily living.   Where the changes become part of a person’s way of living, weight loss can be maintained long term.

For patients who are heavier, formally defined as obese, and beginning to develop harmful health problems because of their weight, the use of drugs has become important and, when used together, can take off upto 15% of the excess weight, avoiding the need for more invasive solutions.   These can include the use of devices inserted into the stomach at operation or endoscopy, but have the disadvantage that they need to be removed after a short period of time.   Using a safe drug with lifestyle changes leads to greater weight loss and less tendency for weight regain.

For a specialist Consultant appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

The only real long term solution for severe types of obesity is either a gastric bypass operation or a sleeve gastrectomy (these operations are collectively known as bariatric surgery).   Weight loss is usually but not always largely maintained for more than 20 years after these procedures, with resulting improvements in longevity, and disappearance of many obesity associated health problems including diabetes.

What is bariatric surgery, gastric bypass and sleeve gastrectomy?

Is there an alternative to bariatric surgery?

Not all patients elect for surgery and some need to get on with weight loss while considering their options.  Other obese patients cannot risk surgical intervention.  . The majority of patients then face a dearth of evidence-based alternatives.

The effects of gastric bypass surgery can now be mimicked in part through pharmacological treatment. As we consume a meal, a hormone called GLP-1, affects the brain’s response to food.  It is usually present about 20 minutes after eating. The increase is seen at greater levels in patients who have had gastric bypass.  Liraglutide (Saxenda), a drug that acts in the same way as the hormone GLP-1  is  used for treating Type 2 diabetes and, in higher doses is  an effective treatment for obesity.   The drug helps overweight people feeling satiated far earlier into their meals, feel full for longer and and this assists weight loss.  At London Medical we have been using this hormone extensively in diabetes and more recently as a treatment for obesity.   In its presentation at the highest dose as Saxenda, it is now available in the UK for the treatment of obesity and it’s use is an integral part of our SmartWeight programme.

For a GP appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

The SmartWeight approach to Obesity

Devised and directed by an expert team, who together have over 30 years of experience in managing overweight problems, the London Medical SmartWeightTM programme focuses on losing AND sustaining healthy weight forever.    Moving away from drastic weight loss as a goal and focusing instead on long-term weight management and health, and addressing the underlying relationship with food allows a more holistic basis for approaching well-being. . Targeting this gut-brain axis in a personalised way using medication, and considering a personal tailor made recommendation using therapy together with Saxenda and the most up to date dietary interventions with regular support, work not only to reduce weight but to prevent weight regain in the long term.  To help you achieve this, you will have behind you a formidable multidisciplinary team of experts in the SmartWeightTM team.

By putting your trust in London Medical, you get:

*        The expertise of a leading team of academic and clinical key opinion leaders and consultants in the field of weight management

*        You will be best placed to receive to the latest state of the art revolutionary treatments for obesity as soon as evidence of their safety and benefit is obtained as the clinicians are involved in their development and in clinical trials

*        You have access to support from many different specialities so that your all your needs are expertly looked after

  • We have the skills to manage your eating patterns and achieve an agreed long term weight maintenance goal

*        We use apps, and email and video support to keep in contact with you and help you through your journey

*        Where a patient’s obesity has reached a serious level, and is associated with other illnesses, the slow process of sufficient weight loss which can take years, and the risks of weight gain, make a recommendation to have bariatric surgery of some sort imperative especially as there is so much evidence now to support this operation in terms of benefit, life expectancy and safety.   Referrals will be made to Mr Ahmed Ahmed, who is the head of the Bariatric Surgery Unit at Imperial College.

For a nurse or dietitian appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

The SmartWeightTM Team at London Medical

The team at London Medical is a coordinated group of dedicated and expert people. They work together in one unit to help you achieve your goals.  The lead health professional is Dr Christina Prechtl, who has worked with obese patients for many years. She is currently engaged in groundbreaking clinical trials at Imperial College London, to prove the efficacy of weight loss tools.   Together with Carin Hume, the Senior Clinical Dietitian at London Medical, the programme will be initiated and explained to you at first visit.  Our nutritionists are skilled at interviewing and establishing the nature of the problem you have – and the relative importance of behaviour, psychological issues, dietary knowledge, will power or genetics in the generation of your weight problem.  They will discuss personal ways in which you can begin to help yourself.

All patients will see one of the consultant endocrinologists, Dr Harvinder Chahal, Dr Ralph Abraham or Dr Alex Miras  and medication will be prescribed when  appropriate.     Other  medical issues such as the risk of heart disease and stroke, hypertension, diabetes or hormone deficiencies will be reviewed and treatment recommendations made.   The side effects and benefits of the medication that will be prescribed will be explained to you.

For a specialist Consultant appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

Dr Prechtl and the other two Senior Clinical Dietitians, Mrs Symone Genovezos and Ms Carin Hume will provide psychological therapy and dietetic support to all patients. Between them, they have 15 years of expertise in helping patients with the latest dietetic approaches and are able to tailor treatments to the individual.  Dr Christina Prechtl has further experience in the management of patients’ relationship with food, eating and themselves by using techniques and therapies including CBT and cognitive analytical therapy (CAT).  She was further trained in performing psychological assessments in obese and overweight patients and has completed about 500 of these in the private and NHS setting in the past 7 years.

Patients that have underlying psychological difficulties and need special help in diagnosis and treatment, will be referred to our psychiatrist Dr Samantha Scholtz.    She has great experience in the psychological reasons behind and the psychological consequences associated with weight changes and will help you adjust to a frame of mind set for weight maintenance.

Patients who require bariatric surgery advice are referred exclusively to Mr Ahmed Ahmed, Consultant Surgeon and Head of the Bariatric Surgery Unit at Imperial College.

Obese patients with sleep apnoea difficulty are referred to Dr Himender Makker, Consultant Respiratory Physician.

Musculoskeletal disease with symptoms can be treated either by Nikos Stamos, our physiotherapist or Mr Haroon Mann, Consultant Orthopaedic Surgeon.

For a GP appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

SmartWeightTM – The Way to Change – What to expect

All patients must start the kick-start 6 weeks SmartWeight Programme.    At your first visit:

*        There will be an  initial assessment by either Dr Christina Prechtl or Ms Carin Hume on the likely requirements of your programme.    Your current position in terms of eating and activity patterns will be assessed together with your readiness and motivation to change and obstacles to success in the past.   It will serve as our benchmark in monitor progress in the future.    An initial prescribed food plan  will get you started – this will change as you communicate your progress to your dietitian.    Initially, and with the influence of your medication, we will be strict in ensuring that you can start well and achieve initial weight loss, which is always greater in the first few weeks, as a greater percentage of water rather than fat, is lost.

*        A first consultation with an Endocrinologist – either Dr Chahal, Dr Miras, or Dr Abraham either on the same day or at another time

*        Initial fasting blood tests to include FBC, ESR, routine biochemistry, thyroid function, fasting insulin, fasting lipids

*        Baseline DEXA body composition analysis in order to assess the extent of visceral fat and its loss as weight loss is achieved.   Visceral fat (the fat in liver, the abdomen, the heart and pancreas, is a metabolically active fat compartment associated with an increased risk of diabetes and cardiovascular disease and hypertension and raised triglyceride.   It is associated with increased risk of diabetes, heart disease and strokes.  Increasing exercise levels will assist in changing the amount of muscle mass present

*        Initial resting metabolic rate and respiratory quotient using the ECal system, on your current diet.  You will be asked to breathe in and out of a mouthpiece for 5 minutes while sitting quietly in order to give us a measurement of your resting energy expenditure.   From this, we can make estimate your total energy expenditure in a day and this allows us to prescribe you a calorie restriction based more on fact than guesswork.   Many overweight people feel that they gain weight because their metabolism is “slow”.  There is no truth in this as obesity is associated with a higher metabolic rate though it may be less than for somebody with equivalent height, weight, gender and muscle mass.   We consider it helpful to get a direct measure of a patient’s resting metabolic rate, particularly as it will fall with weight loss and dietary prescriptions will need to be modified.  The test will be repeated later in the programme.

  • Instruction and support in starting injectable daily treatment with Saxenda (Liraglutide). The costs of the drug are included in the first 6 weeks and are available at a substantial discount thereafter for patients continuing with the SmartWeight programme.   It is believed that continued use of this medication is essential in helping prevent weight gain in the future
  • Two further consultations with your dietitian over the next 6 weeks. These do not have to be face to face consultations, but can include video conferencing, email or phone communications. They will assess well-being, side effects and progress on the prescribed plan.
  • For a nurse or dietitian appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

What happens after the first six weeks of my participation in the SmartWeight programme?

Most patients will have lost about  5%  of their starting weight in this first period (depending on gender and initial metabolic rate) and will have made a start in adjusting to a different way of life and consuming less in food.   We now want to support you in continuing your weight loss as and later help you sustain your body weight long term.  Unless you were unable to tolerate the medication, you will be encouraged to continue with it as this helps in sustaining your achieved weight loss.   For the next 20 weeks, in Phase 2 of your programme, you will continue to work with your dietitian and other doctors in making changes to your eating behaviour and lifestyle.   The intensity in which this is done, is individual and will be agreed with your dietitian and doctor at London Medical.   You should continue to lose weight and be making permanent changes in your lifestyle.   At the end of this 20 week period, measurements will be made of your body composition and metabolic rate and you will see your endocrinologist again.   From this point on, a personal ongoing plan will be agreed with you so that you continue to be seen and monitored and encouraged to stick to your agreed strategy.   This can be tailored to your specific requirements and, usually, involves helping you adhere to principles of lifestyle management that will help you maintain your weight, with or without the help of medication.

For a specialist Consultant appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk

What is not included?

Some patients have need for other consultations (with, for example, a consultant psychiatrist/ full course of psychological therapy or sleep apnoea consultant) or blood tests, electrocardiograms, echocardiograms, or overnight sleep oximetry and these would all be separately charged.   If a patient requires more frequent support or help – including additional consultations or weekly support, these will be charged in addition.   The cost of Saxenda after the initial 6 week period will be charged separately but at a discount to its normal price to patients not on our programme.

For a GP appointment (no Doctor’s referral required) or to get a second opinion Call +44 (0)800 0483 330 Email info@londonmedical.co.uk


 

To enquire about our weight management program, please get in touch using our simple contact form.