Breaking the Stigma of Medications for Weight Loss

Breaking the Stigma of Medications for Weight Loss

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.

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How does your metabolism affect your ability to lose weight?

How does your metabolism affect your ability to lose weight?

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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Intermittent Fasting Workshop

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Intermittent Fasting Workshop

One of the techniques taught in my complete weight loss program is knowing what to eat and when to eat. In my latest weight loss workshop, we spent some time discussing a basic principle used for weight loss that has proven effective for so many people…intermittent fasting.
You can see a pre-recorded version of what we covered in the live class below. However, it’s best to attend live workshops as they happen.
Sign up for emails to be notified of any future workshops so you can participate LIVE!
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Why losing weight is harder with Type II Diabetes

Why losing weight is harder with Type II Diabetes

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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Get Moving!

When most people think of exercise, they imagine things like running on a treadmill, aerobics, and weight lifting. Which is correct, yes, those are all examples of exercise. However, exercise is also so much more. If running on a treadmill has you feeling like a hamster on a wheel, there are other options. There are even hidden ways of getting exercise that doesn’t feel like exercise at all.

Exercise is defined as “physical activity to sustain or improve health and fitness.”

Before we discuss ways of getting your body moving, let’s discuss the many benefits that increased physical activity can have on your life. You may be surprised to find out that it isn’t limited to weight loss.

What are the benefits of exercise?

1. Improves mood.
Have you ever heard the term “runner’s high?” Ask anyone who has a regular exercise routine, they’ll all tell you how great they feel afterward. Not only is there a sense of accomplishment, but there’s a scientific reason why. When you exercise, you stimulate the natural endorphins in your brain. So you’ll get that “ahhhhhh” happy feeling when you’re done.

2. Improves sleep.
Chances are you’ve been to a party, barbecue, or beach where children are running around, hyper, having the best time. Parents usually make a comment about how well the children will be sleeping tonight. It’s true! Studies have shown that an increase in physical activity can be directly linked to the amount of slow-wave sleep you get. Slow-wave sleep refers to deep sleep, where the brain and body have a chance to rejuvenate.

3. Decreases pain.
Maybe you’ve heard the term “A body in motion, stays in motion. A body at rest stays at rest.” If you suffer from arthritis or some other painful physical ailment, you may equate movement with pain. However, making an effort to continue moving throughout the day can actually decrease your pain.

*Please check with your doctor to see if exercise is a good idea for your particular ailment.

4. Improves your cardiovascular health.
Improving blood sugar and reducing risk of Type II diabetes, or improving DMII for those already diagnosed. A Cochran review comparing 14 randomized controlled trials with 377 participants showed a decrease in HgbA1c of about 0.6% with exercise
Reducing blood pressure and triglycerides, decreasing your risk of heart attack and stroke.

5. Improves brain function.
Exercise improves blood flow to the brain, reduces inflammation, lowers the level of stress hormones, and decreases the risk of cognitive impairment from dementia and Alzheimer’s.

6. Decreases fat tissue and increases muscle.
The most obvious and well known reason people exercise, the changes in physical appearance. Think of your body like a furnace. Exercising “ignites the furnace” and uses our stored fat as energy to fuel our physical activity. The more physical activity, the more fat is burned for fuel.

However it’s important to note that you cannot outrun a poor diet! Which really makes sense when you think about it. You’re eating poorly, causing a surplus of fat storage. You can only burn so much through exercise. There has to be an intake deficit.

What are some alternate forms of exercise?

Exercise is sustainable if it means doing things that you actually enjoy.

Here are some examples:

  • Kayaking
  • Rowing
  • Hiking
  • Walking
  • Jogging/running
  • Biking
  • Skating/rollerblading
  • Skiing
  • Snowboarding
  • Walking on a treadmill
  • Elliptical
  • Stationary bike
  • Weight lifting
  • Bodyweight strength training: Squats, planks, push-ups, crunches, quadruplex
  • Bodyweight cardio: Jumping jacks, burpees, mountain climbers
  • Strength training with weights
  • Jumping rope
  • Dancing
  • Stretching
  • Swimming
  • Rock climbing (belaying or bouldering)
  • Sports: Golf, Tennis, Baseball/softball/whiffle ball
  • Classes: Zumba, Orange Theory, CrossFit, Beach Body (i.e. PiYo),
  • Yoga: I love SarahBethYoga (I’m not paid to endorse her and I’m not an affiliate, but she has tons of free classes online.) Truly Yoga in Pike Creek, Delaware, Kripalu for the full experience.
  • Refit
  • Kickboxing
  • Personal training

 

How can I get started with an exercise routine?

Choose a start date. This is important. Choose a date and stick to it.

Choose the number of days per week. If you’re new to exercise, start small and increase as you go according to your comfort level.

Plan your activity. Not sure what you like? Use the list above and try each one, working your way down. You’ll expose yourself to new things and increase the potential of really falling in love with an activity. Then it won’t feel like exercise at all!

Decide how much time you will give yourself. Again, if you’re new to exercise, I would start small with 30 minutes (or less) of low-impact movement a day then increase as you go.

Write this in your calendar. Having your intentions written on a calendar for you to see makes it easier to stick to it.

TIPS:

  •  Start slow and gradually increase activity to avoid injury.
  • Sign up for a 5k to walk or jog. Going with a group can really be the boost you need.
  • Ask a friend to join you. Sometimes, things are better with friends. Try Zumba classes together or escape to a calm lake and try canoeing.

For more info on all things health and wellness, check out the full blog, listen to the podcast and sign up for emails so you can get future blog posts right in your inbox.

 

That’s all I have for today. 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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Does protein cause weight gain?

Does protein cause weight gain?

Protein is important for weight loss because it improves satiety, the ”full” or “satisfied” feeling you experience while ingesting a meal that triggers you to stop eating.

Quick side note: I’ve got a podcast episode on this information as well if you prefer to listen instead.

A common misconception is that protein will make you gain weight. While this does have some truth to it, it typically doesn’t lead to fat gain unless you eat it in excess.

So, how do you know how much protein your body needs?

The US Department of Agriculture (USDA) recommends 0.8 to 2.0 g/kg/ per day of protein, depending on your level of physical activity, sex and age.

Let’s calculate your personal intake recommendation.

    1. Your weight __________
    2. Divide that number by 2.2 _________ (This is your weight in kilograms.)
    3. Next, multiply this by 0.8 ________
    4. Equals your goal for daily protein intake __________

For example:

  1. If you weigh 200lbs
  2. 200 divided by 2.2 is 90.9
  3. 90.9 multiplied by 0.8 equals about 73.
  4. So, your daily protein goal will be 73 grams.

If it’s easier: you can use the USDA Protein Intake Calculator which will base your results on your weight and activity level.

*It’s important to note that there are special situations where protein intake may be limited even further, such as kidney disease, so be sure to check with your doctor.

How does protein work in the body?

Proteins break down into amino acids and are used by our bodies as building blocks for bone, muscle, skin, brain tissue, and parts of our DNA.

In times of high energy demand, those amino acids can be used as energy by being converted to glucose.

However, when you overeat protein, the amino acids can be converted to glucose and stored as fat once your energy stores are full. This is especially true if you have a sedentary job and don’t move much during the day.

On the other hand, too little protein can lead to disease processes so we need balance.

Plant-based protein is best.

Quinoa is an example of a plant-based protein that contains all 9 essential amino acids, including the ones that our body cannot make on its own.

  • It is a seed so it is also packed with healthy fats.
  • It is rich in vitamins and minerals such as folate and magnesium.
  • It is quick to make, only taking about 15 minutes.
  • There are over 120 varieties of quinoa: white, red, and other colored options. They are all nutritious.

Nuts are another viable option as they are high in protein and packed with healthy fats, all leading to increased satiety.

Other forms of protein are:

  • Fish, which can be dense in healthy fats such as DHA and EPA.
  • Land meats such as chicken, turkey, beef, and pork
  • Animal products, such as eggs, cheese and milk

I’ve created a cheat sheet below for you to use as a reference.

Click to download Healthy Protein Cheat Sheet

Download healthy protein pdf

 

Track your protein intake for 3 days. Use the guidelines in the chart and formula provided to see if you are meeting your goal, under or over, then adjust as needed for a healthy weight!

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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