Weight Loss Medications: When to Consider Them

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Obviously as a dietitian, promoting a healthy diet and lifestyle are my top priority when working with patients. However, there are some instances where (temporarily) supplementing your efforts with a medication may help you reach your goals and keep you on track.

Today I wanted to discuss what situations I come across when working with patients where I recommend they talk to their doctor about starting a weight loss medication, and what types of medications are on the market that your doctor may recommend.

*I want to preface these reasons first by saying I work with patients one on one and can typically tell they’re being honest with me with eating balanced meals, meeting adequate calorie, macronutrient, and micronutrient requirements before going on to these options. I also assess if their current weight is healthy based on body composition and body type, and only recommend medication use if they are heavily overweight or obese and need further assistance with weight loss.

1. If You Feel Hungry ALL THE TIME

If I have been working with a patient for a while and can tell they are being honest and are meeting all of their calorie, macronutrient, and micronutrient needs, but still feel like they are hungry most or all of the time, then adding a medication to suppress their appetite may be an option to help them reach their weight loss goals. Typically, a higher protein and high fiber diet with moderate amounts of healthy fats will help keep you satiated for longer, but if this still isn’t doing the trick, then a medication that helps suppress appetite may aid in reaching your goals.

I know first hand how unbearable feeling hungry or unsatisfied can be, but the weight loss process should not feel like torture. If it has been months and you have met with a professional (whether it be a dietitian or doctor) to determine if more adjustments need made to your diet or lifestyle first, and nothing is working, then a medication that suppresses appetite may be something to consider.

Some common appetite suppressing medications on the market currently include Phentermine, Bontril, Tenuate, Qsymia, Contrave, Ozempic, and Saxenda. All medications have risks for side effects so always talk to your doctor about the pros and cons of starting these medications.

2. If You Have Not Seen the Scale Move in Months

There is a “set point” theory (which has not yet been proven, FYI) in which our bodies get used to a certain weight and we will not be able to break from this weight. While this has never been proven, I do work with many patients who come across weight loss plateaus. Typically, we adjust our approach with the path we’re on (ex. adjusting calories/macronutrients, adding or subtracting certain types of foods in diet, trying various intuitive eating methods, modifying exercise regimen), but sometimes it can be daunting for a patient to meet with me and not find progress on the scale. I do look at other forms of progress such as body composition, visceral fat changes, blood pressure, cholesterol, and blood sugars, but know that the number on the scale is also important to many patients as well.

If you are not making progress with reaching your weight loss goals despite incorporating all of these healthy changes, you could take a look at other factors in your life that could be influencing your weight.

How are you sleeping and how stressed are you? Poor sleep hygiene and stress can increase cortisol levels, and when cortisol levels are higher it can be more difficult to lose weight.
Are you on any medications that have weight gain as a side effect? Some medications such as prednisone, Insulin, anti-seizure medications, beta blockers, neuropathic pain, and anti-depressants have weight gain as a side effect. Switching to a more weight-neutral medication can be an option (1).

It may be time to ask your doctor about adding a medication to get over your plateau if you’ve addressed some of these other issues and still can’t see the scale budge.

I do want to add that many times, patience is KEY and sticking with your healthy regimen will typically help you break that plateau. We are a society that likes FAST results, so it does also help to reflect on if you are setting the bar too high for yourself.

If you are struggling with motivation, you are not alone. Behavior change is hard and it can seem daunting when trying to reach a goal that may seem out of reach at this point. While I may suggest to seek out professional mental help, I also try to dig deeper as to why your motivation remains low and help you understand more realistic expectations with your current behavior and long term success.

If I sense that a patient is about to throw in the towel all together despite all of the healthy habits they have adopted, I may also suggest adding a weight loss medication to their regimen to help keep their motivation high.

So those are some of my top reasons as to why I would suggest adding a weight loss medication to your regimen, but remember to always discuss this with your doctor. Typically weight loss medications work by increasing norepinephrine release, suppressing appetite, inhibiting absorption, or activating glucagon-like peptide (GLP-1) receptor, or a combination of the above (1). There are always risks involved when starting a new medication (and I usually try to keep patients off medications as much as possible) but being very overweight and obese has its own risks so always be aware that you have options.

If you have struggled with your weight, feel free to schedule a consult or call for more information. Overall, understanding and implementing adequate nutrition is the first step when it comes to weight management.

Jordan Chen, MS, RD

785-236-9607

1. Bartfield, Jessica. Pharmacological Management of Obesity and Diabetes: Important Considerations for Optimal Patient Care, vol. 41, no. 6, June 2021, pp. 24–29.

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