John Rieger can’t pinpoint the exact trigger that led to his decision to embark upon a 145-pound weight loss journey but there were signs it was time. “I was huffing and puffing when I went upstairs,” said John, whose growing girth had hit 328 pounds and had spawned several medical problems. “It was a buildup of slow weight gain over time. I knew I was not right.”
Eighteen months later, John is down to 183 pounds, has gone off his two blood pressure medications and no longer needs his CPAP breathing machine since his sleep apnea has disappeared.
John and his wife, Mary Platter-Rieger, who lost 70 pounds, are vibrant proof of the health benefits of significant weight loss. Both are participants in the UC San Diego Weight Management program, a comprehensive weight loss program that emphasizes maintaining weight loss as strongly as the initial effort to lose the extra pounds.
“Many people can lose weight in the short-term through diet and exercise,” said Eduardo Grunvald, MD, medical director of the weight management program, part of the UC San Diego Bariatric and Metabolic Institute. “But the data show that for the overwhelming majority of people, the weight loss doesn’t last long. Our program provides people with a variety of tools that will help them maintain that reduction over time.”
Those tools include some of the traditional fare, such as low-calorie meal replacements, shakes and exercise, but also incorporate weekly group classes taught by health educators, who are also registered dieticians or clinical nutritionists. The classes educate participants about food, nutrition and lifestyle choices that impact weight loss or gain. “I’ll talk to them about things like environmental control,” said health educator Kelly Faulstich. “Maybe it’s getting rid of their junk food or adding fruits and vegetables so they’re as easy to grab as potato chips. Or if they live with non-dieters, they might consider having a separate food cupboard. It’s about proactively making changes to support their efforts.”
Grunvald said UC San Diego partners with the Health Management Resources (HMR) program for meal replacement products and other items. The program, which was named the number two Best Weight-Loss Diet in U.S. News & World Report’s 2015 rankings, includes two phases and can be customized to individual needs. Phase I involves a structured rapid weight loss program followed by the weight maintenance phase. Participants also have the option of medical supervision by clinic physicians.
“Everybody that goes into this program or any program is looking for a magic bullet, but I’ve realized there’s no such thing in weight loss,” said Mary, who went from 213 pounds to 143 pounds and no longer needs her blood pressure medicine. “You need to make lifestyle changes and to do that you need help, time and education.”
Mary and John, both retired biologists, had tried other programs, losing some weight, but always gaining it back. “We also tried to control it on our own,” said John. “We weren’t gaining weight, but we just couldn’t seem to lose any either. We decided we needed some help to get over that threshold and start losing.”
In Phase I, Mary used the program’s nutritionally balanced meal replacements, including pre-prepared meals and shakes. She lost weight and eventually transitioned to the maintenance phase, where she makes healthy foods and controls her portions. John, meanwhile, felt he needed the “decision-free” plan which meant only drinking shakes. Participants can choose to make their own meals, rather than purchase program food, provided they maintain caloric restrictions.
A key tenant, the couple said, was the direction to eat every two to three hours to stay satiated. “They also teach you how to eat in ways so you don’t feel hungry,” said Mary. “If I were to feel hungry, I’d go off this diet quickly. But I don’t.”
Mary and John attended the weekly classes and participated in a check-in call each week with their health educator. They credit the education and awareness gained as key factors in their weight loss. “They bring awareness to opportunities out there you hadn’t really thought about before,” said John.
For example, exercise became something that didn’t require a gym. “In the program, they define exercise as anything that moves your body through space,” said Mary, adding that participants were initially encouraged to do 10 minutes of exercise three times a day, if possible, and to incorporate it into their daily lives. “Well, we’ve all had to stand and wait somewhere for 10 minutes,” said John. “So I started thinking about what I could I do in that time that would be beneficial. I began taking the stairs or walking around in a parking lot. I realized I could do exercise almost anywhere.”
For Mary, learning about calorie-dense versus calorie-light foods was an eye-opener. She recalls being struck by the dietician’s revelation that a large rib eye steak, which Mary used to eat without a thought, can easily encompass 15 to 20 ounces. “Over time I went from feeling I had to have this huge, rare steak to feeling satisfied with a 3 ounce portion. It’s still rare and it’s still rib eye, but I no longer need that large amount.”
Grunvald isn’t surprised by such observations. “This is really a behavior modification program,” he said. “People are learning new skills and practicing them with the guidance of a coach, much like learning a sport or a musical instrument. Only in this case, they’re learning how to maintain healthy behaviors long-term.”
Once participants lose their desired weight, Grunvald recommends six months in the maintenance phase at a minimum. During maintenance, participants continue to participate in regular weigh-ins, attend classes and consult with program dieticians weekly.
Mary is currently in maintenance mode. She eats approximately 1,200 calories a day and does 30 minutes on the treadmill one to three times a day. John, who also exercises daily, has decided to stay in Phase I in order to lose another eight pounds.
Their weight loss has brought much more energy and activity to their lives. John is rewarding himself by taking classes in woodworking at a local community college, something he’d always dreamed of doing. Mary, meanwhile, now has more stamina for her volunteer work with Project Wildlife and for her love of animal photography.
She feels confident that she’ll keep the weight off. “The type of food I’m eating now is very different from what I ate before,” she said, adding that she eats lots of fresh fruit and vegetables, some grains and protein.
John is equally convinced of the permanency of their weight loss. “The shakes and meal replacements help you lose the weight,” he said. “What keeps us there is all the education, the behaviors we’ve learned and the thinking we’ve developed about weight control.”
For more information on the UC San Diego Weight Management program, call 858-657-7237 or email firstname.lastname@example.org. For more information, visit weightmanagement.ucsd.edu
Care at UC San Diego Health
Bariatric and Metabolic Institute