Elementia

Our Program: F.A.Q.

Frequently Asked Questions

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What is a Bariatrician?

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What is obesity?

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What is a realistic expectation of my weight loss results?

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Why see a medical specialist for weight loss?

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What is the cost to me to complete your program?

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What tests do you include in your initial examination?

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How do you follow my progress?

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Why should I choose your program over others?

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Am I a candidate?

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Do you treat adolescents and children?

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What if I had bariatric surgery in the past?
 

What is a bariatrician?

A bariatrician is a licensed physician (Doctor of Medicine [MD] or Doctor of Osteopathy [DO]) who subspecializes in weight loss medicine. (The word bariatric stems from the Greek word barros, which translates as heavy or large.) Often people hear the word “bariatrics” and think of weight loss surgery. This is because weight loss surgery is done by bariatric surgeons. However, bariatricians provide non-surgical weight loss to patients (whether they have had weight loss surgery, are thinking about it, or have no desire for it.) Not all physicians who claim to be bariatricians have had appropriate training and board certification from the American Society of Bariatric Physicians (ASBP) and the American Board of Bariatric Medicine (ABBM). Appropriately trained Bariatricians, like Dr. Higgins (Formerly Swindler) and other physicians at MBL address the obese or overweight patient with a comprehensive program of nutrition, exercise, lifestyle changes and, when indicated, the prescription of appetite suppressants and other appropriate medications.

 While any licensed physician can offer a medical weight loss program to patients, members of the ASBP have been exposed, through an extensive continuing medical education program, to specialized knowledge, tools and techniques to enable them to design specialized medical weight loss programs tailored to the needs of individual patients and modify the programs, if needed, as the treatment progresses. ASBP members are uniquely equipped to treat overweight, obesity, and associated conditions.

A physician-supervised medical weight loss program may be the safest and wisest way to lose weight and maintain the loss. Overweight and obesity are frequently accompanied by other medical conditions, such as type 2 diabetes, hypertension, cancer, and others. A bariatric physician is trained to detect and treat these conditions, which might go undetected and untreated in a non-medical weight loss program.

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What is obesity?

It is now known that millions of American adults are overweight or obesity. It is now known by the American Medical Association, the Institute of Medicine, and physicians everywhere, that obesity is now regarded as a chronic medical disease with serious health implications caused by a complex set of factors. Recognized since 1985 as a chronic disease, obesity is the second leading cause of preventable death, exceeded only by cigarette smoking. Obesity has been established as a major risk factor for hypertension, cardiovascular disease, diabetes mellitus and some cancers in both men and women. Obesity affects 58 million people across the nation and its prevalence is increasing. Approximately one-third of adults are estimated to be obese. Obesity results from a complex interaction of genetic, behavioral and environmental factors causing an imbalance between energy intake and energy expenditure. According to the National Institutes of Health, an increase in body weight of 20 percent or more above desirable weight is the point at which excess weight becomes an established health hazard. Lower levels of excess weight can also constitute a health risk, particularly in the presence of other disorders like diabetes, hypertension and heart disease.

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What kind of weight loss results can I expect?

The question is fair, but to try and answer for every person is impossible. Have you noticed most weight loss advertisements that show pictures of a person that lost big pounds, then the small print says "results not typical"?

Medical Bariatrics America program developer Dr. Allen Rader, Dr. Higgins (Formerly Swindler)'s mentor, knows what his program typical losses have been. He also developed a bariatric computerized software medical record and has tracked weight loss of all patients making at least two visits to his clinics. He has presented the results in a series of lectures at local medical practices and at the National Weight Loss Physician programs.

As of June 30th 2010, 12,251 patients lost 112,323 pounds in their first month of the program.

First month results at MBA clinics from year 2000 - June 2010**

Weight # Pts # Pts 1 mo F/U # No Show Pts # WT GAIN otal wt loss 1 Mo. Avg. Loss (lbs) % pts  FU % pts lost wt Avg % BBW lost
>400 76 66 10 0 1301 19.7 87% 100% 4.90%
375 - 399 78 66 12 1 984 15.1 85% 98% 4.00%
350  - 374 109 98 11 2 1447 15.1 90% 98% 4.30%
325 - 349 228 200 28 6 2549 13.1 88% 97% 4.00%
300 - 324 450 388 62 8 5153 13.6 86% 98% 4.50%
275 - 299 854 744 110 23 8907 12.4 87% 97% 4.50%
250 - 274 1299 1120 179 40 12521 11.6 86% 96% 4.60%
225 - 249 1996 1771 225 52 18058 10.5 89% 97% 4.70%
200 - 224 2799 2454 346 64 22540 9.4 88% 97% 4.70%
175 - 199 3217 2808 410 84 22803 8.4 87% 97% 4.80%
150 - 174 2389 2076 312 90 13696 6.9 87% 96% 4.60%
<150 559 460 98 26 2365 5.4 82% 94% 3.90%
Totals: 14,054 12,251 1803 396 112,323 11.8 87% 97% 4.50%
 
**   # = “Number of”; pts = patients; F/U = followed-up; lbs = pounds, mo = month; avg = average; wt = weight; BBW = beginning body weight.

A physician-supervised medical weight loss program may be the safest and wisest way to lose weight and maintain the loss. Overweight and obesity are frequently accompanied by other medical conditions, such as type 2 diabetes, hypertension, cancer, and others. A bariatric physician is trained to detect and treat these conditions, which might go undetected and untreated in a non-medical weight loss program.

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Why see a medical specialist for weight loss?

A true medical weight loss specialist has done extra study, training, along with written and oral testing to become board certified in weight loss medicine. To become board certified, the National Board of Bariatric Medicine sends a previously board certified physician to the office to make sure the office is compliant with all of the American Society of Bariatric Physician guidelines appropriate charting, and is compliant with state drug enforcement agency laws. MBL is home to Lexington's ONLY board certified bariatrician.

Not only is Dr. Higgins (Formerly Swindler) a treatment specialist, she is also an instructor that teach other physicians in their weight loss medicine methods. She has trained numerous physicians in her office. Dr. Higgins (Formerly Swindler) is Lexington's premier bariatrician. She is WKYT's weightloss expert. Other entities that have had Dr. Higgins (Formerly Swindler) as a weightloss expert include: WLEX, HOT102, and 98.1. She has been the keynote speaker for many local, statewide, and national conferences. Dr. Higgins (Formerly Swindler) has taught bariatrics to physicians in residency, and soon will br the mentor for training bariatricians along the east coast. Dr. Higgins (Formerly Swindler) is of the seven bariatricians in the USA who sits on the American Board of Baratric Medicine and helps direct the future training of bariatricians. Local physicians are referring patients to their office, but an MD referral is not necessary.

Weight loss with a Bariatrician is a total program. She is double board certified in bariatrics and family practice. We want you to not only lose weight but to also maintain the loss. Therefore, not only are there individualized weight loss programs, but there are individualized weight maintenance programs as well. Bariatricians are experienced in helping overweight patients in the personal highs and lows during a weight loss program. They are familiar with in the road blocks to becoming successful in controlling the overweight and obesity disease process.

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What is the cost of your program?

Dr. Higgins (Formerly Swindler) wants to make her program available to everyone because she knows what weight loss can do for so many people on so many different budgets. MBL's electronic medical system can print out for patients a summary of the visit’s costs and diagnoses so that patients can submit this to their individual insurance plans for reimbursement. Many patients are surprised to learn how much of the costs can be tax deducted, too. Unfortunately, not all insurances reimburse for weight loss programs. This is why it is our goal to keep costs of a visit similar to a subspecialist’s co-pay and prescription co-pay.

The basic first visit at the office costs about $90. This includes:
· History and physical exam done by the Physician.
· Complete body composition analysis.
· Weight, measurements, and vital signs.
· A 45 minute physician presentation in a small group.
· One-on-one with the physician to discuss your individual plan after the presentation.
· Nutritional and possible medication instructions are included.

Blood tests are needed during the first visit to appropriately determine individual needs. They can be done through our MBL office for about $85, or recent labs done in the past 3 months can be brought in for review. These cost about $300 in most other labs. The lab tests needed include blood chemistries, liver functions, kidney functions, fasting cholesterol panel, CBC (complete blood count), and two thyroid blood tests.

An EKG may need to be obtained. This depends on your medical history, your physical exam and other factors. They are not done on everyone but only when indicated. Costing about $150 in most offices and more in the hospital, our physicians obtain and interpret the EKGs for $55.

Follow-up visits typically are monthly during active weight loss. Follow-up visits average about $70-$100 depending on if medications are needed and dispensed.  After completion of the active weight loss phase, patients are encouraged to enter our maintenance program. Hundreds of patients are active in our maintenance program. During this time, visits are spaced out to 2, 3, or 6 months apart depending on how the patient is doing. There is no added cost to the maintenance programs besides the regular visit cost.

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What tests do you include in your initial examination?

Physicians do only the blood tests and EKGs that are felt to be absolutely necessary for appropriate medical care based on the patient’s current medical history, current medications, and current medical diseases. There are multiple causes of overweight and obesity that may be identified in some screening labs.  Also, many consequences of overweight and obesity may cause abnormalities in blood testing. These must all be identified prior to beginning a weight loss program. By finding these and correcting these, patients are often able to do much better in their weight loss results.
 
Most biochemical causes of being overweight and obese are fairly common. These can usually be identified with some basic lab testing. However, a few causes of being overweight obesity are identified only with very unique and often very expensive lab testing. Many offices will do hundreds of dollars of blood testing on every patient to try to find the one patient with the very rare biochemical causes of obesity. This means in some offices patients spend hundreds of dollars on blood testing that wasn't necessary.
 
Dr. Higgins (Formerly Swindler) has chosen to do initial basic screening profiles on every patient, and then only do the more elaborate blood testing on patients that require it or who don't progress with weight loss as expected to find out if some other biochemical process is blocking the loss. This is always discussed with the patient in advance. Together, MBL physicians and the patient try to determine the least expensive way to obtain the labs.
 
Initial blood tests are done for about $85. These cost about $300 in most labs. The lab tests needed include blood chemistries, liver functions, kidney functions, fasting cholesterol panel, CBC (complete blood count), and two thyroid blood tests.

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Why should I choose your program over others?

Successful results Experience Scientific Knowledge
Professionalism Compassion Understanding
...all at prices that are affordable to almost everyone.

Successful Results and Experience

Medical Bariatrics of America, associated with Medical Bariatrics of Lexington, is now tracking over 15,000 patients that have been treated in the program. Bariatrak, the electronic medical record system used by MBL, was designed to track the specific needs of the bariatric patient as well as to follow patient results.  This program documents any changes done in the program and the result in patients’ success to help improve patient care and design the best treatment protocol for you. Results have been so successful that Dr. Higgins (Formerly Swindler) has been invited to train other physicians around the nation how to become successful weight loss physicians and how to appropriately follow their patients’ progress.

We know from our database tracking system that 97.7% of patients in this program lose significant weight (on average 9.3 lbs) in their first month. 78% of patients lose enough weight in just 3 months to reduce their long-term risk of diabetes by greater than 50%. Patients that lose weight in the program have improvements in their lipid profile (cholesterol and triglycerides) equal to or better than commonly used cholesterol medicines. Many patients are able to come off blood pressure, cholesterol, diabetic, antidepressive, heartburn, and other medications. Patients have now lost over 71,555 combined pounds in just their first month in our program, and over 210,000 pounds total. Numerous physicians, nurses, and other health care providers are patients in the program.

Professionalism

The American Society of Bariatric physicians has a set of 15 criteria “principles of excellence” that all bariatricians are encouraged to follow. These include always putting patients’ welfare above all, avoiding value judgments concerning a patient’s behavior, complying with all state and federal laws, providing adequate and truthful information to the patient about their disease, and cooperating fully with other physicians in providing medical care to every patient.

 Scientific Knowledge

As a specialist in weight loss medicine, Dr. Higgins (Formerly Swindler) has passed all written and oral examinations by the American Board of Bariatric Medicine along with site review to be board certified in bariatric medicine. The office is in compliance with all ASBP and DEA guidelines and laws. National Conferences are attended by Dr. Higgins (Formerly Swindler) and members of her staff twice a year to maintain current knowledge on advances in obesity.  Dr. Higgins (Formerly Swindler) has passed these same exams and has been a lecturer at the national conferences. She is constantly researching all new information on weight loss.  They work with other physicians to help maintain the best patient care possible. Dr. Higgins (Formerly Swindler) has spoken to numerous physicians throughout Kentucky on current weight loss practices and has truly become Lexington’s weight loss expert.

Compassion and Understanding

Upon a first visit to the clinic, Dr. Higgins (Formerly Swindler) shares how the disease of obesity has affected her and her family. She saw her grandfather die of heart disease and diabetes that could have been prevented with weight loss. She helped her father lose about 60lbs after realizing he was the oldest living male is his family as all others had died prematurely from heart disease. She also helped herself prior to entering the field of bariatrics to lose weight and to decrease her bad cholesterol from twice the normal amount (LDL of 197) to normal range (about 80). After years of training in family medicine and working in various emergency rooms treating chronic and acute obesity related diseases such as high blood pressure, diabetes, sleep apnea, high cholesterol, and heart disease, she realized how most of these conditions could have been cured or prevented if obesity was appropriately treated. She also saw how much weight loss training was lacking in the medical field along with necessary patient education time, forcing patients to rely on programs not supervised by physicians and using medications and herbs obtained illegally or over the internet without regard to their current medical history. Dr. Higgins (Formerly Swindler) has therefore made Bariatric medicine her passion, and it is her goal to uphold expertise in this field, promote and reflect a healthy lifestyle, and provide safe and effective weight loss and maintenance to all who desire to combat or prevent this disease. Her experiences have allowed her to be empathetic and understanding towards both the emotional and physical well-being of her patients.

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How do I track my progress?

Monitoring a patient active in a weight loss program is essential. The rate of weight loss, the amount of weight loss, vital signs, percent body fat and percent lean tissue, emotional stability, and biochemical health must all be considered as a patient is losing weight.

Dr. Higgins (Formerly Swindler) is a bariatrician (non-surigcal medical weight loss specialist) and is specifically trained to know how and when to follow up with patients.  Several programs are available.  Most patients are monitored monthly with visits in the office.  Sometimes a person needs more frequent visits for closer observation, training, and motivation.

The clinic maintains a confidential database and is tracking over 15,000 weight loss patients’ results. These results are broken into subsets based on initial patient weight, age, sex, and other factors. When a new patient is started into the program, the database results along with the new patient’s medical history, physical exam, and blood tests then helps Dr. Higgins (Formerly Swindler) to know how much weight loss to expect in the first month and beyond. If expected weight loss is not obtained, then she knows the questions to ask, tests that might be necessary and changes in medication that might help the patient achieve the expected weight loss.

Training patients for weight loss maintenance begins on the very first visit. Information from national weight loss conferences, experiences from patients, experiences from her mentor, Dr. Rader, the 2007 Bariatrician of the Year, subspecialty training done at The Cleveland Clinic Foundation, and information from the National Health-care Weight Loss Registry of 10,000 weight loss patients who have lost 30 or more pounds is used to help determine an appropriate maintenance plan for every patient.

Dr. Higgins (Formerly Swindler) establishes weight guidelines to help every patient be prepared for relapses in their weight.  All patients have a safety plan specific for their current weight and know when to return to the office.

Patients that fall out of the program for whatever reason are contacted by the office on a reasonable basis for encouragement in maintaining their weight loss or are invited to return to the office for additional bariatric care.

Patients that do not choose to stay active in the program have been contacted for information as to why they did not stay active in the program and information obtained from these questionnaires is used to improve the program. This can be proven because the percentage follow-up each year has steadily increased and the average weight loss in every weight category has improved throughout the years.

Medical Bariatrics of Lexington is committed to provide to all of its patients the most medically appropriate, safe, and effective weight loss and maintenance programs currently available.

For further questions, call us at (859) 263-SLIM (7546). We’d love to hear from you.

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Am I a candidate?

Whether you have thought of bariatric surgery in the past, have had bariatric surgery, or absolutely do not want to have surgery, MBL wants to talks to you about your individual needs. Dr. Higgins (Formerly Swindler) is not a surgeon so does not perform surgery, but rather treats people medically (similar to your primary physician) on a short term or long term basis. Dr. Higgins (Formerly Swindler) does have a very good working relationship with local bariatric surgeons who do refer patients prior to surgery, after surgery, and people who are not candidates for surgery. We will evaluate all patients on an individual basis and determine what parts of various programs for which each person is a candidate. As a general rule, we can evaluate patients between the ages of 13-65. All patients are a candidate to at least learn about nutritional and lifestyle changes that are appropriate for them. All patients will have their current medications reviewed to determine if any are potentially blocking weight loss. Some patients may be a candidate to use various medications to help with their weight loss along with their behavioral changes. Sometimes, after labwork has come back, some patients are found to have undiagnosed medical conditions that may be blocking their weight loss such as hypothyroidism (low thyroid), diabetes, Cushings syndrome or others. If any of these are found, not only do you need to know this, but your primary physician needs to know this as well so we both can monitor any disease processes. Again, although Dr. Higgins (Formerly Swindler) is a medical physician, (not a surgeon), she is a bariatric subspecialist that is trained to help patients lose and maintain weight whether they have had bariatric gastric surgery, the lap-band surgery, or they have no desire to have weight loss surgery.

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Do you treat adolescents and children?

Every patient situation is different; MBL works with children from age thirteen and up along with at least one of their parents. We feel it is vital to the success of the child that at least one parent attend the start-up class and be present during visits. Anyone under the age of 18 is required to have a signed consent form from a parent or guardian. Parents are encouraged to follow nutritional guidelines discussed in the office so as to be a role model for the child and to understand any challenges encountered.

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What if I had bariatric surgery in the past?

Although patients that have had surgery in the past often have special nutritional requirements depending on which surgery they have had, Dr. Higgins (Formerly Swindler) is trained in these special needs and encourages everyone to be followed not only periodically by their surgeon, but also by a medical bariatrician to help them maintain weight loss or to help loss any weight that was regained. Please see the “am I a candidate” link above for further explaination.

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