(MDs who specialize in the treatment of obesity)
Type of Counseling: in-person, one-to-one, by an MD, nurses, dietitians or physicianís assistants
Typical Cost: $500-1,000
Type Program: medically supervised, may include use of anti-obesity drugs, fasting, very low calorie diets (VLCDs), bariatric surgery, etc.
Type of Foods Used: fasting supplements, regular grocery store food
At-Home or Direct Mail Plan Available? Not applicable
How To Locate A Bariatrician In Your Area
The ASBP (American Society of Bariatric Physicians) provides a national physician referral service, by calling: 303-779-4833. A recent change has been that the Yellow Pages has recognized bariatric MDs under the heading: bariatrics (weight control). ASBP also has a fax on demand service, or via mail. Call the number below and follow the instructions.
American Society of Bariatric Physicians
5453 E. Evans Place
Denver, CO 80222
Who Are Bariatricians & How Are They Trained?
It is estimated by BestDietForMe.com that 800,000 Americans per year are served by bariatricians. So, they are significant players in the medically supervised weight loss programs arena. First, a bariatrician must be a state-licensed physician. He/she then specializes in bariatrics. They do not have to be a member of the ASBP in order to practice. Since they use medications as part of their treatment regimen, they must obtain a DEA certificate (The Federal Drug Enforcement Admin. registers and approves such medications).
The ASBP reports that 70% of its members have a primary focus in such specialties as: internal medicine, general practitioner, family medicine, psychiatry, endocrinology, etc. -- in other words, bariatrics is not their only area of practice. In the other 30% of the cases, they concentrate ONLY in bariatrics (a level which was higher when Oprah Winfrey generated tremendous publicity for liquid protein diets back in 1989).
All states give written exams to license a physician, and some states do have reciprocity agreements. However, the ASBP is the leading physician/clinician education provider in the field.
One main advantage for overweight persons to see a bariatrician, instead of a commercial program, is that obese persons may have other medical problems they don't know exist (i.e. diabetes), which are discovered by the bariatrician. More extensive medical monitoring, long-term support, alternative medication therapies, and partial reimbursement by medical insurance are other advantages. In addition, appetite suppressant medication therapy may work, where dietary restrictions have failed in the past.
Formed in 1950, the American Society of Bariatric Physicians (ASBP) is a national, non-profit professional association of physicians with a membership that had swelled to a record 1,560 by year-end 1997, compared to 750 in early 1996. This doubling of the ranks in just two years was due to the rush by many doctors to get a piece of the phen/fen and Redux market. Currently, the association has about 1,200 members.
This society represents about one-third of all bariatricians in the country. These doctors have a special interest in the study and treatment of the obese patient and in the medical health conditions associated with being overweight. The society encourages excellence in the practice of bariatric medicine through continuing post-grad medical education, the exchange of obesity information, and research on the prevention, cause, course, effects and treatment of obesity.
In 1991, the ASBP opened its membership up to Masters or PhD. degreed psychologists, dietitians, and exercise physiologists as "Associate" members.
Some bariatric MDs are still conservative regarding advertising their services, and comply with local norms of the medical community. Therefore, it may be difficult for weight loss patients to locate them.
Caseloads can vary widely, depending on the number of "extenders" available to the doctor. Extenders are nurses, dietitians or assistants. These staff people can see up to 3 patients per hour or as many as 50 per day. The bariatrician himself usually requires about 90 minutes for a typical patient visit, and may only do several of these per day.
What Treatment Methods Do Bariatricians Use?
After gathering information, including a detailed medical history, a complete physical exam and relevant laboratory tests, the bariatric physician and patient work together to formulate a program for life. Stressing the necessity of changing the patientís lifestyle as well as eating behavior, the plan centers on the medical and psychological benefits of weight maintenance, not just numbers on the scale.
Via the medical history, the doctor reveals certain obesity triggers: pregnancy, smoking cessation, depression, working night shifts, having a sedentary occupation, etc. It's not uncommon for a bariatrician to find that in their practice 30% of morbidly obese patients have a history of sexual molestation as a child or as a teen. In such cases, the physician will do a psychiatric consultation with them, since they tend to use their obesity as a defense mechanism. A commercial weight loss clinic is not normally equipped to either diagnose or refer a medical problem of this nature.
In the physical exam, blood profiles and urinalysis are usually performed on all new patients, and EKGs are used if there is a history of cardiac problems. Though vitamin supplementation and medications may be used, a sensible food program that teaches new and better habits, in combination with an exercise program, is felt to be the key to good nutritional treatment of obesity. A sample plan used by some bariatricians might start the patient on a 1,000 calorie-per-day diet, containing a maximum 10 grams from fat. When the patient loses their required amount, they're put on a 1,400 cal./day diabetic diet, eventually raised to 2,000 cal./day. Fat intake is raised to 20 grams daily, with a request that they never exceed 30. This regimen is not cast in stone--it will vary from physician to physician.
The ASBP reported in 1998 that 38% of its members used a very-low-calorie diet, or "VLCD", while the other 62% used controlled medications and behavior modification methods. A bariatrician is a licensed physician qualified and trained in the administration of protein-sparing modified fasts.
The length of treatment can vary from several months to several years. Most weight loss clients see a bariatrician for several months. ASBP members don't usually target patients with 10-20 "cosmetic" pounds to lose.
Most patients, 69%, come in for weekly visits, with another 27% coming in bi-monthly. More than a third of all visits require 30-60 minutes or longer, and bariatric patients can expect more active roles and longer office visits than for most other medical conditions. Like other weight-loss programs, success is not guaranteed. Clients of bariatricians may have high recidivism rates as well.
Medications Used: There are basically two classes of appetite suppressants--amphetamines and non-amphetamines. Bariatricians who choose controlled drug therapy most commonly use Class 3 and 4 controlled medications such as the brand names: "fastin" (generic name: phentermine) or "pondimin" (fenfluramine) to treat obesity provided they are not used alone. Other brand names in this non-amphetamine appetite suppressant class include: Adipex-p, Anorexin, Bacarate, Bontril PDM, Ionamin, Melfiat, ObeNil, Plegine, Preludin, Pre-State, Sanorex, Statobex, Tenuate, Tepanil, Trimtabs, and Voranil.
The initial visit and physical usually costs $250-$450, and weekly follow-up visits typically average about $40. A typical patient may spend $50 per week for 12 weeks for the fasting supplement, nutrition bars, teas, and other products provided by one of the major VLCD vendors (Optifast, HMR, Medifast, etc.). Usually at least one or two follow-up visits are required with the doctor after the goal weight is attained. The average length of time a patient is served by a bariatrician is about 3 months. However, this figure is getting shorter.
From BestDietForMe.comís research and interviews of practicing bariatricians, we found that the largest share (about 40%) of patients pay $600-1,200 on average, for treatment for a year. Nearly one-third pay $240-600, and another 24% or so pay between $1,200 and $2,160. Only about 6% pay $2,400-3,000 for a year.
The ASBP reports that the majority of insurance firms do not cover treatment by bariatricians. Reimbursement really is at the discretion of the insurer, and they may not cover the cost of lab tests in some cases, especially if they think a physician may be trying to cover a patient for weight loss under the guise of another medical condition.
BestDietForMe.com analysts feel that treatment by bariatricians is one of the best types of medically supervised weight loss one can find. These are physicians who have chosen to specialize in the treatment of overweight persons, and have gone the extra mile to become board certified, take courses and exams. Consequently, they know more about weight loss than the average physician (Internist or General Practitioner). They can prescribe obesity medications, or use fasting plans. They monitor you closely. They can also address special needs and psychological issues. All in all, a solid program.
The information on this web site is intended for information purposes only and is not intended as a substitute for medical advice. Before starting any weight loss program, it is recommended that you consult your physician or other health care professional.
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