What weight loss professional am I looking for?

November 9, 2023 2:42 PM

After a lot of unsuccessful effort to lose weight on my own, I am seeking some professional help. I don't know what kind of professional I need because there are a lot of contributors to my earlier failures. What kind of professional should I be contacting? Details inside.

In general, I know what good eating looks like. My downfall is portion size and snacking, which is exacerbated by my food environment (involving a spouse who loves carbs and a 4 year old with a sweet tooth). I need support around satiety, boredom/stress eating, and accountability.

In the past, I have worked with a dietician (who helped somewhat with satiety but was unwilling to help with boredom/stress eating or accountability) and a fitness trainer (who helped with accountability but was not able to help with the other two). I have had some success in the past with intermittent fasting and extended fasting (up to 48 hours), but my dietician was very opposed to both of those methods and insisted on small daily calorie deficits even though I struggled with adherence.

I have also had issues with satiety swings (an eating plan worked great for 1-2 months and then suddenly left me ravenously hungry). My normal doctor didn't see anything amiss in my bloodwork (normal thyroid levels etc), but I have not had more extensive food or hormone testing. If there is a professional who can also offer those things, those could potentially be useful.

What kind of professional should I be searching for?

posted by philosophygeek to Health & Fitness (6 answers total)

If you haven't tried the latest generation of weight loss medications - Wegovy (the same active ingredient as diabetes medication Ozempic) and very recently Zepbound (the same active ingredient as diabetes medication Mounjaro) - they may be the next step. They have been proven to be surprisingly effective for many and can be prescribed by your existing PCP. The primary issue at play is cost, as these are expensive medications, and so your weight, existing health conditions and insurance coverage would be the major question here. I personally have had very good experiences with Mounjaro and control of satiety.
posted by I EAT TAPAS at 3:02 PM on November 9, 2023 [3 favorites]

I don't think anything you've described is outside the norm for people who are looking to lose weight. If you eat at a deficit for an extended period of time (whether that is achieved through fasting or through small daily deficits), or deny yourself specific foods, it's not unusual to suddenly have the body crave those things. It's part of what makes sustaining weight loss so challenging for many people.

A good dietitian should help with things like offering strategies for boredom and stress eating; it may be that you just need a different one.
posted by synecdoche at 5:30 PM on November 9, 2023

I do not know how much you need to lose or if you have other medical issues, but talk to your primary care doctor. Mine was able to recommend a medical program which my insurance is paying for. It is a one year hospital and community based program for people who are at risk for diabetes due to weight and their A1C. The one hour a week class covers everything from nutrition, activity, sleep, portion size, substitutions, handling eating out etc. It is a group of about 15-20 people in the class and is very supportive and non-judgemental. Everyone is losing weight - at different rates but the idea is to really make life-style changes slowly so you can stick to it. I think many people need something that is supportive and also holds them accountable to make real changes.
posted by maxg94 at 5:33 PM on November 9, 2023 [2 favorites]

A relative has been going to an obesity clinic (I believe it is called medical weight loss & management). This is a clinic led by a board certified obesity medicine physician affiliated with our big local hospital system (so fully endorsed by/a part of the prevailing medical model and eligible to get reimbursed by insurance). It is also is a multidisciplinary practice so in addition to prescribing the GLP-1 inhibitors mentioned above, they have a dietician and counselor on staff and entry into the program required both meetings with the dietitian and the counselor/therapist.

If there's something similar in your area that would be my first stop. Skip clinics focused on bariatric surgery.
posted by jeoc at 6:52 PM on November 9, 2023 [1 favorite]

If you want weight loss results that are statistically likely to be successful and sustained over time, your option is to pursue weight loss surgery. You could also consider using one of the new injectable weight loss drugs and plan to stay on it long-term. (No judgment. I’m on medication I plan to take for the rest of my life.) If you want weight loss results that will most likely, based on decades of research, be successful for a time and then lead to weight gain, choose any other intentional weight loss intervention, program, or practitioner. I’m not trying to troll you. I pursued weight loss off and on for years: dieting on my own, dieting with a weight loss program, following a personal trainer’s diet and exercise plan, and dieting under the supervision of an RD. I succeeded at losing weight (15-50lbs) every time… until I eventually got to the part of the cycle where I plateaued, got injured, went through a stressful time, or otherwise became unable to sustain the plan and gained back everything I lost and then some. And every time, as my weight went up, I figured I just needed more discipline and a different program to follow. But it turns out finding the right provider or program is like finding the “right” slot machine at a casino. The most likely outcome of a non-surgical weight loss plan is weight gain, just like the most likely outcome of playing the slots is losing your money. If you feel out of control with your eating, a weight-neutral RD who works on intuitive eating could be really helpful for developing a healthier and more peaceful relationship with food.
posted by theotherdurassister at 12:07 AM on November 10, 2023 [3 favorites]

This is such a tough one. I once was able to find such a person through my employer's wellness program. I think her official title was "Health and Wellness Educator" but that is such a vague sounding title I don't know what it would be elsewhere. Basically she coached me through all the things you are talking about. Not just what to eat, but why certain eating patterns were hard and what I could do about that. How I could fit exercise into my day, given work/parenting. I wish I still had access to such a service, because it was incredibly helpful.
posted by EllaEm at 8:03 PM on November 12, 2023