What is Obesity Treatment?

Physician-supervised Options

Physician-supervised weight-loss programs are one-on-one treatment options that take place in a medical office. These programs are led by a health care Provider, such as a:

  • Medical Provider (MD, DO, PA, NP)
  • Registered Dietician (RD)
  • Health Psychologist

Many times, several HCPs are involved and work as a team in these programs as they include not only medical advice, but also nutrition and lifestyle counseling.

The costs of these programs vary depending on the services offered. Your health insurance company might cover all or some of this treatment. If you have additional obesity-related health conditions such as high blood pressure or type 2 diabetes, it might affect your coverage for these treatment options. Be sure to read and understand your insurance coverage.

At your first visit, a medical provider will meet with you. This consultation can include:

  • A detailed medical evaluation for obesity-related conditions
  • A look into your daily lifestyle
  • A physical exam
  • Weight history (including past weight-loss attempts)
  • A psychological history

Many patients come to the clinic with undiagnosed type 2 diabetes, high cholesterol, thyroid disorders, or sleep apnea. Your HCP may recommend additional tests based on your medical history and the initial physical exam.

To help manage any obesity-related conditions as well as weight loss, your program can include:

  • Lifestyle modifications (nutrition and physical activity)
  • Pre-packaged meal replacement plans
  • FDA-approved prescription weight-loss medications

Pre-packaged Meal Replacement Plans

Pre-packaged meal replacement plans are a medically supervised weight-loss program. They use meal replacement options along with lifestyle modifications and behavior change counseling to help people reach and maintain their weight-loss and health goals. These programs work as a transition to a healthier, self-prepared nutrition plan while offering education and support. Examples of these programs include:

  • OPTIFAST®
  • Health Management Resources (HMR)
  • Advanced Health System (AHS)
  • New Direction (Robard Corporation)
  • Medi-Fast

How Does it Work? Individuals who are interested in starting a supervised weight-loss program must do so through an HCP. Most programs list participating providers on their websites.

A medically supervised weight-loss program has individualized phases. The phases generally begin with meal replacements and transition to the use of self-prepared foods for long-term weight-loss. These programs also include guidance from a team of HCPs, access to group or individual counseling, and other support options. Each program will vary and it is important to discuss them with your healthcare provider to find the best option for you.

Weight-loss: Individual results will vary, but patients may lose as much as 50 pounds or more over 18 to 24 weeks.

Concerns: As with any meal replacement program, there are concerns about the ability of participants to successfully readjust to eating healthy, self-prepared foods following the meal replacement phase. Additionally, insurance coverage varies, so interested individuals need to review their health insurance policy and contact their health insurance company if they have questions or concerns about their coverage.

Medical Weight Management

Who is a Candidate for Medications to help treat Obesity?
While everyone would love a magic pill to help them with weight loss, the reality is that lifestyle changes remain the best option for long-term success. Many people have found that lifestyle changes, combined with medications that aid in weight-loss have been very effective.

The FDA has approved six prescription medications for use in people with a BMI over 30 or a BMI over 27 when a patient has additional obesity-related conditions. You cannot make the decision to take these medications alone. They are available by prescription only, and you will need to discuss them with your HCP. Currently, they are not approved for patients to use during pregnancy.

The average weight-loss results from prescription weight-loss drugs are 5-10% of your starting weight. It is important to know that everyone responds differently to medications. The average result will be seen by most people who take the medication, while others will see a larger amount of weight-loss or none at all.

Work with your HCP to set realistic goals and develop a complete understanding of the potential results and side effects of
medications used to treat obesity. This will help you plan for success and prepare for any set-backs on your journey with weight-loss.

Will my Insurance Cover Medications to Treat Obesity?

Insurance coverage of prescription weight-loss medications varies by state and by an insurance provider. You can log-into your insurance provider’s website and look under the pharmacy benefits page to see if your insurance plan covers the medication you are considering.

A Closer Look at Medical Weight-loss Medications:

Phentermine (Adipex®, Lomaira® and Suprenza®)

The average weight-loss results from prescription weight-loss drugs are 5-10% of your starting weight. It is important to know that everyone responds differently to medications. The average result will be seen by most people who take the medication, while others will see a larger amount of weight-loss or none at all.

How does it work? Phentermine is a weight-loss medication that is available by prescription only and has been FDA-approved since 1959. It works on chemicals in your brain to decrease your appetite and includes a mild stimulant to give you energy. Phentermine is a pill taken once a day in the morning and is intended for short-term use. Common side effects are dry mouth and sleepiness.

Weight-loss: The average weight-loss is 4-5% of your initial body weight after one year. For a person weighing 200 pounds, that means about a 10- pound weight-loss.

Concerns: The stimulant may increase your blood pressure and heart rate, so you must be monitored by an HCP who is experienced in prescribing this medication. Patients with some heart conditions (such as uncontrolled blood pressure), glaucoma, stroke, or overactive thyroid should avoid this medication.

Orlistat (Xenical® and Alli®)

How does it work? Orlistat is available over-the-counter as alli® and in a higher-dose by prescription called Xenical®. Both are FDA-approved for weight-loss and work by decreasing the amount of fat your body absorbs. It is taken three times per day before meals that contain dietary fat. Orlistat allows your body to only absorb 2/3 of the calories from the fat consumed in your meal. The other 1/3 is carried away indigestion and becomes part of your stool. More information can be found at MyAlli.com.

Weight-loss: The average weight-loss is 5% of your initial body weight. For a person weighing 200 pounds, that means about a 10- pound weight-loss.

Concerns: This medication does not work well for people already eating a low-fat diet as their calories from fat are already low. People taking Orlistat should take a multivitamin as there is a chance for vitamin deficiency. Side effects are limited but can include cramps, gas, stool leakage, oily spotting, and gas with discharge. These symptoms will improve with a lower-fat diet.

Naltrexone HCI/Bupropion HCI (Contrave®)

How does it work? Contrave® was approved by the FDA in 2014 and is a combination of two medications approved for other medical conditions. Naltrexone is a medication previously aproved for the treatment of narcotic and alcohol dependency. Bupropion is approved as an anti-depressant and a medication to help people stop smoking. When used together, they work to decrease appetite and control eating.

Weight-loss: Among individuals who took Contrave® for one year, 65% lost at least 5% of their initial body weight (10-pound weight loss for a person who weighs 200 pounds) and 39% lost at least 10% of their body weight (20 pound weight-loss for a person who weighs 200 pounds).

Concerns: The most common side effects are nausea, constipation, headache, dry mouth, vomiting, and dizziness. This medication also had a small occurrence (6%) of increased blood pressure and heart rate.

Phentermine-Topiramate ER (Qsymia®)

How does it work? This combination of medication was approved by the FDA in 2012. Phentermine is a weight-loss drug that received FDA approval in 1959. Topiramate is traditionally used for migraine prevention and in seizure prophylaxis. Together, they work to decrease your appetite and increase a feeling of fullness after eating.

Weight-loss: Weight loss can vary by dosage. At the lower dose, 62% of individuals on Qsymia® lost 5% of their starting body weight. (10-pound weight loss for a person who weighs 200 pounds). Among people taking the higher dose, 48% lost 10% of their starting weight (20-pound weight loss for a person who weighs 200 pounds).

Concerns: The most common side effects are dry mouth, constipation, and pins-and-needles feelings in the face, arms, hands, and feet. Insomnia may occur if taken later in the day. Women who are pregnant or who are considering becoming pregnant should not take Qsymia® as it has been known to cause birth defects.

Liraglutide Injection (Saxenda®)

How does it work? Liraglutide is an injectable medication that was approved by the FDA in 2014. It works by increasing your body’s natural production of insulin, which regulates blood sugar levels. It also decreases the production of a hormone that opposes insulin, slows down the emptying of the stomach, and helps regulate fullness. It is also used to treat type 2 diabetes.

Weight-loss: In a study of individuals who were on Saxenda® for one year, 73% lost at least 5% of their starting body weight (10-pound weight loss for a person who weighs 200 pounds), and 41% lost at least 10% of their initial body weight (20-pound weight loss for a person who weighs 200 pounds).

Concerns: The most common side effects are nausea, vomiting, diarrhea, and constipation.

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