Some of you may remember the television show “The Biggest Loser.” For those who do not, exceedingly overweight (i.e. people with severe obesity) participants were subjected to very intensive lifestyle modification. This included very low calorie diets and aggressive exercise regimens with personal trainers. Most of the participants lost significant amounts of weight.
However, if you have watched some of our prior videos on our website and social media, you will know that hunger and satiety hormone imbalance will make this a setup for weight regain. Briefly, the hunger hormone, ghrelin, increases when weight is lost. In people with severe obesity, the satiety hormone, called leptin, is secreted in high amounts by fat cells. However, this intense leptin signal is eventually “tuned out” by the brain, resulting in “leptin resistance.” So, we have a patient who has lost significant weight through intense lifestyle changes, which we applaud. However, when the lifestyle changes are dialed down to a more sustainable level, all of the people on the show regained their weight (unless they had undergone bariatric surgery after the show ended). Data regarding these patients were tracked in a study of the show participants after it was completed and taken off the air.
What is the takeaway from this prospective study of patients with severe obesity who lost significant amounts of weight through lifestyle? Without a means of controlling hunger and food cravings, the elevated levels of ghrelin (again, this is the “hunger hormone”), these people will undoubtedly regain weight, perhaps all of it or more. What is to be done? This is where there is a very legitimate role for anti-obesity medications. Be they the newer injectable pharmaceuticals such as Wegovy or Mounjaro, or oral meds such as Qsymia or Contrave, these medical treatments can prevent or minimize the weight regain that will almost certainly occur otherwise. The same is true for patients after bariatric surgery. Most of us know people that regained significant amounts of weight after undergoing a gastric sleeve or gastric bypass. Medication can avoid the unfortunate outcome of weight regain despite what can be a very effective surgical treatment.
In summary, anti-obesity medications are not just for weight loss. They have an important role to play in preventing weight regain as well. Of course, medications are always meant to be an adjunct to lifestyle changes. Proper diet, exercise, restful sleep, avoiding risky substances, strong social connections are all very important and should be engaged in whether medication or surgery are employed or not. Lifestyle is primary.
