Obesity is a common problem that can cause fatigue, diabetes, fatty liver disease, and sleep problems, and raise the risk of many cancers. It reduces energy, and can take the pleasure out of many aspects of life. Extra weight also places stress on vital organs, including the heart, liver, and kidneys, as well as joints and the reproductive system. Although organs can work under this extra stress for a number of years, eventually they are likely to fail. Most organs lose about 80% of their capacity before symptoms are evident, and by that time, it is often too late to return them to normal function. The conditions associated with obesity are: Cancer Cardiovascular disease Diabetes Liver disease Obstructive sleep apnea Losing weight can help improve and sometimes cure many of these conditions, as well as fertility issues. Losing weight can also lead to a life with fewer medications, lower health expenses, and overall greater enjoyment. At the Yale Metabolic Health and Weight Loss Program, we offer all nonsurgical weight-loss interventions in one location. Our philosophy is to focus on health, rather than specific disease, and to tailor our care to each patient’s specific needs and goals. The first step in our care is to determine weight-loss goals. Patients may need to lose 5 to 10% of their body weight to help in the treatment of a disease. We will help patients choose from interventions that include intensive meal-replacement programs, a range of medications, or endoscopic (nonsurgical procedure) options. Sometimes, there are additional medical necessities, such as an upcoming surgery, that require a specific weight-loss goal. We will explain the advantages and disadvantages of the various options, but the choice will depend primarily on what feels right to the patient. We provide therapies under the medical supervision of obesity experts. Patients can choose from the full range of tested interventions: Lifestyle changes: Nutrition counseling goes hand-in-hand with medical management of metabolic health. Care will include a personal visit with a registered dietitian with advanced training in weight management. OPTIFAST® program: OPTIFAST® is a medically monitored weight management program that allows patients, under the supervision of a physician, to consume a low-calorie diet and receive comprehensive lifestyle education. The OPTIFAST program provides full meal replacement for 12 weeks and transitions to self-prepared “everyday” meals in conjunction with comprehensive patient education and support, to help patients achieve long-term weight loss. Medications: All medications are used as part of a comprehensive program that includes proper nutrition and a healthy lifestyle. Contrave® is a single pill that contains two medications (naltrexone and bupropion) and is taken twice a day. It will reduce appetite and can produce weight loss in the 5 to 10% range. Phentermine is taken once in the morning, and is prescribed for a few weeks.

At Laboratory Medicine, we study the molecular and cellular components of blood and other body fluids. This work is crucial to diagnosing and managing illness and understanding the mechanisms and origins of disease.Our physicians, known as clinical pathologists, provide consultations to other doctors regarding optimal laboratory diagnostic approaches and the interpretation of complex laboratory tests. Our team includes pathologists, scientists, phlebotomists, medical technicians, technologists, and others who perform important support functions for our state-of-the-art laboratory. We are available every day, 24 hours a day, for physicians. We perform approximately 10 million tests each year, and also provide specialized high-tech testing to other hospitals in the Yale New Haven Health System and institutions throughout New England, and as far away as Puerto Rico. We also operate multiple satellite facilities and patient service centers located throughout the state. We ensure that every test we offer—at every location—is accurate and reliable. When physicians request to have patients’ blood drawn, here is what happens: Collection: A doctor, nurse, technician, or phlebotomist will draw the patient’s blood. Several tubes may be needed for different types of tests. Depending on what illness the patient might have, his or her doctor may want to obtain a urine sample, throat swab, or other sample. After the sample is collected, the container is labeled with the patient’s name and other information. The sample is received and processed by the Laboratory, and testing begins: Chemistry Testing Blood and other bodily fluids are tested for chemicals, drugs, and substances that indicate disease. We check cholesterol and other tests for risk of heart disease, glucose to monitor diabetes, or thyroxin to monitor the thyroid gland. Hematology Testing We analyze the amount and function of blood cells and plasma. Examples include the Complete Blood Count (CBC) that tells the doctor how many cells of each type are in the patient’s blood, and the prothrombin time (PT) to measure the time it takes for the blood to clot. Microbiology Testing We test a variety of specimen samples for infections caused by bacteria, fungi, or parasites. We often do urine cultures for urinary tract infections. Virology Testing We test for viral infections. This includes rapid tests for respiratory viruses such as influenza, molecular tests for noroviruses, and antibody tests for HIV. Immunology/Molecular Diagnostics Some tests are used to determine whether the immune system is functioning properly. State-of-the-art analysis of DNA and RNA is used to test for a variety of diseases and for the risk of developing certain diseases. Other specialized tests include the ANA, used to screen for autoimmune disease, and Factor V Leiden genotyping for patients with blood clots. Tumor Profiling Laboratory This lab analyzes tumor DNA to predict the sensitivity or resistance of tumors to a

Our goal at the Diabetes Center is to give patients the tools necessary to successfully manage the day-to-day challenges of living with diabetes and prevent long-term diabetes complications. We provide comprehensive management and education for adults with type 1 and type 2 diabetes. We focus on lifestyle interventions and use the latest medications and technologies to improve our patients’ health. We also treat patients with: Pre-diabetes and metabolic syndrome Obesity Polycystic ovarian syndrome Lipid or cholesterol abnormalities Our nationally recognized doctors and nurse practitioners work as a team to address our patients’ needs in managing diabetes and other conditions. We understand that living with diabetes presents challenges. We focus on education and making patients their own advocates. Through the most current and state-of-the-art treatments, we will help them better manage their care. Oral Medications There are several classes of oral diabetes medications that we may prescribe if patients have type 2 diabetes. These medications differ in the way they work to reduce blood glucose levels. Frequently, oral medications from different classes are used in combination. Sulfonylureas: These drugs increase the amount of insulin produced by the pancreas. Meglitinides: These drugs rapidly increase the amount of insulin produced by the pancreas. Biguanides: Metformin is the only biguanide on the market. It is thought to work by reducing the production of glucose in the liver. Alpha-Glucosidase Inhibitors: These medications reduce the amount of glucose absorbed in the intestines. Thiazolidinediones: This agent makes the body more sensitive to insulin. Dipeptidyl Peptidase 4 inhibitors (DPP-4 inhibitors): These drugs increase the amount of insulin produced by the pancreas after a meal and reduce the amount of glucose produced by the liver. Injection Therapies There are several classes of injection therapies for diabetes. These treatments are given by an injection under the skin. The most common injection therapy is insulin, which comes in many different formulations that differ in how fast they work and how long they last. Below is a list of the different types of insulins. Technologies and Experimental Treatments Insulin Pumps: Insulin pumps were first pioneered at Yale in the 1970s. An insulin pump is an electronic, pager-sized, battery-powered device that delivers insulin continuously through a small plastic catheter under the skin. Insulin is delivered in different amounts (“basal” or “bolus” levels) during the day and controlled by the patient. While fasting, patients will administer a low level of continuous “basal” insulin to keep their blood glucose in the normal range. Prior to meals, they will determine a “bolus” of insulin based on the amount of carbohydrates in the meal. Continuous Glucose Monitoring systems (CGM): A CGM is a device that measures glucose under the skin (also known as “interstitial” glucose) every five minutes thr