Clinical Program
The UCLA Medical Weight Management Program focuses on individualized dietary prescriptions based on lean body mass assessed by bioimpedance analysis (BIA). Typical meal plans included between 5-10 meal replacements/day and a total of between 500 and 1000 Calories per day designed to achieved a deficit of at least 500 Calories per day below maintenance calories. Most patients began the program with total meal replacement while some selected a modified plan with one whole food meal per day. Prescribed calories from meal replacements and food were based on calorie deficits below the resting metabolic rate estimated from lean body mass. Patients were prescribed dietary protein intakes match to the lean body mass at 1 gram per pound lean body mass per day leading to a total protein intake of approximately 2.2 grams of protein/kg body weight per day. Meal replacements from several suppliers utilized high quality protein combined with 40% carbohydrate vitamins and minerals. The proteins used included soy, pea, casein and whey proteins. After a period of time, many patients transitioned to a partial meal replacement program where four or five servings of meal replacements per day combined with a defined meal of about 300 calories of lean protein and non-starchy vegetables. After the first 2 weeks in the program, patients were encouraged to exercise for 30 min per day and to add resistance exercise.
Weights and vital signs were measured weekly. Laboratory tests including complete blood count, electrolytes, and a basic metabolic panel (Quest Diagnostics, San Juan Capistrano, CA) were also recorded at baseline and at 3-week intervals. The BIA to assess lean body mass was repeated every 6-8 weeks.
Exercise was recommended and encouraged in the physician and dietitian visits after the first two weeks in the program. Patient visits at the clinic also included consultations with physicians and dietitians. The program also included voluntary attendance at weekly group behavior change and group nutrition education classes.
The cost of the program varied from $50 to $65 per week depending on the level of dietary restriction and need for monitoring including meal replacement products. Insurance plans including private insurance and health savings accounts were typically used to cover the cost of the program in part. Payments were collected monthly in advance and were non-refundable unless there was prior notice for planned vacations or family emergencies. Laboratory tests, body composition analysis, and classes were included in the monthly program fee.