Why Use Medications for Obesity Treatment?
Appetite and weight are complex systems regulated by the brain. There are numerous hormones related to these systems. Some individuals who struggle with weight have abnormal hormone signaling to the brain, causing increased appetite and weight gain. Also, when a person loses weight with diet and exercise, the body fights this weight loss by increasing the hormones that cause hunger, decreasing the hormones that tell the body when to stop eating, and decreasing metabolism, all of which can lead to the weight regain that most individuals experience.
At LifeWeigh, we understand the biological changes that can make weight management so difficult, and we will help you with specific nutrition plans, physical activity, and other tools that can help you overcome these biological changes. Weight loss medications, commonly referred to as anti-obesity medications, help offset some of the biologic changes that drive weight gain, to help you have better control over your appetite, making it easier to stick to your nutrition plan.
You and your provider should discuss if a weight-loss medication may be appropriate for you, and if so, which medication may be a good fit for you. There are many factors to consider, including your medical conditions, current medications, potential side effects, risks and benefits, and cost.
Currently FDA-approved anti-obesity medications include:
- Phentermine (Lomaira®, Adipex®)
- Phendimetrazine (Bontril®)
- CONTRAVE® (bupropion/ naltrexone)
- BELVIQ® and BELVIQ XR® (lorcaserin)
- Qsymia® (phentermine/ topiramate XR)
- Saxenda® (liraglutide 3.0)
- Orlistat/ Alli®
Weight-loss medications may only be prescribed for patients with obesity (BMI greater than or equal to 30) or who are overweight (BMI equal to or greater than 27) with at least one weight-related medical condition. They should only be used along with a lifestyle program including nutrition and physical activity. The various medications have differing risks, benefits, and side effect profiles. Your provider will review these with you, and together you can decide if a weight-loss medication may be appropriate for you. You should not take any weight loss medications if you are pregnant or breastfeeding.
All weight-loss medications work slightly differently, and results may vary between individuals. In general, the expected weight loss from medications in addition to comprehensive lifestyle changes, is approximately 5-15% total body weight loss in one year.
*** WE CAN STOP HERE FOR WEIGHT LOSS MEDICATIONS, OR CONTINUE WITH THE BENEFITS OF 5-10% WEIGHT LOSS LISTED BELOW. THIS COULD ALSO GO UNDER “MEDICAL WEIGHT LOSS ***
Potential Benefits of a 5-10% Weight Loss
The recommendation for medical weight management is to induce and maintain at least a 5-10% weight loss. Some people wrongly assume that they have to achieve an “ideal body weight” to see health benefits from weight loss, but this is not the case. Rigorous scientific evidence supports that even a modest 5-10 % weight loss can have very significant positive effects on your health, such as:
HDL: A 5-10 percent weight-loss can result in a five point increase in HDL cholesterol, which is your “good” cholesterol, which protects you from heart disease. HDL cholesterol of more than 40 mg/dl for men and more than 50 mg/dl for women is protective against heart disease, and these numbers are generally not affected by cholesterol medications.
Triglycerides: High triglycerides increases a person’s risk for heart attacks and strokes among other problems. Losing 5-10 percent of body weight was shown to decrease triglycerides by an average of 40 mg/dl, which is a significant drop. This level can further improve with exercise, a diet low in concentrated sugars, carbohydrates and fats as well as with reduction of excessive alcohol intake.
Excess body weight accounts for about 25-30 percent of cases of hypertension. By losing 5-10 percent of one’s weight, blood pressure, both systolic and diastolic, decrease by 5 mmHg on average. In conjunction with appropriate nutrition and physical activity, these blood pressure lowering effects could be potentially even better.
One of the laboratory markers used to screen for diabetes and to monitor its treatment is called Hemoglobin A1C. The normal level should be below 6.5. Research has shown that a 5-10 percent weight-loss can decrease this marker by half a point on average. This comes close to the effect that some anti-diabetic pills have on blood sugars. With specific dietary plans and physical activity, we can see much greater benefits on Hemoglobin A1C. Some studies have shown a 60% remission of diabetes with specific, strict nutrition therapy. Another large trial showed that the risk of developing diabetes can be lowered by 58% with a 7% weight loss. This was better than what could be achieved with medications.
Another condition that is seen with weight gain is a phenomenon called insulin resistance. Insulin is responsible for keeping blood sugar levels normal. In this condition, high levels of insulin are needed because tissues are resistant to its effects, and as such, the pancreas has to produce more and more insulin to keep blood sugar levels within the normal ranges. Insulin resistance can often be seen 10-15 years before an individual develops abnormal blood sugar levels, known as pre-diabetes and eventually, diabetes.
When someone has insulin resistance, the resulting high levels of insulin in the blood cause an increase in fat tissue especially in the waist area, abnormal cholesterol, and sometimes a change in certain hormone levels in women that causes male pattern hair growth and infertility. Modest weight-loss was found to significantly decrease insulin levels and thus to help with reversing these conditions.
According to the American Heart Association, metabolic syndrome is characterized by a group of metabolic risk factors. Metabolic syndrome can be identified in patients if they present with three or more of the following:
Waist circumference >40 inches (102 cm) in men; >35 inches (88 cm) in women
- Triglycerides >150 mg/dl
- HDL <40 mg/dl HDL in men; <50 mg/dl in women
- Blood pressure >130/85 mm Hg
- Fasting glucose >100 md/dL
Metabolic syndrome increases the risk of coronary artery disease, stroke, peripheral vascular disease and type 2 diabetes.
The primary clinical management goal is to reduce the risk of cardiovascular disease and type 2 diabetes. Risk-reduction steps include smoking cessation; reduction of LDL cholesterol, blood pressure and glucose levels to the recommended levels; increased physical activity; and developing healthy dietary habits. Weight loss resulting from medical treatment has been shown to be an extremely effective therapy for metabolic syndrome.
Joint/ Spine Disease
Osteoarthritis is the leading cause of disability in the US. Obesity significantly affects joint and spine health and is a strong contributing factor in the development of osteoarthritis and other painful, debilitating orthopedic conditions. Every 1 pound of weight loss results unloads 4 pounds of joint stress. A 10-pound weight loss decreases compressive load by 48,000 pounds per one mile walked. This decreased load on the joints and spine, in addition to the decreased inflammation, makes a very significant difference for patients struggling with obesity and joint/ spine disorders.
Each point over a BMI of 29 caused an additional 4% decline in your chances of becoming pregnant. For patients undergoing IVF, a higher than normal BMI can make it more difficult to get to the embryo retrieval stage because they may not respond as well to fertility medication which can lead to cancelled cycles. The egg retrieval procedure can be technically difficult in patients with high BMIs, and consequently, the chances of conception are decreased. In addition, studies have shown that women whose BMIs are either above or below the normal range are more likely to produce immature eggs during their treatment cycles, leading to lower success rates. If you are struggling with infertility, losing even modest amounts of weight can significantly increase your chances of becoming pregnant and having a healthy pregnancy.
Obstructive Sleep Apnea
Obstructive sleep apnea is a sleep disorder commonly diagnosed in patients affected by excess weight that snore or gasp for air during sleep. It’s caused by pauses and gaps in breathing during sleep and results in insufficient oxygenation. This causes fatigue and sleepiness during the day. It also is responsible for making certain diseases less responsive to treatment, like hypertension or weight loss, for example.
It has been shown that a 5-10 percent weight-loss may improve sleep apnea by up to 50%, and sometimes if the apnea was not very severe, one can be weaned from the CPAP breathing machine.
In studies looking at the effect of excess weight on cells of the human body, it was found that fat cells and especially abdominal fat cells produce a large number of substances that result in inflammation. This inflammation has far reaching effects on the body, and can affect risks of heart disease, joint disease, lung disease, cancer, and many other medical conditions. When weight-loss achieves a level of 10 percent, the levels of inflammatory substances circulating in the blood drop significantly and therefore the risk of medical conditions associated with excess weight drops as well.
All these improvements caused by weight-loss as low as 5-10 percent ultimately lead to very significant benefits. If you are someone who would benefit from a 5-15% weight loss, you would likely be a good candidate for our medical weight management program.