17: Is this Normal? Weight Loss Medication Side Effects with Dr. Francavilla
Jun 12, 2023Anti-obesity medications can be valuable tools in supporting individuals with weight loss, but when deciding if this is a route you want to take, it’s crucial to acknowledge and address their potential side effects.
For healthcare professionals, it is essential to carefully evaluate each patient's unique circumstances, monitor their progress closely, and provide comprehensive support throughout their weight loss journey.
I was delighted to sit down with an absolute pioneer in obesity medicine, Dr. Carolynn Francavilla, to dig into some of these important issues in obesity medicine. Dr. Francavilla is a physician that is board certified in family medicine, as well as a diplomat of the American Board of Obesity Medicine. We look into the common side effects of anti-obesity medications, how to avoid excessive weight gain during pregnancy, and weight loss recommendations for postpartum women.
Common side effects of anti-obesity medications
Generally speaking, this is heavily dependent on the medication because they all have different side effect profiles.
One of the most popular anti-obesity medications right now is Wegovy or Semaglutide, where we’ve seen a lot of buzz in the media. The studies indicate that the vast majority of people were able to tolerate the side effects, meaning most people did not quit the medication in the studies due to side effects. There are definitely a lot of mostly GI side effects (meaning stomach and intestinal issues), such as constipation.
Whenever you experience a side effect, it’s important to make sure that you are talking about it with your physician or whoever is prescribing that medication, so that they can look at the complete picture.
Constipation
Some people may have had great bowel movements before and now all of a sudden, things have slowed down, as they may not be getting the same level of hydration and fiber that they had before the medication.
A lot of the traditional things we use to treat constipation still work great with the medication, such as:
- Making sure you're getting enough to drink. Without enough water, you will have constipation. A lot of people talk about having a decreased appetite with the medication, but a lot of people have decreased thirst too and are not drinking as much. That means you may now need to be more intentional and plan your water intake.
- MiraLax is an over-the-counter treatment that people can use if they need it for loose stools.
- Taking fiber supplements like Metamucil or psyllium caps.
- Encouraging movement on these medications such as yoga, walking, and core strength work.
Unfortunately we don’t have the best data on which probiotic is the best to recommend to people, but experimenting with this could also bring results. Magnesium is another possible intervention but you need to make sure you know which type of magnesium you're getting because some of them are much better at producing bowel movements than others.
Diarrhea
Interestingly, fiber can also sometimes help with diarrhea. Some people do well bulking up with more fiber with Metamucil or psyllium husk. Some people can use an anti-diarrhea medication over the counter like Imodium, once your doctor has made sure there's not a different cause for your diarrhea.
Most of the time those diarrhea symptoms get better, but any change in bowel movements should always be discussed with your doctor because there could be other things going on like inflammatory bowel disease or colon cancer.
Approaching weight loss with people who have Binge Eating Disorder (BED)
This is something that has traditionally been missed in a lot of weight loss programs.
The question Dr. Francavilla likes to start with is whether there are times where you feel like your eating is out of control.
This is different to doing something that might just not be meeting your health and nutrition goals, like finishing off a burger and fries at a restaurant. Instead, this is about a real loss of control, where you feel like you can't stop eating. For some people that's going back and forth for more over the course of one or two hours, and they just can't stop grazing. For other people it's hidden or secretive behavior, which always indicates there is some sort of disordered eating.
Other signs to look out for include eating to the point where you physically feel really uncomfortable afterwards, are emotionally distressed, or are dwelling and beating yourself up.
Some studies show that 80% of people emotionally eat. We're all going to lose control occasionally with how much we eat. But when it's a repetitive thing that happens and keeps causing a lot of distress, then we should work on treating that.
Most people have no idea that binge eating disorder is a diagnosis, so they don't always realize that what they're doing is disordered. Sometimes it's just a light bulb moment for people to realize that is not how everyone acts around food. Many people get a mental sense of relief from treating the binge eating disorder, even if they don't see a change on the scale. It can be life changing to not have so much mental energy going into how you act around food.
When we treat the binge eating disorder and those binge episodes go down or go away, some people will lose significant weight. Others don't lose any weight, which can feel super frustrating. However, there is always a next step. Once the relationship with food is healed, then you can start to look at things like medications or surgery if necessary.
The medication that is FDA approved for binge eating disorder is Vyvanse. People have gone from five or six episodes of binge eating a week to practically zero with that medication. But we don't always know if that's going to mean weight loss, so it’s really important to come into this with no expectations with regard to weight loss and treat it as a chronic condition which needs to be managed longer term.
Tips to avoid excessive weight gain during pregnancy after stopping weight loss medications
Although weight loss before pregnancy can be beneficial to both mom and future babies, it's really important to bridge the gap and make sure that we, as doctors, are there for them during pregnancy with different interventions if we were helping them before pregnancy.
A lot of times when we're having this conversation before pregnancy with patients, it's about figuring out when they are planning to get pregnant. For some patients, it's a distant goal, where they might want this in 5-10 years in the future. That gives plenty of time to stabilize things and enables the patient to be at a new weight before they conceive.
However, some patients come in and are ready to get pregnant in the next six to nine months. In this case, I’d be more hesitant to start a medication knowing things could quickly change. If I know you're going to stop birth control and try to get pregnant in three or six months, I would probably not recommend using a medication super short term. This is because there is a really high risk that when we stop these medications, we know most people regain the weight. Therefore, I would rather see more modest weight loss, but do more in terms of lifestyle before getting pregnant.
You also need to consider that there are people who are healthier at different weights. Some people have a lot of metabolic dysfunction at lower BMIs, and some people are at a higher BMI, but have blood work that looks great. So it’s important to have individual conversations with your physician about how at risk your weight is really making you.
Weight loss recommendations in postpartum
The data that I have seen shows most women should be close to their pre-pregnancy weight by about a year. Around 6-12 months is a good timeframe to evaluate whether you are close to your pre-pregnancy weight or not. This is not to put pressure on anyone, but should encourage you to seek additional help sooner rather than later, if you are having a harder time than average. You could speak to someone who can help with lifestyle changes or even an obesity physician.
You can drop around 20 pounds immediately once you have your baby. The baby itself is around 6-10 pounds, and there's a lot of fluid that changes. If you have a normal weight gain in pregnancy of around 30-40 pounds, it’s reassuring to know you're not going to have to lose all of that.
There are a lot of factors to consider, especially if you're breastfeeding, as a lot of women struggle to cut calories, cut carbohydrates, or increase exercise too dramatically, and make enough breast milk. While it’s something that you definitely need to navigate, it’s not a reason to be afraid of making changes. A lot of women are able to successfully reduce calories, exercise more, and make enough milk. If you are breastfeeding, check in with your body and if you are making a change in terms of nutrition or exercise, see if it's impacting your milk supply.
More about Dr. Francavilla
Carolynn Francavilla Brown, MD, FOMA, D-ABOM is board certified in family medicine and a diplomate of the American Board of Obesity Medicine. She is the owner and founder of Green Mountain Partners for Health in Lakewood, Colorado where she practices family and obesity medicine. She runs the Colorado Weight Care program where she focuses on treating weight to improve and prevent medical problems. Dr. Francavilla has also spoken at national conferences on obesity topics including: treatment of PCOS and obesity, obesity and breastfeeding, obesity and pregnancy and postpartum, and obesity advocacy issues. She is currently on the Obesity Medicine Association Board, and has been the Chair of the OMA Advocacy Committee from 2014-2021. She is dedicated to helping as many clinicians as possible treat obesity!
