Medication for Weight Loss: Not an Instant Solution

All of a sudden, it’s a whole new ballgame in weight management.

Of the new drugs found to be effective in losing weight, only three – Wegovy, Mounjaro, and Saxenda – are FDA-approved for obesity. Ozempic and Victoza are FDA-approved for diabetes, which was the objective for development of all of them.

Although these diabetes drugs are not all are approved for weight loss, some people are requesting them for this purpose. People are losing weight on the drugs and that has caused such a demand that pharmacies are routinely running out. Insurance payers are scrambling to evaluate and qualify when and how to cover them. Like with anything new, it’s been hard to sort out what’s what.

Who is a candidate for medication?

For people with severe obesity, tools like medication or bariatric surgery can be effective when other weight-loss strategies do not work. One doctor noted, “For most patients with severe obesity, lifestyle approaches aren’t up to the task. (She described them as trying to clear a major snowstorm with a shovel instead of a snowplow.) The new medications, particularly when coupled with bariatric surgery, are tools of appropriate power to address a problem that has proven resistant to change and comes with increased risk of life-threatening conditions such as high blood pressure, diabetes, and fatty liver disease.” (1)

Barring severe obesity or metabolic disorders, lifestyle modifications are recommended as the first line treatment for obesity. Per the Mayo Clinic, “Weight-loss medicines are meant to be used along with diet, exercise and behavior changes, not instead of them.”

Health Coach Program Specialist with BeneFIT Corporate Wellness, Catherine Finney, MS, RD, LD, NBC-HWC, CHWC, (Catie) agrees. “I think there is a misconception out there that taking a pill or getting a shot can solve the problem,” she says. “People may have busy schedules and the medication may seem like an easy solution. But it’s not.”

She urges anyone considering weight loss therapy to talk with their doctor and ask: “What happens when I stop the medication, or the surgery is completed?”

“There has to be a maintenance plan in place that includes diet and exercise,” says Catie. “You not only need lifestyle modifications to make medication or surgery successful, but you might find that you are able to reach a healthy weight simply by getting yourself on a healthier track.”

“Post-menopausal women are an excellent example,” she continues, “since they typically have difficulty taking off the weight they gain naturally. But they aren’t automatically candidates for medication. If they were participating in health coaching for example, we would work on lifestyle changes first.” 

A place for health coaching

According to one study on bariatric surgery, “It is now well established that a large proportion of patients experience significant weight regain during long-term follow-up.” (2) The study went on to find that, “The most common causes are thought to be loss-of-control eating or ‘grazing,’ noncompliance to dietary recommendations, return to previous eating habits, sedentary lifestyle, and physiological compensatory mechanisms such as changes in hormones that regulate energy intake leading to increased appetite and food cravings, and increased caloric intake.”

This again points to the importance of a maintenance plan. Which is why some insurers are counting health coaching as a necessary component to qualify for coverage of medications used for weight loss. A health coach can be the sustainability factor that keeps the patient consistent with healthy behaviors.

“Health coaches are guides,” says Catie. “We do not tell anyone what to do. We listen to our clients and follow their lead in terms of their goals and what they want to focus on. That makes coaching ideal in this situation. It not only addresses the behavioral and relationship aspect of food, but it also provides the accountability that can make the difference between success and failure of any weight management practice.”

“Health coaching is really about improving quality of life, which is also the ultimate goal of weight management,” she says.