Note:  Permanent weight loss can never be accomplished without permanent lifestyle changes, and must be a part of any weight loss attempt.  The SHIELD MLC Weight Loss Program is a comprehensive, physician-supervised program that was developed by Dr. Cluff for those who have made their best effort but have been unsuccessful and need additional assistance.  It combines all the components of an effective long-term weight loss program (permanent and healthy lifestyle changes, one-on-one professional guidance, group support, education, accountability, and effective goal-setting) with an initial boost provided by a low-dose appetite suppressant, which is prescribed in a unique way that is healthful instead of being a potentially harmful short-term solution.  Together these elements launch and guide you down the path towards long-term weight loss success.

SHort-term, Intermittent, Early-afternoon, Low-Dose (Phentermine with) Mandatory Lifestyle Changes.  It is the use of low-dose phentermine (18.75 mg/day), given short-term (≤1 year), intermittently (every other month), in the early afternoon, and prescribed only as long as lifestyle changes are made and continued.  The SHIELD MLC approach utilizes phentermine in several beneficial ways, while “SHIELDing” you from its many potential downsides.  And, it ensures the highest chance of turning your weight loss efforts into long-term success. 

Phentermine is only FDA-approved for short-term use.  It is a potentially addicting stimulant medicine that has possible side effects of dry mouth, elevated blood pressure, insomnia, rapid heart rate, tremor, dizziness, irritability, headache, and stomach upset.  It is contraindicated in agitated states, high blood pressure, hyperthyroidism, glaucoma, significant heart disease, and a history of drug abuse.  However, although it is only used short-term, you will see that the benefits can last a lifetime. 

Phentermine loses its efficacy after a few weeks, can be habit-forming, and has potential side effects.  Intermittent (every other month) use largely overcomes these issues.  It also helps patients learn how to continue their lifestyle changes on their own between prescriptions, thus building self-sufficiency. 

Most patients struggle with their hunger during the last half of the day, far more than the first half.  The most damage to their waistline begins in the early afternoon.  Taking phentermine at that time assists patients in making better eating choices, and may give them a little extra energy, when they need the most help.  Taking phentermine in the morning, on the other hand, encourages poor eating habits.  It causes many to skip or eat an inadequate breakfast and eat too little during the first half of the day.  This may leave them more hungry at night and lead to worse night-time bingeing.

1) It decreases the chances of side effects (including insomnia) and dependence; 2) one feels less of a change when not taking the medicine; and 3) most folks desire only a little help with their eating habits, and do not want to rely fully on medicine. 

Phentermine is an inexpensive and effective prescription appetite suppressant.  It may also provide some extra energy to help you develop a regular exercise program.  As such, many folks feel it is the closest thing we have to a magic pill.  However, because of its downsides and the fact that its efficacy wears off after a few weeks, it is only approved for short-term use.  Therefore, as traditionally prescribed and recommended, it leads only to short-term weight loss, in addition to encouraging poor eating habits as described above.  SHIELD MLC uses phentermine differently, in a revolutionary way that truly can be magical, by encouraging healthy lifestyle changes and helping you learn how to manage your weight long-term.  If done as prescribed, 1) it serves as an incentive to make the necessary lifestyle changes (refills are only given if lifestyle changes are made); 2) it suppresses your appetite and may help you exercise by giving you more energy when you need it the most;] and 3) (this is the most important) using phentermine actually teaches you a skill that is crucial to long-term weight loss success.  This skill is learning how to pay attention to your true hunger level, something Dr. Cluff calls “Checking Your Fuel Gauge” (CYFG).  This allows you to learn to eat when you are truly hungry and less when you are not.  The reason phentermine helps one learn this is because after taking it, when presented with an opportunity to eat, one naturally assesses one’s hunger level to see if the medicine is working.  This skill is then carried over, exercised, and further developed during the months between phentermine prescriptions and beyond.  Developing the skill of CYFG helps to develop long-term control over food and power over our natural “drive to eat.”  Overweight folks generally struggle with a greater drive to eat, and learning to CYFG helps to normalize this drive. 

Without making permanent lifestyle changes, any weight loss effort, including the use of phentermine, results in only temporary weight loss.  After your first prescription of phentermine, refills are only provided if important lifestyle changes are made.  Long-term lifestyle changes, which include a healthy diet and exercise, are the key to long-term health.  These lifestyle changes and the long-term weight loss they provide, along with not smoking, will prevent most cases of heart disease, cancer, stroke, and diabetes (the first, second, third, and sixth most common causes of death, respectively).  As such, they will also likely save our health care system. 

Permanent lifestyle changes are never easy; however, those required by the SHIELD MLC program are much simpler than most programs require, and can be facilitated by using phentermine.  Nonetheless, these lifestyle changes must not be made overnight, or they cannot be sustained.  SHIELD MLC encourages subtle, realistic, maintainable changes in your eating and exercise habits, founded on the medically sound principles of SvelteLife, a free program developed by Dr. Cluff (see www.sveltelife.com).  Beginning exercisers build slowly into a rational routine of only 100 minutes per week (although more is allowed).  Along with learning to CYFG, participants also strive to follow “The ½:¼:¼ (Half-Quarter-Quarter) Rule” of healthy eating.  These are the types of changes that are sustainable and lead to long-term weight loss success. 

They are tracked through a unique goal-setting and tracking system called the “SvelteMap.” 

To have long-term success, you must not rely solely on the boost that phentermine provides to make the necessary lifestyle changes.  We will provide you with education and teach you skills that will help you make these changes permanent.  Nonetheless, phentermine may also help as described above.  Since most experts agree that it takes a few weeks to develop a habit, and the prescription lasts a full month, the goal is to develop healthy patterns of diet and exercise by the end of your first prescription, which then become a permanent part of your life. 

Weight loss occurs when lifestyle changes are made, which are facilitated by our comprehensive program.  Dr. Cluff’s SvelteLife program has been in place for many years, long before the development of the SHIELD MLC approach.  You may choose to make the journey without phentermine, or to delay its use.  We can help you succeed with or without it (we can help you determine if it’s right for you).  If you desire a prescription, you will receive it at your initial visit.  Refills are then provided every other month thereafter, as long as efforts are made to continue the lifestyle changes, for a maximum of six 30-day prescriptions (spanning one year).  Many will learn how to have success on their own after only 2-3 prescriptions, and be able to discontinue their visits.

Can I discuss other issues during the SHIELD MLC visits?

Other issues need to be reserved for a separate visit.  Exceptions include questions regarding a healthy lifestyle, weight loss, and cardiovascular risk factors.

Call 972-869-2772 to schedule an appointment for a SHIELD MLC visit.  Your initial visit will be with Dr. Cluff and last about 25 minutes.  Subsequent one-on-one visits will last about 15 minutes, and will alternate every other visit with group meetings, which will last about one hour (see the schedule below).  You will return weekly for the first month, every other week for three months, then monthly thereafter, as long as you feel it is helpful or needed.  Regular follow-up is highly encouraged for the purposes of learning, guidance, and accountability, and required as long as phentermine is being prescribed.  Visits can be discontinued when self-sufficiency is attained. 

Insurance generally does not cover phentermine prescriptions, nor office visits dedicated solely to weight loss (we are hoping this will change).   However, visits are usually covered if you have cardiovascular (CV) risk factors such as elevated sugar levels (e.g., diabetes), abnormal cholesterol or triglyceride levels, and/or elevated blood pressure.  In that case, your usual copay applies to one-on-one visits.  Group visits cost $20.00 for all participants (out-of-pocket).  In addition, phentermine is generally inexpensive. 

If you do not have any cardiovascular risk factors, and therefore insurance does not cover your visits, the initial visit costs $136.50 if you are a new patient and $119.50 if you are an established patient.  One-on-one follow-up visits are $73.50 each, and group visits cost $20.00.  Payment for each visit is due at the time of service.  The cost of phentermine prescriptions depends on the pharmacy.  Estimated cost for the first four months (11 visits – the minimum recommended attendance): 

Cost* (4 months or 11 visits)	New Patient	Established Patient
Higher CV risk, with insurance	(If copay = $20) $220	(If copay = $20) $220
Cash pay	$604	$587

*Does not include cost of phentermine prescriptions (usually inexpensive – depends on pharmacy) 

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Initial SHIELD MLC Schedule