Most physicians were not taught to do that, however. "I learned more in medical school about malaria than about obesity," says Michael Kaplan, a board-certified internist and bariatric specialist who also has a degree in osteopathy. That's changing: Awareness that obesity is a complex metabolic issue, not a simple matter of willpower, is growing in the medical community. "Obesity is a chronic disease," says Kaplan, founder and president of the Center for Medical Weight Loss. "The only person who should be managing this disease is a physician."
Kaplan used to practice general medicine but switched to weight loss five years ago because he grew tired of treating obesity-related ailments. "I knew that if most of my patients just lost weight, they would be able to stop taking pills for diabetes and hypertension,'' he says. His new specialty proved so financially successful that in September 2006 he began marketing his program to other primary care physicians. In two-day seminars in hotel convention rooms, Kaplan teaches doctors how to prescribe a low-calorie diet and weight loss drugs and how to predict the number of pounds patients will lose. He also brings the doctors up-to-date on obesity research and provides patient education materials and a six-hour DVD on counseling techniques. Kaplan charges $17,000 a head and grants each participant the right to use the Center for Medical Weight Loss name. As of August 2007, 75 doctors had signed up to open 91 centers.
Some experts argue that two days of training can't begin to cover what a doctor should know to handle weight problems. "You can't jump into it," Dr. Katz says. "You should spend years studying it." But others say they welcome any move to expand treatment in a nation where two-thirds of adults are overweight. "Two days is not ideal, but the country is in a desperate state," says Michael Dansinger, MD, an obesity researcher at Tufts–New England Medical Center in Boston and consultant to NBC's reality show The Biggest Loser.
Kaplan's centers typically offer patients prescription appetite suppressants and high-protein, low-calorie shakes and bars—although only, he says, as part of a broader program aimed at long-term diet and lifestyle changes. It's a common approach: The Medical Weight Loss Clinic in Michigan—which has 28 centers that treat 400 to 600 patients a week—hands out prescription drugs to nearly half the clientele, says Alberta Lipinski, a nursing supervisor there. At Dr. Smith's Get Thin Program, with four offices in metropolitan Atlanta, about 93 percent of patients "opt for" appetite suppressants, says founder Walter Smith, DO.
For those on an 800-calorie diet, the shakes and bars are designed to preserve muscle and avoid the chemical imbalances associated with what is essentially supervised starvation. Patients must be checked weekly for nutritional deficits and shouldn't remain on the diet beyond four months. Studies show patients lose three to six pounds a week while they're on the diet, but most of them gain the weight back when they stop. "Those 800-calorie diets are very effective for short-term weight loss but notorious for long-term failure," says Dansinger.
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