In the War Against Obesity, Are Drugs Our Best Weapon?

I remember many things from growing up in the 80’s, like big hair, clothes in neon, shoulder pads, acid washed jeans and jelly shoes to name a few. Like many kids, I was living in ignorant bliss about a lot of things. I’m not sure I had even heard the term obesity let alone knew what body mass index (BMI) meant. The prevalence of obesity would reach epidemic status in the 80’s and be declared a chronic disease by the American Medical Association in 2013. (A quick side note: I think it’s important to recognize that BMI is just one measurement for obesity and should not be relied on solely or even as the primary measurement. There are other methods which can be used, all which like BMI, have their pros and limiting factors to consider.) Recognizing obesity as a chronic and complex disease would start a shift in how obesity is viewed on an individual and social level, as well as the measures taken to prevent and treat it. Obesity is linked to many diseases which lead to premature death and is seen as a preventable condition. As obesity rates soar, our government and healthcare systems continue to try different tactics to effectively treat this condition. 

The first line of defense against obesity is lifestyle modification. This includes areas like diet, exercise, sleep and stress management. Most of us are probably familiar with such modifications and have probably tried several tactics in these areas, perhaps even multiple times only to feel defeated and revert back to old habits. While lifestyle modifications can be a low cost, effective method of preventing obesity as well as the treatment of it, like many things, it is easier said than done. Lifestyle modification is driven by behavior change which does not come easily to most of us. It often means deconditioning a behavior in addition to creating a new one. (i.e. Instead of having ice cream after dinner each night, we go for a walk.) 

So if lifestyle modification is the first line of defense/treatment with obesity and it’s not working for whatever reason (and there can be many) what else is there? If we look beyond and in addition to behavior change, we start to look at things like surgical procedures and the use of prescription medications. Surgical procedures like gastric bypass and sleeve gastrectomy are two popular procedures which, while relatively safe, are also still major surgeries which do involve some risks. A far less invasive approach that is gaining in popularity is prescription weight loss medications.

At first glance, one might think, great, weight loss in a pill, no lifestyle change required. Well, not quite. As with any medication, there is much to consider and each of us will  likely fall on a different point when we assess the risk/reward. This piece is not intended to sway you one way or the other when it comes to prescription medications for weight loss, rather it is to raise some questions to consider as you make the best choice for you. First and foremost, the physical risks, i.e. side effects, can be important factors to review. Like all other medications, they can provide the intended effect and they may also be accompanied by unwanted side effects. Cost may also be a limiting factor as some insurance plans may cover the medication and others may not. Another consideration is what does the long term plan look like? This is an important discussion to have with your medical provider. How long should I plan to be on it? What happens when I come off of it? How do the risks of staying on it long term versus the benefits of losing/maintaining a healthy weight look?

While the above questions are without a doubt important, it’s equally important to state that the efficacy of the weight loss drugs (and weight loss surgery) will significantly increase when healthy lifestyle changes are implemented and sustained as well. While I am absolutely an advocate for looking at healthy lifestyle practices first, I recognize that these changes do not come easily and are downright HARD for many and even if we can get started, sticking to them can feel impossible. The lack of consistency and long term change can result in minimal or short lived results which can further deflate motivation. The use of weight loss drugs can help people find success and make things like portion control with food not feel so exceedingly hard. It can instill a sense of confidence that “Yes, I can do this.”

So again, this post is not intended to sway you to be for or against weight loss drugs. As with many drugs, I think it is a case by case basis and there are more things than just numbers to consider. In my experience coaching individuals around weight management, most individuals are reluctant to go the medication route. They would rather do it through lifestyle modifications but they have reached a point where they are so frustrated and defeated by failed attempts that now they also feel like a failure for utilizing prescription weight loss medications. What I hope this post has shed light on is that it isn’t an either/or situation all of the time, sometimes it’s an and. You can take prescription weight loss drugs under the guidance of your doctor and work to make lifestyle changes for success. I know these choices can result in a lot of judgment both internally and externally but I hope this has helped alleviate some of that so you can explore what is right for you and let go of any judgments.