Some Notes on the Center for Medical Weight Loss

Stephen Barrett, M.D.

In September 2009, a local newspaper ad headlined "Lose Weight. Never Find It Again" caught my attention. The body of the ad stated:

There's no more effective way to lose weight than with a physician directed program. Only a medical doctor can customize a plan based on your unique metabolism, hormonal disorders, medication, and other physical weight-loss issues. Find out why thousands are turning to The Center for Medical Weight Loss for fast, affordable, weight loss. Call to be connected with the center nearest you [1].

Because most overweight people have neither hormonal disorders nor a "unique" metabolism, and because no weight-control program can guarantee permanence, I decided to look closely at what the advertisers were offering. Here's what I found.

Background History

Be-Thin, Inc., which does business as The Center for Medical Weight Loss (CMWL), is a Delaware corporation headquartered in Tarrytown, New York. Various Web sites state that the company was founded in 2006 by Michael Kaplan, D.O. and now has over 250 franchised centers in the United States. Kaplan practices bariatrics under the name Long Island Weight Loss Institute.

In 2008, the California Department of Corporations reported that CMWL franchisees paid a set-up, training, and exclusivity fee of at least $14,995 in addition to a monthly membership fee of at least $495 and a monthly advertising and media contribution of at least $2,600. In August 2008, the California Corporations Commissioner ordered the company to stop offering or selling franchises within California unless and until it registered with the state to do so [2].

Another founder, Andrew L. Orlander, has served as Be-Thin's vice president for business development since January 2008. Orlander attended New York Chiropractic College from 1979 to 1983 [3] and became licensed in New York State in 1983. In 2001, he was charged with bilking insurance companies for more than $10 million in fake or inflated claims at a network of medical centers in New York State. Press reports indicate that Orlander ran the centers through a front company, paying a medical doctor several hundred thousand dollars a year to act as their owner, to circumvent a state law that bars chiropractors from owning medical practices. Orlander was also charged with laundering the proceeds and conspiring to help personal injury lawyers inflate their patients' claims to win higher awards in civil cases against insurers [4]. In 2002, Orlander pleaded guilty to one count each of mail fraud conspiracy and health fraud [5] and was ordered to serve 33 months in prison followed by three years of supervised release. He was also ordered to pay restitution of $2,389,229.00. He was released in June 2004, surrendered his chiropractic license in 2006, and paid the restitution in 2008. The medical doctor (Mark Greenbaum, M.D.) received a six-month prison sentence and surrendered his license in 2005.

Web Site Content

CMWL maintains two similarly formatted sites, one for doctors and one for patients.

The doctor site offers to generate 20-40 new patients per month who pay an average of $1,200 for their programs. Franchisees are offered basic training, monthly teleconferences, e-mail support, continuing education courses, and, marketing that drives new patients to their clinic. The program is open to doctors who are board-certified in any specialty and are in good standing with their licensing boards. Most participants do not operate "centers" but offer the program in addition to their regular practice. Most who mention the CMWL program on their Web site link to CMWL's patient site rather than describing the details themselves. Some don't mention it at all.

The patient site states that CMWL offers three basic plans:

The initial visit costs $19. The patient site contains "success stories," a clinic locator, and a tool for estimating expected 6-week weight loss for program participants. On January 18, 2010, there were nine success stories about people who lost from 28 to 245 (or 285) pounds. Some contain no time frame, making it impossible to tell when they participated in the program, how long it took to lose their weight, or whether they were able to keep it off. The biggest loss, identified as 245 on the main page but 285 pounds in the individual story page was reported by a 37-year old man who said he went from 505 pounds to 220 pounds in nine months. A disclaimer on the bottom of the page states that the nine results are "not typical."

The "expected" weight loss is obtained by entering one's age, height, weight, gender, and contact information into an interactive form. The results are expressed as a 10-pound range of loss, plus the caloric intake required to generate the loss. By filling out the form repeatedly I found that the "expected" loss for most people who are overweight (BMI 25-29) or moderately obese (BMI 30-35) ranged from 3 to 5 pounds per week, with the amount varying slightly with age and gender.

The site also claims that "99% of patients that follow the program lost weight," but an asterisk after this statement leads to the following statement:

Based on a stratified sample of 349 patients over a six-year period. Patients must have remained on the program for a minimum of 28 days and be monitored with at least two physician visits within first 31 days to be included in the study. A variety of nutritional meal replacements were used. 99% of the patients that followed the CMWL program, including a low calorie diet and individual counseling with CMWL physicians, from one month up to a year, weighed less at their last weigh-in than their starting weight.

If I understand correctly, CMWL's study looked at patients who followed its program for a month or more and were weighed the last time they were seen. However, what happened to them after that was not tabulated. In addition, the amount of lost weight was not disclosed. This strikes me as a very strange way to report on effectiveness.

In 1995, the Institute of Medicine (IOM) suggested that to facilitate comparisons, obesity management programs should tabulate:

The most important consideration in evaluating program effectiveness is whether the results last—as determined by a follow-up of at least 1-2 years.

In my opinion, CMWL's "99%" claim provides no information whatsoever about its program's effectiveness. I suspect that it is intended to suggest that the program is 99% effective. I have emailed a request for a copy of the study, but so far have received no response.

The Bottom Line

CMWL's advertising suggests that its program produces rapid and permanent weight loss. However, the information on it Web site provides no basis to judge whether its methods are effective or how they compare to other programs.

References

  1. Advertisement. Raleigh News & Observer, Sept 18, 2009.
  2. Desist and refrain order. California Dept. of Corporations, August 20, 2008.
  3. Andrew Orlander. Naymze Web site, accessed Jan 18, 2010.
  4. Worth R. Fraud charged at six clinics in Westchester and Rockland. New York Times, Jan 30, 2001.
  5. Thomas PR, editor. Weighing the Options: Criteria for Evaluating Weight-Management Programs. Washington, DC: National Academy Press, 1995.

This article was posted on January 21, 2010.

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