Physician Area - FAQ's

How Can OTC Help Me With My Obese Patients?
Is there a minimum weight to join OTC?
Are There Contraindications to Your Weight Loss Program?
Do You Prescribe Weight Loss pills?
Is it too expensive, such that my patients will not be willing to pay for it?
Do you Recommend Bariatric Surgery?
Do You Recommend Fad Diets?
Who Manages The Patient While They are Losing Weight?
Why have you dedicated your career towards treating obesity?
Who do I contact for more information or to refer a patient?
Doesn’t Everyone Just Gain their weight back?
What can I do as the patient’s physician to help promote long-term weight loss?

How Can OTC Help Me With My Obese Patients?

OTC is a multi-disciplinary weight treatment program in Sacramento, serving obese patients in Sacramento since 1983 and Davis since 2004. We use long-term behavioral therapy together with a medically-supervised diet. Our team of physicians, behaviorists, dieticians, therapists and exercise physiologists work to help obese patients lose and maintain their weight in a chronic conditions model. Patients understand that even if they lose weight, they will always be an obese person in a thinner body and at risk for regain. We work closely with our patients during times of relapse and offer the opportunity to adopt the skills they need to meet the challenge.

Is there a minimum weight to join OTC?

Yes. OTC’s focus is on the care of severe obesity and those with associated comorbidities. All patients must be approved by the medical director. In general, patients must have a BMI over 30, or a BMI of 27 with comorbidities. There is no maximum BMI, and the average BMI upon entering OTC is 38.

Are There Contraindications to Your Weight Loss Program?

Yes. A few conditions prevent us from entering our medically supervised diet. These include: Type I diabetes, unstable angina, end-stage liver disease and end-stage kidney disease as they are approaching dialysis, and pregnancy or women who are breastfeeding.

We see many conditions rapidly improve at OTC: congestive heart failure, asthma, sleep apnea, knee and back pain, metabolic syndrome, diabetes and hypertension. Depression is often improved after weight loss.

Do You Prescribe Weight Loss pills?

No, not routinely. OTC is not a pill-based clinic and we prescribe weight loss medicines sparingly. I have had some success in prescribing newer weight loss medications in maintenance to assist with behavioral change. This is done on a case–by-case basis and currently accounts for fewer than 10% of our patients.

Is it too expensive, such that my patients will not be willing to pay for it?

No. OTC is affordable for most patients and fees are carefully explained at the information session.

Although obesity remains a diagnosis that is not reimbursed by health insurance carriers, portions of the care at OTC are covered by some insurances if the patient has comorbidities such as diabetes, coronary artery disease, hyperlipidemia and metabolic syndrome.

We have introduced a new payment plan for patients, one that spreads the cost of the care out over the entire course of treatment, including long-term behavioral care. We believe most patients will be able to afford our care without significant personal sacrifice.

Do you Recommend Bariatric Surgery?

Yes. Bariatric surgery seems to be the appropriate option for a returning patient with a history of weight cycling. We also treat patients whose goal is to reduce surgical risk for future surgery. Some of these patients complete the program without needing the surgery. OTC is able to provide support for the post-gastric bypass surgery clients that will assist them with nutritional concerns and lifestyle changes that are important after surgery.

Do You Recommend Fad Diets?

No. Upon completion of our medically supervised diet, we recommend a diet emphasizing lean protein, fruits and vegetables and whole grains. We make caloric adjustments based on their resting metabolic rate and calories burned with exercise.

Who Manages The Patient While They are Losing Weight?

We tell your patients that you are their physician and that we are here in a specialty role only. During the weight loss phase, we see your patient weekly, and we often need to make medication adjustments for patients who have diabetes or have hypertension. In most cases, we are able to discontinue these medications within a few weeks of initiating the diet. For all other medical issues not related to their weight loss, we will refer the patient back to your office.

The communication between OTC and the primary physician is a critical link. We welcome your calls or e-mails. We will also send you monthly updates as to the progress of your patient.

Why have you dedicated your career towards treating obesity?

My initial interest in obesity care started shortly after I began in practice. Prior to that time, I had little knowledge about the disease of obesity and felt many of my patients simply lacked willpower. Yet, I was bothered by the degree of suffering that I saw as a result of obesity. This included long hours in the hospital caring for the comorbidities associated with obesity. I also heard the frustrations of my clinic patients when they were unable to lose weight. Later, I saw the indiscriminate use of phen/Fen and felt there must be another way. Many of the patients presented with side-effects and were looking for a “quick fix.” These problems lead me to an interest in bariatric medicine and began my passion for working with an orphan disease.

Who do I contact for more information or to refer a patient?

If you have a patient you may think may be a candidate, please have them call OTC (916/978-0300) and speak with Pam Perkins, our Director of Patient Services. We will invite them to an information session that will explain the entire process.

If you and your staff would like to learn more about OTC, please call us. We would be happy to come to your office, explain our program, and answer your questions.

Doesn’t everyone just gain their weight back?

No. Our medically supervised diet is merely a tool to get patients out of risk in a safe and effective manner. From the outset, we explain to patients that they must work with us in our behavioral program for 18 months AFTER they have lost their weight. The combination of diet, behavioral therapy, exercise and diet instruction is an approach that works well.

Published studies show that the combination of diet and behavioral therapy works well.

Success rate defined as maintenance of all weight (100%) initially lost, or maintenance of at least 9 to 11 kg of the initial weight loss and time of observation in 21 study groups. VLCD, very-low-calorie diet; BT, behavior therapy; CD, conventional diet. Adapted from Ayyad and Andersen Obes Rev, 2000, 1,113-119 .

What can I do as the patient’s physician to help promote long-term weight loss?

The management of obesity as a chronic disease is a team effort. Periods of relapse are to be expected, and relapse under behavioral supervision is part of the process to achieve long-term lifestyle changes. If you have a former OTC patient who is regaining weight, please encourage them to give us a call. We will greet them warmly and work with them to get back on track.

Also, patients are often tempted to participate only in the weight loss portion of the program and not attend our recommended 12 to 18 month post-diet behavioral therapy program we have termed Skills. A quick suggestion that maintenance is the critical part of their treatment will encourage them to stick with the program.