Weight Achievement and Intensive Treatment Program (Why WAIT)

Our 12-week program is successful because it covers weight management from all angles. We help patients with their weight loss goals by recommending:

• Adjustments to diabetes medications to help enhance weight reduction.
• A structured diet with regular food and meal replacements.
• Weekly learning sessions that cover Joslin Nutrition Guidelines.
• An individualized exercise plan that gradually increases from 20 to 30 minutes/day (3 to 4 times/week) to 45 to 60 minutes/day (6 times/week).

Through cognitive-behavioral intervention, one-on-one support, and group education, many of our patients see major results that help them manage their diabetes.

Group Education

Group learning sessions are conducted each week for the initial 12 weeks. Each session covers a different topic that is relevant to weight management and diabetes. They last for 60 minutes and are lead by the diabetologist, EP, RD, or psychologist on the team. Participants also receive handouts for future reference.

Cognitive Behavioral Intervention

Group behavioral support sessions are conducted during the initial 12 weeks of the program. A clinical psychologist leads each session, which incorporates key components of cognitive-behavioral therapy for weight loss already validated in other clinical trials. These components include:

• Self-monitoring of eating and exercise
• Behavioral goal setting
• Stimulus control techniques
• Cognitive restructuring
• Assertive communication skills
• Stress management
• Relapse prevention

Exercise Intervention

An exercise physiologist (EP) designs an individualized exercise plan for you, based on your health status and exercise capacity. The plan includes a balanced mix of aerobic exercise (cross and interval training), resistance exercise (circuit and superset training), and flexibility exercise (stretching).

The exercise plan includes a weekly 60-minute exercise session under the supervision of the EP. In addition, the EP gives each participant exercises to do independently at home throughout the week.

Our participants progress gradually during the 12 weeks until they reach the target of 60 minutes 6 days/week.

Dietary Intervention

The nutrition component of the Why WAIT program includes using meal replacement shakes for breakfast and lunch for the first few weeks, plus a selection from 17 dinner menus for the evening meal. We provide snack lists for use in between meals.

The menus and meal replacement shakes have a nutrient breakdown of about 40% carbohydrate, 30% fat, and 30% protein, according to the Joslin Nutrition Guidelines. Participants keep food records, which are evaluated each week by the registered dietician. At the six-week mark of the program, we give participants breakfast and lunch menus, which they may use in place of meal replacement shakes.

Intensive & Interactive Medication Adjustments

The Why WAIT program’s diabetologist will change or adjust diabetes medications to reduce or eliminate medications that might contribute to weight gain.

We try to prescribe medications that have little or no impact on body weight, or even those with proven weight-loss potential, as long as they are not contraindicated and are covered by medical insurance. Insulin therapy may be reduced during the program.

We provide all participants with a glucose meter and ask them to monitor blood glucose more frequently. Based on monitoring results, medications are adjusted weekly by a diabetes nurse practitioner and a certified diabetes educator.

Tested in Clinical Research and Proven Effective

The Why WAIT program has been tested in clinical research and has demonstrated many health benefits to overall health, including weight reduction in people with diabetes.

Participants have lost an average of 10 percent of their initial weight (an average of 23 to 24 pounds) and 3 1/2 inches from their waistlines. They have kept that weight off for at least six months of follow-up. The A1C measurements of participants have decreased by almost 10 percent, from an average of 7.26 percent to 6.37. Their lipid and kidney profiles have also shown statistically significant improvements. Changes like these reduce the likelihood of some of the long-term complications of diabetes.

• 10.3% (24 lbs) weight lost after 12 Weeks
• 8% average weight loss at Year 1
• 6.4% average weight loss at Year 5
• 6.9% average weight loss at year 10
• Waist circumference decreased by an average of 3.7 inches
• Together with significant improvement in A1C, lipid profile, blood pressure and reduction of medications. Several patients with newly diagnosed type 2 diabetes had partial or complete remission from diabetes after Why WAIT program.

You're eligible for the Why WAIT program if:

• Your BMI (body mass index) is between 27 and 50.
• You are cleared by your physician to exercise.

You're not eligible for the Why WAIT program if you:

• Are unable to exercise due to orthopedic, eye or cardiac limitations.
• Have abnormal kidney function (serum creatinine >1.5 mg/dL and/or severe microalbuminuria).
• Have an eating disorder or are under treatment for major mental illness.
• Are using steroids (cortisone or similar medications), have cancer, or other medical problems that the Why WAIT team decides would not be suitable for the program structure.

Before participating in Why WAIT, we require you to:

• Have exercise stress, if one was not performed within the last 2 years
• Get a dilated eye examination
• Pass an exercise capacity test called a 6-minutes walk test (performed at Joslin by the program’s exercise physiologist)

Before and after the program, we will also conduct the following tests:

• Fasting body composition using the bioelectrical impedance analysis (BIA) technique to evaluate your percentage body fat and fat-free mass
• Full metabolic evaluations
• Extra blood test to evaluate markers of inflammation, coagulation and vascular health
• Evaluations of quality of life by answering several questions

This program is designed to offer multidisciplinary services that complement regular diabetes care and are provided in a group format. All services in the Why WAIT program are recognized as reimbursable, but levels of payment are different based on your medical insurance requirements for authorizations and co-payments.

Out-of-pocket expenses are limited to the regular co-payment, insurance deductibles, and any balance after insurance, plus a non-refundable $250 administrative fee paid after acceptance into the program. We offer financial advice to all participants before enrolling in the program.