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When resolutions aren’t enough: medicine and weight management

Feeling like you’ve tried everything and you’re still stuck with some stubborn pounds? Sometimes behavior change alone isn’t enough and it may be time for a medical intervention. 

Tryon Medical Partners internal medicine specialist Dr. Ilhem Remmouche guides her patients through medical weight management on a daily basis. She answers some key questions about when medicine might be worth considering in a weight loss journey. 

Why do people struggle with weight management? 

Most people misunderstand the root cause behind being overweight. There is a misconception that it is a lack of willpower and with enough discipline, they wouldn’t have a problem shedding the excess weight. However, weight gain is complicated and often involves several bodily systems including the gut, nervous and endocrine systems. 

“If you think of weight management as just calorie counting, then you’re going to be disappointed when you try to lose weight and it doesn’t work,” Dr. Remmouche notes. “It’s important to understand that weight gain is a complex problem and people need to practice self-compassion to solve it.” 

Who is a good candidate for medical weight management? 

Medication is not always necessary in achieving a weight management goal. Dr. Remmouche typically only considers medication for people who:

  • Have been trying to lose weight for 3-6 months (at least) 
  • Have made substantial lifestyle changes without seeing significant results
  • Have a BMI over 30, or between 25 and 29.9 with risk factors like diabetes and cardiovascular disease
  • Have a waist circumference over 40 inches in men and over 35 in women (or lower, in certain populations). 

Some important considerations for those who: 

  • Are already on medication that could be increasing their weight (for instance, sulfonylureas medication for diabetes type 2 or certain antidepressants). In this case, Dr. Remmouche would first consider potential substitutes for those medications to see if that helps manage weight.
  • Have a history of substance dependence. Some weight loss medication can be addictive and abused. If a patient has struggled with substance use in the past, Dr. Remmouche recommends staying away from sympathomimetic weight management medications and consider some other options.
  • Have used weight management medication unsuccessfully for 12 weeks on the highest dose and haven’t lost at least 5% the total body weight, take a break, the medication may not be solving the root problem. 
  • Are pregnant or breastfeeding. Taking weight management medication may cause birth defects. 

If a patient is a good candidate, Dr. Remmouche focuses on prescribing a variety of FDA-approved classes of medications including, but not limited to, GLP-1 Receptor Agonists, which are weekly or daily injections. 

However, unless patients concurrently make lifestyle changes (diet, exercise and behavior modification including stress management), they will all reach a plateau phase and their metabolisms will naturally slow down and they might gain the weight back. 

“Our body has a set desired weight and it will constantly work to revert back to it,” Dr. Remmouche remarks. “If we don’t put lifestyle changes in place to keep the weight off, it won’t work.” 

If medical weight management isn’t right for me, what else should I try? 

Dr. Remmouche recommends focusing on three main categories:

  • Diet. It’s not just about the amount of calories, it’s about what type. Stay away from anything that will spike insulin (refined carbs and sweet drinks), cut down on snacking, focus on whole food rich in healthy fat, protein and fiber, and make sure you’re eating foods you enjoy so that your diet is sustainable. 
  • Exercise. Exercise allows you to burn more calories, build muscle to speed up your metabolism and lowers stress levels. 
  • Behavior modification including proper sleep hygiene. Outside of diet and exercise, sleeping habits are also important. If your body is sleep-deprived, it will be in a state of stress and unable to lose weight.

“Most importantly, don’t try to change everything at once,” Dr. Remmouche recommends. “Focus on one step at a time, and take it in bite-sized pieces.” 

Visit the Tryon website today to learn more about weight management options or to make an appointment for help and guidance.