The problem with most medical weight loss programs is that they focus too much on weight loss and not nearly enough on overall health.
Long-term, sustainable weight control can only occur in a context of total health optimization. Helping a patient improve his or her digestive function is a critical first step in this direction.
“The body needs to maximize digestion and nutrient absorption in order for someone to lose weight in a healthy way,” says Stuart Porter, DO, a Springville, UT, family physician and co-founder of Somae Health ( www.somaehealth.com ) a new medically-guided weight management program that begins with restoration of healthy gastrointestinal function.
The reality is, most overweight and obese people have highly dysfunctional digestive tracts. Many have dysbiosis, leaky gut, irritable bowel and compromised absorption. They consume a lot of calories but may in fact be poorly nourished.
“I’m very concerned about gut health. I think this is where a lot of problems begin,” Dr. Porter told Holistic Primary Care. “Many chronic conditions can be linked back to gut issues. If we don’t turn that around, restore healthy gut flora, and optimize digestion, people will continue to crave the wrong foods. You really need optimal digestion for optimal nutrition.”
A Four-Phase System
Somae is a new 4-phase, 12-week, physician-guided program that Dr. Porter developed over several years. “I’ve been involved in trying to help patients lose weight for a long time. I’ve tried all sorts of things: Fen-Phen, high-protein diets, Zone, Right 4 Life, South Beach. None gave lasting results. I started using Human Chorionic Gonadotropin (HCG) a few years ago, and found that it did work. Gradually, we started to build a more comprehensive program focused on improving body composition, balancing physiology and enhancing overall health.”
Somae begins with restoring digestive health while at the same time teaching patients about healthy whole foods. A team of specially trained mentors provide the education, and Dr. Porter said this is essential for long-term success.
The initial preparation phase has a digestive cleanse component, primarily using raw foods. Patients alternate between one day on raw fruits & vegetables, then two days on fluid only—a combination of filtered water, lemon juice, maple syrup and cayenne pepper, then another day on raw foods. We give probiotics, digestive enzymes and a multivitamin high in vitamin D,” explained Dr. Porter. “You really need to prime the digestive tract before doing anything else.”
The second phase is the intensive weight loss phase, lasting 21-42 days, depending on the desired weight goal. Patients go on a very low-calorie diet, typically 500-800 calories per day, and also take HCG, a hormone naturally produced during pregnancy that enables women to mobilize deep fat stores.
The Role of HCG
In recent years, exogenous HCG has been rediscovered by many clinicians working in weight loss. One of its virtues is that it enables people to tolerate very low calorie diets without feeling hungry. This was initially described by Prof. A.T.W. Simeons in the 1950s (join www.holisticprimarycare.net and read more about HCG in “The Weight is Over” from our Fall 2009 edition).
“People can lose weight without HCG, but it is a lot harder,” said Dr. Porter. “A 500 calorie diet is tough to maintain, but with HCG people don’t feel too bad. Enzymatic functions are also improved on HCG, as is gonadal function, especially in women. The weight comes off readily, and that can be very motivating. Plus, they tend to maintain muscle mass when on HCG.” Somae gives patients the option of HCG via injection or as sublingual drops.
The diet is oriented around whole healthy foods, not prepared meals, shakes, or meal replacement bars. The goal is to teach people how to cook and eat healthfully, not to make them dependent on processed foods and monthly meal plans. Exercise also plays a role. Patients are encouraged to exercise every day, with a brisk 30-minute walk being the minimum.
Stabilization & Maintenance
Though Dr. Porter shies away from giving patients specific predictions of how much weight they will lose in how much time, he has found that women typically lose 25-30 pounds after 12 weeks; men lose 30-40 pounds.
After completing the intensive weight loss phase, patients enter a third “stabilization” phase, where they continue on a low-fat diet, though not as calorie-restricted as in phase two, and without HCG. They are monitored closely during phase three. “We want to make sure the hypothalamus has re-set itself and there’s no weight regain,” said Dr. Porter. Mentors continue to teach healthy nutrition. Patients also continue with the probiotics and digestive enzymes (if necessary) introduced in the first preparatory phase.
The final phase is an ongoing maintenance phase, which is really just continuing to follow healthy eating guidelines, and incorporating healthy lifestyle principles into all aspects of life. Patients can use supplements as needed. Hopefully, by this point in the program, it has become second nature to make healthy nutritional choices, and no longer something external or imposed.
Dr. Porter said that beyond weight loss, the program produces beneficial physiological shifts in multiple domains. Hemoglobin A1C’s tend to normalize, blood pressure decreases, LDLs decrease while HDL’s rise.
Designed for Primary Care
It is an ironic fact of American health care that doctors can bill insurance plans for treating the end-stage effects of overweight, but cannot bill for time spent helping patients lose weight. It’s a source of endless frustration for many.
“I felt for a long time like I was spinning my wheels, trying to treat all the ill effects of obesity and overweight, but not really getting to the bottom of it. It was like trying to clear the smoke but not really dealing with the fire,” says Vaughn T. Johnson, MD, an Orem, UT, family physician who is among the nation’s first doctors to bring the Somae program into his practice.
The program, he explained, makes comprehensive weight loss an economically feasible prospect for his busy primary care practice. But it does so in a way that doesn’t involve selling patients a lot of products or creating “kickback” incentives.
Somae pays participating physicians fair market value, typically in the range of $400 per hour, for the initial intake consultation and follow up visits. The company’s website enables patients who are interested in losing weight to find participating doctors, so there is a practice-building element as well.
The day-to-day educational work and patient monitoring is done over the phone by trained mentors provided by Somae. On enrollment, a patient is assigned to a personal mentor who is available for daily consultation calls, especially during the intensive weight loss phase. The mentors provide the patients’ physicians with periodic progress reports, so doctors stay in the loop.
Because much of the time-intensive patient support work is “outsourced,” there are no additional start-up costs or staff requirements on the physician side.
Somae provides patients with a host of educational materials, eating guides and cookbooks, which the mentors help them use. It is very much a “teach a man to fish” approach. “We don’t tie people down to meal plans for the rest of their lives. We teach them to eat healthfully,” said Dr. Porter.
Somae is an out-of-pocket cost for patients, but it is not terribly expensive. The total cost for the 12-week program, including the HCG, probiotics & other supplements, educational materials and mentoring is $1,195—just under $100 per week. The company does provide 18-month payment plans, bringing the monthly costs down as low as $60 per month. This is much lower than many commercial diet programs, and there are no additional monthly costs for prepared foods or special meal replacement products.
Forget BMI, Look at WHR
Over the years, Dr. Porter has learned a lot of practical skills in working with overweight people. One key factor is to set realistic goals, and not just in terms of pounds lost, but health improvement and risk reduction goals.
He believes it’s time to retire the Body Mass Index as a standard measure. It may be easy to calculate, but BMI is not all that helpful in assessing overall health or guiding weight loss. Waist-to-Hip Ratio (waist circumference at the navel divided by hip circumference at the widest part of the buttocks) is a much better indicator.
Dr. Johnson agreed. “A person’s BMI might be high but if they have a lot of muscle mass, it can be a healthy overweight. WHR is a wonderful predictor of insulin resistance, diabetes, and cardiovascular risk. If WHR is high, it’s an indicator of risk. Period. There’s no such thing as a “healthy” elevated WHR.”
The Somae philosophy places less focus on pounds and calories, and more on foods and nutrient density. “We need to shift away from calorie counting and teach patients how to make healthier, smarter food choices,” said Dr. Johnson. “It’s amazing how much good, and how much bad can be done with a fork!”
Dr. Porter added that genes do play a role, but that gene expression can be greatly modified by our environment, our lifestyle, and what we eat. “I generally de-emphasize genetics with my patients. We can’t change our genes or our parents, but we can do a lot to change our lifestyles. I’d say overweight is about 10% genetics and 90% lifestyle.”
Ya Gotta Believe!
A physician’s beliefs have tremendous impact on weight loss outcomes. “If the doctor doesn’t believe it is possible for a patient to lose weight, the patient picks that up unconsciously, and it can be really undermining. On the other hand, if a doctor presents something that he or she truly believes can help, the patient picks up on that and it is very encouraging.”
Likewise, the doctor’s own health & weight profile is an important influence. Dr. Johnson noted that if a doctor is overweight and doesn’t look healthy, it will be very hard for a patient to take weight loss guidance seriously. “It sends a mixed, very conflicting message. We really try to practice what we preach. I’m not going to ask patients to make changes in their lives that I don’t know I can make myself.”
To this end, Somae makes the program available to all new affiliate physicians and their staff, at cost. “We want doctors and clinical staffers to experience real weight loss and real health. If they experience it themselves, they’re much better able to convey the value to patients.”
