Medical Weight Loss in Fort Smith, Arkansas

Medical weight loss is weight care directed by a physician, built on your medical history and your lab work and adjusted over time. It is not a diet you buy and it is not a med spa. Dr. Herraka is a diplomate of the American Board of Obesity Medicine and treats the metabolic health underneath it.

What medical weight loss is

Medical weight loss is weight care directed by a physician, built on your medical history and your lab work, and adjusted over time. It is not a diet you buy, and it is not a med spa. Our program runs alongside the liver program at Digestive & Liver Center of Arkansas. Your plan is created and supervised by Ihab Herraka, MD, who is board-certified in Obesity Medicine as well as Gastroenterology and Internal Medicine. One physician looks at your weight and at the health problems your weight may be driving, including blood sugar, cholesterol, blood pressure and your liver, and treats them together instead of one at a time. We care for patients from Fort Smith, Van Buren, Greenwood, Alma, Barling and Charleston, and from Poteau and Sallisaw in eastern Oklahoma. The program is based at our office on Old Greenwood Road in Fort Smith.

Why weight is biology, not willpower

If diets have worked for a while and then stopped working, that is not a character flaw. It is how the body is built. Your body treats a lower weight as a threat and defends it. When you eat less, hunger hormones rise, fullness signals fall, and your metabolism slows down so you burn fewer calories than you did before. Insulin resistance, poor sleep, stress, certain medications and thyroid problems can all push in the same direction. That is why the weight so often comes back, usually with interest. Medical weight loss works on those biological signals, using nutrition, activity, treatment of the underlying conditions, and medication when it is appropriate, instead of asking you to simply try harder.

What board certification in Obesity Medicine means

It means the physician sat and passed a separate certifying exam from the American Board of Obesity Medicine, on top of his residency and fellowship training. Dr. Herraka is an ABOM diplomate. That exam covers the science of appetite and metabolism, nutrition, physical activity, behavior change, weight-loss medications and their risks, and the medical conditions tied to excess weight. It is training in obesity as a medical condition, not a marketing add-on. Weight loss is sold in a lot of places in Arkansas, clinics, spas and online subscriptions. This certification is one clear way to tell who has trained specifically in it.

Who this program is for

In general terms, this program is intended for adults with a body mass index of 30 or higher, or a BMI of 27 or higher with a weight-related condition such as type 2 diabetes, high blood pressure, or fatty liver disease. Your actual eligibility, and whether medication is appropriate for you, is decided at your visit based on your full history and labs, not on BMI alone. You may be a good fit if:

• You have lost weight before with diet and exercise and regained it
• Your weight is in the overweight or obesity range
• You have type 2 diabetes, prediabetes or insulin resistance
• You have been told you have fatty liver disease (MASLD) or metabolic syndrome
• You have high blood pressure, high cholesterol or high triglycerides
• You have sleep apnea, joint pain or fatigue that is worse with extra weight
• You want lab work, monitoring and a physician's judgment, not a subscription box In most cases you do not need a referral. If your plan requires one, our staff will help you arrange it.

What to expect, step by step

Your first visit is a full medical evaluation, not a weigh-in. Here is how the program usually runs.

• Your first visit. We review your weight history, what you have already tried, your other medical conditions, your medications and supplements, your sleep, your schedule and your goals. We measure weight, height, body mass index, blood pressure and waist circumference.
• Metabolic lab work. Most patients have a metabolic panel, liver enzymes (ALT and AST), fasting blood sugar or HbA1c, a lipid panel and thyroid testing. These labs look for the causes hiding underneath the weight, including thyroid disease, insulin resistance and liver injury.
• Liver assessment when it is indicated. Because excess weight and fatty liver travel together, many patients also have FibroScan liver testing, a painless in-office scan that measures liver fat and stiffness in about ten minutes.
• Your plan. We build a nutrition plan around the food you actually eat and the hours you actually work, with a protein target, and an activity plan that starts where you are. No crash diets and no shame.
• Medication, only if it fits. If a prescription medication is clinically appropriate and safe for you, we discuss the options, the side effects and the cost, and you decide together with Dr. Herraka.
• Follow-up visits. We see you regularly to track weight, blood pressure, labs and side effects, and to adjust the plan or the dose. This is the part that most weight-loss programs skip, and it is the part that makes results last.

GLP-1 and dual-action medications, explained plainly

GLP-1 medications are prescription drugs that copy a natural gut hormone your body already makes after you eat. They slow the stomach, lower appetite, quiet food cravings and improve how your body handles blood sugar. Semaglutide works on the GLP-1 receptor. Tirzepatide works on two receptors, GLP-1 and GIP, which is why it is often called a dual-action medication. Both are FDA-approved for chronic weight management in adults who have obesity, or who are overweight and have a weight-related health condition, and both are meant to be used alongside a reduced-calorie diet and increased activity. They are real medications with real side effects. The most common are nausea, vomiting, diarrhea, constipation and reflux, which are usually worst when the dose goes up and often settle with time, slower dose increases and smaller meals. Less common but more serious problems can include pancreatitis, gallbladder disease and dehydration. They are not right for everyone. Both carry an FDA boxed warning about thyroid C-cell tumors seen in animal studies, and they must not be used by anyone with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia type 2. They are also not used in pregnancy, and they are used cautiously, if at all, in people with a history of pancreatitis or severe gastrointestinal disease. That is exactly why the decision starts with an examination and lab work rather than an online form. We prescribe FDA-approved medications through a pharmacy, and our staff files the prior authorizations. Injectable weight-loss medicines are usually filled through the specialty pharmacy your plan uses, and we will tell you where yours is coming from before you start.

Protecting your muscle and your liver while you lose weight

Losing weight quickly can cost you muscle and stress the liver, so we build in enough protein, regular resistance activity, and a sensible pace, and we watch your liver enzymes along the way. Weight loss is also the most effective treatment we have for fatty liver disease, with benefits that grow as your weight comes down, which is why our weight program and our liver program run under the same physician, in the same clinic, on the same chart. For the specific percentages of weight loss tied to improvement in fat, inflammation, and scarring, see fatty liver and weight loss.

What results are realistic

Results vary from person to person, and no honest clinic can promise you a number. What we can promise is an honest starting assessment and a plan matched to your biology. In general, medically supervised programs aim for a steady rate of loss over months rather than weeks. Patients who add an FDA-approved weight medication typically lose more than those using nutrition and activity alone, but the range is wide, and some people respond much better than others. The trials that led to FDA approval of semaglutide and tirzepatide reported average weight loss in the range of roughly 15 to 20 percent of starting body weight over about a year of treatment, with the higher figures tied to the higher doses of tirzepatide; older weight-loss medications produce smaller average losses. Individual results depend on the medication, the dose and how consistently it is used, and no trial average is a guarantee for any one patient. Two honest points most advertisements leave out. Obesity behaves like a chronic condition, so if the medication stops, appetite and weight often return, and a plan for the long term is part of the conversation from day one. And weight is not the only score that matters: improvements in blood sugar, blood pressure, triglycerides, liver enzymes and energy often show up before the scale moves as much as you would like.

When surgery is the better answer

Medical weight loss is not the right fit for everyone, and we say so plainly when that is the case. Some patients, particularly those with a very high BMI or obesity-related health problems that have not responded to medication, are better served by bariatric surgery. We do not perform weight-loss surgery ourselves; when it looks like the better option, Dr. Herraka will tell you directly and help coordinate a referral to a bariatric surgeon at Mercy Hospital, rather than continuing a medical approach that is not working.

What patients say

Digestive & Liver Center of Arkansas holds a 4.7-star rating on Google from patients across our practice, including our weight loss and liver programs. We are glad to share more about what patients can expect when you call to schedule.

Cost & insurance

Office visits and lab work for weight-related medical conditions are covered by most major medical plans in Arkansas. Coverage for weight-loss medications is the part that varies the most. Some plans cover them fully, some require prior authorization, and some exclude them entirely. We accept most major plans, including Medicare and both Arkansas and Oklahoma Medicaid, as a gastroenterologist in Fort Smith who accepts Medicaid. Our staff will check your benefits before your visit and tell you what your plan does and does not cover, including medication coverage, so you are not surprised later. Self-pay options are available for elective services, and we will quote them to you directly before anything is scheduled. Please call the office for current pricing.

Ready to start?

If you are tired of starting over, a medical evaluation is a good first step. Call Digestive & Liver Center of Arkansas at (479) 242-2888 to request an appointment, or stop by 3416 Old Greenwood Rd, Fort Smith, AR 72903. We are open Monday through Friday, 8:00 a.m. to 5:00 p.m., and we see patients from across Fort Smith, the River Valley and eastern Oklahoma.