16: Anti-Obesity Medications: A Life Sentence?

So many patients struggle to wrap their minds around taking anti-obesity medications for life, despite obesity being a chronic medical condition. If you were to look at other chronic conditions like rheumatoid arthritis, people generally have no issues taking lifelong medication for that. 

Yet when it comes to weight, we see this strong desire to come off something that is helping you manage a chronic condition. Considering this medicine allows you to eat in a way that supports you better, and gives you the energy to move your body, is it really sensible to remove it?

Today I want to explore how using historical data can reinforce learning to play the long game when it comes to weight management.

Looking at the long term picture

Obesity is a chronic medical condition. 

That means you have periods where you:

• lose weight and are doing great
• are managing your weight and it’s stable
• are struggling, don't even realize that weight's coming on, and feel out of control

There is such variety but the main thing that persists is that everything people have done for decades is not effective. 

With some of these newer medications, the change has been that not only do you lose the weight, but you keep it off. I always say if you could have done it on your own, you would have. No one ever comes to work with me that has not tried a million things before.

If you need medication to help either start losing weight or continue to lose weight, and it allows you to eat in a way that supports you better, while giving you the energy to move your body more, it does not make sense to get rid of that medicine. 

When you reach your weight goal, it may be that there is some negotiation around the dose of the medication, but when you completely remove it, the studies show us that the weight comes back.

Even if you hear the hero story where someone says they lost the weight, came off the medication, and are fine, they are usually only a few months out. By five years we see most people have regained the weight if the intervention was taken away. This is why I want you to start to think of the bigger picture and really care about your long-term metabolic health and weight cycling, which is really not great for us.

We also know that each time you reattempt weight loss, it usually takes more and more effort to get the same results that you got before. 

Therefore a mindset shift is needed, where instead of focusing so much on needing this medicine for life, you start to focus on how to maintain this amazing progress you have made.

Everyone is trying to figure out how they can get off the medicine, but is there anything wrong with needing that help? Whatever it takes to help you on your health journey is what is needed.

Using historical data

If you are someone that's debating starting a medicine or you're on it and  really wanting to get off of it, I want you to go back as much as you can and take data from the past. 

I want you to look at the long-term trajectory of your weight. For most people, it has progressively gone up and up, and for others there’s been a slow creep.

There may have been big life changes such as pregnancy or divorce that might have led to weight coming on again, or it could just have happened slowly over time. Take a look at the pattern over time and write down all the different methods you tried along the road, e.g. high school Weight Watchers, going to the gym two hours a day etc. 

I want you to just look at the data and get rid of all the other emotional thoughts. Just look at what your weight has been over time, and all the things that you've done.

Knowing what you know now, what are your thoughts about either starting a medicine, being on a medicine, or continuing on a medicine?

When it comes from a place of data, that is usually the most empowered place, because what you're not coming from a place of emotion and thinking you’re a failure. This is a chronic medical condition.  If we treated it in the same way as something like rheumatoid arthritis, we’d likely have no issues taking the medicine longer term or desperately wanting to titrate it down.

Medication assisted behavior change

When you look back at the graveyard of ineffective things you have tried in the past like keto, calorie counting, Jenny Craig, etc. you realize that starting the medication is what removed the uncontrollable urges to eat, and put you on the playing field everybody else is on where they're not struggling with their weight. 

The medication assists behavior changes like making healthy food choices, doing the movement, and taking really good care of yourself. The fallacy is then to remove this medicine once you have developed these habits. However, it was the physiologic help with hormone imbalances in your body when you went on these medications, that significantly contributed to those healthy habits.

While it’s important to take this information on board if considering weight loss medications, you also don't need to make all of these decisions today. The only thing that might make this journey lighter for you is to stop judging yourself if you are needing one tool in the treatment of chronic obesity.

Anti-obesity medications are ultimately treatments, not band-aids. They're not gimmicky, and they're not things that work like meal replacements, where the view is very short-term. This is an entirely different land.