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Doctoring Results

February 2, 2012 By:
Richard Pawlak, Perfect Fit Feature
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No one has to remind us that we’re an overweight nation. Almost daily, news reports contain stories about childhood obesity, seniors returning to the consumption of rich, fatty foods, even programs for overweight pets.

You may not be concerned if your poodle puts on the pounds, but when your jeans aren’t fitting the way they used to, blouse buttons are popping, and your swimsuit is too snug for the water, you may want to do something about it beyond blaming the washer and dryer. 

If weight loss is a serious concern, there are equally serious programs at some of the most prestigious medical schools and hospitals in the country, several of which are located in the Delaware Valley.

OLD SCHOOL

The Perelman School of Medicine at the University of Pennsylvania runs the Center for Weight and Eating Disorders, part of the Behavioral Health division of its Department of Psychiatry. Founded over 45 years ago by the internationally renowned scholar, Albert Stunkard, M.D., as the Obesity Research Group, the center conducts a wide variety of studies on the causes and treatment of weight-related disorders. More recently, the center has begun to offer professional services to the general public rather than only to participants in research studies. Its programs include nutrition counseling, exercise guidance, meal replacement and group support.

“Dr. Stunkard is the grandfather of understanding the mental health aspects of obesity,” says David Sarwer, Ph.D., director of the Center’s Albert J. Stunkard Weight Management Program. “His decades of research have resulted in a range of programs here to address the physical and psychological aspects of weight management.”

As complicated as the solutions to weight loss might seem, the program’s website (www.med.upenn.edu/weightloss) is straightforward and easy to digest, and lays out the programs in simple language.

The “Health First” program, for example, is a 13-week medically supervised program that combines meal replacements, portion-controlled foods and fresh fruits and vegetables. “You are under the care of medical, clinical mental health professionals,” adds Sarwer, “as well as dietitians.” Participants attend weekly lifestyle modification classes, and their health is closely monitored by the program staff. The program includes cooking demonstrations, according to the website, as well as suggestions for healthy eating while traveling, dining out, or enjoying the plethora of foods that are integral parts of the holidays.

“Not only that,” says Sarwer, “but our environment, our society, has evolved to where food is much more available than it used to be. Fast food, convenience stores, food trucks — how easy is it to find a Starbucks or a Dunkin’ Donuts? — make it particularly hard to resist impulse eating. We try to also teach techniques in the program for coping with impulse and emotional eating.”

THE LONG GOODBYE

The largest medically supervised program in the Philadelphia area, available at Jefferson Hospital, has been peeling the pounds off participants for more than 15 years, employing a high-protein, limited-carbohydrate regimen, extensive educational components and a longstanding maintenance program.

“The vast majority of people who enter our program respond very well,” says Cheryl Marco, director of the Jefferson Weight Management Program (www.jefferson.edu/endocrinology/weightmanagement/), “especially during the first 12 weeks, during which we create an 800 calorie per day program using Optifast liquid meal replacement drinks and 5 small meals throughout the day. Patients have been averaging 15 percent weight loss, with several patients who have lost over 100 pounds each.”

Dr Serge Jabbour, chairman of Jefferson’s Department of Endocrinology, Diabetes and Metabolic Diseases, heads the medical monitoring of the initial 12-week Optifast program, including the maintenance program that follows.

“Many people actually choose the second phase of our program — to attend our weekly classes — before entering the Optifast program,” says Marco. “We educate participants on behavior, physiology, exercise and attitude, and I think this is the best thing about our program: that we combine this medical/biological component with the emphasis on education and maintenance over the long term. 

“Most of the people in our program enjoy it so much, they come in every one to two weeks for two years or more,” adds Marco. “They then enter our program’s third phase, which is all about maintaining their new lifestyle, with seminars and education on cooking, sleep and motivation. Our program has the largest active maintenance group of any weight-loss program that I know.”

THE BODY SHOP

Changing your eating habits and other behaviors, understanding the social, biological and psychological challenges to weight loss, even overhauling your own lifestyle may not be enough to make serious weight loss feel like an accomplishment. After all that work on the internals, the exterior may now need some rebuilding.

That’s where Dr. George Zavitsanos comes in. He’s a plastic surgeon in the Einstein Healthcare Network, and has extensive experience with the final puzzle piece for many of the participants in medically supervised weight loss programs: body sculpting.

“There has been an exponential increase in patients who have had significant weight loss through surgery as well as dieting” says Zavitsanos. “This has led to a dramatic increase in body contouring procedures. After substantial weight loss, the skin and tissues often lack elasticity and cannot conform to reduced body size. The skin begins to sag. Body contouring surgery tightens the skin in the affected areas.

“Abdomens, upper arms, breasts, faces and thighs — they’re the most common spots for surgical body contouring following major weight loss,” Zavitsanos explains. “Contouring improves the shape and tone of the underlying tissues and removes excess skin and fat which reestablishes normal body appearance. The most commonly performed procedure in our office is the tummy tuck (abdominoplasty),” adds Zavitsanos. “The results are immediate, long-lasting and predictable, and patient satisfaction is exceptional. Breast lifts, with or without implants, are the next most common, followed by face lifts. Arm lifts and thigh lifts are less common procedures, but we do quite a few of them.”

Body contouring may seem like a daunting prospect, but getting ready for one or more procedures isn’t much different than preparing for routine surgery.

“We start with a complete understanding of the procedure,” Zavitsanos details, “as well the expectations, and limitations. “Basic blood work and a general health assessment from your physician will be necessary. Medications should be taken and optimized prior to your procedure. We advise to avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding. Abstinence from smoking is of utmost importance for at least six weeks, preferably longer. And be prepared to have a friend or family member assist in your care for at least the first 24 to 48 hours for the majority of these procedures.”

Medically supervised weight loss programs, while extremely effective, take time and require a certain level of patient perseverance. But the results of body sculpting procedures can usually be seen immediately.

“There is an immediate restoration of normal body shape and contours,” Zavitsanos continues, “and over the course of a year the results will continue to improve. The overall results are long-lasting, provided you maintain a stable weight and general good health and fitness.” 

This article originally appeared in Perfect Fit, a special section of the Exponent. Richard Pawlak is a frequent contributor to Special Sections and Inside magazine.

GETTING SERIOUS

Center for Weight and Eating Disorders, Albert J. Stunkard Weight Management Program, Perelman School of Medicine, University of Pennsylvania, 36th and Market Sts., Philadelphia., 215.746.4100, Director: Dr.David Sarwer, Ph.D., www.med.upenn.edu/weightloss

Jefferson Weight Management Program, Walnut Towers, Suite 600, 211 S. 9th St., Philadelphia, 215.955.5732, 215.955.1925, Director: Cheryl Marco, www.jefferson.edu/endocrinology/ weightmanagement/

Einstein Healthcare Network, Division of Plastic and Reconstructive Surgery, George Zavitsanos, MD, 467 Pennsylvania Ave., Suite 203, Fort Washington, 215.641.2300, www.einstein.edu/departments/ plastic-reconstructive-surgery.html

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