Most people have struggled with weight in some way at one time or another, and diet fads have been around for decades. The Beverly Hills Diet, the Grapefruit Diet, the Cabbage Soup Diet…they all made big, splashy headlines, but rarely did any of them work well enough to have staying power.
So what does work when you have significant weight to lose? In a nutshell, a practical and comprehensive approach is the way to go. And one size doesn’t fit all. Thankfully, we have lots of tools, support options, and medications we can utilize for a proactive multidisciplinary strategy.
Why Do We Gain Weight?
Before we dive into weight loss solutions, let’s first talk about why we gain weight in the first place. There are many complex factors involved that influence our weight. To name a few causes:
- Family history (it is always our parent’s fault!)
- Aging (it’s easier to gain and harder to lose weight as we get older)
- Sleep disturbances
- Certain medical conditions
Nutrition, of course, also plays a significant role. If we’re eating a calorie-dense diet and the body sees itself in a hyper-caloric state, insulin levels increase. Insulin is a storage hormone that can start to build up adipose tissue (aka fat cells) and makes new fat cells. When we gain weight, that triggers a cascade of inflammation in the fat cell which triggers the immune system and results in high insulin levels. Obesity is a state of chronic inflammation. The pathophysiology of weight gain is very complex, and the insulin story is just one piece of a vast puzzle.
How Does Weight Affect A1c?
Excess weight increases insulin resistance, which may mean you’re more resistant to your medications, and you may need more insulin to get your A1c under control. On the other hand, medications often become more effective when people lose weight, and A1c tends to improve.
Rethinking Weight Loss Expectations
Managing weight is a very personal and emotional experience. If we aren’t at our desired weight, we can feel guilty and as if we have failed. But we must let go of the guilt and understand that weight loss is a process. It is not a sprint but rather a marathon.
For most people, losing half a pound to a pound a week is a realistic expectation, so if you’re doing well, you’re losing four pounds per month. But many want to lose 30 pounds in a month, setting themselves up for failure before they even begin.
Slow and steady is the way to go. It’s about modifying habits and solidifying a new lifestyle.Instead of fixating on a number on the scale, it’s essential to focus on re-engineering your lifestyle so it’s aligned with where you want to be with your weight. That way, when you do lose weight, you’ll keep it off. And every step you take, no matter how small, is meaningful in making new, healthier choices, decreasing inflammation, and being able to move a little easier.
The Benefits of Weight Management Specialists
Many healthcare clinics have weight management specialists who can help you develop a comprehensive weight loss plan. They often include expert medication guidance, visits with registered dietitians, health coaches, mental health professionals, exercise physiologists, and additional personalized support.
Lifestyle Target: Nutrition
One of the first targets in weight management is reducing or eliminating highly processed foods such as packaged food with artificial coloring and ingredients (chips, processed meats, donuts) and sweet drinks (soda, juices). Incorporating more natural foods like fruits, vegetables, legumes, and other whole foods that are lower in caloric value and higher in fiber will help decrease inflammation in the body.
Eating a lower-carb diet will significantly help people with diabetes because glycemic control is better if you aren’t consuming high amounts of processed carbs. Nutrition is very personal, and there isn’t one specific diet that will fit everyone. Working with a registered dietitian or certified health coach who understands your personal and cultural preferences can be beneficial.
Keeping a food diary is also an excellent tool because we subconsciously do things like throw in an extra cookie when we’re at Starbucks for a cup of coffee. Writing down what we eat focuses our attention and makes us think about what we eat and why.
Lifestyle Target: Exercise
For those new to exercise, you can start slowly with low-impact options like walking, swimming in a pool, riding a stationary bike, doing chair yoga, or using an arm bicycle. Arm bicycles can increase your heart rate while seated, so it’s a good option for people with mobility issues.
There’s also something called non-exercise activity thermogenesis (NEAT), which means all those extra activities we do that are not exercising. Examples are: standing instead of sitting, parking a little farther away when you’re out shopping, and taking the stairs instead of the elevator – anything that allows you to move more frequently throughout the day adds to a caloric burn and will help with weight loss.
Tried, True, and New: Proven Medication Options
There are several FDA-approved weight loss medications, but all of them need to go hand-in-hand with lifestyle changes:
Qsymia has been around since 2012 and works like an appetite suppressant. It’s taken once daily, and people can expect to lose about 11% of their body weight. It is contraindicated in hyperthyroidism and glaucoma. It should be used with caution in people with kidney stones since it can increase the risk of stone formation.
Contrave has been on the market since 2012 and is taken once daily. Contrave works through the brain to decrease appetite. As a result, people can expect to lose about 10% of their body weight. It’s contraindicated for people with eating disorders and uncontrolled hypertension.
Saxenda is a GLP-1 receptor agonist that induces satiety. Saxenda is the same medication as Victoza used for type 2 diabetes, just at a higher dose. Saxenda was FDA-approved in 2014, is taken once daily, and people can expect to lose about 10 to 15% of body weight. Possible side effects of Saxenda are gastrointestinal such as nausea and vomiting.
Wegovy is the newest GLP-1 receptor agonist on the market, and was FDA-approved in 2021. It’s the same medication as Ozempic but at a higher dose, and indicated explicitly for weight loss. It’s taken once weekly, and people can expect to lose about 15% to 20% of their body weight. You can read more about Wegovy here.
If you have type 1 diabetes and obesity you can use Wegovy, which will likely also help your blood sugars. Remember that the insulin requirements will drop with weight loss, so be in touch with your health care provider.
Possible Side Effects of Wegovy
About 30% of people experience nausea when they first start taking Wegovy (for 70% of folks, though, it’s smooth sailing). It’s recommended that you start with a low dose and titrate up slowly. A typical starting dose is 0.25 mg a week for 4 weeks, and the highest amount is 2.4 mg. Going up to the full dose can take 5 months.
Who Is a Good Candidate for Wegovy?
Wegovy is for those with a body mass index (BMI) of 30 kg/m2 or greater (defined as obese) or overweight (BMI ≥27) who have at least one weight-related comorbid condition like diabetes, hypertension, high cholesterol, or sleep apnea.
BMI stands for Body Mass Index, which considers the person’s weight and height. For example, a 5′ 10″ male with a BMI of 30 would be 210 lbs; for a 5′ 4″ female with a BMI of 30, her weight would be 175 lbs. You can check your BMI with this calculator.
Additional Perks of GLP-1 Receptor Agonists
The beauty of GLP-1 receptor agonists is that they induce satiety, so you feel full and eat less. These medications help to reduce glucose levels, lower A1c, and reduce heart attacks and strokes.
There are incredibly effective tools at our disposal regarding weight management. It’s essential to take a multidisciplinary approach, set realistic expectations, go slow, and acknowledge all the small things you do that move you closer to your goal. Every step makes a difference and is meaningful in creating new, healthier habits, and taking better control of your health.