PART 3: Managing Weight with Weight-Loss Medications
Is it right for you? Back when the “new normal” was new, I wanted to connect with all of you out there who—on top of everything else—are worried about maintaining a healthy weight during quarantine. With so little knowledge of what the future would hold, it seemed useful to share my experience and provide tips for “getting through.” But now, the reality is sinking in that life may be a hybrid model for a long time—not quite this new normal, but not quite the old normal either. So I decided to address an important tool for weight loss that doesn’t necessarily relate to lockdown but about which there may be a general lack of reliable information. Let’s talk about weight-loss medications.
Weight-loss medications vs weight-loss supplements. Is there a difference?
First, let’s be very clear on terms. Weight-loss medications, or medicines, are entirely different from weight loss supplements. A medication is regulated by the U.S. Food and Drug Administration (FDA) and available by prescription only. It gets approved after years of clinical trials studying how well it works and how safe it is, and continues to be monitored indefinitely by the FDA.
Supplements, on the other hand, are not regulated by the FDA. Essentially, anyone can sell anything over-the-counter as a supplement, and even tell us it will melt weight off. But research has clearly shown that claims made by supplement manufacturers can be completely false, and supplements have caused people serious health problems. In fact, the FDA mandates that any supplement have a label stating it is not meant to diagnose, treat or cure any condition.
How do weight-loss medications work?
Most of the meds available today work by changing the chemical signals to parts of the brain that control appetite and desire for food. Each medication works in a unique way, because each works on a different network of chemical signals in the brain. But they all help dampen hunger signals and increase the feeling of fullness. This means eating less, and as a result, losing weight. There is one medication that works completely differently, by blocking the body from absorbing fat from food.
Who is a candidate for weight-loss medication?
The most important thing to remember is that weight-loss medications do not replace the need for a healthy lifestyle. Weight loss is more than a tablet or a capsule. Being aware of why, how and what you eat, staying as active as you can, and building healthy habits that can be sustained over time are always key elements of success. Medications are an additional tool that can complement these efforts. If you are trying, making changes, but are unable to lose weight, or if over time your weight loss cannot be sustained, then you could discuss with your physician if medication may be right for you, or consult with a physician specializing in obesity medicine.
You may be eligible if you check off the boxes below (based on FDA regulations)
Your body mass index (BMI) is higher than 30. To calculate BMI use the CDC’s adult BMI calculator.
Your BMI is over 27 and you have weight-related health issues like high blood pressure, high cholesterol or type 2 diabetes.
You have been making lifestyle changes but have been unable to lose weight, and/or you have a history of losing weight, gaining it, and losing weight again.
Even if you check off all of these boxes, adding medications for weight loss may not be appropriate for you. It also depends on your medical history, other medications you take, insurance benefits, and a shared decision-making process between you and your physician.
What happens when a medication is prescribed?
When I prescribe a weight-loss medication, my focus is on how weight loss will help improve a person’s health. We always discuss expectations—I remind my patients that exercising and healthy nutrition are essential, and that like with all medications, these can have side effects and risks. We review the average weight loss that can be expected. But I also emphasize that an individual’s response to a med is variable and unpredictable. In fact, one person may get no benefit at all from a specific drug while another may be a ‘high responder’ who loses much more than the average. Using medication is always a trial and we monitor closely during regular follow-up visits to review whether the medicine is working: if so, we continue, and if not, we change course.
I am often asked by my patients how long they will have to be on the weight-loss medication. This one is tricky. Many think they can take a med until the weight loss goal is achieved, then stop and keep the weight off. But that may not be realistic. Most studies have shown that a medication that works needs to be continued to keep the weight off. However, it will always be reasonable to do a trial of stopping it; if the weight loss can be sustained through the new habits alone, great! And if the weight creeps up, the med can be restarted.
I have been humbled by the impact that changing hunger signals in the brain with a weight-loss medication can make. For some of my patients, these medications have been simply transformative, helping them be successful at something that had been a lifelong struggle. But decisions about which medication might be the best fit for you personally, and how long to continue it, are not always simple, so be sure you are working under the guidance of a qualified physician. It may be hard to resist the temptation to lose weight quickly and “effortlessly.” But take my advice: losing weight safely and gradually, and working on forming new habits that can be sustained, is the best way to a healthier you.
In Part 4 of this series, I will share with you strategies and tips on how to keep the weight off long term. Until then, be well.
Dr. Florencia Halperin is the Chief Medical Officer at Form Health. She is a Harvard-trained endocrinologist dedicated to helping people lose weight to improve their health.