Dear Jenn,

I lost 35 pounds with the help of weight-loss medication. Since the successful weight loss, I feel positive about my self-image and appearance. Family and friends have told me I look radiant. It took approximately seven months and a great deal of effort, but I did it! Now that I have achieved my weight goal, my doctor has taken me off the medication, claiming I cannot be on it forever. Without the medication I have been struggling with hunger issues and weight maintenance. I’m afraid my weight will escalate upward. Can you suggest how to keep the weight off without medication to control my hunger?

Sincerely,
Addicted to Weight-Loss Medication

Dear Addicted to Weight-Loss Medication,

Congratulations on your successful 35-pound weight loss! Management of desirable weight is a continuous work in progress. Let’s explore.

How Weight-Loss Medications Works

Weight-loss medications suppress or anesthetize appetite. This causes the feeling of fullness, which reduces hunger, resulting in the consumption of less food, calories and inevitably, weight loss. Weight loss and maintenance have to do with scientific, mathematical, reliable and measurable phenomena. Body weight is about the calorie, and how the calorie is utilized in the body.

• Calorie Intake < Calorie Expenditure = Weight Gain
• Calorie Intake > Calorie Expenditure = Weight Loss
• Calorie Intake = Calorie Expenditure = Weight Maintenance

Note: For this discussion, “weight” is being referred to as “body fat, not “body fluid.” Fluid gain and/or loss can be measured on a scale, too.

Illness, medical conditions, medications, hydration status, pregnancy and menstruation are all examples of how fluid status can affect the appearance of weight gain or loss. But fluid weight is not fat weight.

As noted above, weight-loss medication affects appetite and therefore indirectly influences metabolic processes by changing appetite, affecting blood glucose and body composition.

Losing Weight

Many things that are worthwhile take effort. Some examples are working at a marriage, raising children, or taking on a challenging job. Losing desirable weight and maintaining a healthy weight are also challenges. Not easy at all. There has been research indicating that when stopping weight loss medication, hunger increases even more than before starting the weight-loss medication (“Ghrelin Hormone Function and Definition” Cleveland Clinic, April 22, 2022). Apparently, the hunger-stimulating hormone ghrelin and the hunger suppressant-hormone leptin are involved.

The article “Why Obesity Is a Disease” (Obesity Medicine Association, December 30, 2023) stated: “Obesity is a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.”

The pathology of obesity is vast and varies based on the cause of weight gain. There is not just one type or cause of obesity. Obesity subtypes include congenital, stress-induced, menopause-related, and MC4R-deficient, to name a few. Obesity is related to genetic, psychological, physical, metabolic, neurological and hormonal impairments. It is intimately linked to heart disease, sleep apnea, and certain cancers. Obesity is one of the few diseases that can negatively influence social and interpersonal relationships.

Like other chronic conditions, obesity requires addressing and follow-up to keep the condition under control. Diet, exercise and medication all play a part in controlling obesity. Therefore, the need for maintenance dosages of weight-loss medication is currently being studied for long-term effects and outcomes.

Good news … At Nutrition Transformations, we guide you and support the effort to practice the following, which helps weight loss success and maintenance:

1. Understand emotional eating, disordered eating, triggers, and the ability to identify true hunger vs. emotional hunger.
2. Have self-control regarding eating.
3. Live and eat mindfully.
4. Regularly exercise: at least 150 minutes of moderate exercise weekly.
5. Get enough sleep approximately seven to nine hours nightly: Sleep deprivation affects hunger hormones by stimulating ghrelin. And sleeping well allows for feeling energetic.
6. Get stress under control: Stressful situations stimulate hormone reactions that can make one feel hungry, challenging weight loss efforts and maintenance difficult.

We will develop healthy menus and recipes for you and your entire family.

Foods to Include in the Diet For Weight Maintenance

Eating a healthy, balanced diet is key to achieving and maintaining a healthy weight. Incorporating nutrient-dense foods into your diet can help you feel full and satisfied while providing your body with energy and nutrients. Here are some good foods to eat for weight loss and maintenance:

1. Fruits and Vegetables: Fruits and vegetables are low in calories and high in fiber, vitamins, and minerals. Eating a variety of colorful fruits and vegetables can help you feel full and satisfied, while also providing your body with the nutrients it needs. Aim to eat at least five servings of fruits and vegetables per day.
2. Whole Grains: Whole grains such as brown rice, quinoa and whole-wheat pasta are a good source of fiber and complex carbohydrates, which can help you feel full and satisfied for longer. They also provide your body with important nutrients such as B vitamins, iron and zinc.
3. Lean Proteins: Lean proteins such as chicken, fish, beans and tofu are a good source of protein, which can help you feel full and satisfied. They also provide your body with important nutrients such as iron, zinc and B vitamins.
4. Nuts and Seeds: Nuts and seeds are a good source of healthy fats, fiber and protein. They can help you feel full and satisfied and may also provide health benefits such as reducing inflammation and improving heart health. However, they are high in calories, so it is important to eat them in moderation.
5. Low-Fat Dairy: Low-fat dairy products such as milk, yogurt and cheese are a good source of calcium and protein. Calcium is important for bone health, while protein can help you feel full and satisfied.
6. Healthy Fats: Healthy fats such as olive oil, avocado and nuts are important for overall health and can help you feel full and satisfied. However, it is important to eat them in moderation, as they are high in calories.
7. Water: Drinking plenty of water can help you feel full and satisfied and may also help you eat less. Aim to drink at least eight glasses of water per day.

Limit or avoid foods that are high in sugar, saturated and trans fats, and refined carbohydrates. These foods are often high in calories and low in nutrients and can contribute to weight gain and other health problems.

Conclusion

When taking weight-loss medication, it is important to learn how to eat healthy, control calories and get familiar with portion sizes. Practice eating mindfully. Keeping a food diary encourages accountability and reflection of the weight-loss journey. Exercise is a must for the best health outcome and boosting metabolism. Addressing emotional eating behaviors and understanding the difference between real versus emotional hunger will help sustain weight-loss goals. Developing the ability to have self-control and discipline when it comes to eating behaviors is imperative. If you are interested in successful long-term weight loss and management reach out to Nutrition Transformations. Let’s work on your weight-loss goal and better your health together. It’s not too late. Weight-loss medication is available with our on-call physician, Dr. Jeffrey A. Berman, MD.

Yours in good health,

Jenn

www.Nu-transform.com

718-644-1387