Weight Loss

Dr Fatoki acquired his bariatric practice in May 2007 after resigning his position as the Medical Director at Health Professionals Limited. Dr Fatoki obtained further training in the practice of Bariatrics through the American Society of Bariatric physicians (ASBP). The American Society of Bariatric Physicians (ASBP) is a national medical specialty society of physicians who offer comprehensive programs in the medical treatment of overweight, obesity and associated conditions. Established in 1950, ASBP establishes and maintains bariatric practice guidelines and sponsors accredited continuing medical education programs for physicians and others to encourage excellence in the practice of bariatric medicine.

Dr Fatoki has been board certified in Family Medicine since 1993 and is currently in the process of completing his board certification requirements in Bariatric Medicine.

Dr Fatoki’s interest in Bariatrics evolved from his frustration with his inability to achieve weight loss or adequate blood glucose control in his diabetic and obese patients through traditional approaches. In spite of the current medical and government recommendations, Americans continue to develop obesity and other chronic illnesses like heart disease, diabetes, gastric reflux and heart disease at an alarming rate. Dr Fatoki has struggled with his own weight and gastro esophageal reflux for many years. He tried different diets, exercise and medications but was unable to achieve or maintain his goal weight. He plateaued after losing weight on the Atkins diet a few years ago. The search for an alternative and a new approach led Dr Fatoki to the ASBP. His program, though based on the Bariatric Practice Guidelines, offers his own unique approach to the treatment of obesity and its associated conditions.

He was able to accomplish and maintain his goal weight based on the program he developed.

Bariatric program

The program was developed with the patient in mind. We tailor the program to each individual patient and do not sell any expensive meal replacements. Our program is affordable and costs less than most commercial programs.

My goal is to help you lose the weight and keep it off.

80% of the weight people lose is based on their eating habits and food choices. With this in mind, I target the patient’s eating habits, lifestyle and physical activity from the first day in the program.

I do not advocate or prescribe a diet because people who go on a diet tend to gain the weight back once they go off the diet. As an analogy, losing weight on a diet is like preparing for a big test. After putting everything on hold to prepare for an exam, most people go out to celebrate and go back to everything they had put on hold. Most people who lose weight on a diet tend to behave the same way. They go out to celebrate and right back to their old eating habits until they gain all the weight back. Also, as individuals, we have different food choices. My diet and eating habits may not be suitable for another individual. With this in mind, I do not prescribe diets or meal plans which most people cannot maintain on the long run. Instead, I recommend a reduced carbohydrate diet that is specific to your eating habits, food likes and dislikes. When people are deprived from eating what they like, they tend to crave and overeat when they have access to those foods.
The key to losing the weight and maintaining it is to pay attention to what you eat. I still eat fast foods like McDonald’s, Wendy’s etc. but I am smarter with my choices and how often I eat there. I read my food labels very carefully. In fact, I spend a significant amount of time reading food labels.

Our philosophy is that obesity is a chronic illness and needs to be managed as such. Just like asthma, diabetes and hypertension, obesity is not curable, is influenced by behavior, has a hereditary component and can be managed appropriately with an effective combination of medications, exercise and lifestyle changes.

Prior to beginning treatment, each patient is scheduled for a comprehensive history and physical exam. A body mass analysis, diagnostic testing (including laboratory work and possibly EKG) are obtained to rule out any medical or co-morbid conditions. Medications are prescribed according to the Bariatric Practice and Anorectic usage guidelines developed by the ASBP.

What to expect

Initial visit:

You should expect to spend at least 1 hour during this visit. When you arrive in the office, you will be given some paper work and consents to sign. Some of these forms can be downloaded from our website and completed prior to the visit. In addition, a baseline photograph, diagnostic testing and body mass analysis will be performed by one of Dr Fatoki’s assistants. You can have your diagnostic tests done by your regular physician and bring them with you to your appointment. Tests cannot be older than 3 months to be acceptable.

Once this initial step is completed, you will be seen in the consultation room by Dr Fatoki. The physician will review your history form and obtain more history or clarify your responses as indicated. Next, a physical examination will be performed. (This does not include breast, pelvic or rectal).

The printout of your body mass analysis will be discussed with you in detail. A nutritional recommendation is made based on your eating habits. Lifestyle modifications and exercise are recommended based on your individual situation and habits. Medication and supplement regimens are also individualized to the patient. Exercise recommendations are made at this visit. Research has shown that people who lose weight and maintain exercise about 30 minutes five days a week. We start working towards this goal from the very first visit.

Follow up visits:

Weight Loss phase

Patients are usually seen for the first follow up visit 2 weeks after the initial visit. After that, patients are seen every 4 weeks. During the follow visits, your vital signs and weight will be obtained. You will also consult with Dr Fatoki who will make changes to your regimen as needed.

The amount of weight loss varies per individual patient and how well you follow the recommended nutritional and lifestyle changes. The weight loss is better than what is accomplished by non physician supervised commercial programs.

You will be seen every 4 weeks until you reach your goal weight.

Maintenance Phase:

Once you attain your goal weight, you will be transitioned to the maintenance phase. You will be weaned off the weight loss pills but continued on supplements and other medications as needed. Follow up visits will be gradually extended to every 3 months. During maintenance, you should continue to weigh yourself regularly, exercise and continue with the life style changes which you have made. It is important that you maintain your eating habits as stressed during the weight loss phase.

Since obesity is a chronic disease that cannot be cured, there may be some weight regain. If this occurs, we can restart the weight loss medications just as I would for a diabetic whose blood sugar becomes uncontrolled or an asthmatic that is starting to have more attacks. During maintenance, weight loss medications can also be restarted during high stress periods or around the holidays for patients who tend to gain weight around those times. Again, the treatment is tailored to your individual needs and situation.
You will be scheduled for monthly follow up visits while on weight loss pills.

I recommend that you return to the office after gaining 5 or more pounds which you are unable to lose on your own.

Frequently asked questions (FAQs)

How can I join the program?

Call or send an e mail to the location that is convenient for you. You can fill out the contact form on line and someone will contact you to schedule an appointment by the next business day or the time you specify.

Why should I join your program?

My program is proven. It has worked for me and many other patients. It is based on scientifically proven methods and the latest medical information from obesity research. I am a Family physician who is a member of the ASBP (*link to ASBP.org*). I follow the Bariatric guidelines and attend regularly sponsored activities by the ASBP. Your weight loss is supervised by a qualified physician who can assess all your medical issues.

Can I continue to see my regular physician or healthcare provider?

Yes. In fact, I encourage it. I will see you as a weight loss specialist. I function as a consult like a cardiologist, etc. I will address issues you may have that relate to obesity and its co-morbidities. You need to see your regular physician for your routine health maintenance and management of other chronic illnesses for which you are being treated. I will communicate with your referring physician regularly so they know what recommendations and medications I recommend.

Can I continue to take my other medications?

I will review any other medications and check for interactions with any medications that I prescribe. I look at your “whole medical picture” before devising a treatment plan for you.

How much does your program cost?

The fee is affordable but varies. I try to work with you to make the program available to as many people as possible. You can obtain your diagnostic tests from your primary care provider and bring them in.

Does insurance cover your program?

In some cases, yes. If you have medical problems related to your obesity which I am managing, the cost may be covered by your insurance. We will bill the insurance for you but you are still responsible for the cost of the treatment if it s not covered by your insurance. If you have no met your deductible, you will be expected to pay for the visit at the time you are seen.

What type of insurance do you accept?

We accept PPO, Medicare and self pay. We do not accept Medicaid or HMO.

How is your bariatric program different from what is offered by my regular physician?

I have obtained extensive training in obesity and its related disorders meaning I am better qualified to treat obesity just like a cardiologist is better qualified to treat heart disease in some cases. I treat patients who have been unsuccessful in the treatment recommended by their primary care provider. I also serve as a consultant to physicians who need someone with more experience to manage their patients with obesity related disorders.

How much weight can I expect to lose in the first month?

Most of my patients lose an average of 5 pounds or more within the first 2-4 weeks if they follow the program. Depending on what combination of medications and supplements you are on along with exercise and your eating habits, you may lose significantly more. The weight loss is probably less than you would get with a fad diet because my goal is a gradual and steady weight loss which you can maintain without feeling deprived.

Do you use recommend meal replacements or low calorie diets?

I generally don’t but if that is what works for you, I will work with it. From my experience, I have found that those are difficult to maintain. No one is going to eat protein bars or milk shakes as a meal for the rest of their life. My philosophy is to get you used to making better food choices from what is available in your local grocery store. Moreover, many of those bars, shakes and packaged foods are not as healthy as you may think.

I have tried a low fat diet but I am unable to lose weight. Why is that so?

I could not lose or maintain weight loss on a low fat diet either. That is why I became a bariatrician to explore alternatives. As a bariatrician, I am better able to help you because of my training and the many resources available to me.

Do you use Phentermine and is it safe?

Yes. I use Phentermine and it is safe. The problem with “Fen-Phen” was with Fenfluramine, another drug that was combined with Phentermine. Fenfluramine was taken off the market but Phentermine has always been available. It has been available since the 1950s and is the most cost effective medication available for weight management. It needs to be prescribed and managed by a Bariatician who is adequately trained to manage the disease of obesity.

What are your criteria for starting weight loss medication?

I follow the ASBP anorectic usage guidelines.

There are no universally accepted minimum criteria for appropriate usage of anorectic agents. The scientific and medical community is well aware that there are multiple factors contributing to obesity, as well as several physiologic parameters which have been shown to contribute to increased health risks [morbidity and mortality]. Such parameters may include ideal body weight (Metropolitan tables), body mass index (BMI), percent body fat, visceral fat distribution, waist circumference, and/or waist-to-hip ratio. These should be taken into account by the bariatrician and patient considering anorexiant therapy.
The ASBP recognizes that there are several acceptable anorectic agent usage criteria for patients including (but not limited to) at least one of the following parameters:

•BMI ? 30.0 in a normal, otherwise healthy individual
• BMI ? 27.0 in an individual with associated co morbidities [e.g. type II diabetes, hypertension, abnormal glucose tolerance, atherosclerosis, cardiovascular disease, stroke, hyperlipidemia, hypercholesterolemia, osteoarthritis, gall bladder disease, breast cancer, or sleep apnea]
• Current body weight ? 120% of a well documented, long-standing, healthy weight that the patient maintained after age 18
• Body Fat ? 30% in females
• Body Fat ? 25% in males
• Waist-hip ratio or waist circumference such that the individual is known to be at increased cardiovascular and/or co-morbidity risk due to abdominal visceral fat
• Presence of a co morbid condition or conditions aggravated by the patient’s excessive adiposity
Their use may also be appropriate in a number of other situations including (but not limited to): Prevention of regain in a person who has lost weight, occupational needs for maintaining a low body weight, prevention of weight gain in patients with a familial/genetic predisposition to associated co morbidities. It is recognized that BMI’s may appear high in athletic individuals who are not obese and low in individuals with a low lean body mass (sarcopenia). Therefore, BMI as a criterion is of limited value without clinical correlation. (ASBP, anorectic usage guidelines.)

Can I become addicted to the weight loss pills?

The probability of psychological dependence is low when anorectics are used in medical weight reduction and maintenance programs appropriately supervised by bariatricians. (ASBP, anorectic usage guidelines.)

Can I use diet bills if I have a medical problem like diabetes, hypertension or high cholesterol?

Certain medical problems often associated with obesity such as diabetes, hypertension and most serum lipid abnormalities usually respond favorably to weight loss. The anorectics (weight loss medications) may be useful in helping patients with these conditions achieve meaningful weight loss. As noted by Albert Stunkard, M.D., Professor of Psychiatry, University of Pennsylvania, “There are strong positive indications for the long term use of appetite suppressants. Many obese, hypertensive and diabetic patients can control their conditions by weight loss. Unfortunately, however, many of them cannot lose weight by diet alone. As a result, they are forced to rely on long term use of medication to control their hypertension, diabetes, and other conditions. If these patients must receive long term medication, they may well be better off on appetite suppressants than on the usual remedies.” (ASBP, anorectic usage guidelines.)

I have depression. Can I still join your program?

The obese patient may be prone to depression. In such cases the anorectics may be helpful in the patient’s weight loss program, which in turn may help with the depressive state. Patients with significant depressive symptoms should be considered for antidepressant therapy. (ASBP, anorectic usage guidelines.)

How much weight do I need to lose to reduce my health risk?

The evidence is increasingly strong that significant health benefits may occur with a 5-10% weight loss that is maintained. In addition, helping patients avoid the tendency to gradually increase weight while getting older may, in and of itself, be a significant health benefit. Also, even a modest weight loss is frequently associated with an increased sense of self worth. (ASBP, anorectic usage guidelines.)