Medical Weight Management

Hartford HealthCare Medical Weight Loss provides evidence-based clinical care to patients with obesity by using nutrition counseling, exercise counseling, and pharmacotherapy.

The program provides an in-depth personal assessment to evaluate the source of the patients' weight-related issues and manages weight challenges associated with other chronic comorbidities including Type 2 diabetes, congestive heart failure and obesity hypoventilation syndrome.

The program works with each patient to create an individualized care plan, using a shared decision to address barriers to weight loss, medication-induced weight gain and to control cravings and binging behaviors. The program is tailored for patients with weight regain or weight plateau after bariatric surgery and patients with significant comorbidities who are interested in behavioral strategies and anti-obesity agents prior to bariatric surgical evaluation.

Program Goals

• Developing a multidisciplinary team including board-certified physicians in Obesity Medicine, bariatric surgeons, advanced practitioners, registered dieticians who work collaboratively  to assist patients with weight loss and maintenance through lifestyle intervention, medicine and surgical interventions if needed.
• The weight management program is dedicated to research in the field of obesity medicine. The program is presently working with our bariatric surgical research team to develop research studies within our department. Our goal is to establish a grant funded research study for the upcoming year of 2018.
• Educate and train internal medicine and family medicine residents in the field of obesity medicine by developing a 2-4 week outpatient rotation with our weight management program.
• Develop a Nutrition and Obesity Medicine Fellowship.

Availability For Input Consultations

• Available for inpatient consults at Hartford Hospital on a weekly basis for patients with a BMI ≥ 30 admitted to the inpatient service in which obesity was the underlying cause for their admission. The obesity medicine consultation service will assist with the care of patients who have been admitted with:
  • • Cellulitis.             
    • Acute Congestive Heart Failure Exacerbation.
    • Obesity Hypoventilation Syndrome.
    • COPD exacerbation.
    • Type 2 DM- Hyperosmolar Hyperglycemia State.
    • Stroke/ Transient Ischemic Attack.
    • Pseudotumor Cerebri.
    • High-risk Transplant Patients with BMI greater than or equal to 30.

Find out more about the Medical Weight Management Program and locations near you call 1.833.861.5433.

When Should You Consider Weight Loss Surgery?

As an Obesity Medicine Specialist, I care for people  with obesity after bariatric surgery, prior to bariatric surgery, not interested in or do not meet criteria for bariatric surgery.

It is common to hear during an office visit, “If I eat less, exercise more, I know I can lose weight." Although this may be true for some people, it does not apply to all.

How do we know “Eat less, exercise more” is not universally applicable? Our country is in an obesity epidemic. One out of every every three people are considered obese -- but obesity is not entirely due to poor food choices and lack of activity.

Obesity is a complex and multifactorial disease. Research shows people with obesity have brain circuit dysfunctions and dysregulation of hormones produced from the gut and fat cells, causing weight gain.

Obesity is similar to bone joint disease, lung disease, heart disease in which lifestyle modifications and medications may not be enough and surgery may be the next best option.

The American Society of Metabolic and Bariatric surgery provides guidelines when surgery should be discussed with patients.  Surgery should be considered with patients with a Body Mass Index of greater than or equal to 40, patients with a Body Mass Index greater than or equal to 35 and one or more obesity-related comorbidities, such as Type II diabetes (T2DM), high blood pressure and obstructive sleep apnea or patients who have been unable to sustain healthy weight loss with prior weight loss efforts, including weight loss medications.

Weight is sensitive. Patients vary considerably in their readiness and capacity for weight management and weight loss surgery. When discussing weight loss surgery with patients, using the 5 As (Ask, Assess, Advise, Agree, and Assist) helps facilitate a sensitive, nonjudgmental and respectful conversation:

• ASK for permission to explore readiness for change in treatment.
• ASSESS obesity class, complications, and barriers
• ADVISE on obesity risk, benefits of modest weight loss. Discuss treatment options such as weight loss surgery.
• AGREE on health outcomes  and treatment plan
• ASSIST in accessing appropriate resources and providers for bariatric surgery, if appropriate.

Obesity is a chronic relapsing disease.  Weight loss medications and surgery may not be suitable for everyone.  But as a clinician, I know that providing the best options for patients is critical to achieving their best weight.

Dr. Devika Umashanker is an Obesity Medicine Specialist at Hartford HealthCare Medical Group.