Today we’re going to talk about a question I get often. How do I know if I need weight-loss medication?
Unfortunately, the answer isn’t simple, and many factors must be considered. The first step is to talk with your primary care physician to rule out certain health conditions (e.g., hypothyroidism, Cushing’s disease, and PCOS) or medications (e.g., steroids, antidepressants, and beta blockers) that can contribute to excess weight. It’s a good idea to rule out these possibilities before starting a weight-loss medication.
Then your provider can help you set realistic weight goals and help you make changes to your diet. You can also get help increasing your physical activity and monitoring for any weight-related health risks (e.g., high blood pressure, joint pain, and type 2 diabetes).
When these lifestyle changes (diet and exercise) aren’t enough for you to lose the weight you desire, weight-loss medications like semaglutide may be helpful.
It’s important to remember that obesity is a chronic, complicated medical condition. And it’s difficult to manage. When a person has excess body fat, they’re at risk for many health problems like high blood pressure, type 2 diabetes, stroke, heart disease, high cholesterol, depression, anxiety, fertility issues, joint and muscle pains, sleep and energy problems, erectile dysfunction, and several types of cancer.
The fact of the matter is people with obesity die younger than people who do not have obesity.
It’s also important to keep in mind that even when taking weight-loss medications like semaglutide, you must continue to eat healthy and exercise regularly to maintain long-term weight loss.
What causes obesity (weight gain)?
When it comes to weight gain, most people know that obesity can be caused by eating too many calories and not exercising enough. But the fact is that a complex interaction of our genes and hormones with our environments causes obesity.
Scientists have been studying how our genes and hormones affect our weight for years. Researchers have studied leptin levels, POMC gene mutations, testosterone and estrogen levels, and cortisol levels.
Also, lack of sleep, stress, and an unhealthy gut microbiome can lead to weight gain.
Too little sleep leads to higher levels of ghrelin (a gut hormone that stimulates appetite) and lower levels of leptin (a hormone released by your fat cells that suppress your appetite).
When we’re stressed, our bodies release cortisol (the stress hormone). Short-term, this hormone helps to increase our heart rate, blood pressure, and blood sugar. But, with repeated stress, over time, you begin to feel tired, and depressed and experience weight gain.
An unhealthy gut microbiome can affect how you store fats and absorb nutrients from your food, making it harder to maintain a healthy weight. Like lack of sleep, an unhealthy gut may also increase the amount of ghrelin, causing you to feel hungry, which may lead to weight gain.
How can I improve my sleep, stress levels, and gut health?
Last week I briefly talked about ways to improve your sleep environment by avoiding technology, caffeine, and alcohol before bed. Other tips to improve sleep are to use your bedroom for sleep and intimate activities only (avoid watching television, reading books, and working on your computer), have a consistent bedtime and wake time, and keep your bedroom dark and at a comfortable temperature.
Stress can come from all types of life events (e.g., work, death of a friend or family member, divorce, childbirth). What is stressful for one person may not be stressful for someone else. Depending on our current situation, certain things can make us more sensitive to life’s stresses (e.g., financial situation, health situation, support system at home). But one thing is certain: decreasing stress can help reduce the effects that stress can have on our minds and bodies. Engaging in regular physical activity, if able, practicing meditation, spending time with friends or family, getting quality sleep, talking to a therapist, and eating healthy food can help relieve the effect of stress.
I’ve talked about gut health in the context of BPC 157. But as a refresher, you can improve your gut microbiome by eating a diverse range of foods, particularly high-fiber foods like broccoli and lentils and foods rich in polyphenols (e.g., whole grains and dark chocolate). You also should limit your intake of artificial sweeteners and take antibiotics only when necessary. You may also want to consider talking to your healthcare provider about taking a daily probiotic to help reduce gut inflammation and encourage “good” bacteria to grow if you continue to have stomach pain, cramping, gas, or bloating.
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