Weight Loss Management - The "Powell Protocol"

The Powell Protocol is a weight loss program which was created by friend and NaPro colleague, Bernadette Powell, PA-C. I was so impressed with Bernadette's ingenuity to create this weight loss regimen, and to hear about the successes she was having with her patients, that I asked her if I could borrow her idea and implement this service with my own patients. Thank you Bernadette! 

The Powell Protocol effectively brings about weight loss by incentivizing patients to first meet goals implementing Life-Style changes (diet and exercise) in order to "earn" a GLP-1 agonist, which will then further augment their continued weight loss. Thus, patients will need a lower dose of a GLP-1 agonist, and the risk of gaining back their weight, once the medication is discontinued, is significantly diminished. 

Your appointments at MyCatholicDoctor with me will be one FULL HOUR in length. All of your appointments for weight loss will be individualized to meet your specific weight loss goals. As mentioned, we will start with Life-Style changes, which will include a diet plan to optimize your metabolic health and a structured exercise regimen of your choice. 

After 3 mos, if you have met the initial goals we set, you will be offered a GLP-1 agonist called tirzepatide (a compounded version), as long as your weight still qualifies for this medication. We will start with a low dose 2.5 mg ofTirzepatide, which will be added to your established diet and exercise regimen to augment continued weight loss. 

Schedule your weight loss appt with Sharon here. 

FIRST APPOINTMENT: 

1. Medical History & Setting a BMI Goal: 

I will take a comprehensive medical history and we will set a goal weight with an optimal Body Mass Index (BMI). A BMI between 22.6-25 kg/m² is considered optimal. Research trials have consistently demonstrated this in large-scale studies among diverse populations. Check out your own BMI using my favorite BMI calculator. 

2. Diet to Optimize Metabolic Health: 

We will discuss what how to optimize metabolic health by simply eating the proper foods in the proper order. This simple adjustment to your diet will help you avoid large fluctuations in blood glucose levels, and even allow you to eat the foods you love (in moderation), while still achieving your optimal  weight/BMI. 

All patients will be asked to listen to the YouTube talks given by Jessie Inchauspé, who is a French biochemist, and author of the book "Glucose Revolution". I would recommend you start with the talk entitled: “Sugar Cravings: 3 reasons you have them and the proven science to destroy them | Episode 1 of 18”, and then move through Jessie's talks in chronological order. Of course, if you prefer to read her book rather than watch videos, please do. You may wish to print out Jessie's free handout called, "The 10 Glucose Hacks"  which I have posted for you at the bottom of this webpage. 

3. Exercise Regimen: 

We will discuss an exercise regimen of your choice, that will consist of 30 minutes five days per week of some sort of cardiovascular activity, eg: walking, jogging, hiking, swimming, biking, pickle ball, tennis, formal exercise classes, etc... You can further enhance your program by adding in 20-30 minutes of weigh-lifting at the gym, even if the weights are not very heavy. Routine and consistency are the keys to success! 

4. Set Individualized Goals: 

At the end of this initial appointment, you and I will have agreed upon two specific Life-Style goals: one for diet and a second for exercise. Your "diet goal" will be so simple! All you have to do is commit to watching twenty of Jessie's YouTube talks and log your progress. Your log can be simple, consisting of the date and name of the video you watched. You will be asked to submit the log to me via the Tebra patient portal prior to your next FU visit. You do NOT have to log in what you ate.... you will learn that counting calories is not necessary and you will simply enjoy eating, properly. Whereas, an "exercise goal" is equally as simple...Just document 30 minutes of exercise done 5 days per week for 10-12 weeks consecutively, and send the completed log to me through your patient portal. Please be sure to send logs in pdf format. WORD format is not viewable in our Tebra Patient Portal System.

5. Schedule First FU Appointment:  

As we wrap up your visit, I will schedule your First FU appt in approximately 3 months.  

SECOND APPOINTMENT:

1. Diet & Exercise Log Review: 

During this first FU visit, we will go over your personalized Diet and Exercise logs, which you have submitted to me via the Tebra patient portal. If you met our two previously set goals, congratulations!!! You have earned your GLP- agonist! If you have not met your two Life-Style goals, we will brainstorm together and set new goals which may be more attainable. 

2. GLP-1 Agonist Therapy: 

If Life-Style goals have been met, and your weight/BMI still qualify for a GLP-1 agonist, I will prescribe a compounded version ofTirzepatide for you. We will start with a low dose of 2.5 mg, with a plan to continue with this dose for one month. Tirzepatide is given once-weekly as a subcutaneous injection (this means you are injecting into the skin, not deep down into the muscle). Here is a great instructional video how to inject tirzepatide. You should rotate your injection sites between different areas of the abdomen and/or your upper thighs. The advantage of injecting into the abdomen is that you will absorb more of the drug, but the disadvantage is that you may experience more GI side effects. What is more important is that you understand to rotate injection sites. 

3. Discussing Side Effects: 

During this visit, we will also discuss the most common GI side effects experienced with Tirzeptide. Large scale studies have demonstrated the following symptoms are most common: nausea, vomiting, diarrhea, constipation, upset stomach and/or abdominal pain. Research has indicated that the side effects occur more frequently when you first start this medication and/or right after your dose is increased. However, most clinical trials do report that these GI side effects will diminish in frequency and severity over time. 

3. Schedule your next FU Appointment:  

As we wrap up your visit, I will schedule your next FU appt in approximately 1 month. 

THIRD APPOINTMENT:

1. Diet & Exercise Log Review: 

During this visit, we will again go over your Diet and Exercise logs, which you submitted to me via the patient portal. Please note, updated logs must be submitted prior to each FU visit. Most patients will have met their Life-Style goals by this time. 

2. GLP-1 Agonist Therapy: 

If Life-Style goals have been met, and your weight/BMI still qualify for a GLP-1 agonist, I will prescribe a compounded version ofTirzepatide for you. We will start with a low dose of 2.5 mg, with a plan to continue with this dose for one month (see injection tutorial and common side effects above). If you started 2.5 mg of Tirzepatide at your last visit, we will discuss how you are tolerating the medication, and we will make a decision to continue with the 2.5 mg dose for another month or increase your dose to 5 mg. 

3. Healthy Weight Loss: 

Our goal for your "Healthy Weight Loss" regimen will for you to be losing 0.5 to 1 lb weekly. Thus, once you are losing 0.5 to 1 lb weekly, we will stop uptitrating your Tirzepatide, and we will stick with this management plan until you have met your goal weight/BMI. We will continue to meet once monthly, until you have achieved your goal weight. Then we will very, very slowly decrease your Tirzepatide dose, as we continue to closely monitor your diet, exercise regimen and weight, to ensure you are maintaining your optimal BMI. 

4. Schedule your FU Appointment:  

As we wrap up your visit, I will schedule your next FU appt in approximately 1 month.