Let's start with a simple but often overlooked question.

Why are you the weight you are?

  

The consensus for the last 25 years or so has been that we have a "set range" that the body wants us to be. That's why we are the weight we are. You can think of it as being like a dial in the back of your brain (near where other automatic, important, things like breathing, heart rate and body temperature are controlled).

 

The details of this are well understood now and involves a balance of 8 neurotransmitters within the brain, at least 8 hormones communicating between the brain and the gut, and input from the vagus nerve. Basically, it's very complicated with a lot of room for personal variation.

 

This target weight is programmed by a variety of things including genes (bigger parents tend to have bigger kids), what your grandmother ate in pregnancy, what your mother ate in pregnancy, what medications you've been on (a few frustratingly turn it up permanently - none turn it down permanently reliably yet unfortunately), how you're sleeping, certain viruses, a variety of environmental pollutants... none of which we can change because they happened in the past.

 

It also tends to drift up as we get older (at least until about 65yo), with different people drifting up at different rates.

Exercise tends to reduce this rate of age-related increase, but unfortunately isn't great for turning it back down in most people.

 

What this means practically is that if we overfeed someone today, the next day they won't be very hungry and their metabolism will go up to compensate until they come back to their "set range" (we call it a set range - not a set point - as we tend to wander around a target by a kilogram or so rather than sticking to an exact value). Similarly if we cut down on intake for a day (miss meals for some reason/dieting) we get hungrier and our metabolism slows as the body tries to get back to the weight it wants to be.

 

The further you get from the set range the more the body digs its heels in, with more hunger and a slower metabolism.

 

You can think of it like a spring, as the further you get away from the body's target the harder it gets.

 

Different people have different springs. Most people can lose about 5-8% of their body weight before the body really digs it's heels in and further loss gets very hard, but some people can lose 1% and be hungry, cranky and slow (a really tight spring), whilst others lose a lot without a lot of trouble  (a looser spring - these people tend to be the ones that end up on the advertisements for weight loss programs).

 

No matter which though, if we stop putting in the effort the spring pulls us back up to target (and tends to reset the set range just a little bit higher as a lot of people notice with yo-yo dieting).

Why is it this way? It just is and we need to deal with it. (and getting into it would be a much longer talk).

 

So what does this mean? Dieting (and to a lesser degree exercise) can work really well for some people - but for most of us 5% isn't the goal.

At the other end of the spectrum there're the surgeries, which have been around for over 50 years now and have come a long way, with results now ranging from pretty good to life-changing for most people. But there are issues with (relatively small but real) risks, cost and access.

 

In between we have medications.

 

There's a long history of weight loss medications going back over a century. Most of them have been pulled from the market due to side effects.

So about 20 years ago people asked if instead of using one medication at high dose, with the other hormones trying to balance it out, what about if we used 2 or 3 medications at low dose with the hope of them acting together at different places, but with less side effects. So various researchers, and then doctors, tried various combinations of the old, well established and understood, medications to see what could be achieved.

 

Until about 5 years ago the best of these combinations resulted in about 10% weight loss (one in 18 people would have a lot more, and for about 1 in 20 they just didn't work very well). Since then we have new medications that have re-written the scene and better ones seem to be on the way over the next few years. Combining these new ones with some of the older ones, weight loss in excess of 20% is not unreasonable to expect with no or tolerable side effects for 19 out of 20 people.

 

This can have huge benefits on a large variety of medical conditions as well as overall quality of life.

 

 

As this is currently a pilot program we will only be accepting 10 patients a day whilst we work out the kinks. If unsuccessful today - please consider applying again tomorrow.