You don’t want to settle for the “easy way out”, but haven’t seen adequate weight loss results with diet and exercise. Now what? Perhaps medication isn’t a cop out after all. We now have a better understanding of obesity as a chronic disease that requires chronic management, much like diabetes or high cholesterol. Really? Yes! Let’s dig deeper.
As a former primary care doctor, I have diagnosed many people with type 2 diabetes in my career. The initial treatment plan typically involves some work on nutrition and exercise, as well as weight loss. If follow up labs show that the blood sugar still isn’t in a healthy range, we add medication. Let me emphasize the word add. Medication doesn’t replace efforts to improve nutrition and activity. We never say that you can eat whatever you want and lounge around on the couch, letting the medication do the work for you. Of course not! It’s a combination of medication, along with healthy nutrition and exercise, that we strive for to bring blood sugar under good control.
Now, let’s shift the discussion from diabetes to obesity, and from sugar to weight. The same principles apply. We know that with an intensive lifestyle program (diet, exercise, behavioral change), a typical person can lose and maintain a weight loss of approximately 5 – 6% over 10 years. For most people, that doesn’t feel like enough. If you weigh 300 pounds, do you have a goal of losing and maintaining a 15-20 pound weight loss? Probably not. By adding medication, we can get that number up to 10 – 12% weight loss. Now we’re looking at a 30 to 36 pound sustained weight loss for a 300 pound person. Better, right? But medication doesn’t work alone. To achieve and maintain that 10% weight loss, we use a combination of medication AND lifestyle modification. Used alone, medication leads to less weight loss than lifestyle modification alone.
So, I submit to you that this is not the easy way out! Medication for obesity now serves as chronic treatment for a chronic disease, much like medication for diabetes. One may need to be on treatment for years to help maintain weight loss, and that’s okay. When we treat excess weight with medication, we are trying to prevent the need for medication for co-morbid conditions like diabetes, high cholesterol, arthritis, and so on, that may come from obesity. We’re treating the root of these other health problems, trying to prevent or manage them with weight loss.
But what about those people on TV who lose 100 pounds without surgery? Unfortunately, we know that these folks typically regain the weight. Fighting excess weight requires hard work and constant vigilance. Without medication to fight the biologic drive towards weight regain, most people will eventually return to their baseline weight. This is not a disease of willpower. Those who have faced a long term struggle with their weight know that this is a disease with a powerful biologic component, driven by hormonal (and neurological) changes.
We need to take away the stigma of using medication for weight management. We don’t judge those who take meds for diabetes or high cholesterol, right? We understand these are diseases with both genetic and environmental components. We further understand that it takes a lifetime of attention to diet, exercise and often medication to bring these diseases under control. Let’s eliminate the stigma around medication for the treatment of obesity. It shouldn’t be treated as a last resort or a sign of weakness. It’s simply another tool in our toolbox to fight this chronic disease.
Please talk to your primary care doctor or a board certified Obesity Medicine specialist to learn more about using medications if your BMI is greater than 30 (or if it’s greater than 27 and you have diabetes, high cholesterol, sleep apnea, metabolic syndrome or high blood pressure).
Thanks for listening and I wish you the best of health!
Lisa Oldson MD