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Weight Loss. What’s the best option for you?

Weight loss.  This is an ongoing conversation throughout our Society.  It has become quite the industry not just in Medicine, but in our retail environment.  There are many weight loss programs, some focusing on nutrition, some on exercise and in the medical world, those involving medications or even surgery.  This plethora of options have led us to feel that the Science of weight loss is a bit of a mystery.  All the information out there can put you into a tailspin! So you may ask, which choice is right for me?  Patients ask me, “I don’t know where to start, how do you do it?  What can I take that is safe or is surgery right for me?”  Millions of dollars and hours are spent on this topic.  It is a topic best searched not alone but with the help of your Health Care Provider, friends and family.  There is power in the numbers when it comes to weight loss.  No matter the choice however, the final conclusion and solution is that which is right for you.  No one method or medicine is good for all. 

There are several schools of thought when it comes to weight loss.  There are some who say that weight loss is purely the practice of accounting, “calories in versus calories out.”  I would argue that this is only partly true.  There are others who would say, “add exercise -period.”  Again, I would argue that this is also partly true.  Then there are those who claim, “those Patients will never be able to do it on their own! #Surgery!”  In certain circumstances, this is partly true as well.  The bottom line…weight loss is not so much about Science; it is not a singular event.  Weight loss is about changing one’s lifestyle.  If we are overweight, obese or just not happy with our current physical state and well-being, then something about our current lifestyle is prohibitive to feeling our best.  This lifestyle must change. 

We hear a lot about diet and exercise, but not so much about the medical and surgical therapies available.  Medical versus surgical therapy depends on your medical history and personal circumstances.  Surgical therapy includes those that limit the size of your stomach or bypassing most of your stomach decreasing your absorption ability.  As for medical therapy, there are many options.  First, let me make clear that no one pill will lose weight for you.  The goal for weight loss medications is to help you overcome your barriers to weight loss beyond optimal diet and exercise.  Barriers include appetite or craving control, energy issues to maintain an exercise program or combination of all of the above.  The typical Patient is one who has a BMI greater than 30 who have failed to lose weight with regular diet and exercise or if they have a BMI of 27 or greater and have already developed diabetes and heart disease.  If you are considering weight loss surgery such as a gastric sleeve or bypass, this therapy may be helpful in preparation for it.  They are not indicators for all Patients so talk with your Health Care Provider about your concerns and challenges. 

Below is a list of medications to consider in your weight loss journey if you are determined to be a good candidate for medical therapy.  I do not endorse any specific one, but provide this for your information.  This is also not all inclusive but the most commonly used and available. 

  • Orlistat – Works by decreasing your fat absorption which helps with weight reduction and may improve your cholesterol levels.  Side effects may include loose stool or diarrhea.   
  • Metformin – if you are known to be pre-diabetic, may help improve your glycemic control and therefore lower insulin levels that would help with weight loss.  Side effects include loose stools however should improve with time.
  • Phentermine – a generic and widely available option, but not to be confused with the infamous Fen-Phen which was said to cause heart disease.  Phentermine is a stimulant and works to decrease your appetite and does increase your energy levels.  It does have addiction potential and is only advised to use for 12-weeks at a time.  Side effects may include dry mouth, difficulty sleeping, but more importantly may increase your heart rate and blood pressure, and therefore must be followed carefully by your Health Care Provider. 
  • Belviq – a serotonin-acting agent that may help regulate the control center for appetite, thereby helping you feel full sooner.  It is FDA approved to take for long term weight loss.  Side effects may include headache, nausea or fatigue. 

Lastly there are combination therapies available and include,

  • Qsymia – a long acting version of Phentermine and Topiramate which works to decrease appetite and cravings.  It is FDA approved to take for long term weight loss.  Topiramate has been used in the treatment of seizure disorder and migraines.  Side effects may include dry mouth, constipation or nerve disturbances. 
  • Contrave – combination of Buproprion and naltrexone that works to decrease your appetite and cravings.  This is not recommended as a first line medication but may be best for the person who is not only trying to lose weight but quit smoking as well. Buproprion has been used in the treatment of Depression or to help you quit smoking. We believe it works by helping regulate one of the brain’s hormones – epinephrine, which affect appetite control as well.  This medication cannot be used in someone with a seizure disorder or uncontrolled hypertension. 

Bottom line, you have options in your weight loss journey.  The best option is based upon many factors and best discussed and determined by working with your Health Care Provider.