In the daily operation of your clinic, one of the first things you have a patient do is stand on the scale. Why do you regularly check their weight? Simple: you understand the connection between a healthy body and a healthy weight. Weight cannot tell us everything, but that one number is a decent indicator for many other concerns you may have as their physician.
Obesity, if it is never dealt with appropriately in the present, will lead to serious (and expensive) problems in the future. Physicians can and should play a more significant role in reversing this trend, one patient at a time.
Patients prefer to be healthy; this is often measured by finding and keeping a healthy weight and body-fat composition. In the short-term, this means having more energy, getting better sleep, achieving better focus, and experiencing less pain and discomfort. In the long-term, maintaining a healthy weight means longevity and avoiding the physically devastating and financially costly effects of untreated obesity.
A growing number of physicians are adding weight-loss programs to their clinics. They have become dissatisfied with the twenty-second “Eat less and exercise more” speech as they wrap up their visit. Physicians and specialists like you are beginning to offer this valuable service and are seeing significant growth in their practices as they do.
Regardless of the particular details of any weight-loss program physicians may offer, lifestyle modification (food, exercise, sleep, etc) will play a significant role. Although in certain cases, even substantial modifications may not result in long-term success and anti-obesity medications, or AOMs, will be needed. For the appropriate patients, pharmaceutical intervention will be an integral approach to long-term weight management.
AOMs are indicated for patients with a body mass index of more than 30 kg/m2 in general, or more than 27 kg/m2 with one or more obesity-related conditions, such as type-2 diabetes, hypertension, obstructive sleep apnea, or hyperlipidemia. These medications can also be considered for patients with a body fat composition above 30% for men and above 35% for women, although for women who are pregnant or who are actively trying to become pregnant, AOM’s are contraindicated.
The truth is that each body is different, and weight loss is not as simple as removing some calories from their dinner and adding minutes to their workout. Factors such as hormone regulation in the gut, intestines, and brain control hunger and satiety and are significant contributors to a patient’s ability to lose weight. In these cases, even the strict adoption of healthy habits may not result in significant or sustained weight loss.
Many patients choose Enara Health because of our expertise in the use of anti-obesity medications and begin their program with the use of the following medications. Others decide to start an AOM protocol following weight gain after some initial success with lifestyle changes alone.
There are currently a handful of commonly used and FDA-approved anti-obesity medications being utilized by physicians. As you know, hormonal systems are complicated and since different drugs target different pathways, it is important to deeply understand each drug and how it might impact your patients.
Below are short summaries of the most popular medications.
Phentermine is the oldest and most commonly used medication for obesity, approved by the FDA in 1959. It is classified as a DEA schedule IV stimulant agent, so there are some prescribing precautions to consider. However, it is not associated with abuse or addiction when used for obesity. Although it is technically FDA approved for short-term use, most healthcare providers agree that it is safe and effective for long-term use. Phentermine works by reducing hunger and caloric intake at the level of the brain. Patients may lose up to 5% of their body weight. Pros of phentermine include its generic availability and affordability, while cons include the limited weight loss and a possibility of it becoming less effective over time.
Qsymia (Phentermine/Topiramate Combination)
Qsymia is a combination medication that includes phentermine and topiramate, and it is only available as a brand-name drug. It is considered a long-term medication and is classified as a DEA schedule IV medication because it contains phentermine. The medication’s side effects are similar to those of phentermine, with the addition of paresthesia and possible cognitive impairment with a higher dose of topiramate. Qsymia is contraindicated in patients with renal stones and in pregnancy, and some recommend additional monitoring, such as regular pregnancy tests, for premenopausal patients. The advantage of Phentermine/Topiramate is that there are two medications working together to decrease hunger and increase fullness, leading to more weight loss (up to 5-10%) than phentermine alone. However, the cost of Qsymia is higher since it is a non-generic medication.
Contrave (Bupropion/Naltrexone Combination)
Contrave is a combination medication that includes bupropion, a common antidepressant, and naltrexone, an opioid antagonist. It can help with fullness and cravings and may be helpful for those with coexistent depression or emotional eating issues. It is contraindicated in patients with a seizure disorder or those who take opioids for chronic pain. Side effects of Contrave include nausea, constipation/diarrhea, headache, insomnia, and dry mouth.
Liraglutide (Saxenda) & Semaglutide (Wegovy):
Liraglutide (Saxenda) and Semiglutide (Wegovy) are GLP-1 agonists initially approved for glycemic control for type 2 Diabetes Mellitus and now FDA approved for weight loss. They are self-administered via subcutaneous injections, with Liraglutide taken daily and Wegovy taken weekly. They both increase satiety or fullness. The most common side effects include nausea, vomiting, diarrhea, constipation, headache, and dizziness. Although these side effects may be limiting for some patients, most tolerate them well with the recommended dose titration. Semaglutide is the newest medication available for weight loss and is very promising, with some studies showing up to 15% weight loss in about 50% of patients.
Unfortunately, many of the most popular, FDA approved anti-obesity medications are relatively expensive and not all insurance plans will cover their cost. If you are considering adding a weight-loss program to your clinic that includes the use of AOMs, be ready to help your patients navigate their coverage agreements. Also, in some cases, insurance companies will require prior authorization before they will cover this class of medications.
Read our recent blog, “Anti-Obesity Medications – Are You Covered?” for more tips on finding out if and how your health insurance plan will cover the medications.
At Enara, we have streamlined the entire process and help our partner clinics grow through the addition of a medically-led weight-loss program. We offer wrap-around guidance to patients, including a cooperative, collaborative team of nutritional and exercise specialists.
We understand primary physicians and specialists have very limited time with their patients and certainly not enough to fully guide them through the complexities and nuances of a weight-loss program. Our teams at Enara will come alongside patients so they can lose weight and improve their overall health through both pharmacotherapy and meaningful lifestyle change.
If you believe your clinic could benefit from adding a weight-loss program through Enara, connect with our sales team today. Or, start by learning more about the program and how it could easily fit in your clinic’s current practice.