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

Make an enquiry

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.

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.

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.

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.

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.

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

Make an enquiry

London Medical Smartweight Programme

Losing weight is usually good for you – everyone knows that. But losing it the first time is only half the battle: the real challenge is keeping it off and enjoying all the benefits on an on-going basis. We have a programme that really helps you achieve this. It combines 3 key ingredients

  1. Leading consultants with vast experience specialising in every aspect of weight management
  2. The latest break-through drugs, such as Saxenda and Mysimba, prescribed carefully by specialist doctors
  3. Friendly support from a whole team who can help you win the weight mind game by creating a tailor-made programme around your individual needs

Did you know that the average dieter loses 9 times their bodyweight in their lifetime, trying time and again unsuccessfully to lose weight and not put it back on? We really do know how to break through this dispiriting cycle. No false promises. No unrealistic targets. Just a friendly, highly expert and supportive programme that will enable you to achieve what you previously may not have been able to do.

You only have to commit for an initial three month course. It only costs £6 a day. And you even get a reduction in the cost of these revolutionary drugs.

Research shows that losing just 5-10% of total body weight can have significant health benefits. You feel better, fitter, more energetic. Your blood pressure and cholesterol levels go down. A little bit of weight loss can go a long way to improving your quality of life and life expectancy.

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.

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
  • 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 treatments 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 treatment with lifestyle changes leads to greater weight loss and less tendency for weight regain.

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. Our treatment 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 treatment 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.

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 our treatment 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
  • The latest state of the art revolutionary treatments for obesity, checked and tested for their safety and the benefit they provide. Our clinicians have been closely involved in their development and clinical trials
  • Support from many different specialities so that your all your needs are expertly looked after
  • Long experience in helping people to manage their eating patterns and achieve an agreed long term weight maintenance goal

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

Make an enquiry

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.

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.

The SmartWeightTM Programme

Day 1

There will be an initial assessment by one of our dieticians 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 monitoring progress in the future.

An initial prescribed food programme 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 careful to ensure that you start well and achieve initial weight loss. This is always greater in the first few weeks when a greater percentage of water rather than fat is lost.

A first consultation with an Endocrinologist – on the same day or at another time to suit you.

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

Measurement of your initial resting metabolic rate and respiratory quotient on your current diet, using the ECal system. 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 estimate your total energy expenditure in a day and this allows us to prescribe a calorie restriction based on fact rather 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, although 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. The test will be repeated later in the programme in weeks 4, 8, and 12.

Instruction and support in starting injectable daily treatment with Saxenda (Liraglutide) or Mysimba. The costs of the drug are not included in programme but are available at a discount from our pharmacy. It is believed that continued use of this medication is essential in helping prevent weight gain in the future.

At this stage we will book in all your follow up ‘visits’ Included in the programme is a ‘visit’ every 2 weeks. You will be able to choose how you wish your programme to work; you can select any combination of face to face meetings, video calls, telephone calls or emails.

The initial programme is for a minimum commitment of 3 months at which point you can choose to continue and see the consultant endocrinologist again for a follow up.

Summary

£180 per month for a minimum period of 3 months renewable.

2 consultant led appointments

Inital blood tests as described above

4 metabolic rate measurments

6 follow up visits with the diabetes team in a format of your choice (face to face, telephone, email)

Discount on purchases through our pharmacy

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 excercise 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.

Make an enquiry

To enquire about our weight management program, please get in touch using our simple contact form or email diabetes@londonmedical.co.uk