There is a long history of stigma surrounding weight loss medications and I need your help to break it. The more people that know the truth, the more we can combat the weight, together.

Excess weight is an independent risk factor for heart disease, including heart attacks, and strokes, and creates body-wide inflammation which can clog blood vessels.

Think about it.

The last time you injured yourself, for example, bumped your arm or leg, there was likely redness and swelling. This is inflammation. Now, imagine this redness and swelling in the blood vessels, slowing down or blocking blood flow.

This is why I am so passionate about treating my patients aggressively to lose excess weight. This is done through thinking purposefully about what you eat, when you eat, physical activity, and medications.

It’s the latter that we’re going to be discussing today.

High blood pressure, diabetes, and high cholesterol are all treated with a combination of lifestyle interventions and medications, and we don’t bat an eye when someone is taking medication for one of these ailments.

So, why do we think any differently about weight loss medications?

One reason is the belief that people gain weight because they are not disciplined, they just overeat, or they are losing control. This is false.

Obesity is a disease just like high blood pressure, diabetes, and high cholesterol, and we should be treating it as such.

I believe medications can have a huge impact on your results and if deemed safe, I often prescribe them for my patients during their first visit.

Who are weight loss medications indicated for?

For adults with a body mass index above 30 or above 27 with comorbidities such as high blood pressure, diabetes, and high cholesterol, weight loss medications can be safely prescribed to assist in your weight loss journey.

Just a 5-10% weight loss can improve both metabolic health (which is the body-wide inflammation, blood pressure, cholesterol, fatty liver disease) and decrease the pain in the body from the excess weight.

At LaRocca Medical Weight Loss, I will closely monitor your health after prescribing the correct medication for your goals. We start with a body composition assessment, EKG, and order
labs to ensure proper monitoring, so you can relax knowing your health is always a top priority.

What are some medications that can be prescribed for weight loss?

Name: Phentermine (generic, Adipex, Lomaira)

How it works: it works as a stimulant by increasing norepinephrine and acting in the hypothalamus to decrease hunger signals, suppressing appetite
TYPICAL RESULTS: 10% weight loss (when prescribed in combination with Topiramate)
Possible Adverse Reactions: insomnia (take early), abnormal heart rhythm, high blood pressure, headaches
Note: It cannot be used in people with heart disease, uncontrolled blood pressure, glaucoma, or hyperthyroidism.

Name: Topiramate (generic, Topamax)
How it works: it stops neurons (which are individual nerves) in the hypothalamus from transmitting hunger signals, suppressing appetite
TYPICAL RESULTS: 10% weight loss (when prescribed in combination with Phentermine)
Possible Adverse Reactions: metabolic acidosis (your doctor would tell you this) or prior allergy, generally this medicine is very well tolerated but can make some people feel sluggish, mentally and physically so it is generally taken at night or counteracted with phentermine; it can also cause tingling (called paresthesias) which can be improved with natural remedies.

*Both the above-mentioned medications can be taken individually, or as a combination pill, called Qsymia.

Name: Semaglutide (Ozempic, Wegovy)
How it works: GLP1RA suppress appetite in the brain and increases satiety, the feeling of being full, this is double action; it also decreases blood sugars and is a well-known diabetes medication
TYPICAL RESULTS: 15% body weight loss in 1 year
Possible Adverse Reactions: gastrointestinal side effects, including nausea, vomiting, diarrhea, or constipation, in rare cases pancreatitis
Note: Contraindicated with personal or family history of some thyroid cancers

Name: Bupropion (Wellbutrin)
How it works: increasing dopamine which stimulates the neurons in the brain that decrease hunger signals, it is also well known as a depression medication
TYPICAL RESULTS: 5% weight loss (when prescribed in combination with Naltrexone)
Possible Adverse Reactions: mood changes, insomnia, headache, increase blood pressure rarely, and nausea/constipation
Note: Contraindicated with seizure disorders as it can lower the threshold to have a seizure and uncontrolled blood pressure

Name: Naltrexone
How it works: synergistically with bupropion, meaning it improves how well bupropion stimulates neurons in our brain responsible for decreasing hunger signals
TYPICAL RESULTS: 5% weight loss (when prescribed in combination with Bupropion)
Possible Adverse Reactions: Contraindicated with opioid use or other drug overuse
Note: Generally, naltrexone is not used individually for weight loss.

*Bupropion can be given alone or with naltrexone in a combination pill called Contrave.

Name: Orlistat (Over the counter or prescription)
How it works: inhibits an enzyme, called lipase, that breaks down fats – this makes it so they are not absorbed and are eliminated through the stool
TYPICAL RESULTS: about 6% body weight loss in 1 year
Possible Adverse Reactions: stool leakage which is not appealing, but some people are willing to deal with this; increased risk for certain types of kidney stones, and poor absorption of fat-soluble vitamins (which are vitamin ADE and K), so recommend taking a multivitamin
Note: constipation is a well-known side effect of weight loss and Orlistat can help to combat that while providing additional weight loss. It is contraindicated in people with chronic malabsorption syndrome or decreased flow of bile, called cholestasis.

How can I have weight loss medications prescribed to me?

If this has resonated with you I recommend that you discuss this topic with your primary care physician or schedule a consultation with me.

*Disclaimer: I do not have affiliations with drug companies or financial interest in these medications. Generic and brand names are used here for brand recognition for your educational purposes.

Till next time, stay healthy.

Dr. Kristine LaRocca

Disclaimer: Although I am a medical doctor, I am not YOUR doctor. So the things I teach are not to be used as medical advice. You should consult your physician to discuss what is best for you personally.

If you would like to become my patient, schedule a free consultation below.

We’ve all heard the word metabolism, but do you know what it actually is?

Metabolism is the process by which your body converts what you eat and drink into energy your body needs to function.

This can process can be faster or slower depending on a few variants, and you can actually control how slow or fast your metabolism is with your food intake and exercise regime.

Let’s get into the science of it.

(Prefer to listen instead? Check out my podcast episode on this topic here.)

We all create energy mostly from glucose (blood sugar), and from ketones (from the breakdown of fat).

The energy that your body needs to function is called your energy expenditure. Energy expenditure is made up of 3 things:

• Resting metabolic rate
• Physical activity
• Dietary thermogenesis (energy needed for digesting food)

An increase in body tissue, either muscle or fat, increases your resting metabolic rate. This is the energy required to fuel the body’s functions down to the cellular level.

Meaning;

Increased weight = increase in metabolism.

Weight loss = decrease in metabolism.

It makes sense. If you have more body tissue overall, your body has more functions to support. It must get blood and oxygen to all the tissues and must complete more cellular processes.

It’s important to note that resting metabolic rates are different in everyone and we do not have enough evidence to say that a higher or lower metabolism predisposes someone to weight gain.

Having said that, athletes are in a different category. For example, someone who is lean and building large amounts of muscle may increase caloric intake and increase their resting metabolic rate, but this does not apply to the average person trying to lose weight.

In non-athletes, 70% of the daily energy we use is from our resting metabolic rate, 20% is from physical activity, and only 10% of the energy we use up is from diet-induced thermogenesis.

Increasing muscle mass with resistance training, such as lifting weights or using resistance bands, can make a big difference. The more muscle mass you have, the less your metabolism will slow as you lose weight. This means that instead of your resting metabolic rate going down while you lose weight, you can keep it up.

For someone who is “lean,” the energy that muscles use while you are resting can be approximately 3 times higher than fat. The daily metabolic rate of muscle could be 13 kcal/kg/day and adipose tissue (or fat) 4.5 kcal/kd/day. This varies depending on the muscle to fat ratio. On the other spectrum, if you have hundreds of pounds of body fat the resting energy, the metabolic rate, will increase to maintain the fat tissue.

The bottom line

The reason you are overweight is not that you have a “low metabolism.” In fact, if you have excess body fat, you most likely have a “faster metabolism.” As you lose weight your metabolism slows down.

How can we apply this information?

The goal is not to have a “fast metabolism.” The goal is to use energy in your body efficiently.

The best two ways to do that are to;

1. Stop grazing & snacking through the day. Plan to eat 2-3 meals per day and leave the snacking behind.
2. Maximize your exercise results. Schedule time for exercise. Keep changing up the type of exercise you are doing. If you continuously do the same thing your body becomes efficient at it and it stops being as effective. You can use more energy when your body is constantly doing new things.

Wang Z, Ying Z, Bosy-Westphal A, et al.: Specific metabolic rates of major organs and tissues across adulthood: evaluation by mechanistic model of resting energy expenditure. Am J Clin Nutr 2010 92:1369-1377. https://www.ncbi.nlm.nih.gov/pubmed/20962155

Pontzer H, Durazo-Arvizu R, Dugas LR, et al.: Constrained Total Energy Expenditure and Metabolic Adaptation to Physical Activity in Adult Humans. Curr Biol 2016 26:410-417. https://www.ncbi.nlm.nih.gov/pubmed/26832439

Till next time, stay healthy.

Dr. Kristine LaRocca

Disclaimer: Although I am a medical doctor, I am not YOUR doctor. So the things I teach are not to be used as medical advice. You should consult your physician to discuss what is best for you personally.

If you would like to become my patient, schedule a free consultation below.

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According to the CDC, in 2020 13% of adults in the U.S. were living with Type II Diabetes (DMII), and even scarier, 34.5% were diagnosed with prediabetes. These are high numbers!

If you’re living with Type II Diabetes, chances are your doctor has already told you the best way to combat this disease is to lose weight. Easier said than done, right?

Here’s the catch 22, Type II diabetes affects the ability to lose weight, on the other hand, obesity can lead to the development of Type II Diabetes. It’s a double-edged sword.

I also talk about this on a podcast episode. Listen to the podcast.

How does Type II Diabetes or prediabetes make it harder to lose weight?

You develop DMII or prediabetes when your blood sugar levels are consistently high. This is caused, in most part, by ingesting highly processed foods, such as flour and sugar thus causing consistently elevated insulin levels. It is harder for people with prediabetes or Type II diabetes to lose weight because their insulin is always elevated.

In order to fully understand why Type II diabetes makes it so difficult to lose weight, first, we need to understand what happens in our bodies when we eat processed foods.

Let’s break down how our bodies create fat:

Step 1: You ingest foods that are highly processed (foods that contain flour and/or sugar). For example, we’ll say a big plate of spaghetti with garlic bread. These processed foods are broken down to glucose, then absorbed into the bloodstream, increasing your blood sugar (glucose) levels. Some glucose in our blood is necessary. Our bodies need it for energy. Too much, too fast is harmful though.

Step 2: The rise in glucose causes your pancreas to produce the hormone insulin. Insulin plays an important part. Think of insulin as a key used to open up cells to let in the glucose. Remember, we need that to happen to have energy.

Step 3: Once our cells have enough glucose for the energy our body needs, the rest of the glucose is stored for later use. One of these storage forms is fat. The insulin goes to the fat cells, unlocks them, and stores the glucose to plump up those fat cells. Remember, insulin is a key to open the cells, so if insulin is consistently elevated, you will always be storing fat.

*If eating processed foods was a once in a while treat, your blood sugar would eventually go back down to a normal level. However, when you consistently eat these foods that’s when you’re faced with a problem.

Screening for Type II Diabetes

There is a new recommendation by the United States Preventive Services Task Force to get screened for Type II Diabetes if you are over the age of 35 and overweight. “Overweight” is defined as a body mass index higher than 25. This recommendation was initially for people aged 40 and older, but we are now finding that patients are being diagnosed with DMII earlier. Screening also allows for earlier detection of prediabetes which gives time for early intervention and treatment.

If you have struggled with weight loss and are unsure about your blood sugar levels, you should be screened either with a fasting glucose level or a hemoglobin A1c, which is a 3-month average of your blood sugar. Talk to your doctor about these labs, or when you sign up to become my patient, these are part of the initial lab panel.

What are the benefits of increasing insulin sensitivity?

Improving insulin sensitivity means that your body responds better to the insulin it is producing and will need to produce less of it. There are many benefits to increasing insulin sensitivity.

• Weight loss! They go hand in hand. Weight loss improves insulin sensitivity and improved insulin sensitivity leads to more weight loss.
• Decrease or stop medications. I have gotten some of my patients off of medications completely or greatly reduced the number of medications taken, simply by teaching them to be mindful of when and what they eat. At a certain point, the pancreas gets burned out from making too much insulin and can’t produce it anymore, and there are disease processes that harm the cells that make insulin. However, in most cases, Type II diabetes can be controlled with nutrition, timed eating, and physical activity.

What can you do?

1. Decrease highly refined foods such as bread, pasta, white rice, cereals, chips, crackers, and sugars.
2. Intermittent fast under the guidance of a physician. This is not safe to do independently on many of the DMII medications, such as insulin. I have a free workshop coming up on September 15th at 4 pm ET where I will teach you how to create a personalized IF plan that works for your lifestyle.

You are not helpless when it comes to Type II diabetes and prediabetes. You can take control. In most cases, this disease can be managed, prevented, and even reversed. With knowledge and determination, you can completely change your life.

If you’ve been diagnosed with DMII or prediabetes, a medical weight loss program may be right for you. LaRocca Medical Weight Loss is now enrolling. The consultation is free and there is no obligation.

Till next time, stay healthy.

Dr. Kristine LaRocca

Disclaimer: Although I am a medical doctor, I am not YOUR doctor. So the things I teach are not to be used as medical advice. You should consult your physician to discuss what is best for you personally.

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