As I write this blog, obesity in the U.S. continues to escalate, from 15% in the 1970s to nearly half the population in 2023. Contrary to popular belief, obesity doesn’t just come with the aches and pains caused by mechanical failures of the extra weight. The issues caused by unhappy, engorged fat cells cause mayhem in the body, leading to multiple chronic diseases including Obstructive Sleep Apnea, Type 2 Diabetes, Hypertension, High Cholesterol, Fatty Liver disease and many more.
Sadly, many of the medications used to treat these conditions lead to further weight gain, and it is not long before a patient is on multiple medications for multiple diseases on a path to significantly decreased health.
If you remember nothing else from this blog, please remember this: Chronic diseases don’t have to be chronic. Just a 5-10% weight loss can lead to reversal of the majority of obesity-related diseases. Here’s how.
Our Approach to Weight Loss
At Medical Weight Loss of New York, we take a holistic approach to weight loss. In Obesity Medicine, there are four pillars that are used to develop a disease-reversing weight loss plan:
- Nutrition: Coming up with the right meal plan for the individual that produces excellent weight loss while preserving muscle so that weight loss can be maintained.
- Exercise: Adding the right amount of activity at the right time to improve weight loss without increasing hunger. Exercise is also an important part of maintaining weight loss.
- Behavioral Modification: Whether it’s binge eating, carb craving, night eating, emotional eating or something else, this is where we explore and treat the behaviors behind the eating patterns.
- Medical Management: This is where the disease reversal happens! As a medical practice, we review bloodwork, vitals, and medications. We address causes of the weight issue as well as adjust medications as weight loss occurs and diseases are reversed. It is my favorite part of what we do!
Medical Management for Disease Reversal
I can tell you as a Family Practice physician and an Obesity Medicine specialist, the approach taken to treat chronic diseases such as Diabetes is totally different in each field.
In Family Medicine, we are instructed on how to “treat” chronic diseases. For example, with Diabetes we focus on getting the Hemoglobin A1C (a 3 month glucose marker in the bloodstream) at or below 6.5 regardless of the cost. This can mean loading that person up with multiple weight gaining medications such as Insulin, Sulfonylureas, Meglitinides and others. Although you can win the battle producing lovely bloodwork with this approach, you now have a patient who is 50 pounds overweight. That extra weight gain often leads to more chronic diseases like hypertension, high cholesterol, Fatty Liver disease, joint problems and many others. Now you have lost the war, and bought yourself a lifetime of medications that will continue to grow over time as you do.
In Obesity Medicine, it is a completely different approach. By using the 4 pillars mentioned above, we set out to reverse weight-related diseases by creating and sustaining a 5-10% weight loss or more. As long as that weight loss is maintained, the disease can be reversed once and for all.
For diabetes, the process is stepwise, starting with Insulin. It is so important that the patient checks their blood glucose regularly so the insulin can be cut in a safe and effective manner. I follow the weight and the glucose ranges every 1-2 weeks and cut insulin accordingly, with the glucose goal during active weight loss between 120 and 150. It is much safer to run a little higher rather than low during the weight loss phase. Next come the oral agents such as Sulfonyureas, and Meglitinides. The goal is to be off as many medications as possible and produce bloodwork that is within the healthy range above.
Note: This process must be supervised by a practitioner preferably who specializes in Obesity Medicine. Never try to do this at home on your own.
Do we ever add medications to help with the disease reversal process?
We will sometimes add medications that are weight-losing to replace the weight-gaining ones used for diabetes. GLP-1 agonists such as Ozempic and Mounjaro are extremely helpful in this process, as are SGLT-2 medications such as Jardiance, Invokana and Farxiga. GLP-1 agonists work by impacting insulin take up in the gut, as well as by decreasing hunger in the brain, and slowing transit time through the gut. SGLT-2 inhibitors cause you to eliminate glucose through your urine, which positively impacts weight and blood glucose levels.
So what is going on with some of these medications, and why do I keep hearing about them in the press and on social media?
I have been an Obesity Medicine physician since 2006, and I can honestly tell you that I have never seen the media get so involved in the medications used for weight loss. There is clearly an end goal in mind that doesn’t seem to be favorable for the patient, which concerns me.
Anti-obesity medications are a key tool used in our practice to help patients lose weight, and maintain their weight loss. As discussed above, only a 5-10% weight loss helps reverse chronic diseases. By itself, Ozempic (also marketed as Wegovy for weight loss) has a 12% weight loss at the highest dose. Mounjaro (which is being fast-tracked by the FDA for approval for weight loss) has a whopping 22% loss at the highest dose. When coupled with an excellent diet, exercise and behavioral plan, these medications are a key part of the disease-reversing process not only for Diabetes, but for other diseases like Hypertension, High Cholesterol and fatty liver disease. Unfortunately, when not coupled with the other pillars (especially nutrition), these medications can cause real problems as they can completely remove the urge and interest to eat. This is why it is so important to be followed by an expert that knows how to address these issues with a multidisciplinary approach including a sound nutrition plan.
Other anti-obesity medications such as Phentermine have been around for over 60 years, and have stood the test of time. Phentermine has been proven to be safe and effective, despite the misinformation campaign launched against it since its inception. It remains the only anti-obesity medication out there that increases metabolism. The injectable medications such as Ozempic and Mounjaro have been around as a class since 2005. They are getting better with time—weekly dosing and improved appetite suppression, increased weight loss, and decreased side effects.
There are many other medications used in our field to facilitate weight loss and maintenance. Please see my previous blog for the complete list.
Chronic Diseases Don’t Have to Be Chronic!
Remember, chronic diseases do not have to be chronic! It only takes a 5-10% weight loss to reverse the majority of chronic diseases associated with obesity. Every day at Medical Weight Loss of New York, we remove medications from a patient’s growing list, helping both their longevity, quality of life, and finances. For a person with diabetes, this means preventing blindness, the need for dialysis, amputations, and many more. Nobody wants to spend the majority of their income on health insurance and payments for prescription medications. To turn this ship around, connect with an obesity medicine specialist—experts in disease reversal, and get rid of your diabetes for good.