Heather Thomas speaking: In designing the correct meal plan with a patient you have to understand what is going on with their lifestyle. Is this someone who needs a break from food and would do better on a meal replacement plan with no decisions. There are a lot of patients that do best with that initial approach. 

Ethan Lazarus speaking: at CNC we do individualized food planning. There are lots of ways to structure this so we have different approaches. The nice thing about an individualized plan is that it empowers the patient and dietitian to do it in any way they are comfortable and without restricting any specific foods. Used for maintenance programs and specialized diets, specific health benefits, we can structure an exchange plan to lower cholesterol, not intended for aggressive weight loss. 

A step up is called an advanced program. This is skewed towards protein. It is increasingly clear that protein rich diets tend to be more effective for weight loss. Compared to exchange, higher in protein and lower in carbs and fats. Most problem foods are out of sight out of mind. But still encourage protein, vegetables, fruit, dairy, and can also use meal replacements. Typically we use this for 20-30 pounds of weight loss, but 50 pounds can be achieved especially with meal replacement. 

The most aggressive types of weight loss programs are the protein sparing modified fast or optifast. On a modified fast we use mostly meal replacement or mostly real food, versus optifast which is a full meal replacement using drinks, soups and bars. This is nice for a person that wants a break from food. Relies on stimuli narrowing – if not exposed to a lot of food cues, there is less hunger. Most people feel well, lose weight quickly and aren’t hungry. 

One tool usually won’t do the trick usually we need multiple tools, so we do combinations of treatments for example combine the food plan, partial meal replacement and a weight loss medication, a behavioral program and support visits, giving better results with losing weight and keeping it off.