A CASE from Weight Loss Clinic Dr Peter Goulden MD, FRCP, PGCE Assistant Professor & Diabetes Program Director Division of Endocrinology & Metabolism UAMS College of Medicine

A Case from the Weight Loss Clinic 45 year old male. Referred himself to the weight loss clinic as had been getting back pain and had been investigated and had been told weight loss would help No significant Past Medical History but had not attended doctor for some time BMI 45.6 kg/m2 Had been on a weekend “food trip” ahead of entering the program Diabetes Prevention Program, reported in 2002.7 In this randomized, controlled trial of 1,079 participants aged 25-84 years, a 58% reduction in incidence of diabetes over 3 years was reported in subjects treated with an intensive lifestyle intervention that included MNT

A Case from the Weight Loss Clinic Fasting lab glucose of 153 mg/dL Fasting triglycerides = 121 mg/dL Alanine Aminotransferase = 50 IU/L Would prefer to avoid medication

Options Diet & Lifestyle advice (Weight loss & carbohydrate moderation) Medication (Metformin if no CI) Both

What We Did Enrolled to a 1200kcal diet Achieved 26.9 pounds weight loss in 12 weeks with close medical supervision LAB PRE WEIGHT LOSS Fasting glucose 159 mg/dL Triglycerides 121 ALT 50 IU/L POST WEIGHT LOSS 3 months 98 mg/dL 57 mg/dL 36 IU/L

UAMS Weight Loss Program 16 week program & bespoke diet – daily restriction from 400kcal+ Endocrinologist led and obesity educator delivered Caloric restriction tailored to individual Carbohydrate moderation Weekly review with nutritionist 1-2 monthly review with MD depending on case

Question for Discussion Patient centered decision making key Weight loss and carbohydrate awareness may have a profound impact Counseling has to be tailored to the individual How can weight loss programs be best delivered to the population allowing for variance in health literacy and other factors