Have you beaten yourself up trying to diet your way to sustainable weight loss? You’re not alone. It can be hard to know which of the hundreds of diets and retail weight loss plans to try. Then there’s the disappointment and frustration when nothing seems to work.

One thing that’s often missing from many commercial programs is personalized support from health care experts – something that’s part of a medically supervised weight management program. And because your brain can get comfortable with your current weight and resist change, it may be that prescription weight loss medications or other treatments could help.

Read on to learn about medical weight management programs and prescription weight loss pills or injections that might help.

Medical weight management is a program to help people lose weight and maintain that weight loss. This means that medical weight management programs have a big focus on helping you build daily habits for maintaining a healthy lifestyle. Your doctor may also recommend prescription weight loss medication.

Medical weight management is different than dieting on your own because you have a team of experts to offer guidance and support, and to hold you accountable. You’ll have regular check-ins to celebrate your successes and talk about your challenges.

Your team will include both a doctor and a dietitian. Depending on your needs, you may also work with nurses, physical therapists and psychologists. This team will identify the best treatment plan based on your unique attitudes, habits, environment and physiology (how your body works).

Medical weight management can be a first step or ongoing

Good candidates for medical weight management are those who’ve tried lifestyle changes but struggle to maintain them. To be considered for medical weight management, you need to have a BMI (body mass index) of at least 35. If your BMI is lower than 35 and you’re interested in weight loss medications, it may still be worth talking to your primary care doctor about it. Most weight loss medications are used for people with a BMI of at least 30, or 27 with a weight-related condition.

Your BMI is a measurement of your body fat based on your height and weight. You may know your BMI already, but if you don’t, you can use this BMI calculator to figure it out.

Medical weight management may make sense for you if one of the following describes you:

1. Losing 7-20% of your body weight would help you reach a comfortable weight.
2. You have a BMI over 40 and your health insurance plan requires a medical weight loss attempt before surgery, or if surgery isn’t covered by your plan.
3. You can’t have bariatric surgery because of a medical or psychological condition that would make surgery harmful.
4. You’re interested in using a medication for weight loss, and have checked with your insurance provider and know which weight loss medications may be covered based on your risk factors.

How much you lose with medical weight loss depends on your body

Weight loss is highly variable, as everyone’s body responds differently to treatments. Your doctor can help give you an estimate for how much weight you can expect to lose. They can also share information about other options (like bariatric surgery) which could be part of your treatment plan.

Medical weight management takes time

Everybody is different, so it’s hard to know how quickly the weight will come off. Some people will start dropping pounds right away. But for others, it can take a little longer.

It’s important to remember that medical weight management isn’t a speed run. The goal isn’t losing weight as fast as possible, but creating sustainable changes that will help you manage your weight over the long-term.

Most people need to stay on the medicine for sustained weight control

Most weight loss medications are used longer-term to help you manage your weight. When medications are stopped, most people will gain back most of the weight. That doesn’t mean you’ll be in a medical weight management program forever. Once you’re able to keep the weight off for 3-6 months, you should be able to work with a primary care doctor for ongoing weight control.

Bariatric surgery can be a more permanent option for people who would like to sustain weight loss without medicines (or less medicine). Candidates for bariatric surgery are those with a BMI of 40 or higher or a BMI of 35 or higher with at least one weight related condition.

How medical weight loss programs work

If you have uncontrolled hunger, cravings and “brain chatter” about food, a medical weight management program can help you identify and change habits so you can lose weight.

Medical weight management programs work by addressing the behaviors, habits and attitudes that are getting in between you and a healthy weight.

Identifying a sustainable diet for weight loss success

Food choices can play an important role in weight management, but eating a nutrient-rich diet is about more than simply following a restrictive diet. A medical weight management program takes an individualized approach to nutrition, focusing on sustainable changes that support weight loss and overall health.

A balanced eating pattern may include more fiber-rich foods, vegetables, fruits, whole grains, lean proteins and healthy fats, while limiting highly refined carbohydrates and other foods that are easy to overconsume. These choices can help you feel satisfied, support good nutrition and make it easier to manage calorie intake.

There’s no need to label foods as “good” or “bad,” and most foods don’t need to be completely off-limits. Instead, the goal is to develop a balanced approach to eating that fits your preferences, lifestyle and health needs.

One of the benefits of a medical weight management program is ongoing support from a registered dietitian. Your dietitian can help you understand how different foods and eating patterns affect your health and weight management goals, while providing practical strategies to make changes you can maintain over time.

Creating an exercise plan you can live (and lose weight) with

It could be that you don’t know where to start with an exercise program. Or maybe you exercise regularly and find that you’re not able to drop pounds (or that you keep gaining weight).

As part of a medical weight management program, you’ll learn about the exercises that will help you achieve and maintain a healthy body weight. Because here’s the thing: not all exercise is created equal when it comes to managing your body weight.

Most people will benefit from a combination of cardio, strength training and flexibility exercises. If you have physical limitations that are getting in the way of exercise, a physical therapist will help you ease into an exercise program.

Using mental health support to address your relationship with food

Food is fuel, but it’s more than that. Eating is at the center of social activities. And for many people, food is comfort when they’re sad, stressed or tired.

Food can also be a source of frustration. It may seem like you can’t lose weight no matter what you eat and what you do. Even if you lose weight, the pounds can return – the process can go on and on. This yo-yo dieting can affect your relationship with food and has the potential to lead to an eating disorder like binge eating disorder.

To lose weight (and keep it off), it’s important to address your attitudes and emotions related to food. Experts at the weight loss center can help you understand what might be causing emotional eating and put together a treatment plan that will help you deal with stressors in the future.

Understanding the physiological factors of weight management

Weight control isn’t always as simple as balancing what you eat with what you do. It may be that your body’s processes are working against you.

Generally speaking, when you gain weight, it means you’re eating more calories than your body is burning. But this can happen even if you’re exercising regularly and eating a healthy diet. Your caloric needs may be different because of aging or certain behaviors. But dieting also changes how your body works and how many calories it needs.

Your brain gets used to your body being a certain weight and takes steps to keep you at that size. Losing weight can actually lower your metabolic rate, meaning that your body burns through food more slowly, so you need to eat less. And that’s not the only change. After losing weight it’s common to have an increased appetite, even though you need fewer calories to support your smaller body. That means you might regain the weight or gain even more.

If there are physiological reasons why you can’t lose weight, there are medications that may be able to help.

What you should know about prescription weight loss medications

There are a lot of questions about weight loss medications. Like, what is the most effective weight loss prescription drug? What prescription drugs make you lose weight fast? Are GLP-1s the only option? There is a lot of information to consider.

Weight loss medications are most effective as part of a larger program

The first thing to know about prescription weight loss medications is that they work best as part of a larger medical weight management program that includes a balanced diet and regular exercise. Weight loss medications are not a miracle cure but may help people who aren’t able to lose weight with diet and exercise alone.

Your doctor will discuss the available options and help determine which may be the best fit for you based on your weight loss goals, medical history, preferences, safety considerations and cost. If you have weight-related conditions such as prediabetes, high blood pressure or obstructive sleep apnea, your doctor may recommend a medicine that can help improve those conditions while also supporting weight loss.

After starting a medication, you'll have regular follow-up visits to monitor side effects, assess your progress and determine whether the medication remains a good fit for your treatment goals. If things are working well, you’ll continue on that prescription. If the weight isn’t coming off or you have bothersome side effects, your doctor may recommend a different option.

It’s also important to note that if weight loss medications work for you, you’ll likely need to keep taking them if you want to keep the weight off.

Weight loss medications aren’t an option for everyone

Medications have different guidelines for use. These may relate to:

• Your age – Many of the medications are just for adults but some are approved for use in children. There are also medications that may not be appropriate for people over 65 years old.
• Your medical conditions – Depending on other medical conditions, you may not be able to take some weight loss medications. For example, some medications may not be appropriate if you have liver problems or are prone to seizures.
• Your weight – Most weight loss medications are used for people with a BMI of at least 30, or 27 with a weight-related condition.

How does weight loss medication work? It depends on the medicine.

Medications can lower your set-point body weight. This means the brain stops defending a higher weight and is comfortable at a lower weight. Instead of having hunger going up and metabolism going down, medicines can use hormonal changes to address the physiologic responses to weight loss. Medications usually work by doing one or more of the following:

• Controlling hunger – Reduces your appetite by providing a feeling of fullness and reduced cravings for certain foods.
• Reducing absorption – Makes it so your body is less able to process certain nutrients such as fat, so your body metabolizes fewer calories.
• Increasing fat burning – Helps your body burn more calories.

Most people who try weight loss medications lose weight

Most people who try weight loss medications lose at least some weight. For some, weight loss is modest, while others lose 15%, 20% or more of their body weight with newer medications.

The amount of weight loss depends on many factors, including the type of medication you take and how your body responds to it. Your results can also be affected by how consistently you follow other parts of your treatment plan, such as eating a balanced diet, staying physically active and attending follow-up appointments.

Your doctor can help you understand what results may be realistic based on the medication you're considering, your health history and your weight loss goals.

Typical weight loss with weight loss medications (percent of total body weight)

Not all weight loss drugs are safe

A common question is, are weight loss pills safe? The answer is that weight loss medications that are approved by the U.S. Food and Drug Administration (FDA) are generally considered safe and effective. When side effects happen, they are usually mild and include nausea, constipation and diarrhea. Serious side effects are rare.

Pills and supplements that aren’t approved by the FDA aren’t always safe. They also tend to be less effective than prescription medications (if they work at all).

How do you know if a weight loss medication is FDA approved? Most FDA-approved medications are only available by prescription. The only FDA-approved medication that’s available over the counter is orlistat, which we’ll talk about below.

FDA-approved weight loss drugs

There are different FDA-approved weight loss medications that may be recommended as part of a medical weight management program.

Bupropion-naltrexone (Contrave)

This weight loss pill is a combination of two medications. It includes an antidepressant (bupropion) and a medication used for opioid and alcohol use disorder (naltrexone). Side effects include nausea, constipation, headaches, vomiting, dizziness and insomnia.

GLP-1 agonists: Semaglutide (Wegovy), liraglutide (Saxenda) and orforglipron (Foundayo)

GLP-1 agonists are a class of medications that work by mimicking the effects of the naturally occurring GLP-1 hormone in your body. They help regulate appetite, slow stomach emptying and increase feelings of fullness, which can help reduce food intake and support weight loss. Some types of GLP-1s have additional approvals for reducing the risks of weight-related conditions. The amount of weight loss varies by medication and by individual. Common side effects include nausea, vomiting, diarrhea, constipation and abdominal discomfort.

GLP-1/GIP agonist: Tirzepatide (Zepbound)

Tirzepatide is a dual GLP-1 and GIP agonist. It works similarly to GLP-1 agonists but activates two hormone pathways instead of one – the GLP-1 hormone and the GIP hormone. Tirzepatide is also approved to help reduce the risk of obstructive sleep apnea in people with obesity. Common side effects include nausea, constipation and diarrhea.

Orlistat (Xenical, Alli)

Orlistat is a weight loss pill that makes it so your body can’t digest fat as efficiently. Instead, the fat comes out in your poop. As a result, you absorb fewer calories. But it causes a range of digestive side effects, including stomach pain and oily stools. People taking orlistat typically lose 5-10 pounds in six months.

Phentermine-topiramate (Qsymia)

This weight loss pill stimulates your nervous system, reduces your appetite and makes you feel full. The most common side effects include dry mouth, constipation and an uncomfortable tingling sensation.

Setmelanotide (Imcivree)

Setmelanotide is a weight loss injection for obesity caused by specific genetic mutations. The medicine works by helping to activate the melanocortin 4 receptors in the brain. This can lead to reduced hunger, eating fewer calories and a boosted metabolism. Common side effects of setmelanotide include injection site reactions, nausea, headache, diarrhea, hyperpigmentation, and pain in your stomach or back.

Ozempic is not approved as a weight loss medication

Ozempic is an injectable medication used to treat type 2 diabetes. It is not FDA approved as a weight loss medication, but some people using Ozempic also lose a large amount of excess weight. While Ozempic isn’t approved for weight loss, the active ingredient (semgaglutide) is the same as the one in Wegovy, which is mentioned above.

Are medical weight loss programs and weight loss medications covered by insurance? It depends.

Some patients are able to get coverage for prescribed weight loss medications through their health insurance, but each plan is different. This can help offset some costs and make weight management more affordable. If you’re considering a medical weight loss program, the best first step is to contact your insurance plan provider to learn more about your coverage.

Reaching weight loss goals isn’t as simple as eating less and exercising more. We can help.

Weight loss is different for everyone because everyone’s body is different. At Park Nicollet’s Bariatric Surgery and Weight Center, we understand the struggle. We’ll work with you to improve your health by working toward a healthy body weight.