Weight Loss Treatment Options

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Weight Management in 2023                                                          January 31, 2023

Each person is different when it comes to why they are overweight.  It may be a disease process causing weight gain, medications, or the inability to afford healthy foods.  No matter the cause of weight gain, carrying around extra weight poses multiple heart and metabolic health risks to include diabetes, heart disease, high blood pressure, high cholesterol, liver disease and higher overall mortality rates.

Do you have a weight problem?

Professional organizations like the World Health Organization and the National Institutes of Health have agreed to classify severity of our extra weight using our Body mass index (BMI).  When combined with waist circumference, these classifications help the healthcare profession determine a patient’s risk for chronic disease.  It is important to know if you fall into these high risk categories.

BMI = body weight (kg) ÷ height squared (meters) The link below is a free BMI calculator from the CDC

https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

BMI 25-29.9 kg/m2—Overweight

BMI >30 kg/m2—Obesity

30-34.9 kg/m2—Class I

35-39.9 kg/m2—Class II

>40—Class III

Waist circumference can also help assess risks.  People with abdominal obesity are at increased risk for cardio and metabolic health problems.  To measure waist circumference use a soft sided tape measure around the abdomen at the level shown in the image below. 

Image reproduced from UpToDate.com a best evidence data base January 2023.

A waist circumference of >40 inches in males and >35 inches in females is indicative of increased health risks.  For people of Asian decent, health risks are higher with waist circumferences of 35 inches or greater in males and 31 inches in females.

Now what?

If a patient is considered overweight or obese, it is important to lose the weight in hopes of preventing chronic disease.  Losing weight for some people is much harder than others.  Some will do well with dietary changes alone but some will need more aggressive treatment options.  Treatment for each patient should be individualized for success. 

First, medical causes of weight gain should be ruled out.  For example, thyroid problems and certain medications can cause weight gain.  For some people, anxiety or depression can lead to weight gain.  Sometimes, modifications in medications or treatment of a disease process can help with weight loss. 

Most people gain weight from a sedentary lifestyle and the American diet.  In order for anyone to lose weight, lifestyle modifications are always the first step to a healthier you.  It is not as simple as diet modification for some of us.  Diet is where most people fall short when losing weight.  In our culture, it is much easier to eat unhealthy foods than it is to eat healthy foods.  Not too many fast food chains offer fresh fruits and vegetables in their combo meals.  You can easily eat 1000 calories in a meal.

Other things that keep us heavy can include feeling stressed or tired.  Stress can come from obvious everyday causes like kids, spouse, work, and/or money issues.  Stress also comes from things we may not think of as stressful.  For instance, processed sugars cause stress on our bodies.  Not getting enough sleep is another common cause of stress.

No matter the cause of weight gain, nutrition and stress management are the most important part of any treatment plan. 

Activity is also encouraged.  If you like to exercise, go for it.  Exercise has many health benefits and can assist with weight loss.  Activity is parking further from the store to get more steps in.  Using the stairs instead of the elevator.  Getting up from your desk every hour to move around for a few minutes.  Activity is getting more movement in during the day whatever that looks like to for you. 

Medication Options

For some people, exercise and healthy eating are not enough.  There can be a cycle of stress causing someone to hold on the excess weight.  The stress comes from the excess weight and it just gets worse from there.  Some people need a boost with medications to jump start the weight loss process.  This section will cover the pros and cons of the common medications used for weight loss. 

Glucagon-like peptide 1 (GLP-1) receptor agonists—These medications work by    slowing gastric emptying (decreasing hunger). Ozempic (Semaglutide), Wegovy (Semaglutide), and Victoza (Liraglutide) are the FDA approved GLP-1 receptor agonists approved for weight loss. 

Ozempic—Injection 1 time per week under the skin of the abdomen, thigh, or back of upper arm.  It is a multi dose injection pen.  GoodRx prices run about $1000 per month. 

Wegovy—Injection 1 time per week but with a single use pen.  GoodRx quote is $1300-$1500 for a 1 mo supply.

Victoza—Once daily injection.  Multi-dose pen.  Approximately $1300 per month. 

Pros

Very effective for weight loss

Is also a diabetes treatment

Has been shown to reduce major cardiovascular disease events in adults with type 2 diabetes

Cons

Expensive

It is an injection

Can cause severe gastrointestinal side effects (nausea, vomiting, diarrhea)

Orlistat—Decreases fat digestion.  Generic orlistat can costs anywhere from $250-$700 per month.  Over the counter orlistat (Ali) is approximately $50 per month but is a lesser dose.  Orlistat is taken 3 times per day with meals. 

Pros

Has over the counter option

Safe for most people

Can decrease high cholesterol

Cons

Not the most effective

Gastrointestinal adverse side effects

Can decrease levels of fat-soluble vitamins like vitamin D

Phentermine-topiramate—Can be used as a combination drug (Qsymia $200/mo) or separately to decrease costs. Phentermine is a stimulant which can decrease appetite and potentially increase energy levels.  Topiramate is an anticonvulsant that is thought to effect cortisol levels which can lead to weight loss. 

Pros

Cheap options

Cons

Phentermine is a controlled substance which makes it harder to get

Cardiovascular contraindications

Not as effective as GLP1 therapy

Is teratogenic meaning that females of reproductive age must have reliable contraception

Can cause kidney stones

Potential for abuse

Bupropion-naltrexone—Bupropion works with dopamine in our brains and is traditionally used as an antidepressant.  Naltrexone is used to treat alcohol and opioid dependence.  When combined, these drugs work with hormones in the brain to reduce food intake.  Contrave is the brand name and there are currently no generic versions.  It costs around $500 per month. 

Pros

Can treat multiple problems other than weight loss

Cons

Side effects (nausea, headache, constipation)

No cheaper options available

Possibly linked to increase in adverse cardiovascular events

How do I know which medication to choose?

There are multiple other medication options for weight loss but the above covers the ones that are more common and FDA approved for obesity. It is important to talk with a healthcare provider to help you decide which one is safe for you.  If your BMI is over 40, it is very to discuss both medication and possible surgical options for treatment of obesity with your provider. 

Does Armstrong Telehealth offer these medications?

Yes! Armstrong Telehealth offers very affordable visits and can prescribe the medications that are right for you (except for phentermine). Referrals for surgical services are also offered. Book online (www.armstrongtelehealth.com) or call (937-857-6327) to discuss appointment times.