Medical weight loss management process and typical case analysis: from clinical assessment to protocol implementation

Medical weight loss involves establishing a safe and effective weight loss plan for obese individuals under the medical guidance and supervision of a physician, with follow-up visits to achieve the goal of controlling weight, body fat, and metabolic abnormalities. It is recommended that qualified medical institutions establish multidisciplinary comprehensive weight loss teams (physicians, nutritionists, psychologists, pharmacists, nurses, and social workers) to provide comprehensive medical weight loss treatment, including nutritional screening and assessment, obesity diagnosis, and medical weight loss intervention (including plan development and follow-up, education, and counseling services). This has a positive impact on the clinical outcomes of obese individuals and plays a crucial role in achieving and maintaining ideal weight and improving quality of life. Healthy weight loss is achieved through setting goals, a reasonable diet, appropriate exercise, and behavioral management. The recommended initial outpatient visit time is 30-45 minutes, and the follow-up visits from the second to the sixth visit should last 15-20 minutes, with the participation of a clinical nutrition specialist at each visit. The medical weight loss treatment plan requires 36 months, but the weight maintenance phase is recommended to be followed up for 26 years to reduce the chance of weight regain. The first phase generally involves intensive weight management, primarily reducing weight exceeding the ideal weight or reducing body weight by 5%-15%. Typically, a 3-4 month weight loss program is needed, requiring intensive lifestyle management. For obese individuals who meet the indications and have no contraindications, a short-term high-protein weight loss program can be used; this involves reducing dietary sodium, saturated fat, and added sugar intake. At the second follow-up after the initial consultation and weight loss plan, changes in weight and body fat should be assessed, and treatment may be intensified if necessary. During the second follow-up, patients can be guided to learn about medical knowledge related to weight loss assistance, and dietary adherence should be monitored. At the third follow-up, if the weight loss goal has not been achieved, adherence should be monitored, and referral for medical treatment should be considered. Increasing physical activity, reducing energy intake, and losing weight are all key to correcting multiple health risk factors. Patients should learn to eat according to their dietary prescription plan, read food labels, modify their daily menus, prepare or purchase appropriate foods, and choose healthy options when dining out. For highly motivated patients who have contraindications to high-protein intake, intermittent fasting and calorie-restricted diets can help achieve weight loss goals. These diets can also be used as a maintenance diet after the initial weight loss program is completed. (I) Screening and assessment of medical weight loss

Screening measures include height and weight to calculate BMI, waist circumference and body composition; fasting blood glucose, blood lipids, blood pressure, liver and kidney function, and complete blood count and other safety indicators; and establishing files based on family history, medications, smoking, medical history, diet, and exercise habits.

The assessment includes evaluating the patient's willingness and motivation to lose weight; anthropometry, biochemical data, clinical examination, dietary survey, lifestyle, psychological and quality-of-life assessment. (II) The 4A principle for guiding patients to change their lifestyle habits.

Assessment involves evaluating the patient's daily dietary habits and food intake frequency.

Asking: By asking questions, we can gain a deeper understanding of the patient's beliefs and obstacles to changing unhealthy lifestyle habits.

Advice: Guide patients, encourage them to start with small doses, and build confidence through success.

Follow-up (arrangement) To enhance compliance, regular follow-ups are necessary to consolidate achieved results and set the next goal. (III) Nutrition and Exercise Prescription Development 1. Diagnosis includes nutritional problems and diagnosis, namely, understanding and assessing the daily total energy intake, dietary fat, saturated fat, sodium and other nutrient intake levels; eating habits and behaviors; physical activity level and exercise function status; and appropriate biochemical indicators through dietary recall or food frequency questionnaires.

Develop individualized dietary nutrition prescriptions based on the assessment results and addressing existing dietary and habitual problems. These prescriptions may include high-protein diets, intermittent fasting diets, and energy-restricted diets.

Dietary guidance includes developing recipes; making healthy food choices; and guiding behavioral changes to correct unhealthy eating habits.

Exercise guidance involves determining the type, intensity, and duration of exercise.

Education should be provided to patients and their family members to help them focus on their dietary goals and know how to achieve them; to understand the salt, fat, and water content of common foods, the nutritional value of various foods, and the Chinese Dietary Guidelines, etc.

Weight loss precautions should combine behavioral change patterns with adherence to established dietary plans. Dietary guidance and lifestyle adjustments should be tailored to individual circumstances, prioritizing different risk factors and proceeding gradually. (IV) Case Analysis

Medical weight loss prescription formulation for obese patients [Case] ​​Mr. Deng, 50 years old, height 178cm, weight 98kg, general manager of a company, has a 10-year history of hypertension and has been taking antihypertensive drugs for 5 years. He eats out frequently, drinks an average of 5 liang of liquor per day, and smokes 30 cigarettes per day. He has an irregular lifestyle and poor sleep. No obvious cardiovascular or cerebrovascular diseases or kidney complications have been found. He hopes to improve his health through medical weight loss. (1) Medical weight loss screening and assessment: Inquire about current medical history, measure blood pressure, waist circumference, and body composition; other metabolic complications related to obesity, such as blood sugar, blood lipids, cardiac function, and renal function; understand nutrition-related obesity risk factors (such as staying up late, mental stress, eating out, drinking alcohol, and prolonged sitting). (2) Clinical assessment, tests and examinations (optional): 1) Cardiac function, renal function (including 24-hour urine protein, urine albumin excretion rate, etc.), liver function, and thyroid function. 2) Human energy metabolism analysis (indirect energy test method). 3) Vitamin and trace element detection, endocrine function assessment. (3) Understand the patient's diet and behavior, and assess the current dietary nutrition and exercise status. The content includes, but is not limited to: asking about the patient's meat and vegetable habits; how many meals a day (including snacks); staple food intake; vegetable and fruit intake; meat, eggs, and dairy products (whole or skim) intake; cooking oil and nut intake; household seasonings (salt, soy sauce, chicken essence, MSG, pickled products, etc.) intake; frequency of eating out; drinking habits, and calculate the daily alcohol intake (energy intake that cannot be ignored); physical activity status, current physical activity level; smoking time and years, and whether the patient plans to quit smoking (benefit for blood pressure control). (4) Develop a dietary nutrition and exercise prescription 1) Calculate the standard weight: 178-105=73kg, the actual weight is 98kg, the BMI is 30.9kg/m², which exceeds the standard weight by 30%, which is considered obesity. The general manager's work is light physical labor. 2) Calculate daily energy intake: Based on 2025 kcal/kg body weight, the total daily energy intake is 73 kg × (2025) kcal/kg = 1460~1825 kcal. 3) Dietary prescription: A high-protein diet for 3 months, with a planned weight loss of 15 kg. Example diet (56 meals/day): Breakfast: Whey protein powder + fiber powder + multivitamin supplement; Snack: 100g of nonfat/low-fat yogurt or 25g of low-GI staple food (90-100 kcal); Lunch: 25g of staple food + 100g of high-quality protein food + 250-300g of vegetables; Snack: Whey protein powder + fiber powder + multivitamin supplement; Dinner: 50g of staple food + 100g of high-quality protein food + 250-300g of vegetables; Snack: 150-200g of fruit. 20g of vegetable oil for cooking per day. Salt: <5g/day. 4) Exercise prescription: Increase daily physical activity, persist in exercise, walk or brisk walk for 30-40 minutes every day, supplemented by 20 minutes of resistance training, 7 days a week. Overweight or obese patients with hypertension should strive for 300-500 kcal of exercise energy consumption per day, or 1000-2000 kcal per week, to promote weight loss or control. Those who want to maintain a lower weight after weight loss can engage in 60-90 minutes of moderate-intensity exercise every day. (5) Lifestyle guidance 1) Eat a light and low-salt diet. Only eat half the standard amount of fat, oil, and salad dressing; limit pork, beef, mutton, and ham to one-third of the usual intake. 2) Strictly limit the intake of high-sodium foods. The daily salt intake should not exceed the limit of 5g; in addition to paying attention to the limit of salt and soy sauce, special attention should be paid to foods high in sodium such as chicken essence, MSG, beverages, and canned food; try to eat less or no processed foods. 3) Double your daily intake of vegetables, fruits, and dairy products, especially leafy greens, various fruits, and root vegetables (such as oranges, beets, spinach, potatoes, and bananas), low-fat dairy products, legumes, and nuts, to increase potassium, calcium, and magnesium intake. 4) Strictly control alcohol consumption: men should consume no more than 50ml of spirits, 300ml of red wine, and 750ml of beer per day; women should halve these amounts. 5) Adjust work stress and relax. This is beneficial for improving sleep and helping to control blood pressure. 6) Gradually reduce smoking, aiming to reduce smoking to less than 20 cigarettes per day over 2-3 months. (6) Nutrition education: Provide patients with food nutrition education, healthy dietary choices; teach them how to read food nutrition labels; help them recognize high-salt foods and know how to avoid excessive salt intake; and explain the benefits of exercise and the importance of weight loss. Monitor blood pressure and follow up on feedback.

Establish follow-up schedules and goals, and conduct timely follow-up visits to assess the weight loss results.