Frequently Asked Questions
How is your clinic different from the other weight loss clinics?
We are focused on understanding all aspects of your health—medical conditions, medications, stressors, emotional/coping skills including your approach to life and the ways in which they contribute to your weight condition. Working in a team we assess and address each aspect to help you make sustainable realistic change. We know weight loss is difficult. Dr. Rubino works closely with you (and your primary care doctor) to optimize treatment of the conditions associated with weight loss that may be impeding your weight loss efforts. Obesity is associated with many conditions: diabetes, heart disease, high blood pressure, sleep apnea and other sleep disorders, high cholesterol, esophageal reflux, cancer, PCOS, depression, osteoarthritis, back pain, limited mobility, etc. Many of these conditions are aggravated by being overweight but improve with weight loss. Sometimes the treatment of these co-morbidities can interfere with weight loss directly (e.g., medications for type 2 diabetes) or needs to be optimized (e.g., sleep disorders or pain) to improve one’s energy/quality of life, indirectly helping you make behavioral changes needed for weight loss.
The weight loss plan is individually developed and can be as intensive as a full comprehensive plan with weekly visits or a supporting a plan with monthly visits. Some people decide to jump-start a program by using meal replacements for 4-8 weeks and then work with food. A full range of services is available to you and works best when adapted to your lifestyle.
Each member of our professional staff has graduate level education and extensive experience. We work closely with you and spend the time it takes to provide good care, support and education to equip you for managing your weight and associated medical conditions. This is not a canned program where you are treated like a number; handed meal replacements, a diet and a bucket of pills.
How much weight should I expect to lose?
Every individual is different, and the amount and rate of weight loss depends on many factors. Please see the Results section for more.
What if I start a program in the comprehensive plan and then don’t like it?
Occasionally a patient will start one approach and then decide to switch—this is not a problem. It is important to find a plan with a structure that is doable for you.
Why would I choose to use meal replacements?
In the comprehensive program, many of our patients start with full or partial meal replacements to help structure their meal plan gradually adding more food as they lose weight and feel in more control.
But I like food; do I have to use meal replacements?
No—we really encourage working with food and our dietician staff will work closely with you to develop a plan that works for you whether you cook, or eat out. Our goal is to help you have a healthy relationship with food.
But I don’t have time to do a full comprehensive plan?
You don’t have to. We have many patients who come in monthly and work with a staff member of their choice. We are very flexible and want to help you find the approach that works best for you.
Can I get an endocrine evaluation?
Absolutely, we address commonly associated endocrine problems—insulin resistance, type 2 diabetes, polycystic ovarian disease, hypertension, hypercholesterolemia and hypogonadism. If there is a concern that there is another underlying endocrine issue, it can be evaluated in our clinic or referred back to your physician. Rarely, other adrenal or pituitary diseases can contribute to weight and are addressed appropriately.
Do you use thyroid hormone for weight loss?
No, it is not medically advisable to treat weight with thyroid hormone. If you have a true thyroid disorder, it will be addressed with evidence-based medicine as appropriate. We often see patients who have been inappropriately treated with thyroid hormone resulting in fatigue, continuing that is of risk to bones and heart. If so identified, we recommend correcting that situation.
Do you give B12 shots?
I do not prescribe B12 for weight loss. There is no scientific evidence that B12 injections result in weight loss. Many patients after gastric bypass require B12 injections due to malabsorption issues and I will prescribe B12 injections for these patients as appropriate.
Do you use hCG for weight loss?
No, I do not. Scientific research studies show that hCG injections are not an effective therapy for weight loss. Hormones have powerful complex effects on human physiology. As an endocrinologist, I would not inject hormones without scientific evidence for efficacy and safety.
What do I do when I hit a plateau?
Weight plateaus (periods of time in which weight loss seems to stop or slows) are common. No one loses weight in a continuous steady pattern. Our experience is that from time to time weight will hover within a range of 1-2 pounds then drop again after several weeks. If one continues the behavioral changes, often clothes are getting looser despite the resistance on the scale. We typically reassess all aspects that can be contributing to resistance to weight loss and determine what can be altered in the plan. If someone is really struggling with hunger or craving, we may discuss the use of anti-obesity medication to help him or her move forward.
How do I recognize success when the scale is not changing?
It is also important to appreciate all of the changes that are happening and look for success in areas such as improved mobility, decreased pain and shortness of breath, improved reflux symptoms, improved blood sugar, etc., as well as altered changes in managing food, increased activity and bettered coping skills. It ultimately is the behavioral changes in response to the environment rather than the measurement on the scale that determines success. The scale is helpful in that it is a reminder to stay focused but it should not undermine all of your other efforts and deter you from pursuing your goals. We work with you to develop long-term goals and recognize multiple measures of success as you work toward sustainable weight loss.
What is Dr. Rubino’s philosophy around the use of anti-obesity medication?
The normal physiologic regulation of the body tends to protect weight and impede weight loss. The new anti-obesity medications are targeted to areas of the brain and gastrointestinal tract involved in this regulation. Use of anti-obesity medications can help a person with cravings, hunger and drive to eat more. Medications work optimally when making the behavioral changes necessary to lose weight and keep it off-- exercise, choosing healthy foods and portions, managing emotional eating and may be used as a temporary intervention or chronically. Weight gain can often be a vicious cycle and medications can help break this cycle and allow the behavioral changes that you have been working on be more effective. That being said, there are some patients who do not need obesity medication to lose weight but they use it during maintenance when the increase in craving and hunger can be difficult to manage and the risk for regain is high.
What medications does Dr. Rubino use?
She prescribes FDA-approved medications and a few medications off-label. She assesses what medications may be most suitable for a given individual weighing potential side effects with chronic medical conditions and other medications you may be currently using and discusses the options with you. She has more than 18 years of experience with the use of these medications since she has been a clinical investigator for the pharmaceutical companies involved in the development of the drugs recently approved by the FDA.
Why do you recommend an extended maintenance phase?
All of the evidence shows that maintenance is difficult and that the most successful weight loss is associated with a continued persistent structured life approach with strong coping skills. For many, this takes considerable time and support to integrate these changes into one’s life. In addition, the body fights the weight loss with strong hormonal signals that convey hunger, lack of satiety and increased desire to eat in an effort to push your body back to the previous weight. We recommend a maintenance period for at least one year after weight loss. Many of our patients continue to touch base with us quarterly or annually to continue to reinforce these changes.
What do I do if I haven’t lost all the weight I wanted to?
We know that not everyone loses the amount of weight they hope to lose and/or they experience periods where personal circumstances prevent further weight loss. This might be a time to consider switching to sustaining the weight lost and work on consolidating patterns and habits. Future weight loss can be initiated when personal circumstances shift or renewed motivation occurs. A good realistic assessment of what is sustainable in the context of one’s environment is critical here.
I have lost weight many times but always regain--when am I at risk for weight regain?
Clinical experience shows that there are susceptible times for weight re-gain - between years 1-2 of maintenance; during periods of intense or chronic stress and life change; after injuries/illnesses that alter ability to sustain activity/exercise level; changes in routine due to job change, retirement, or life transition. These susceptible times can lead to vulnerability in what may have previously been a sustainable maintenance plan. Over time one can become fatigued by the diligence necessary to keep focused and become distracted by other factors in life. We are here to help you work through these challenging experiences. These do not represent your failure at weight maintenance, but rather part of the long-term issues inherent in keeping weight off. For most, this is a chronic problem requiring ongoing management.
What is the difference between medical weight loss reporting and surgical weight loss reporting?
It is important to understand that there are different ways of reporting weight loss. Surgical weight loss is often reported as the percent of weight lost compared to how much someone needed to lose. So if a person weighs 250 pounds and her optimal weight is 150, she is determined to be 100 pounds overweight. If she loses 50 of that 100 pounds that would be reported as 50% weight loss. Medical weight loss reports the same weight loss relative to her starting weight of 250 pounds, so for this same 250-pound patient who loses 50 pounds, this would be reported as 50/250 or a 20% weight loss
What if my schedule does not permit me to routinely make it to the Center?
We offer tele-health services, as appropriate. We can work together to ensure your support and guidance.
Are your services covered by insurance?
Payment is due at time of service. While we do not accept insurance as payment, we will gladly provide you with the documentation necessary for you to submit to your insurance company for reimbursement. Any reimbursement due will be sent from your insurance company directly to you.
Are you in-network? And how much should I expect to be reimbursed
We are not considered in-network with any insurance company. You will be reimbursed at the out-of-network rate provided to you through your insurance plan, assuming you have out-of-network benefits available to you.
Do you accept Medicare?
We are considered an Opt-Out practice with Medicare, meaning we are not allowed to submit claims to Medicare, and neither are our patients. Some Medicare patients have a private secondary insurance plan that allows them to submit claims from an Opt-Out physician practice, but many do not. To compensate for this inconvenience, we offer a 10% discount to Medicare patients on all provider visit and lab services fees.