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.