Two thirds of Americans are either overweight or obese as defined by body mass index (BMI), a staggering number. And this number is going up. There are many reasons for the rise, but over-nutrition and our adherence to the Standard American Diet (SAD) are considered to be the most important. Our bodies were never meant to eat such a rich diet in an uninterrupted way. The energy-dense and ultra-processed foods not only pack on the pounds, they also change the way our gut signals to the brain that it is full. The modern understanding of obesity is that it is a chronic disease that is primarily rooted in the subcortical regions of the brain.
My goals for patients who are overweight depend on the degree of their problem, and include weight loss as well as changing the relationship to nutrition. The treatment of over-weight and metabolic dysregulation is not just eat less and exercise more, though these are obviously important. Aside from changes in nutrition, activity, sleep, and stress, there must be a tiered approach based on the latest science that includes jump-starting fat oxidation with very brief dietary interventions such as fasting, establishing sensible meal plans that are appropriate for each patient and tracking weight carefully to identify plateaus.
To help you reach your goals, there are FDA-approved drugs for weight loss that are now considered safe and in some cases, even health promoting. We also have a handful of anti-diabetic medications that can be repurposed to address metabolic health. But a lifetime of taking drugs is not a victory. Nor is persistent see-saw dieting, and so success means establishing change that is stable and enduring. The primary issue is one of resetting the physiological weight set point or ponderstat, and this is where we can leverage certain drugs and interventions to offer a method that is uniquely effective.