Medical Weight Loss
What is Obesity Medicine
What is Obesity Medicine?
Obesity Medicine is a growing field of medicine dedicated to the comprehensive care of patients with obesity. As of January 2023, there are 6000 physicians in the USA that are certified as Diplomates to the American Board of Obesity Medicine. This is less than 1% of the active physicians in the United States.
What is Obesity?
Obesity is a medical condition that is characterized by excessive adipose tissue (fat cells) having an adverse effect on health.
Obesity can cause a wide range of negative health consequences, including an increased risk of type 2 diabetes, heart disease, high blood pressure and joint problems. Obesity is also linked to depression, anxiety and other mental health problems.
Obesity Is
- A disease.
- Caused by many factors.
- Treatable and manageable.
Obesity Is Not
- Your fault.
- Yours to manage alone.
- Just about food.
- Cured by a miracle treatment.
How is Obesity Treated?
A comprehensive clinical approach to obesity treatment involves guidance on nutrition, physical activity, behavior, and medication. Obesity is not a short-term problem that can be fixed with a single treatment. It requires ongoing management. Successful obesity treatment often requires lifestyle changes that must be maintained over time to prevent weight regain. It is important to know personalized solutions matter. Given every person has a unique
What are Evidence Based Medications to treat obesity?
Evidence based medicine is a medical approach that uses the best available scientific evidence to guide clinical decision making. It involves integrating clinical experience with external evidence from research to provide individualized patient care. Evidence based medicine to treat obesity include the following FDA Approved Medications “on- label” for Anti-Obesity Treatment: Phentermine, Orlistat, Buproprion/Naltrexone, phentermine/topiramate, liraglutide, semaglutide. Plentity is considered a medical device to treat obesity.
There are also additional medications that can be prescribed “off-label” which means prescribing a medication for a purpose other than its regulatory agency approved indication or dosage. It is legal and may be necessary in some situations to prescribe medication off-label where alternative treatment options are unavailable or ineffective. Off-label prescribing can still be safe and effective in treating obesity. Off-label medications to help treat obesity include Metformin, Buproprion, Naltrexone, Topiramate and Zonisamide.
What are the NOT evidence based medicine to treat obesity?
-The HCG (human chorionic gonadotropin) shot and “vitamin shots” are not evidence-based approaches to treat obesity. Please note vitamins are useful to treat deficiencies in vitamins and may be prescribed during your visits if a deficiency in a vitamin is detected on blood work.
-Compounded semaglutide is also not considered safe by many obesity medicine physicians. Semaglutide is a patented molecule. Authentic semaglutide is only available via Novo Nordisk. If another company manufactures this product it would violate the patent for Novo Nordisk and it would be without potency or purity standardization. There is also a concern for questionable manufacturing standards. FDA registered manufacturing facilities must adhere to current Good Manufacturing Practices and one such standard is product consistency. Compounding facilities are not required to adhere to this standard. Pharmaceuticals but not compounded products must maintain such standards so that the finish product performs as advertised and is consistent with published evidence. Also, one standard of compounding is that a compounded product is not commercially available. Therefore compounding pharmacies may add agents to the active ingredient. This alters semaglutide and changes it in a manner that is not the same as authentic semaglutide used in clinical trials or in branded semaglutide.
-Treatments like liposuction or other cosmetic surgeries are also not treatments for obesity. These procedures are aesthetic procedures. They are not designed to address underlying causes of obesity.
-Over-the-counter weight loss supplements are not regulated by the FDA and often make exaggerated claims with little to no evidence to support their use.
Is it safe to take medications to treat obesity?
Like any medication, medications used to treat obesity can have potential risks and side effects. However, when used as directed and under the supervision of a healthcare professional, they can be safe and effective tools for managing obesity in certain individuals. It is important to remember that medications are used as a part of a comprehensive weight management plan. Medications can also be an effective tool in helping overcome barriers people face when they try to lose weight—- such as increased hunger, reduced feeling of fullness after meals or increased food cravings.
How much weight will I lose?
The goal is for 5-10% total body weight loss. This is the amount of weight that produced improved metabolic health for people. There are people who lose more weight however there is truly no crystal ball in knowing what a person’s response will be to medical obesity treatment and lifestyle changes. On average though active patients of Weight Sense Lake Nona tend to lose more than the initial goal of 5-10% total body weight. In fact, most patients are ecstatic at the health they gain while involved in our care. This translates into feeling more confident, moving better, having more energy and generally feeling healthier in their day to day life.
More on AntiObesity Medicine
Medicine
Dr. Shah may prescribe medicine to help you lose weight and treat obesity if it is medically appropriate.
The choice of medicine is based on the following:
- Individual’s medical history and physical exam.
- Medication accessibility, availability, insurance cost, and side effect profile are considered during the visit.
- Before the visit, it is hard to know which medication the doctor may select.
- If successful in creating 5-10% total body weight loss over six months, medications may be recommended for long-term use.
Anti-Obesity Medications
WEGOVY
Wegovy is a brand name for the medication semaglutide, which is a type of glucagon-like peptide-1 (GLP-1) receptor agonist used to treat obesity. Semaglutide was originally developed to treat type 2 diabetes, but was later found to be effective for weight loss as well.
Wegovy works by mimicking the action of GLP-1, which is a hormone that is naturally produced by the body in response to food intake. GLP-1 helps regulate blood sugar levels and promotes feelings of fullness or satiety, which can lead to decreased food intake and subsequent weight loss. By binding to and activating GLP-1 receptors in the brain, semaglutide can enhance the feeling of fullness and reduce appetite, which can lead to decreased caloric intake and weight loss over time. Additionally, semaglutide may also slow down the rate at which food leaves the stomach and reduce the release of glucose from the liver, which can also contribute to weight loss.
Wegovy is intended to be used in conjunction with diet and exercise to help promote weight loss in adults with a body mass index (BMI) of 30 or greater, or in those with a BMI of 27 or greater who also have at least one weight-related health condition such as high blood pressure or type 2 diabetes. It is administered as a once-weekly injection and is only available with a prescription from a healthcare provider. You can check novocare.com to see if your health insurance covers Wegovy. You can also call your pharmacy benefit plan to see if Wegovy is available as well.
The amount of weight that can be lost with Wegovy (semaglutide) can vary depending on a variety of factors, such as a person’s starting weight, diet, exercise habits, and other individual factors. In clinical trials, participants who took Wegovy as part of a weight loss program lost significantly more weight than those who did not take the medication.
According to the results of the STEP 1 clinical trial, which involved adults with overweight or obesity and without type 2 diabetes, participants who took Wegovy lost an average of 15.3% of their body weight over 68 weeks, compared to an average weight loss of 2.4% in the placebo group. In the STEP 4 clinical trial, which involved adults with overweight or obesity and type 2 diabetes, participants who took Wegovy lost an average of 9.6% of their body weight over 68 weeks, compared to an average weight loss of 3.4% in the placebo group.
It is important to note that weight loss results can vary from person to person, and that lifestyle changes such as a healthy diet and regular exercise are still important for maintaining weight loss. It is also important to talk to a healthcare provider before starting any weight loss program or medication, as they can provide guidance on whether Wegovy is an appropriate treatment option and can monitor for potential side effects.
SAXENDA
Saxenda is a brand name for the medication liraglutide, which is a type of glucagon-like peptide-1 (GLP-1) receptor agonist used to treat obesity. Like Wegovy (semaglutide), liraglutide was originally developed to treat type 2 diabetes, but was later found to be effective for weight loss as well. This medication also works similarly to Wegovy.
Saxenda is intended to be used in conjunction with diet and exercise to help promote weight loss in adults with a body mass index (BMI) of 30 or greater, or in those with a BMI of 27 or greater who also have at least one weight-related health condition such as high blood pressure or type 2 diabetes. It is administered as a once-daily injection and is only available with a prescription from a healthcare provider.
CONTRAVE
Contrave is a brand name for a prescription medication that is used to help with weight loss. It is a combination of two medications, bupropion and naltrexone, that work together to reduce food cravings and decrease appetite.
Bupropion is a medication that is commonly used to treat depression and seasonal affective disorder. It is thought to help with weight loss by reducing food cravings and increasing energy levels. Naltrexone is a medication that is commonly used to treat addiction to drugs or alcohol. It is thought to help with weight loss by reducing the reward response that people experience from eating high-calorie foods.
Together, bupropion and naltrexone work to decrease appetite and promote weight loss. They are intended to be used in conjunction with a reduced-calorie diet and increased physical activity to help people achieve and maintain a healthy weight.
Contrave is indicated for use in adults with a body mass index (BMI) of 30 or greater, or in those with a BMI of 27 or greater who also have at least one weight-related health condition such as high blood pressure, type 2 diabetes, or high cholesterol. It is taken orally in the form of a tablet and is only available with a prescription from a healthcare provider. It is important to talk to a healthcare provider before starting Contrave, as they can provide guidance on whether it is an appropriate treatment option and can monitor for potential side effects.
QSYMIA
Qsymia is a brand name for a prescription medication that is used to help with weight loss. It is a combination of two medications, phentermine and topiramate, that work together to reduce appetite and increase feelings of fullness or satiety.
Phentermine is a medication that is similar to amphetamines and is used as an appetite suppressant. It is thought to work by increasing the release of certain chemicals in the brain that help control appetite. Topiramate is a medication that is commonly used to treat seizures and migraines. It is thought to help with weight loss by increasing feelings of fullness and reducing food cravings.
Together, phentermine and topiramate work to decrease appetite and promote weight loss. They are intended to be used in conjunction with a reduced-calorie diet and increased physical activity to help people achieve and maintain a healthy weight.
Qsymia is indicated for use in adults with a body mass index (BMI) of 30 or greater, or in those with a BMI of 27 or greater who also have at least one weight-related health condition such as high blood pressure, type 2 diabetes, or high cholesterol. It is taken orally in the form of a capsule and is only available with a prescription from a healthcare provider. It is important to talk to a healthcare provider before starting Qsymia, as they can provide guidance on whether it is an appropriate treatment option and can monitor for potential side effects. Both phentermine and topiramate have been associated with potential risks to a developing fetus, so Qsymia is not recommended for use by pregnant women or those who may become pregnant.
PHENTERMINE
Phentermine is a medication that is used to help with weight loss in people who are overweight or obese. It is an appetite suppressant that works by increasing the release of certain chemicals in the brain that help control appetite.
Specifically, phentermine is a sympathomimetic amine that works by stimulating the release of neurotransmitters such as norepinephrine and dopamine in the brain. These neurotransmitters help to decrease hunger and increase feelings of fullness or satiety.
When a person takes phentermine, the medication works by stimulating the release of norepinephrine in the hypothalamus, a part of the brain that helps regulate appetite. This, in turn reduces the desire to eat and can help people to consume fewer calories and achieve weight loss.
In addition to reducing appetite, phentermine may also have other effects on the body that contribute to weight loss. For example, it may increase the body’s metabolic rate, which can help the body burn more calories even when at rest. Phentermine may also help to increase the body’s energy levels, making it easier for people to engage in physical activity and burn more calories.
Overall, the mechanism of action of phentermine is to reduce hunger and increase feelings of fullness, therefore it can support people on their weight loss journey. It is important to use phentermine only under the guidance and supervision of a healthcare provider, as it can have side effects if not used as directed.
VYVANSE
Vyvanse (lisdexamfetamine) is a medication that is used to treat binge eating disorder (BED), a condition characterized by recurrent episodes of eating large amounts of food in a short period of time, along with a sense of loss of control over the eating behavior.
Vyvanse is a stimulant medication that works by increasing the levels of certain neurotransmitters in the brain, including dopamine and norepinephrine. These neurotransmitters are involved in regulating appetite and reward pathways in the brain, and are thought to play a role in the development of binge eating disorder.
By increasing the levels of dopamine and norepinephrine in the brain, Vyvanse can help to regulate appetite and reduce the urge to binge eat. The medication is thought to work by increasing the activity of the prefrontal cortex, a part of the brain that is involved in impulse control and decision making.
In addition to reducing binge eating behaviors, Vyvanse may also help to improve mood and reduce anxiety, which can be common in people with binge eating disorder.
Vyvanse is intended to be used as part of a comprehensive treatment plan that includes counseling and lifestyle changes to help address the underlying causes of binge eating disorder. It is important to use Vyvanse only under the guidance and supervision of a healthcare provider, as the medication can have side effects and may not be appropriate for everyone.
PLENTITY
Plenity is a weight loss device that was approved by the US Food and Drug Administration (FDA) in 2019. It is a non-stimulant, non-systemic, prescription-only therapy that helps to reduce weight in overweight and obese adults with a body mass index (BMI) of 25-40. Plenity is considered a weight loss device and not a drug because it is not absorbed or metabolized by the body.
The active ingredient in Plenity is hydrogel, which is made from cellulose and citric acid. Hydrogel is a substance that swells in the stomach when it comes into contact with water, creating a feeling of fullness. Plenity is taken before meals, and when it is consumed with water, it absorbs water in the stomach to create a gel-like substance that takes up space in the stomach, leading to a feeling of fullness, and potentially helping people to eat less and reduce calorie intake.
Plenity should be used with lifestyle and behavioral changes supporting total wellness and health. It is also not suitable for everyone, and it is important to consult a healthcare professional to determine if Plenity is appropriate for you.