New weight loss drug is a game-changer

Wegovy is injected once a week under the skin, with the dosage increasing every four weeks until it reaches 2.4 milligrams per week. Participants in a study had Wegovy injections for 68 weeks and lost an average of 15% to 18% of their body weight. The average for weight loss drugs already on the market is 7% to 9%.

“No other weight loss drugs have been able to achieve these results, which are comparable to bariatric surgery,” said Kelley M. McIntyre, M.D., an internal medicine physician and medical weight management specialist at Norton Weight Management Services.

The science of semaglutide

Semaglutide is similar to a hormone naturally occurring in the body that regulates your appetite. It also increases insulin release, which is why the drug has been used in lower doses to treat diabetes. But higher doses act on the brain to suppress appetite. Patients on Wegovy felt full sooner when eating and therefore lost weight as their calorie intake decreased.

“One of the benefits of Wegovy would be that it is effective for a wide variety of patients,” Dr. McIntyre said. “It can be used for adults who are not pregnant.”

Getting the most from Wegovy

Although this medication shows promising results, Dr. McIntyre cautioned patients not to rely on the drug alone to do all the work of losing weight.

“Wegovy is a great tool in a weight loss toolbox, but you have to eat a lower-calorie diet and get regular exercise to really maximize the benefits of the drug,” Dr. McIntyre said.

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Many candidates for weight loss surgery also have enlarged livers. This often is due to diets high in sugars and starches. If the liver is too big, the surgeon cannot safely navigate around it to reach the stomach during surgery. This can lead to complications and slow healing after weight loss surgery. This particular diet is also very effective at decreasing the amount of fat in your abdomen, both in and around your organs. It is well known that “central obesity” or increased fat in the abdomen is the most dangerous type of fat in the body and leads to many chronic diseases, increased inflammation, and increased mortality.

The liver has many important jobs in the body, several of which are important to digestion and weight loss. These include the production of bile, which helps break down fats in the small intestine during digestion. The liver also makes cholesterol and special proteins to help carry fats through the body. This organ also is responsible for cleaning the blood of drugs and other substances.

Weight loss surgery diet

“You will work with a dietician before and after your weight loss surgery,” said Meredith C.  Sweeney, M.D., bariatric and laparoscopic surgeon with Norton Surgical Specialists who treats patients of Norton Weight Management Services. “We have you do a liver-shrinking diet for a minimum of two weeks before the procedure.”

It is a low-carbohydrate diet that reduces glycogen (energy stored in the liver), water and fat in the liver.

The diet consists of proteins such as beef, pork, eggs, seafood or chicken, and non-starchy carbohydrates including foods like broccoli, cauliflower, leafy green vegetables. Fruit is limited, as it can be high in carbs and sugar. Alcohol, carbonated beverages, and sugar are also off-limits. Portion sizes are not limited on this diet, and each meal should be well balanced with protein and vegetables.

Tips for patients on the liver-shrinking diet

“We want to set you up for success,” Dr. Sweeney said.  This type of diet is what patients will be consuming after surgery in order to ensure lifelong success anyway, so starting it before surgery only helps develop habits that can continue after surgery.

So here are a few things to keep in mind:

Make sure you eat well: That means no sugar, lots of protein, non-starchy vegetables and healthy fats. and foods. You may need a supplementary vitamin, too.

Hydrate: Drink at least 64 ounces (about 8 cups) a day of sugar-free, calorie-free, noncarbonated liquid per day. Water, plain teas or sugar-free drinks are good choices.

Rely on your team: You will have a dietician who will help you with your diet plan, answer your questions and help you after the surgery. Don’t be afraid to reach out![templatera id=”521238″]

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These weight loss medications are indicated for patients with a body mass index (BMI) of 30 or above, or 27 or greater in the presence of at least one weight-related medical condition, such as hypertension, Type 2 diabetes, fatty liver disease or sleep apnea. They’re prescribed for use along with a reduced-calorie, low-carbohydrate diet, and each has a different mechanism of action.

Patients have to meet specific criteria to be eligible for each of the drugs listed below, and not all of them are covered by insurance.

Qsymia

Qsymia is a combination of phentermine (Adipex-P, Lomaira), which suppresses appetite through norepinephrine release, and topiramate (Topamax), which interacts with the neurotransmitter gamma-aminobutyrate (GABA) and is used to treat migraine and epilepsy.

Qsymia is contraindicated for patients with uncontrolled hypertension, many cardiac diseases and pulmonary hypertension.

A pair of large-scale clinical trials lasting up to a year found the average weight loss of patients taking Qsymia ranged from 6.7% (lowest dose) to 8.9% (recommended dose) over those taking a placebo.

Contrave

Contrave is a combination of naltrexone, an opioid antagonist, and bupropion, a dopamine and norepinephrine reuptake inhibitor sold as an antidepressant under brand names such as Wellbutrin and Zyban.

A clinical trial showed an average weight loss of 4% over placebo at one year, with 42% of patients taking Contrave losing 5% or more of their body weight compared with 17% of patients receiving a placebo.

Qsymia and Contrave are contraindicated during pregnancy and lactation. Women taking any of these medications need to use a reliable birth control method.

Related: This weight loss drug is touted as a ‘game-changer’: Wegovy injections and the obesity epidemic

Saxenda (liraglutide)

Saxenda is an injectable drug that decreases hunger like the glucagon-like peptide (GLP-1) hormone that humans naturally secrete. At one year, a clinical trial showed 56% of patients receiving Saxenda lost 5% or more of their body weight, compared with 25% for the placebo group.

Because Saxenda causes thyroid C-cell tumors in rats and mice, the medication is contraindicated for patients with a family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome Type 2. It also is contraindicated during pregnancy and lactation.

Xenical (orlistat)

Xenical works by inhibiting gastric and pancreatic lipases. The result is that triglycerides in the diet are excreted rather than being absorbed. At one year, a clinical trial showed patients taking Xenical lost an average of 10% of their body weight, compared with the 6% weight loss by those taking a placebo.

Xenical is contraindicated for women who are pregnant or may become pregnant, and for patients with chronic malabsorption syndrome, or cholestasis.

Dr. McIntyre, an internal medicine physician, sees patients at Norton Community Medical Associates – Audubon East LL2 and Norton Weight Management Services.

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For those thinking of starting the new year by shedding some pounds to reach a healthier weight, our weight management specialists have broken down some pros and cons to help you decide what is the best diet for you.

Whole30

Pros

• Increased energy
• Possible weight loss
• Possible improved health from identifying foods that cause skin conditions, seasonal allergies or chronic pain
• Controlled food cravings
• Improved blood sugar
• Improved digestion
• New foods

Cons

• Requires planning ahead (can be time-consuming)
• Weight loss and improved health benefits likely temporary unless accompanied by a lifestyle change
• Very restrictive
• Cost of some foods
• Requires tweaking your favorite recipes or finding new ones
• Difficulty dining out

Recommended for

• Weight loss
• Unexplained aches and pains
• Inflammatory issues
• Issues regulating blood sugar
• Issues with digestion

Keto diet

Pros

• Rapid weight loss
• Fat burn
• Potential decrease in seizure activity for people with epilepsy
• Stabilized blood sugar levels

Cons

• “Keto flu,” or headache, fatigue, dizziness and nausea
• Constipation
• Can be difficult to maintain
• Potential for increased low-density lipoprotein (LDL) cholesterol and risk for cardiovascular disease

Recommended for

• People who want to lose weight and will be monitored by a doctor and registered dietitian

Intermittent fasting

Pros

• Fat burn
• Weight loss
• Improved insulin resistance
• Improved cholesterol

Cons

• Getting too hungry, making poor food choices or “giving in”
• Overeating at mealtimes
• Short-term weight loss
• Muscle loss without adequate protein intake and resistance training
• Digestion issues from eating larger portions
• Negative change in mood or feeling “hangry”

Not recommended for

• People with medical conditions such as diabetes or hypoglycemia
• People who take medication for conditions such as high blood pressure or heart disease
• People with history of an eating disorder

Carb cycling

Pros

• Possible weight loss
• Possible improved athletic performance and reduced muscle breakdown
• Possible improved function of weight- and appetite-regulating hormones
• Possible fat burn
• Possible improved insulin sensitivity

Cons

• Lack of research
• Requires tracking your performance and reduced foods to ensure the muscle breakdown correct amount of carbohydrates
• Degree of difficulty; won’t work if not done correctly (You must follow very closely a specifically planned diet based on a variety of factors related to you and your goals.)

Recommended for

• Athletes
• Those wanting to increase muscle
• Those with specific health goals, since the diet is tailored to the individual

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