Medical weight loss programs – a guide

If you’re struggling with weight loss, you’re not alone. According to the Centers for Disease Control and Prevention (CDC) on overweight prevalence, almost 74% of Americans are overweight and nearly 42% were obese in 2020. If you’re considering medical weight loss programs to help your weight loss journey, we break down your options in this guide.

The realities of losing weight

While most people understand that maintaining a healthy weight is important for good health, many people find it difficult to lose weight and/or maintain weight loss. 

The reality is that losing weight is difficult because the body interprets weight loss as a threat to survival. To counteract weight loss, your body dials back your metabolic rate (the number of calories you burn at rest) just to survive (think breathing, heart rate, digestion, etc.) or increases your appetite, so you eat more. That makes lasting weight loss difficult to sustain in the long term. 

And science backs this up. For instance, studies show that the body’s metabolism slows down when you try to lose weight, adapting to prolonged dieting. The journal Obesity published a study of 65 people whose metabolic rates dropped by hundreds of fewer calories per day following a calorie-restricted diet. This “metabolic adaptation” is largely responsible for the dreaded plateau many people hit when losing weight. 

Also, as people lose weight, their primary hunger hormone, ghrelin, increases. 

One option to help counteract the body’s attempt to prevent weight loss are medical weight loss programs. 

Types of medical weight loss programs

All medical weight loss programs, including obese weight loss programs, are administered under the supervision and guidance of a qualified medical provider, such as a doctor specializing in obesity management and/or a mental health provider who focuses on the emotional aspects of overeating. 

The best medical weight loss programs are comprehensive and address the underlying causes of weight gain, blending a variety of tools to maximize your chances of long-term success. Types of medical weight loss programs include the following.

Behavior modification/obesity counseling 

Behavior modification therapy helps address the underlying causes of overeating, such as boredom, depression, fatigue, or unhealthy coping. Some behavior modification techniques used for weight loss include:

• Mindful eating. Mindful eating is about developing an awareness of food and drink consumption. Rather than controlling calories or measurements, mindfulness focuses on the sensations you experience from food (taste, smell, fullness, etc.) without passing judgment on yourself so that you stay present while eating and don’t eat “mindlessly.”
• Intensive behavioral therapy for obesity. This form of therapy is about problem-solving to identify the negative habits that lead to obesity (for example, inactivity, snacking, etc.) and replacing them with healthier habits, such as meal prepping or food journaling. 
• Support groups like Overeaters Anonymous provide resources and tools to help you make changes in your eating habits along with a support system that can relate to your struggles and share in triumphs. 
• Obesity counseling/cognitive behavioral therapy, such as through a counselor found on Klarity, can help to address the underlying emotional factors like loneliness that drive unhealthy behaviors. 

Medical weight loss medications

Weight loss pills and medications can address several factors that contribute to weight gain but primarily work through one of three mechanisms:

• Appetite suppression
• “Craving” suppression
• Reducing calorie absorption 

Appetite suppression

Medications that suppress appetite help with the hunger that comes with dieting and calorie restriction. The newest and most effective medications fall under the semaglutide and liraglutide drug classes and significantly suppress appetite by mimicking a satiety hormone produced by the gut called GLP-1 (glucagon-like peptide 1), which can lead to significant weight loss. 

Known as GLP-1 agonists, these medications include Ozempic and Wegovy, which are injectable medications, and the newest pill form, called Rybelsus. Only Wegovy is FDA-approved for weight management. Ozempic and Rybelsus are approved for type 2 diabetes treatment.

These medications are groundbreaking because they can produce a weight loss of up to 16% of your original body weight when combined with diet and exercise.

What to know about appetite suppression medications and other options

Semaglutide and liraglutide-based drugs can cause side effects — mainly nausea — that tend to decrease over time as your body adapts to the medicine. Side effects can also be managed by avoiding foods that exacerbate nausea, such as sugary or fried foods, or asking your doctor for an add-on antinausea medication, such as Zofran, to tide you over. 

GLP-1 agonists are pricey (from $900 to $1,400 a month) and aren’t always covered by insurance. Whether covered by insurance or not, there are options to save on Wegovy.

Other medications that suppress appetite include stimulants like phentermine (brand name Adipex) and an antiseizure drug called topiramate generically, which can cause loss of appetite as a side effect and is often prescribed off label for this reason. These drugs have been available for a while and are more affordable — even without insurance. Topiramate costs about $18 with a savings card; phentermine costs about $17 with a savings card. 

Craving suppression medications

Medications that suppress food cravings focus more on the addictive response to food by reducing cravings as opposed to suppressing physical sensations of hunger and tend to work better for overeating that’s not primarily driven by hunger, such as emotional eating. 

Drugs used for this purpose include bupropion (Wellbutrin/Zyban), an antidepressant drug, and Contrave, which is a combination of bupropion and an anti-addiction medication called naltrexone. Contrave costs $99 a month or less with the Contrave savings program.

Another antidepressant medication, fluoxetine (Prozac), is sometimes used off-label for weight loss and is thought to work by curbing cravings and/or improving mood. A one-month supply of the generic costs as little as $4 with some savings programs. 

Vyvanse, a stimulant commonly used to treat ADHD, is also the first FDA-approved medication for binge eating disorder (BED). The generic form is around $100 a month with a savings card through some pharmacies.

Medications to reduce calorie absorption 

Xenical and Alli are two medications made with orlistat to block some of the fat your body absorbs from food. While this can help weight loss, it can also cause unpleasant gastrointestinal side effects, like diarrhea and bloating, if too eat too much fat at once while on the medication. They can also block the absorption of fat-soluble vitamins (vitamins that require fat for absorption),  like Vitamin D and K, so caution should be taken to prevent nutritional deficiencies. 

Alli can be purchased over the counter at drug stores and even supermarkets. 90 60 mg capsules cost around $56. The prescription form, Xenical, is pricier at $803 for 90 120 mg capsules or $673 for Orlistat, the generic form.

Diets

Diet plays a critical role in weight loss, as caloric restriction in some form or another is required for weight loss. However, how you go about achieving this restriction may be easier on some diets than others, depending on the diet and the person. 

You don’t have to do it alone, though. Your healthcare provider can work with you or refer you to a registered dietitian to help you set healthy weight loss goals and make other lifestyle changes that are realistic.

Types of diets commonly used for weight loss include:

• Ketogenic diet/very low carbohydrate diets typically have you eat less than 50 grams of carbs a day.
• Moderate Low-carbohydrate diets – definitions are loose, but they usually have you consume about 70 to 130 grams of carbs a day. 
• Intermittent fasting/time-restricted eating, where you eat meals in a restricted window of time, such as from noon to 8 p.m. 
• Combining dieting with intermittent fasting.
• Calorie cycling is where you cycle days of lower calories with days of higher calorie consumption to prevent a drop in metabolism that often follows long-term calorie restriction.
• The Mayo Clinic Diet – A low-calorie diet designed by Mayo Clinic weight loss experts, such as a 1200-calorie-per-day Mediterranean-style diet plus at least 30 minutes of exercise.

Meal Replacements

Some weight loss programs focus on meal replacement beverages, such as protein shakes or bars to replace meals. You gradually work normal food back into your diet as weight stabilizes. 

This takes the effort of cooking and food prep out of the equation, which makes it easier to follow for some people, while others find it difficult to sustain or get bored with the liquid meals or bars. 

The best meal replacement options are found through a clinician-supervised weight loss program overseen by a medical professional, such as a registered dietician or doctor. 

Meal replacement is more effective in this context because it’s part of a comprehensive program where you have the guidance of a professional trained in weight and/or obesity management. Some examples of programs that use prepackaged meal replacements include:

• Medi-Fast
• OPTIFAST
• Profile by Sanford 

How do healthcare professionals treat obesity and weight issues?

A qualified medical provider, such as a medical professional who can help you with medical weight management and/or a mental health provider who focuses on the emotional aspects of overeating, is best qualified for treating weight issues. Other healthcare professionals who are part of your healthcare team, such as a registered nurse or dietitian, may also help. 

In addition to treating obesity and weight issues with the tools discussed above (behavior modification, medication, etc.), medical providers can offer additional tools, when appropriate, including the following.

Personalized programs

Medically supervised programs combine multiple elements of treatment, such as health coaching, supplements, weight loss medications, behavior modification, and meal and/or exercise plans. 

Most importantly, these programs are personalized to your individual needs and health status. A member of your healthcare team will help design a plan that suits you, combining one or more of the components mentioned above. 

Bariatric surgery

Procedures for medical weight loss surgery include gastric bypass, sleeve gastrectomy, and adjustable gastric banding that make you feel full on smaller portions of food. For example, gastric bypass surgery creates a small pouch in place of your stomach and connects it to the small intestine. 

These procedures have risks, such as surgical complications and malnutrition. They’re typically a last resort in cases of extreme obesity or multiple weight-related health concerns. If you’re interested in bariatric surgery, talk to your primary care doctor, who can refer you to a bariatric surgeon. 

Devices

Medical devices may also be used to aid weight loss, such as those inserted surgically, like laparoscopic adjustable gastric banding (LAGB) that reduces how much food your stomach holds.

There is also a medication-like device called Plenity. It’s patented cellulose (fiber) that absorbs a substantial amount of water and takes up room in your stomach to help you feel fuller more quickly. Even though it’s swallowed like a pill, Plenity is considered a medical device because it’s not absorbed by the body and passes through the intestinal tract intact. 

What to expect from a weight loss program

Although results vary from person to person, the more weight you have to lose, the longer it will take. It’s ideal to approach weight loss as a lifestyle change rather than a quick fix. 

You can expect support, accountability, and guidance from your provider. You need to remain committed by understanding your reasons for following the program, such as improving your health, being around for your grandchildren, or feeling more self-confident and energetic. 

As far as the process goes, while specifics vary from program to program and person to person, here’s the general flow of a program.

• You meet with your provider and discuss which program/approach is right for you.
• Your provider asks questions and takes a detailed patient history.
• You may have bloodwork done and/or get a physical to determine your current health status.
• Your provider devises a treatment plan for you and/or refers you to a clinician who specializes in obesity or weight management to devise a plan on your behalf. Your provider may suggest you see a behavioral counselor as well.
• The clinician who oversees your weight loss program schedules follows up with you as needed.
• Your provider troubleshoots challenges, oversees side effects, and adapts your plan as necessary until you achieve your goals. 
• You and your provider create a long-term maintenance plan once you achieve your goals.

What to look for in a program

A medical weight loss program should be reputable, meaning it’s FDA-approved and overseen by a licensed healthcare professional, which you can find out by asking for their qualifications (degree, license, specialty, etc.), looking at Google or Healthgrades.com reviews, and checking if their program is backed by a healthcare institution, such as a hospital or university. Of course, your initial impressions of the provider, their ease with answering questions, and general bedside manner should factor into your decision as well. 

Find a provider willing to work with you on a long-term maintenance plan and lifestyle changes after medical assistance/medications are over. 

Affordability is another factor to consider. Fortunately, there are options like GoodRx and other savings programs you can look into if your insurance doesn’t cover something. Be sure that you understand all of your upfront costs, and contact your insurance company if you’re unsure about coverage. 

Sometimes, insurance requires pre-authorization from your doctor before a service or medication is covered. In that case, your provider will handle the pre-authorization.

Make sure the program is suitable to your personality, desires, and needs. For instance, if you’re prone to forgetting meds, you may want to try a non-medication-based program or set a reminder on your phone if you want to give weight loss medications a try. 

Questions to ask your provider/the program lead 

There are many questions to ask your provider. Some of the most important include:

• How do I know which program is best for me?
• What online/telehealth weight loss program options exist (if desired)?
• Which programs have the highest success rates?
• What precautions should I take before starting, if any?
• What do I need to prepare for the program?
• How will you work with me throughout the program/what can I expect from you?
• What long-term help and guidance will I get from you/this program?
• What costs can I expect?

How effective are weight management programs? 

Success rates of weight loss programs vary widely depending on the specific approach (medication, device, surgery, diet, etc.). For losing weight in general, the CDC recommends 1 to 2 pounds of weight loss per week. You’re more likely to maintain wight loss if you lose it gradually and steadily rather than lose a large amount at once. 

In general, here’s what you can expect to achieve on different programs.

Behavior modification

According to a scientific paper titled Evidence for Success of Behavior Modification in Weight Loss and Control,  behavior modification can lead to an average weight loss of more than 20 pounds with two-thirds of the weight loss being maintained at a year follow-up, which is considered highly effective. 

Medications

Combining medications with lifestyle changes consistently leads to greater weight loss than lifestyle changes alone. Studies show this combination of weight-loss drugs and lifestyle changes can produce a loss of total body weight of 3 to 12% greater than lifestyle changes alone. 

Diet alone

Low-carb, especially ketogenic, which is a very low-carb diet, is more successful than a low-fat diet for short-term (12 to 24 months) weight loss but averages out after a year. This could be due to the modest appetite suppressive effect of ketosis and other factors like increased metabolic rate. 

Bariatric surgery

Bariatric surgery is the most effective weight loss tool, though it is also the most invasive, expensive, and risky. Patients may lose up to 77% or more of their excess weight in as little as 12 months following surgery and maintain up to 60% of this weight loss 10 to 14 years after surgery.

Start your weight loss journey today on Klarity

If you’re considering a medical weight loss program, whether with a medication-managed approach to weight loss, counseling, or both, find a qualified doctor, nurse practitioner, physician’s assistant, psychologist, and/or therapist who provides medical weight loss services online or near you with Klarity. Get started today.