woman standing on scale celebrating weight

When zipping up our favorite jeans becomes impossible and suddenly sweat pants are the “go to” outfit, we might have to reluctantly face facts that it’s time to get serious about weight loss.

The most common questions I hear are:

  • Does Weight Loss Medication work?
  • Do those fat burning pills I see advertised everywhere really work?
  • How am I going to lose 40 or more pounds?

First of all, let me clear this up right now, despite what Dr. Oz says, those fat burning pills DO NOT WORK. Save your money and use it for comfortable workout shoes. 

When people are 40 or more pounds overweight, they probably know this is not optimal for their health. Also, it is likely they have been overweight for many years, maybe even from childhood. 

During a visit to their health care provider, undoubtedly the topic of weight loss will come up.

There are four choices to consider:

1. Stay the same: I like my life, I like eating what I want, I am not interested in changing what I eat or how much I exercise, I’m willing to live with the outcome.

2. I’d like to make a few changes. Trying to lose 40 or more pounds is overwhelming, but I can commit to some weight loss, 10-20 pounds. I understand that this will help reduce my blood pressure, my risk of diabetes, and my risk of a heart attack. 

I am willing to…

  • become more mindful about what I’m eating and drinking and make healthier choices.
  • Are you feeding your emotions not your stomach? Understanding what triggers your cravings and emotional eating can help you prepare for tough times. Have healthy snacks at the ready-in the car, at work.
  • keep a food diary.
  • Here you can note any feelings that come up which trigger eating certain foods or routines that encourage an unhealthy food-centered experience. (When I shop at the mall I always stop at my favorite cafe for my burger and fries.
  • Pre-Decide what you will eat to reduce unhealthy choices. Read more about that here.
  • A good strategy is to eat three meals and day and plan in a couple of healthy snacks to try to avoid either grazing all day on empty calorie foods, or gorging at a big meal.
  • Insta-Pot anyone?  
  • Increase my physical activity and exercise.
  • The best exercise is something you can stick with. A fun class, or scheduled walk with a friend are good places to start.
  • Exercise IS Medicine! 

3. I’d like to use medication to help curb my appetite and increase my metabolism, along with making eating habit changes. I want another tool in my toolbox.

It shouldn’t feel like “cheating” to use an approved diet drug under medical supervision. These medications DO work for many people, and your health care provider may feel a weight-loss drug is right for you if you haven’t been able to lose weight through diet and exercise and are an adult with the following: 

  • a Body Mass Index (BMI) of 30 or greater
  • a BMI of 27 or greater, and you have weight-related health problems such as high blood pressure or type 2 diabetes

How well do weight-loss drugs work?

Studies show that prescription weight-loss drugs used long-term (for more than 12 weeks) did result in significant weight loss compared with a placebo. This could mean a 3% to 7% loss of total body weight in about a year. Over a few years this can mean significant health benefits from lowered blood pressure, blood sugar and triglyceride levels. If you have lost enough weight to improve your health and you have not shown serious side effects, it is possible your healthcare provider could recommend you continue to take this medication indefinitely.

What’s the downside? 

Nausea, constipation or diarrhea, are frequently reported side effects, but usually improve over time. Of course, there can be serious side effects in some people, so the use of these drugs should be monitored by a healthcare professional.  

If after 3 to 6 months you haven’t lost at least 5% of your body weight your provider will probably want to discuss changing to a different weight-loss drug. 

Also, ask your insurance company which drugs they cover; they can be expensive.

What drugs are approved for weight loss?

Five weight-loss drugs have been approved by the U.S. Food and Drug Administration for long-term use:

  • Bupropion-naltrexone (Contrave)
  • Liraglutide (Saxenda) 
  • Wegovy (Semaglutide) (a longer acting version of Saxenda, it was approved in June of 2021)
  • Orlistat (Xenical)
  • Phentermine-topiramate (Qsymia)

These prescription weight-loss drugs work by suppressing your appetite or increasing the feeling that you’ve had enough to eat. Some of the drugs try to do both. Some of the medications work by making it harder for your body to absorb fat, such as Orlistat.  

Weight-loss drugs should not be considered a magic pill for weight loss. But along with changes in diet and lifestyle they can help you succeed, and improve your overall health. 

4. I need to lose > 100 pounds and surgery with a complete lifestyle change is right for me. I have tried everything else in the past, I know that it means my life will radically change in many other ways. I’m ready.

There are several types of weight loss surgery, also called bariatric surgery. All involve either reducing the size of the stomach or rerouting food to affect absorption, or a combination of both. 

Often after weight loss surgery, the weight is slowly regained. Weight loss medications are now being used after the surgery to help patients control their weight. A study out of Boston University Medical School, reported that cumulative weight gain decreased by approximately 10% in those patients on the weight-loss medications compared with those who weren’t.

Bariatric surgery is a very effective treatment strategy to combat obesity that can be life threatening. Weight loss medication can play a part in its success. 

You can read more about Weight loss, Diet and Exercise strategies here. 

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