It’s not easy for people to talk about their weight with anyone, even their doctors. However, with the challenges of the last two years, the subject of extra weight and its consequences is increasingly of concern.
As the director of the Medical Weight Loss Program at Stamford Health, I’ve guided hundreds of patients through their healthy weight-loss journeys. I developed a program that reviews a person’s weight and medical history, recommends a comprehensive hormonal and metabolic workup, treats patients with safe and effective medications and counsels them on lifestyle interventions. People are not only losing significant weight — with a median of 20% total body weight loss — they are becoming healthier.
When I see patients for the first time, I can guess the statements about their weight that they’ve heard before.
Some are facts:
- “Excess weight is bad for your health. It can lead to type 2 diabetes, high blood pressure, high cholesterol, heart disease, sleep apnea, fatty liver, osteoarthritis and even cancer.”
- “If you lost weight, you’ll likely be healthier and need less medications.”
And some are…not:
- “If you had more willpower and just tried harder to eat less and exercise more, you’d lose weight.”
- “There are no safe ways to lose weight with medications. ‘Diet pills’ don’t work.”
Physicians like me, who’ve studied the science behind what regulates weight, know that it’s not that simple. It’s critical to share with these patients, in simple terms, why excess weight is important to address, why it is so difficult to tackle and what options exist to help.
This was true for a woman in her 60s whom I met in the spring of 2021.
She described that a decade earlier, she was 350 pounds and decided to have gastric bypass surgery. A year after, she was 180 pounds, but since then and especially a year into the pandemic, had regained significant weight. At our first meeting, she was 242 pounds. She was taking four blood pressure medications and she and her doctors knew she should lose weight. I asked about her goals. Like many people, she had a number in mind but also described wanting to be able to keep up with children and grandchildren, be on fewer medications and feel like herself again.
I explained why it is so incredibly difficult to lose weight and keep it off. We now know our bodies, to a large extent, are programmed to hold onto weight. This mechanism is both primitive (how our ancestors were able to survive during famine) and powerful (working from our gut to our brains and everything in between). Many people feel that because of their weight, they’ve been treated differently. Others need help reconciling how they can achieve so much in their lives but can’t lose weight.
I then reviewed her medical history, previous labs and medications. I recommended a workup to ascertain what factors (hormonal and metabolic) may be affecting her to inform my recommendations. Her lab evaluation showed blood sugars in the prediabetes range, elevated cholesterol and elevated inflammatory markers.
We then discussed the way forward. I reinforced the importance of nutrition and healthy exercise. I shared options for weight-loss medications — which have come a long way from the “diet pills” of the past. In particular, the medication I prescribed for this patient is of a medication family that has not only been shown to be effective for weight but also aids with lowering blood sugar, improves blood pressure and kidney and liver function and reduces the risk of cardiovascular events. When appropriate, I prescribe combination therapy with other safe and effective medications and/or provide information on our meal-replacement program. My recommendations are always personalized and the interventions are effective and safe, giving patients a chance at long-lasting weight loss and improved overall health.
As of January 2022, this patient had lost 100 pounds, decreased her body mass index (BMI) from the obese to normal range and shed 12 inches from her waist circumference. Her blood sugar and inflammatory markers are now normal, her cholesterol has improved and we have removed one of her blood pressure medications and decreased the doses of the others. Most important, she feels amazing.
Her results are certainly remarkable, but what it shows is that weight loss is not black and white like numbers on a scale. With the appropriate plan and a trusted and expert medical team by your side, losing weight, keeping it off and being healthier are possible.
Maria Cecilia C. Asnis, M.D., FACE, DABOM, is director of the Medical Weight Loss Program at Stamford Health. She is board certified in obesity medicine, endocrinology, diabetes and metabolism, and internal medicine. She received her B.A. in biological anthropology at Harvard University and her M.D. at Albert Einstein College of Medicine. She completed her internal medicine residency at Montefiore Medical Center and her endocrinology fellowship at Columbia University Irving Medical Center. She is an assistant clinical professor of medicine at Columbia University Vagelos College of Physicians and Surgeons. For more, visit stamfordhealth.org.
