You see the doctors on TV, on billboards everywhere, in magazines. They're competing for patients not just with other doctors, but with celebrities like Valerie Bertinelli and Sarah Ferguson.
That's because these doctors are offering to help you lose weight.
In the past, people struggling with weight went to self-help programs or picked up a diet book. The biggest controversy was about which bestseller to buy — Atkins or South Beach, low-fat or low-carb. Despite the obvious connection between weight and health, few doctors dealt with obesity issues.
"Twenty years ago, if a patient wanted to lose weight, the doctor would just say, 'Push away from the table,' " said Dr. William Dudney, a Tampa psychiatrist who has focused on weight loss for more than 15 years, longer than most.
But as Americans have gotten heavier and some doctors' wallets lighter, all that has changed. Now one local doctor advertises himself as "your best medicine for weight loss." Another has patients doing TV commercials about the pounds they've dropped.
"It's amazing, the number of clinics that have opened up," Dudney said.
The number of doctors signed up to take a national test in September certifying them as weight loss experts has increased by half over last year, says the American Board of Bariatric Medicine.
Medical weight loss clinics can be pricey — they include an upfront fee and ongoing charges sometimes reaching $250 a month. But they are a hit with patients, and doctors say that generally, they can, in fact, help many patients lose weight. Some doctors argue they can do more for patients, helping them with underlying medical problems or psychological issues that have pushed them to overeat.
"For me, it's the discovery of knowing you have a support system," said Tampa resident Laurie Johnson, who has lost more than 50 pounds under a doctor's care.
Still, even some doctors say that some of the new clinics are motivated more by money — most weight loss programs aren't covered by insurance, so patients pay cash — than by concern about weight.
They worry about patients getting unnecessary medicine, supplements or going on extreme diets. And, in the end, there's always the question of how long the doctors' plans work.
"The problem here is that it's easy to set up a program to help people lose weight," said Dr. James O. Hill, one of the nation's best-known experts on weight control. "Physicians can put people on a diet. They can help people lose weight."
So far, so good? Hill, a Colorado scientist and co-founder of the National Weight Control Registry, says not so fast.
"The hard part is keeping it off," he said. "The question is, are doctors' programs any better at that? The answer is, I'm skeptical. Are these really programs that help, or are they taking your money?"
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To Lori McKelvy, it's an investment in her health.
"It's money well spent," said McKelvy, 41, of Dade City. "When you're heavier, you're depressed. … I wasn't feeling good. I was having reflux, achy joints, knee pains that I have never had."
Once a bodybuilder who weighed 97 pounds, McKelvy, who's a petite 5-1, gradually see-sawed up to 168.
Since going to see Dudney, McKelvy has lost 30 pounds over six months. She has 15 pounds to go and is confident about making her goal. She has overhauled her diet, stopped eating out and thrown out the junk food. She's taking an appetite suppressant prescribed by Dudney and meets with him once a month to talk about how things are going.
"I had tried numerous times and would gain it right back," McKelvy said. "I'd lose 10 or 15 pounds and gain that back plus five more."
She doesn't think she could have lost the weight without Dudney's help. She hasn't felt any side effects from the drug and said Dudney checked for potential health problems and other issues that might have contributed to weight gain, before she began.
"He doesn't just prescribe stuff and say, 'See you later,' " McKelvy said. "There's a lot more to it than just giving us medicine."
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Despite the myriad theories on the best way to lose weight, many Tampa Bay weight loss clinics bear certain similarities.
Doctors start with medicine: checking blood pressure, insulin, thyroid, hormone imbalances. Patients with certain health problems may get drugs or different diets. Many will get appetite suppressants and vitamins, often with injections. They get an eating plan and come in often, usually once a week.
Despite their popularity, there's no evidence that injections of vitamins or the hormone hCG — which women normally produce during pregnancy — work. And some doctors say that appetite suppressants — which include Adipex-P, Bontril, and Tenuate — shouldn't be used because they're stimulants that can raise blood pressure.
"There's no evidence that any of them work on any long-term basis," said Dr. Sidney Wolfe, health research director at Public Citizen. "As soon as you stop taking them, your weight goes back up, unless you've done other things."
Other doctors say the drugs can be effective, but caution they should be used carefully and strategically. They think some clinics give too many pills.
When her patients want drugs, she starts them on the lowest dose, said Dr. Lisa Saff Koche, Johnson's doctor.
"Patients are getting more and more educated," Koche said. "They know that drive-by high-dose appetite suppressants and very low-calorie diets are not sustainable for a way of living."
The medical workup is often most important to her patients, she said. They also change how they think about food.
"A lot of times people need accountability," she said. "They have questions and don't understand what to eat."
Dr. Cesar Lara, who has three Pinellas County weight loss clinics, said about 75 percent of his patients take appetite suppressants. Many also start on extremely low-calorie diets, ranging from 500 to 1,400 calories a day. "It's not a diet to live by," Lara cautioned. His program includes meetings about healthier eating habits.
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When Seminole resident DeDe Pollard decided to lose weight last year, she did it without such drugs.
"Are you going to take an injection for the rest of your life?" she said.
A doctor recommended a different option: Weight Watchers. Since then, she has lost 100 pounds and plans on 100 more.
"They're teaching me," she said. "It's the quantity and the choices I make."
Advocates for such programs say Pollard is proof that you don't need a doctor to lose weight.
Even Dr. Howard Eisenson, director of the Duke University Diet and Fitness Center, agreed. But he also said that doctors are finally realizing that they can be a part of making sweeping changes to patients' lifestyles.
"It's been a tough problem to get physicians energized about treating obesity, because for a long time they felt it was hopeless," he said. "The tide has definitely shifted. People are starting to appreciate that lifestyle is at the core of a successful effort."
Lisa Greene can be reached at firstname.lastname@example.org or (813) 226-3322.