SmartWeight Programme

Our expert clinical team will discuss all available options with you. These depend on the seriousness of your weight issues, and other related health problems, and your ability to cope with long term calorie restriction.

There are four treatment recommendations:

• Lifestyle changes (diet, mental health, physical activity) and medication with drugs
• Lifestyle changes alone
• Lifestyle changes and devices (Endobarrier, gastric balloon, AspireAssist)
• Bariatric Surgery (usually either gastric bypass or sleeve gastrectomy)

The easiest, safest and simplest option, best suited to patients with relatively minor weight problems, remains lifestyle adaptation – cutting down on calories, and taking regular exercise. Where these changes become part of your daily life, you can achieve long term weight loss.

For patients who are heavier, formally defined as obese, and beginning to develop harmful health problems because of their weight, the use of drugs can now play a very important role.

Medication can be used in combination with devices inserted into the stomach to achieve rapid weight loss, but such devices have the disadvantage that they need to be removed after a short time. So using proven drugs, together with long-term lifestyle changes, is often the best way to lose weight, without the tendency to regain it.

For severe forms of obesity, the only real long term solutions are either a gastric bypass operation or a sleeve gastrectomy (procedures collectively known as bariatric surgery). Diabetes remission occurs immediately after surgery and is better controlled on less medication subsequently. Weight loss is usually but not always largely maintained for more than 20 years after these procedures, with resulting improvements in longevity, and disappearance of many other obesity associated health problems (including diabetes).

The effects of gastric bypass surgery can now be mimicked in part through pharmacological treatment. As we consume a meal, a hormone called GLP-1 affects the brain’s response to food. It is usually present about 20 minutes after eating. The increase is seen at greater levels in patients who have had a bariatric procedure (gastric bypass).

At The London Diabetes Centre, we have been using the drug Saxenda (liraglutide) extensively (in treating diabetes), and more recently as a highly effective treatment for obesity; so effective, in fact, that it has now become an integral part of our SmartWeight programme.

Liraglutide (Saxenda) is a drug that acts in the same way as the hormone GLP-1. It helps overweight people to feel satiated soon, and to feel full for longer, enabling them to achieve weight loss.

Devised and directed by an expert team, who together have over 30 years of experience in managing weight problems, the London Medical SmartWeightTM programme focuses on losing AND sustaining healthy weight forever.

Moving away from drastic weight loss as a goal and focusing instead on long-term weight management and health.

Addressing the underlying relationship with food and taking a more holistic approach.

Targeting the gut-brain axis in a personalised way using where appropriate medication such as SaxendaTM or Mysimba

To help you achieve this, you will have behind you a formidable multidisciplinary team of experts. People you can trust.

You get:

• The expertise of a leading team of consultants who are academic and clinical opinion leaders in the field of weight management
• The latest state of the art revolutionary treatments for obesity checked and tested for their safety and the benefits they provide. Our clinicians have been closely involved in their development and clinical trials
• Support from many different specialities so that all your needs are expertly looked after
• Vast experience in helping people to manage their eating patterns and achieve an agreed long term weight maintenance goal

• £180 per month – minimum 3 months
• 1 consultant led appointment – with either Dr Chahal, Dr Miras or Dr Abraham
• 1 initial dietitian assessment
• Blood tests
• 6 x follow up visits with SmartWeight team dietitian
• Discount on medications from our in-house pharmacy
• Initial fasting blood tests to include FBC, ESR, HbA1c, routine biochemistry, thyroid function, fasting insulin, fasting lipids.
• A first consultation with an Endocrinologist – on the same day or at another time to suit you.
• There will be an initial assessment by one of our dietitians on the likely requirements of your programme. Your diet, activity and sleep patterns will be assessed together with obstacles to success in the past. It will serve as our benchmark in monitoring progress in the future.
• An initial prescribed meal plan will get you started – this will change as you communicate your progress to your dietitian. To start with, and with the influence of your medication, we will be careful to ensure that you start well and achieve initial weight loss. This is always greater in the first few weeks when a greater percentage of water rather than fat is lost.
• Measurement of your initial resting metabolic rate and respiratory quotient on your current diet, using the ECAL system. You will be asked to breathe in and out of a mouthpiece for 5 minutes in order to give us a measurement of your resting energy expenditure. From this, we can estimate your total energy expenditure in a day and this allows us to prescribe a calorie restriction based on fact rather than guesswork. We consider it helpful to get a direct measure of a patient’s resting metabolic rate. The test will be repeated later in the programme in weeks 4, 8, and 12.
• Instruction and support in starting injectable daily treatment with Saxenda (Liraglutide) or Mysimba. The costs of the drug are not included in the programme but are available at a discount from our pharmacy. It is believed that continued use of this medication is essential in helping prevent weight gain in the future.

Some patients have a need for other consultations (for example, with a consultant psychiatrist/ full course of psychological therapy, or a sleep apnoea consultant), or may require blood tests, electrocardiograms, echocardiograms, or overnight sleep oximetry; these would all be separately charged. If a patient requires more frequent support or help – including additional consultations or weekly support, these will be charged in separately.

Some patients have a need for other consultations (for example, with a consultant psychiatrist/ full course of psychological therapy, or a sleep apnoea consultant), or may require blood tests, electrocardiograms, echocardiograms, or overnight sleep oximetry; these would all be separately charged. If a patient requires more frequent support or help – including additional consultations or weekly support, these will be charged in separately.

• Body composition measurements with DEXA BodyScan or bioimpedance.
• Psychological support
• Help with exercise
• Bariatric Surgery
• Sleep Apnoea Clinic
• Discount on medications from our in-house pharmacy.