Soon
after starting to see
heart patients at the
Wellness Centers it became
obvious that many of them
had weight and insulin
related problems. Another
area of interest and expertise
is in the area of weight
control. Dr. Vagnini is
a Fellow in the American
Society of Bariatric Physicians,
this is a society of physicians
with a special interest
and dedication to patients
with weight related problems.
The following is the protocol
for weight control at
the Wellness Centers.
| I. |
A
Initial History and
Physical is performed |
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*Electrocardiogram
*Blood Chemistries
including: |
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Lipid
Profile
Female/Male Hormonal
Profile
Growth Hormone
Fasting Plasma Glucose
Ferritin
Homocysteine
Fibrinogen
Thyroid |
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*Urinanalysis |
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Protein
Ketones |
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*Physical
Examination |
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Special
attention to circulatory
system
Blood Pressure determined
Ophthalmoscopic examination
Thyroid palpation
Abdominal examination
Foot examination
Evaluation of pulses
(palpation)
Hand/Finger examination
Skin examination
Height and Weight |
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|
*Body
Mass Index Evaluation
*Body Composition
Measurements
*Glucose Tolerance
Test with Insulin
Levels |
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| II. |
Recommendation
of a Cardiac Evaluation |
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*Evaluation
of Valvular Status
*Stress Echo Cardiography
*Echocardiogram
*High Resolution Multi-Site
Imaging |
| |
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|
Carotid
arteries
Aorta
Femoral arteries
Abdominal |
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| III. |
Individual
Meeting with the Doctor
and the Certified
Nutritionist |
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*Evaluation
of the clinical studies
and the laboratory
chemistries performed
*Evaluate for insulin
resistance
*Review of eating
patterns, nutritional
status and weight
history
*Evaluate for carbohydrate
addiction
*Review of exercise
history
*Medical Management
Program developed |
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| IV. |
The
Program |
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*Develop
a Weight Reduction
Profile |
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|
Emphasis
on a realistic weight
loss |
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*Establish
an Eating Program
with emphasis on: |
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|
Insulin
regulation
Moderate Complex Carbohydrate
Low Concentrated Sweets
Moderate Animal Protein
(adjusted for individual
history)
Incorporation of Soy
Protein
Low Saturated Fat
High Fiber
Moderate to High Clear
Fluid |
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*Establish
a tailored exercise
program |
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|
|
Utilization
of aerobic activity
combined with weight
resistance training |
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*Normalization
of Blood Lipids
*Normalization of
Hypertension
*Introduction of an
individual Smoking
Cessation protocol |
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| V. |
Establish
Individual Patient
Oriented Dietary Goals |
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*Behavior
Modification |
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Food
logs when indicated |
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*Introduction
of Short and Long
term Goals |
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| VI. |
Incorporate
Appropriate Vitamin
and Mineral and Herb
Therapy with Metabolically
enhancing nutrients.
The emphasis will
be on: |
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|
*Detoxification
*Controlling Glucose
and Insulin Levels
*Prevention of Food
Cravings
*Increasing energy
level
*Enhancing the metabolism;
facilitating fat burning |
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| VII. |
Introduce
Pharmacological Therapy
to assist with weight
reduction when deemed
necessary |
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*Appetite
suppressants |
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| VIII. |
Referral
for Surgical Intervention
For Obesity when appropriate |
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| IX. |
Review
of Management Plan |
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*Evaluate
each visit |
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|
Weight
Short and Long Term
Goals
Medications
Complications
Control of Dyslipidemia
Blood Pressure
Nutrition Program
Exercise Program |
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