Just in Time for the Holidays: Weight Loss Tips

It’s that time of the year again where we all feed our faces and start to dread stepping back on the scale. You want to lose the weight but you just can’t stop eating. You keep telling yourself you will start your diet Monday or after the holidays. Not only is all of the food you’re ingesting adding numbers to the scale, but it’s also putting you at an increased risk of developing diseases such as congestive heart disease, hypertension, stroke, type 2 diabetes, and various cancers. Here is some information that may help you keep the weight off and start shedding some pounds.

The Importance of Weight Loss

A person who is overweight, meaning they have a BMI greater than or equal to 25 and people who are obese (BMI greater than or equal to 30), have increased risks of multiple conditions along with reduced quality of life and social discrimination. Losing weight also improves confidence and mood and has even shown to increase sex drive. To lose weight, calories must be decreased so that your body can use fat as its main energy source. There are various options you can chose, whether its non-pharmacologic, pharmacologic therapy, or both.

Non-pharmacologic Options

• Diet: Reduce caloric intake to 1200-1500 kcal/day for women and 1500-1800 kcal/day for men. Using evidence- based diets, you can cut out certain foods, such as food high in carbohydrates, to see results. It is important to avoid sugary foods and drinks. And increasing your water intake is crucial for weight loss. Eating foods full of protein such as meat, fish, and eggs can help boost metabolism and minimize cravings for junk foods.
• Exercise: Guidelines recommend individuals who are overweight to exercise for at least 3-5 hours per week. Cardio has proven to be very good for weight loss and can actually elevate your metabolism for up to 24 hours. Cardio can include walking, jogging, swimming, and various other activities. Although weightlifting is not mentioned as a core requirement, it is good strength training to lift at least 3 times a week if possible.

Pharmacologic Options

Over-the-counter weight loss medications should never be recommended to those individuals with cardiovascular disease. Individuals must have a BMI of greater than or equal to 25. Not many effective options available over the counter. Typically there is only one that doctors and pharmacists recommend if in need of a over the counter agent: Orlistat also known as Ali. Take 1 capsule (60 mg) with each meal containing fat. If you skip a meal, skip a pill. Medication works by decreasing the absorption of dietary fat. Individuals are required to take this medication with a multivitamin that contains fat soluble vitamins such as A,D,E, and K either at bedtime or some point throughout the day as long as its separated by two hours from when they have taken an Ali. Main adverse events associated with this medication are GI upset, flatus with discharge, and fatty stools. This medication, along with all of the weight loss medications I am going to discuss, should be avoided in pregnancy.

Prescription weight loss medications are not appropriate for those individuals who are trying to lose small amounts of weight. In fact, a doctor can only prescribe weight loss medications to individuals with a BMI greater than or equal to 30 unless the individual has at least one weight related co-morbidity (hypertension, diabetes, or hyperlipidemia) who qualify for medication with BMI greater than 27. Weight loss should continually be monitored while individuals are receiving medication and should be discontinued after 12 weeks is the individual did not obtain at least a 5% weight loss. Here are just a few of the prescription weight loss drugs:

• Orlistat Rx also known as Xenical: Refer to information above. Only difference is dosing, individuals should take 120 mg with each meal containing fat.

• Phentermine also known as Adipex-P: The medication works as a short term appetite suppressant and is a stimulant which increases norepinephrine. The medication is available in both tablets and capsules and range from 15-27.5 mg which are taken before or right after breakfast daily. Main side effects are increases in blood pressure, fast heartbeat, and agitation. Phentermine should never be stopped abruptly due to a seizure risk and should be tapered off cautiously.

• Phentermine/Topiramate: Extended release also known as Qsymia. Qsymia works by decreasing appetite and making a person feel full. This medication is a controlled substance schedule 4 medication. It is titrated up after 14 days. It is part of the REMS program due to its high teratogenic risks, meaning it can cause a lot of harm to the fetus if a woman takes the medication while pregnant. Main side effects are fast heart beat, insomnia, and dry mouth.

• Lorcaserin also known Belviq: This medication works by increasing satiety, meaning it will make the individual feel full and then therefore eat less resulting in weight loss. It is a controlled substance (schedule 4 medication), which is given as 10 mg twice a day. Main side effects are headache, dry mouth, constipation, and may lower blood sugar. Patients who are taking other drugs involving serotonin and taking this medicine should be monitored due to risk of serotonin syndrome.

• Naltrexone/Bupropion also known Contrave: This medication works by decreasing food cravings and reducing appetite. Contrave is dosed differently than the other medications and is titrated up throughout four weeks reaching a max of 4 pills per day. Individuals are instructed to not take with a high fat meal. Main side effects are nausea, abnormal dreams, and headache. This medication should not be used concurrently with opioids. Opioids should be discontinued at least 7 days prior to using Contrave.

Reference

1. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/AHA Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014; 63:2985-3023.