Earlier today while driving home after finishing a few cases, I got a chance to talk to my good friend and colleague, Dr. Eva Lopez. During our conversation, we got on the topic of the many methods a patient may lose weight. Surgical weight loss is a great option for patients who have tried everything and to no extent found long-term success. But for patients who do not meet the standard BMI requirement for a surgical procedure (35 or more), a second clinical program – medical weight loss – is available. I asked Lopez if she could further elaborate on these programs and her own Be Well 365. Here's what she had to say:

Patients come to my clinic in Boerne for a variety of reasons. They need to lose weight, of course, but we haven't invented a silver bullet treatment just yet. The program I typically administer is really one where we find the right shoe size and go from there.

There are many different types of cases, but the most typical would be to first try dietary. Keeping a food journal and allowing me to review that journal helps me to serve as your coach and advocate in losing weight.

Lipotropic injections are actual injections of B12, which help improve the body's metabolism and aid in losing weight. For patients who have a tough time losing weight on a diet that includes regular journal entries, I extend the option to try a medically tested diet through Medifast. The diet is simple enough: There are shakes, brownies, cheese puffs and more surprisingly tasty options. Patients choose the meal they prefer, and we follow their progress from there. The results are amazing.

Working with a team of dedicated trainers, I also seek for patients to participate in regular physical activity. We offer and recommend metabolic testing, which determines how many calories you burn in a routine and at what heart rates they are burned so we can design the most productive routine. The trainers I work with are specialized in trauma and developing workout schedules for people with medical conditions and illnesses. These trainers have helped patients who are wheelchair-bound lose the weight that becomes harder to lose with these types of physical ailments.

Of the many factors contributing to obesity, we also welcome patients who may have had trouble losing weight because of stress, a busy lifestyle, depression or an illness. Having clinical supervision of your diet allows us to see how your current medications might be affecting your weight gain and how best to curb it. I've seen patients come off of insulin completely after a careful review of their dietary, physiological and psychological conditions.

It often surprises people, but weight loss has two spectrums. Teenagers do not always have the greatest grasp of how dieting and exercise may work, and some avoid food all together to stay small. Commercials and school cafeterias don't help by selling burgers and French fries. It's no wonder some seek starvation as a weight-loss method. By sitting down with them and talking about the correct ways to eat healthy, I've been able to make a difference in their lives that they can take with them after they finish high school.

I chose this as my profession partly because as a doctor, I had to counsel patients about losing weight; the only issue was I had the same problem, so it was like the pot calling the kettle black. I began a goal of making a lifetime commitment to being healthy, and through my own methods, I lost 118 pounds. That didn't slow me down either, because I began figure skating. In 2006, I competed in the Adult U.S. Figure Skating Nationals and received 6th place.

One day while I was sitting in my office, a nurse came up to me and gave me a mug with a bee on it. I asked what the bee was. She told me that bees are not aerodynamically capable of flying, but manage to fly anyway. She said that when she thought about me, she thought about how bees make the impossible happen.

Dr. Nilesh Patel is a fellowship-trained bariatric surgeon and is recognized as a Centers of Excellence Surgeon by the American Society of Metabolic Surgery and Bariatric Surgery. For more information, visit www.bypassdoc.com.

Dr. Eva Lopez is board certified in internal medicine. For more information, visit www.newbeginningsdietclinic.com.