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I hope these individual are also on a proper diet and exercise regimen before the medications and gastric sleeves get done.
Proper diet as if saw a dietitian, did own research on macronutrient versus time restricted eating strategies (which by themselves have not shown to lead to sustained weight loss. but should be used in conjunction with everything else. let's not be one of those "no mortality benefit so i aint doing it" academic nihilists... such as the doctor who read the recent NEJM article stating time restricted intermittent fasting did not lead to a significantly different weight loss compared to caloric restriction alone and decided nahhhh doesn't work... and this physician has quite large waist circumference too. the point of the no mortality benefit so there is no point to doing it is suppose to refer to medications or invasive procedures that cost money and resources. Asking a patient to do something without such a cost to society and has no immediate downsides and possible benefit should not be dismissed so easily. There is no mortality benefit associated with using Mucinex and benzontate for a URI... yet people still prescribe it....) , and have a partner / family member who can support the plan.
Exercise regimen as if find a fitness trainer and really engage in exercise that gets the HR to a level to exceed anaerobic threshold.
I have done CPETs for obese individuals before (sometimes at the behest of the bariatric surgeon. there is some data regarding operative outcomes based on their VO2max) as well as to use their resting VO2 to calculate their RMR (for tailor a caloric strategy) and also an exercise prescription. There is a very nice website that can inform patients which physical activity they can do based on their highest METS. This way they do not get discouraged. MET Values for 800+ Activities - Golf - ProCon.org
Out of the clinical trials I have read (I read through the Columbia obesity course slides), it seems when an isolated intervention is test (which honestly is the proper way to run an RCT), none of these strategies seem to lead to sustained long term weight loss.
But no RCT (not even those done during those monthly long inpatient stays at Rockefeller University with a metabolic kitchen and also under room calorimetry) can properly capture real life successful stories and losing weight when one "throws the kitchen sink at weight management" and includes macronutrient diet restriction, time restricted eating, resistive exercise / weight lifting, aerobic exercise, pharmacotherapy, and possibly surgery (for the Class 3 and above BMI levels).
There is plenty of anecdotal data for patients with Class 3 obesity who "threw the kitchen sink"
Some state it is "expensive" to do so and only "rich people" can afford to do this and there is another instance of the socioeconomic divide.
Well.... there are plenty of youtube do it yourselfers who teach you how to eat healthy and wholesome on a budget ... while those may not be RCTs... we should not dismiss that advice so readily as physicians (especially if you a physician who is overweight yourself).
There is also 24 hour fitness... $10 a month (though they won't ever let you cancel lol) ...
So it's all a mindset.
What about those people who work and are busy? stuck in traffic? have to watch kids? do other stuff?
Buy some weights and put it in your home in your basement, If you are in an apartment, get some dumbells and barbells (tuck them away in the corner when not in use) and use them for a few sets few 5 minute interval. then go do something else then come back
there really is no excuse other than "i just dont feel like it."
but that pretty much highlights the crux of (what I think) Dr Metal is getting at. while the meds work wonderfully, they should not be the only tool. We need to throw the whole kitchen sink at the problem.
side observation .. I notice you did a CPET for a patient seen by bariatrics.... is that typical ask by your bariatric colleagues preoperatively?
also ive noticed that large groups of bariatric surgeons will recruit pulmonologist to be part of their practices... and ive always wondered why? Do you know why?