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Nutrition

Risk Factor Obesity program offers care based on medical and behavioral expertise

11/13/2009

Obesity Program Care UCLA’s Risk Factor Obesity (RFO) program is a dedicated, medically supervised weight management program that takes a comprehensive approach to treating overweight and overfat patients in a supportive, service-oriented environment. The program is highly individualized and is offered in coordination with patients’ primary care physicians to ensure the best care for patients who often have complex medical needs.

Abdominal fat and inflammation

In addition to the well established link with diabetes, obesity can result in chronic inflammation, which is associated with a number of disease conditions. This is particularly true of excess abdominal fat, which can accumulate quickly and outgrow its blood supply. As undernourished fat cells die off, white blood cells arrive to clean up. The interaction of the white blood cells with the remaining fat cells releases a number of hormones and proteins — including interleukin 6, tumor necrosis factor alpha, interferon and leptin — that cause inflammation. This chronic inflammation can promote asthma, heart disease, common forms of cancer and rheumatological and connective tissue disease including lupus and rheumatoid arthritis.

A general guideline regarding abdominal fat is that men should have a waist size of less than 42 inches and women should be less than 35 inches. Research conducted at UCLA showed that a loss of just 5 percent of body weight reduced the inflammation marker C-reactive protein by 30 percent.

Overweight, overfat and BMI

The traditional concept of obesity has centered around the body mass index (BMI) — the ratio of body weight to height squared. But in many cases, BMI provides an insufficient analysis of the patient’s relative body fat. Just as an abundance of muscle can lead to a high BMI in individuals who are not overfat, an overfat person with very low lean muscle mass can have a normal BMI. This condition, known as sarcopenic obesity, is most prevalent in postmenopausal women and is a known risk factor for breast cancer progression.

Physicians in UCLA’s Risk Factor Obesity program rely on bioelectrical impe-dance testing to provide a more accurate measure, using it to measure patients’ body fat, estimate their target weight and estimate their rate of weight loss when complying with the prescribed diet.

The RFO program

The Risk Factor Obesity program provides individualized dietary programs, including medically supervised very-low-calorie diets below 1,000 calories per day and modified low-calorie diets. Meal replacements are specially formulated for the program and include high-protein shakes, bars, cereal, oatmeal and soup.

The majority of patients reach their target weight within six months. At that point, patients are enrolled in a lower-cost maintenance program for an additional six months to one year to help them maintain their weight loss. Program staff prescribe exercise as one of the best strategies for maintaining weight loss.

The RFO program includes a very strong behavioral education component. Patients are encouraged to attend sessions as often as they can. The program offers drop-in clinics held on Saturday mornings and Wednesday afternoons. Behavioral education sessions, physician exams and consults, dietician consults and all medical testing are available during these clinics.

Obesity specialist physicians who are certified in nutrition, clinical psychologists who specialize in food addiction and cognitive behavior change, and registered dieticians all contribute to the broad expertise offered by the RFO program. The program often treats returning patients and medically complex cases. RFO patients include those with congestive heart failure, rheumatological disease, orthopaedic conditions and cancer. Weight loss is often a factor in achieving positive outcomes for these other conditions.

The RFO program is one of only 12 centers of excellence in the nation that make up the CORE (Centers for Obesity Research and Education).

RFO program succeeds where others have failed

“Many patients in the Risk Factor Obesity program have failed other weight-loss programs or are considering bariatric surgery,” says David Heber, M.D., Ph.D., director of the Risk Factor Obesity program. “We offer a very comprehensive medically sound program that has grown over 30 years and has helped thousands of patients achieve and maintain their weight-loss goals.

“It’s a struggle for people to integrate the habits that they learn in weight-loss programs, including ours, into their everyday lives, and we recognize that. There are a number of other things in patients’ lives that interfere and cause them to fall off a weight-loss program. We welcome patients back into our program and encourage attendance.”

Many patients succeed in maintaining weight loss after multiple treatments in the active weight-loss portion of the program. For some, the psychological and physical drive to overeat is so great, they can best succeed by remaining long-term in the low-cost maintenance program.

Participating Physicians

David Heber, M.D., Ph.D.
Professor of Medicine
Director, Risk Factor Obesity Program

Zhaoping Li, M.D., Ph.D.
Professor of Medicine

Program Manager

Mr. Joseph Walker

Contact Information

(310) 825-8173 voice
(310) 794-8837 fax
RFO@mednet.ucla.edu
For more information, or to download an application, visit our website:
http://rfoweightloss.med.ucla.edu





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