Medications for Weight Loss with guest, Dr. Angela Fitch, Ep #008
Today is a very exciting day on the podcast because we have our first guest, Dr. Angela Fitch. She is an internal medicine and pediatric obesity medicine physician and president of the Obesity Medicine Association. She's the former co-director of the Mass General Weight Center in Boston and now she is the Chief Medical Officer for Known Well a new in-person and virtual primary care and obesity clinic that will launch soon in Boston and across the country. In this episode, we will be talking about something that both Dr. Fitch and I are really passionate about, anti-obesity medications that help with weight loss. We will discuss why we think they are important, what kinds are out there and what they do, and why diet and exercise aren't always enough. I hope this information helps you.
Points of interest...
Why do we need medications? [2:08]
Sympathomimetic amines, a class of medications like Phentermine [6:51]
Phentermine Topiramate combination [14:32]
Naltrexone Bupropion combo [17:39]
GLP-1 agonists injections [20:34]
Keeping an eye on nutrition when using medications [28:20]
Plenity [32:29]
Orlistat [35:11]
Medications that are not technically anti-obesity medications [37:25]
Accepting long-term use [39:18]
Why do we need these meds?
Let's talk about why medications are important and why exercise and diet are not always enough. I asked Dr. Fitch when explaining to a patient why these medications are helpful or needed, how do you explain that?
Dr. Fitch says that for so long, especially for the disease of obesity, we have said to people it's just your fault. You should just do better. But biologically it's very hard to lose weight. Losing weight is not a natural process for the human body. The normal functioning of a piece of equipment is to deliver what it's supposed to do, and for the human body, the normal functioning is to gain weight. We are programmed to resist weight loss at all costs, otherwise, we would've died in the wilderness sometime in the past centuries ago.
People don't want to take medicine if they don't "have to" but even in our best lifestyle studies where people are coming into a place and getting counseling once a week and they have a whole team of people that are looking out for them in a research study, the average weight loss is around 2-5%. It's not a lot of weight loss. It's good to lose that 2-5%. Even maintaining your weight is a huge accomplishment in today's world. Everybody thinks it's not hard. The world makes us think it's easy if you just did this or just did that or that you lose weight but the truth is sometimes medicine is necessary and can make a huge impact in someone's success.
Are there some people who may not need the medications long-term?
These medications are for long-term use. In the first podcast I said whatever you do to lose weight, you have to keep doing it to keep it off. You can't just do a 30-day fix, that's not a real thing. These medications are for long-term use and that is something a lot of people have a hard time wrapping their heads around. When we think about obesity as a disease and when we recognize we're fighting biology it makes sense that these are going to be long-term things to utilize as part of treatment for many people. The question I had for Dr. Fitch is if she thinks that there are people whom this is an exception for.
Dr. Fitch thinks there needs to be more research on it, but the nature of it at this point is you need it long-term It’s not an addiction issue, it’s not life or death if you stop the medication, and the worst-case scenario is that you could regain the weight. You can do a trial but don’t try and then let yourself regain 20, 30, or 40 pounds. Do it very controlled. If the weight starts to creep back up, you get back on it with the understanding that it's going to be something that you need long-term, and that’s ok.
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