There is good news in weight management!!
The good news is that everyone who wants to lose weight can do so with some help.
The critical element here is calorie restriction. The diet is the most difficult part of weight management. Weight management is essentially a calorie consumed vs. calorie expenditure balance. A strict diet helps tilt the balance towards weight loss. This is the most difficult but given medical tools available it is actually much easier than one may think. In general, any medically managed program should provide an additional 4-5 Lb. of weight loss per month. The pitfall here is not the first 10 Lb. but it is how to sustain the weight management over the next 12 months, and how to avoid a “yo-yo” diet. After the first successful period of weight loss the body reacts in a number of ways and metabolism actually slows down. The body produces a hormone called Ghrelin which increases appetite to negate any weight loss to restore the original (non-desired) weight. After a 20 Lb. loss Ghrelin increases by about 30% creating a ravenous appetite that will quickly force one to regain the weight back, negating any success. This can last up to a year. Patients and physicians struggle with this issue and patients lose momentum and become discouraged when any success is reversed despite their best effort.
Recent studies have uncovered some interesting characteristics of ghrelin. First, ghrelin increases with decreasing BMI and decreases with increasing BMI. The former is fundamental in explaining the aforementioned compensatory hunger drive that accompanies weight loss and, interestingly enough, the latter may explain why patients with anorexia have a difficult time maintaining a normal appetite after attempts to gain weight. Another study found that patients that are weight cycling (defined as losing more than 10 pounds multiple times within the span of several years) have higher average blood concentrations of ghrelin than non-cycling patients.
Most importantly, researchers have found that even one year after a weight loss program, levels of circulating ghrelin remained higher than before weight loss program was instituted. This finding is key to helping ensure a successful weight loss regimen. We currently have no drugs that can directly target the ghrelin signaling system, but we do have access to medications, such as Saxenda and/or phentermine, that have different mechanisms of suppressing appetite and opposing the ghrelin tide that swells during weight loss. When willpower alone may fail in weight management, countering the effects of ghrelin will prevent our fundamental physiology from undermining our progress.
The really good news is that the correct use of medications can really enhance the original weight loss, and counter the body’s attempts to reverse the weight loss. There are amazing medications available, all FDA approved with an excellent track record in our medically supervised weight management program. Weight loss medications need to be highly personalized and there are no “cookie-cutter” approaches or shortcuts.
Kavian S. Milani M.D
Virginia Family Medicine