Any NP works for a Weight Loss Clinic?

CrunchBerries · Jul 4, 2015

I am currently on a job hunt.
(Helping people lose weight has been one of my dream jobs. I always wanted to work for Weight Watchers or teach a group class at the gym. I strongly believe in exercise and diet.)
An opportunity has opened up for me and I am seriously considering it. I know I am a new grad so I am a little worried about learning weight loss drugs before even working at a family practice. Therefore, I'd like to have more information (if any).
Any NP out here could share any PROS and CONS for this type of specialty?
Thank you!

I'm not a NP but I am a nurse and I work for a bariatric surgeon.

We do not really encourage the use of drugs for obesity, short of PCOS they do not typically work well and they are temporary at best. As soon as they stop the drugs they regain.

The people that are a 30 BMI or bigger (statistically) do not do well with losing to a normal BMI and maintaining. Actually, when someone reaches the level of morbid obesity their chances of losing and maintaining for 5 years is slim without medical intervention (surgery).

I think it is a fair bet to say we are all fans of diet and exercise but patients following through is a huge challenge. Some are just plain too big to do any core exercises and it's painful for them as well.

I am a wls patient myself. I was FAT! Very very fat, a 41 BMI. I tried and tried and I just couldn't do it on my own. In 2006 I got a lap band and that proved to be the biggest mistake of my life! Back then we did not know yet how dangerous and miserable they are. I puked my way down to a 21 BMI. I did revise in 2008 to a VSG (I was at goal but I knew I wouldn't stay there without restriction) and I love my VSG. I just plain couldn't do it without surgical intervention.

It took me a long time to figure out that obesity is a disease, not a character flaw. There is no cure for obesity but we do have excellent treatments and the best known treatment to date is surgery. ( It has fantastic stats depending on the surgery type.

CocoaLoverFNP · Jul 4, 2015

I'm not a NP but I am a nurse and I work for a bariatric surgeon.
We do not really encourage the use of drugs for obesity, short of PCOS they do not typically work well and they are temporary at best. As soon as they stop the drugs they regain.
The people that are a 30 BMI or bigger (statistically) do not do well with losing to a normal BMI and maintaining. Actually, when someone reaches the level of morbid obesity their chances of losing and maintaining for 5 years is slim without medical intervention (surgery).
I think it is a fair bet to say we are all fans of diet and exercise but patients following through is a huge challenge. Some are just plain too big to do any core exercises and it's painful for them as well.
I am a wls patient myself. I was FAT! Very very fat, a 41 BMI. I tried and tried and I just couldn't do it on my own. In 2006 I got a lap band and that proved to be the biggest mistake of my life! Back then we did not know yet how dangerous and miserable they are. I puked my way down to a 21 BMI. I did revise in 2008 to a VSG (I was at goal but I knew I wouldn't stay there without restriction) and I love my VSG. I just plain couldn't do it without surgical intervention.
It took me a long time to figure out that obesity is a disease, not a character flaw. There is no cure for obesity but we do have excellent treatments and the best known treatment to date is surgery. ( It has fantastic stats depending on the surgery type.

Thank you for the reply, CrunchBerries! I was 50 lbs overweight about 7 years ago so I definitely share the experience. I understand how it might feel to be obese. That's why I am considering to work for this type of specialty. I'd like to help others who have failed but are ready to be healthy!

Do you like working with bariatric patients? I have read some of the treatments they do. Why do you recommend such treatments vs. diet/exercise alone? What are the pros and cons of working with obesity?

CrunchBerries · Jul 4, 2015

Thank you for the reply, CrunchBerries! I was 50 lbs overweight about 7 years ago so I definitely share the experience. I understand how it might feel to be obese. That's why I am considering to work for this type of specialty. I'd like to help others who have failed but are ready to be healthy!
Do you like working with bariatric patients? I have read some of the treatments they do. Why do you recommend such treatments vs. diet/exercise alone? What are the pros and cons of working with obesity?

I love working with bariatric patients. It's very rewarding. A typical patient may or may not wear makeup, they dress kind of frumpy, low self esteem shows through clearly. Then they have surgery and as they lose weight you see this massive transformation, they begin wearing makeup, they get a new updated hair style, they are smiling and laughing all the time, they are just happy for the first time in many years wearing their cute little clothes.

By the time we get someone with a high BMI they have tried every diet under the sun, they are typically hypertensive, have sleep apnea, diabetic, etc. Surgery corrects most of this. You can't really expect a 100 BMI person to do well and get to goal with d/e alone, stats show it just plain doesn't work. The drugs are temporary, the regain is huge when you take away the meds.

Surgery IS the easy way out and really, there is nothing wrong with that. We all take the easy way out in life at times. Why stand when you can sit, why walk when you can drive. Obesity is a very real issue and need attention. Immediately post op people are Thanksgiving Day full on 1/4 cup of tuna, there is literally no room for garbage foods and white carbs. It makes it so much easier.

I'm not a fan of lap bands, I personally think they should be taken off the market, they are dangerous long term. I'm also not a fan of RNY in the least although it is a necessary evil in a small minority of wls folks. I am a big fan of VSG and DS. It used to be that RNY was the #1 wls performed in the US. Starting in 2013 VSG is the most commonly done wls type. It's also the safest surgery type we have long term. It's your stomach, just smaller. No malabsorption, etc.

I would suggest joining a few wls F/B pages on wls and just read. You will see their struggles and why they finally decided to get wls. If d/e worked for them they wouldn't have had surgery, right?

CocoaLoverFNP · Jul 4, 2015

Thanks again, CrunchyBerries! ;-) What great information you have.

carachel2 · Jul 5, 2015

I'll chime in. I have a degree in Clinical Exercise Physiology so I too love the coaching aspect appeal of some of the weight loss clinics. I would think you need to be very careful on choosing the type of setting. We have a few in our town and one is really known to be legit, works with patient to make steady dietary restrictions, uses food supplements (but still real food) and minimal supplements. The other one in town uses a ton of weight loss drugs and supplements. I was HOPPING mad when a provider from that clinic put one of my patients on a weight loss drug that she had a clear contraindication to and then also when she started to exhibit signs of CHF, just simply put her on a diuretic without any further testing/follow-up, etc. I am rambling now but my whole point is....find out how much diet and weight loss counseling you will actually get to do.

CrunchBerries · Jul 5, 2015

One of the problems with the morbidly obese are the differences between that population and the normal BMI folks. The electrical activity in the brain is different, the gut bacteria is different, and a big one... Some (not all) studies show that the MO population tends to produce up to 3x the amount of hunger causing Ghrelin as a normal BMI person. Sleeves and DS fix the Ghrelin issue. RNY and DS change the hormonal chain reaction in the gut when digesting food and that is another way surgery helps.

I totally admit, I am a fan of wls. Not as a first option, clearly as a last resort. But d/e does not address these issues and that is why many people just simply cannot follow a diet plan.

One thing I wish I would have had a much better understanding before surgery was the "white" carb issue. I still would have needed surgery for the mere restriction but maybe I wouldn't have gotten so fat to begin with if I would have really, honestly had a solid understanding of white carbs.

I'm telling you, in my population white carbs are addictive and when you take them away you go through a sort of withdrawal. A few days of achy, moody, headache, cranky, cravings GALORE! After about 4-5 days the cravings die down and energy comes back full force.

Another issue, "diets" really don't work. People go on a diet, lose weight, stop the diet, and regain. This is all about a lifestyle change and I think most are going to be hard pressed to find many 60 BMI folks that can embrace that change without surgery. They need the extra help. They've been dieting and exercising their whole life and they dieted their way up to a 60 BMI or more.

Then you have the population that is metabolically challenged. They really can eat 600 calories a day and they still do not lose well. Those people are verrrrrry few in number but they do exist. No diet in the world is going to help them, surgery really is their only option if they want significant weight loss. They need that hormonal chain reaction altered and d/e just doesn't work for them.

Bottom line (for me, anyway) is the higher the BMI the less able they will be to embrace a lifestyle change. They want to, they simply can't.

CrunchBerries · Jul 13, 2015

I was researching something for a friend today and I thought about you. I thought you might be interested in this JAMA article:

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Diabetes Cure with Duodenal Switch

Obesity is the leading cause of Type II diabetes mellitus (adult onset diabetes) in the United States. With sufficient weight loss, diabetes will in most cases improve or resolve. Walter Poires, M.D. published in 2004 a study outlining the improvement in Type II diabetes after Roux-En-Y gastric bypass. Since we began performing the Duodenal Switch (DS) in 1993, we have observed that the majority of our patients following their DS for their morbid obesity have had their diabetes cured immediately following the surgery. In fact, we have seen a remarkable 97% recovery rate for our patients with diabetes. Many of our patients discontinue their insulin and/or oral hypoglycemic medications prior to their hospital discharge.

This phenomenon of immediate cure of the diabetes following the DS is, in large part, due to the intestinal rearrangement that is a component of the procedure. We have found that the improvement in and cure of Type II diabetes mellitus following weight loss surgery is, by far, most dramatic following the Duodenal Switch. We routinely perform the DS laparoscopically (LapDS) since we pioneered this minimally invasive approach in 1999.

Below is a chart outlining the differences following weight loss surgery in the cure and or reduction of diabetes and other serious morbid obesity related diseases reported by Harvey Buchwald, M.D. in his meta analysis published in 2004. In this study over 20,000 postoperative bariatric patients were followed for up to 13 years.

Obesity Related Illnesses that Improved/Resolved Following Weight Loss Surgery:

Diabetes Mellitus :

Gastric Band 47.9%

RnY (gastric bypass) 83.7% **MY NOTE** With bypass diabetes comes back in 1/3 of patients, not so with DS**

Duodenal Switch 98.9%

Buchwald, H. Bariatric Surgery, A Systematic Review and Meta-analysis. JAMA, October 13, 2004-Vol 292, No. 14

from the website paclap.com

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I am indeed a fan of wls and this is just one of many examples of why that is. In Europe they are actually doing a study on normal BMI folks with uncontrolled Type II diabetes. They are giving them a mild version of DS *just* to treat their diabetes.

It is interesting, for sure.

CocoaLoverFNP · Jul 13, 2015

Thank you so much for the info! I learned new things from your post.

Equinox1955 · Jul 16, 2015

I worked at a weight loss clinic for a few months last year. I really enjoyed working with people to inspire them and motivate them to become healthy, and that aspect was very rewarding. However, the company that owned the clinic was new, the middle management was inexperienced and, well, you know the saying "A little power can be dangerous"? This applied to the company; they ran the clinics like they were the Mafia. The upper management were basically never around and did not communicate to anyone other than a selected few middle management (mostly the beautiful women :) !!!! I started feeling like the whole operation was unethical, that management had very few morals and that they were in it solely for profit so I resigned. The concept is good but make sure the managers, owners and CEO are honest and nice.

CocoaLoverFNP · Jul 17, 2015

I worked at a weight loss clinic for a few months last year. I really enjoyed working with people to inspire them and motivate them to become healthy, and that aspect was very rewarding. However, the company that owned the clinic was new, the middle management was inexperienced and, well, you know the saying "A little power can be dangerous"? This applied to the company; they ran the clinics like they were the Mafia. The upper management were basically never around and did not communicate to anyone other than a selected few middle management (mostly the beautiful women :) !!!! I started feeling like the whole operation was unethical, that management had very few morals and that they were in it solely for profit so I resigned. The concept is good but make sure the managers, owners and CEO are honest and nice.

Oh wow! Thank you for your reply. Yes, I am very excited to help people reach their goals. But your experience with the company reminded me of my experience at a laser clinic. I could see why that would make me resign too. The manager solely wanted money without taking patient's safety into consideration. Hopefully, it won't be like that for this clinic I am going to be working for.